E-Book, Englisch, Band 4, 288 Seiten
Chan / Raney / Jr. Pediatric Oncology
1. Auflage 2010
ISBN: 978-0-387-24472-3
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark
E-Book, Englisch, Band 4, 288 Seiten
Reihe: MD Anderson Cancer Care Series
ISBN: 978-0-387-24472-3
Verlag: Springer US
Format: PDF
Kopierschutz: 1 - PDF Watermark
Childhood cancer was almost always fatal before 1970. Today, 80% of ch- dren diagnosed with cancer will survive at least 5 years; 70% will be cured. However, cancer continues to be the leading cause of nonaccident-related deaths in children. More children die each year from cancer than from c- tic ?brosis, diabetes, asthma, AIDS, and congenital abnormalities combined. Nine children die from cancer every school day. Despite the fact that pediatric cancers account for only a small p- centage of the total cancer burden, more effective therapies are needed to improve mortality rates in children. Therefore, our research priority must be the development of new agents and new therapies for childhood cancer. M. D. Anderson Cancer Center has been caring for children with c- cer since its doors opened over 60 years ago. This institution has been home to several research and clinical pioneers whose innovative work has in?uenced and shaped the practice of pediatric oncology throughout the world. Notably, Drs. Wataru W. Sutow, Donald Pinkel, and Norman Jaffe have been credited with introducing curative therapies for children with leukemia and solid tumors. Cancer treatment involves far more than administering chemoth- apy and surgically excising tumors. It requires a multidisciplinary - proach to patient management, particularly in the treatment of solid - mors, which pose the biggest challenge in cancer care today. Surgery and radiotherapy as well as radiographic and pathologic assessments of response are critical factors in the treatment of children with cancer.
Autoren/Hrsg.
Weitere Infos & Material
1;Foreword;6
2;Preface;8
3;Table of Contents;9
4;Contributors;12
5;1 Acute Leukemia;15
5.1;Chapter Overview;15
5.2;Introduction;16
5.3;Acute Lymphoblastic Leukemia;16
5.3.1;Etiology and Predisposing Factors;16
5.3.2;Molecular Genetic Abnormalities;16
5.3.3;Diagnosis;17
5.3.4;Classification Using Flow Cytometry;18
5.3.5;Treatment and Prognosis;18
5.3.6;Hematopoietic Stem Cell Transplantation;19
5.3.7;Supportive Care;21
5.3.8;Special Considerations for Infants;22
5.4;Mature B-Cell Leukemia;22
5.4.1;Clinical Features;22
5.4.2;Diagnosis;23
5.4.3;Treatment for Primary Disease;23
5.4.4;Treatment for Relapsed Disease;24
5.5;Myeloid Leukemia;24
5.5.1;Diagnosis;24
5.5.2;Supportive Care;25
5.5.3;Treatment for Primary Disease;26
5.5.4;Treatment for Relapsed Disease;27
5.5.5;Novel Therapies;27
5.5.6;HSCT;28
5.6;Long-Term Follow-Up;29
5.7;KEY PRACTICE POINTS;30
5.8;Suggested Readings;30
6;2 Hodgkin Lymphoma and Non-Hodgkin Lymphoma;32
6.1;Chapter Overview;32
6.2;Introduction;33
6.3;Hodgkin Lymphoma;33
6.3.1;Clinical Presentation;33
6.3.2;Pathology and Prognostic Factors;33
6.3.3;Diagnosis and Staging;34
6.3.4;Treatment;35
6.3.4.1;Therapy for Primary Disease;36
6.3.4.2;Therapy for Recurrent Disease;36
