05. Cancerul La Copil
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Transcript of 05. Cancerul La Copil
7/25/2019 05. Cancerul La Copil
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CANCERUL LA COPIL
Conf. Dr. Monica Dragomir
2015
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Cancerul la copil este o boala rara !...
• 2% din toate cancerele• A 2-a cauza de deces ( 4- 15 ani)
New Cases of Cancer in the U.S. in 2003
105,000125,000130,000
12,500
020000
40000
60000
80000
100000
120000
140000
Breast Lun !rostate "#ild#ood
"ancers
Cancer Type
N u m b e r
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CNC!"U# # C$%&# S& T&N!"& &N !U"$%
• $n iecare an& '5 000 cazuri noi
- 15000 15 ani * 20000 15 -24 ani • 80% +ot i ,indicate cu trataent ultidisci+linar
• '00.000 500.000 "etateni ai / sunt su+ra,ietuitori ain unuicancer in co+ilarie
20 to 40% au eecte secundare ale trataentelor
•6000 tineri or in iecare an de cancer
Cancerul este prima cau'a (e mortalitate prin boala
la )arste (e peste 1 an in U! ***
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&NC&+!NT
"ateorie de,arsta
$ncidenta (oania -200')
r. "azuri noi3 100000 co+ii
0 1- ani 5
0- 4 ani 5
5- ani
10- 14 ani 8'
15- 1 ani 158
$S /2003 1 ca'uri noi 4 100
000 copii
"omania500 (e ca'uri noi4an
5000 copii cu cancere/ in "C, "%, e)olutie,reci(i)e
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$n oania ista "" - REGISTRUL NATIONAL
DE CANCER LA COPIL
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%T$#$6& #&6N
# C$%&#
1
7emopatii mali8ne#eucemii si #imfoame
1 Tumori soli(e Tumorile cerebrale
2 Tumori specifice copilului Nefroblastomul /T. 9ilms Neuroblastomul "etinoblastomul
3 Sarcoame osoase$steosarcomul
Sarcomul !win8:
Sarcoame tesuturi moi
5
ltele
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Cancerul la copilul mic
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Cancerul la copilul mare si a(olescent
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Cancerul la copilul mare si a(olescent
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7esi re+rezinta doar 1% din toate
cancerele& $+act eotional urias
$lustreaza conce+tul
"ancerul este cura9il !!!:
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;u+ra,ietuirea co+iilor cu cancer 15- 200'(U&CC S&$% 200
ata lo9ala& 615% 55
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UICC- SIOP 2006
In unele localizari > 90%
Limfom Hodgkin: 95%
Nefroblastom: 92%
Retinoblastom: 95%
umori cu celule germinale: !irtual "00%
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;u+ra,ietuirea la 5 ani & 7ierente de 10% to 20%intre tarile uro+ei
rorese ici in ultiii 5 aniin cancerele diicil de tratat
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%ro8rese mici in ultimii 5 ani le8at (e cancerele (ificil (e tratat
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;u+ra,ietuirea co+iilor cu cancer 15- 200'(U&CC S&$% 200
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Supra)ie uire la : ani /;ț
2010 2010 U!
&. #eucemii -.2 <;
&&. #imfoame -2.1 -1.
&&&. Tumori ner)oase 5<,< 5;
Supra)ietuirea
in cancerele copilului "omania )ersus U!
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Cancerul la copil este o boalapotential curabila ***
ata de ,indecare in cancer de+inde de radul deetensie al 9olii
;tadiile localizate ($-$$)3 inci+iente< ata are de ,indecare
;tadiile a,ansate
;u+ra,ietuire +e teren liitat
=indecarea este +osi9ila uneori cutrataente eroice: care aecteaza calitatea,ietii su+ra,ietuitorului
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CNC!"U# # C$%&# =S. +U#T
+&>!"!NT!C$%&# +U#T
>riine
#istoloica
?ezenc#iala3neurala
(sarcoae)
+iteliala
(carcinoae)
7. in stadii
+re-aline
$+osi9il osi9il
tioloie3
actori de risc
ne-leata de actori de
ediu
leata de actori de
ediu
re,entie3screenin
$+act inor $+act a@or
ata de ,indecare ?are ?ica
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S&N+"$! !"!+&T"!
• S+. N!U"$CUTNT! !"!+&T"!- euroi9roatoza& . cere9rale neuro9lasto nero9lasto- ;cleroza tu9eroasa Bourne,ille& .cere9rale
• ?$#& 6!N!T&C!&
- erodera +ientosu& elano- ;d.BecCit#- Diedeann ( "r. 11)& nero9lasto- ;d. 7oCn& leuceii lioae- ;d. 1'E & retino9lasto
• S+.+! &UN$+!>&C&!NT !"!+&T"&- A-aalo9ulineia& lioae leuceii- ;d. Discott-Aldric#& lioae
• S+. &NT!ST&N#!& +oli+oza colica ;d. Fardner cancere colo-rectale
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Neurofibromato'a?oala =on "ec@lin8hausen
#azuistica I$
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Neurofibromato'a?oala )on "ec@lin8hausen
#azuistica I$
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Neurofibromato'a?oala )on "ec@lin8hausen
#azuistica I$
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Neurofibromato'a?oala )on "ec@li8hausen
#azuistica I$
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Neurofibromato'a?oala )on "ec@il8hausen
#azuistica I$
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Neurofibromato'a?oala )on "ec@il8hausen
#azuistica I$
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Neurofibromato'a?oala )on "ec@il8hausen
#azuistica I$
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Sin(rom ?ec@with 9ie(emann
&tt':(()))*nlm*ni&*go!(medline'lus(framing*&tml
b!s*sld*cu
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Sindrom Beckwith- Wiedemann
)))*endote+t*org
)))*geocities*com
)))*laeknabladid*is
)))*gfmer*c&
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Sindrom Beckwith- Wiedemann
)))*endote+t*org
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Sin(rom ?ec@with 9ie(emann"ab(omiosarcom orbitar
)))*indian'ediatrics*net
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>!CT&UN& %"!+&S%$ANT! %!NT"UCNC!"
• alformatii con8enitale
- "ri+tor#idia - cancere testiculare
- Gei#i+ertroia - tuora Dils
- Aniridie - tuora Dils
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Aniridie
)))*atara+ia*'t
&ome*'acbell*net
)))*dal'asso*it
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Hemihipertrofie
)))*t&efetus*net
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grou's*msn*com)))*rozin*com
Hemihipertrofie
)))*nt!t*nl
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7emihipertrofie B nefroblastom
)))scielo*isciii*es
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Nefroblastom
rad*usu&s*edu
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CNC!"! 6!N!T&C! C"CT!"&ST&C&
• +ebut precoce
• #e'iuni multifocale in or8anul afectat
• fectare bilaterala in ca'ul or8anelor pereche• Cancere primiti)e multiple
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%"&NC&%&& +! +&6N$ST&C&N CNC!"!#! C$%&#U#U&
• 7ianostic +recoce& trataent co+leultidisci+linar cu ,iza curati,H
• i+ul de cancer
• Fradul de etensie al 9olii
• 7ianosticul de certitudine&
- icrosco+ie o+ticH
- icrosco+ie electronicH
- iuno#istoc#iie(d.di. intre tuorile cu Icelule ici rotunde& neuro9lasto
lio sarco Cin)
- citoeneticH enetica olecularH
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S!N! S& S&%T$! +! #"D &NCNC!"!#! C$%&#U#U&
• uora ,izi9ilH 3 +al+a9ilH
• Adenoealia
• Ge+ato3 s+lenoealia
• "ealeea
• ;ene neuroloice
• 7ureri osoase
• ;indro #eorai+ar • ;ene enerale de 9oala& +aloare astenie e9ra
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C!>#!!
• arH• "ea ai rec,entH cauzH& tul9urari de ,edere
• "auza tuoralH &
Tumori cerebrale (osa +osterioara)
• ;indroul de #i+ertensiune intracranianH & cealeeJ ,HrsHturi
J3- sene neuroloice de ocar (+areze3 +aralizii de ner,icranieni tul9urHri de ec#ili9ru)
• "ealee - caracteristici clinice&
- recurenta atinalH- intensitate are
- calata de ,HrsHturi
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7&C la su8ar
http:www!"t#$de!or%
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• ;#untul ,entriculo-+eritoneal& siste detu9uri (cu ,al,a cu un
sens) care dreneazaL" din =4 inca,itatea +eritoneala
A.7.A.?. ?edical $llustration ea(200')
)))*l'c&*org('&otos(gre,stone(ei-0.//*gif
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;#unt ,entriculo-+eritoneal
#azuistica I$
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;#unt ,entriculo-+eritoneal
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S!N! N!U"$#$6&C! laterocolis ,strabism con)er8ent /=&
http:www!"t#$de!or%
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S!N! N!U"$#$6&C! laterocolis ,strabism con)er8ent /=&
)))*mat&learning*net classes*colgate*edu(osafi(1ir%20%20s)eet%2***
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S!N! N!U"$#$6&C! %arali'ie (e n. cranieni
&tt':(()))*st3ude*org
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S!N! N!U"$#$6&C! %to'a palpebrala /&&&
&tt':(()))*st3ude*org
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S!N! N!U"$#$6&C!%arali'ie faciala /=&&
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S!N! N!U"$#$6&C!%arali'ie faciala /=&&
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Tumora cerebrala%arali'ie faciala/=&&
#azuistica I$
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%arali'ie faciala la su8ar
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N!U"$#$6&C# S&6NS
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N!U"$#$6&C# S&6NS >acial palsy
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+!N$%T&
1. Tumori mali8ne metasta'ate 8an8lionar ( neuro9lasto t. de ca,u sarcoae )2. ?oli (e sistem leucemii, limfoame
• atoloic& K 10 • FeneralizatH 3 izolatH• J3- #e+atos+lenoealie• "aracteristici clinice& dure ere elastice
• &n(icaEiile biopsiei 8an8lionare
- adenoealie care se enMine3 creNte 12 sH+tHOni- asociere cu e9rH Ni3sau #e+atos+lenoealie- asociere cu anoalii . de ediastin
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%aroti(ita epi(emica
http:www!"t#$de!or%
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Tumora laterocer)icala F a(enopatie
http:www!"t#$de!or%
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?oala 7o(8@in (enopatie
laterocer)icala
#azuistica I$
( ti il if t i
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(enopatie aGilara manifestare unica a?olii 7o(8@in
#azuistica I$
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(enopatie?oala 7o(8@in
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?oala 7o(8@in
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?oala 7o(8@in
+U"!"! $S$S
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+U"!"! $S$S
1. "ancere osoase& Sarcomul !win8, osteosarcom /80%)
- interitentH creste in intensitate cu ti+ul
- cedeazH la antalice uzuale ( in azele +recoce)
- J . osoasH P i+otenMa uncMionalH
P enoene inlaatorii
2. rtrita leucemica&
-'0% din cazuri
- as+ecte radioloice neconcludente
J anoalii #eatoloice
3. etasta'e osoase
- neuro9lasto nero9lasto retino9lasto
- ra9doiosarco
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TU$"& ?+$&N#!• 10 ani& nero9lasto neuro9lasto
• Q 10 ani& lio a9doinal leuceii
• ;tructuri anatoice +al+a9ile la co+il& s+lina rinic#ii sioidulcoloana
• "aracteristici clinice&-. intra+eritoneale& se isca su9 a+asare anuala
Rsi odiicH +ozitia
- . retro+eritoneale& iate +round au contact lo9arnu Rsi odiicH +ozitia
• .Dils& contur reulat o9ilH nu de+HNeNte linia edianH• euro9lastoul a9doinal& contur nodular iat de+HNeNte linia
edianH
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TU$"& !+&ST&N#!
• ?ediastin&
- anterior& . lioide tiroidiene
- i@lociu& adeno+atii- lioae
- +osterior& . neuroene Asi+toatice desco+erire radioloica
intO+latoare
;i+toatoloie data de co+resiune de,ecinatate& tuse stridor #eo+tizie sd. de ,enaca,a su+erioara sd. recurential
Lio Godin& adeno+atiile ediastinale
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Lio Godin& adeno+atiile ediastinale(asi+toatice) au ost desco+erite cu ocaziain,estiatiilor +entru o adeno+atie laterocer,icala @oasa
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nomalii hematolo8ice
• ancito+enie < G9SJLSJrS&
- de9ut in leuceii acute- +rin inlocuirea adu,ei cu celule aline
• Aneie& cronica autoiuna
- in lioae Godin non-Godin
• ro9o+enie&
- $ - lio
- "$7 ra9doiosarco iant t. cere9rale
• Leucocitoza& - leuceii
T reactii leuceoide (inectii +arazitozealerii)
•&n(icatiile me(ulo8ramei&- celule 9lastice anorale +e rotiul de sane +erieric
- de+resia seniicati,a a unei linii celulare
- asocierea cu #e+atos+lenoealie
-a9senta cauzei inectioase deonstrate
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"ab(omiosarcom
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Sarcom (e tesuturi moi
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Sarcom (e tesuturi moi>ibrosarcom
http:www!"t#$de!or%
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>ibrosarcom con8enital
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>ibrosarcoame
)))*'odiatr,toda,*com(article(**%5#4$%5#H
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Sarcom (e tesuturi moi
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