6.3.4.3;Long-Term Side Effects;37
6.4;Non-Hodgkin Lymphoma;38
6.4.1;Clinical Presentation;38
6.4.2;Pathology and Prognostic Factors;39
6.4.3;Diagnosis and Staging;39
6.4.4;Treatment;40
6.4.4.1;Treatment for Primary Disease;41
6.4.4.2;Therapy for Recurrent Disease;41
6.5;KEY PRACTICE POINTS;42
6.6;Suggested Readings;42
7;3 Brain Tumors: Diagnosis, Surgery and Radiotherapy, and Supportive Care;44
7.1;Chapter Overview;44
7.2;Introduction;45
7.3;Diagnosis;45
7.3.1;Clinical Presentation;45
7.3.2;Evaluation;47
7.3.3;Effect of Neurofibromatosis on Diagnosis;48
7.3.4;Neuropathology;49
7.4;Treatment;49
7.4.1;Neurosurgery;49
7.4.1.1;Hydrocephalus;50
7.4.1.2;Tumor Resection;51
7.4.1.3;Surgical Adjuncts;52
7.4.2;Radiotherapy;53
7.4.2.1;New Techniques for Focal Therapy;54
7.4.2.2;Craniospinal Radiotherapy;56
7.4.3;Chemotherapy;57
7.5;Follow-Up and Supportive Care;57
7.5.1;Neuropsychologic Evaluation;58
7.5.2;Late Neurologic Effects;60
7.5.3;Endocrine Evaluation;60
7.5.4;Other Multidisciplinary Care;61
7.6;KEY PRACTICE POINTS;61
7.7;Suggested Readings;62
8;4 Brain Tumors: Chemotherapy and Investigational Therapy;64
8.1;Chapter Overview;65
8.2;Introduction;65
8.3;Low-Grade Astrocytomas;65
8.3.1;Radiotherapy;66
8.3.2;Chemotherapy;67
8.4;Medulloblastoma and Other Embryonal Tumors;67
8.4.1;Preoperative Evaluation and Staging;68
8.4.2;Neurosurgery;68
8.4.3;Treatment of Average-Risk Medulloblastoma;69
8.4.4;Treatment of High-Risk Medulloblastoma and PNET;70
8.4.5;Treatment of Young Children with Embryonal Brain Tumors;70
8.5;High-Grade Gliomas;71
8.5.1;Surgery;71
8.5.2;Chemotherapy;73
8.6;Ependymoma;75
8.7;CNS Germ-Cell Tumors;76
8.7.1;Treatment of Germinoma;77
8.7.2;Treatment of Nongerminomatous Germ-Cell Tumor;77
8.8;Metastatic Brain Tumors;78
8.9;Recurrent Brain Tumors;78
8.10;Role of High-Dose Chemotherapy and Autologous Stem Cell Rescue;80
8.11;Complications and Long-term Care;81
8.12;KEY PRACTICE POINTS;81
8.13;Suggested Readings;82
9;5 Wilms’ Tumor;84
9.1;Chapter Overview;84
9.2;Introduction;85
9.3;Etiology;85
9.4;Associated Congenital Anomalies;85
9.5;Clinical Manifestations;86
9.6;Investigational Studies;86
9.7;Differential Diagnoses;87
9.8;Histologic Classification;87
9.9;Staging;87
9.10;Treatment;88
9.10.1;Surgery;88
9.10.2;Chemotherapy;88
9.10.3;Radiotherapy;91
9.11;Special Treatment Considerations;91
9.11.1;Inoperable and Bilateral Tumors;91
9.11.2;Recurrent, Progressive, and Resistant Tumors;91
9.11.3;Rare Metastases;92
9.11.4;Tumors Allied to or Previously ConsideredWilms’ Tumor;92
9.11.4.1;Rhabdoid Tumor of the Kidney;92
9.11.4.2;Congenital Mesoblastic Nephroma;92
9.11.4.3;Nephroblastomatosis;92
9.12;Side Effects of Therapy;92
9.12.1;Gastrointestinal System;93
9.12.2;Hepatic System;93
9.12.3;Cardiac System;93
9.12.4;Chest, Uterus, and Ovaries;93
9.12.5;Skelton;93
9.13;Follow-Up Evaluation;93
9.14;Prognosis;94
9.15;KEY PRACTICE POINTS;94
9.16;Suggested Readings;94
10;6 Neuroblastoma;96
10.1;Chapter Overview;96
10.2;Introduction;96
10.3;Clinical Presentation;97
10.4;Pathology, Pathogenesis, and Prognosis;99
10.5;Diagnosis and Staging;100
10.6;Treatment;102
10.6.1;Role of Bone Marrow Transplantation;104
10.6.2;Therapy for Recurrence;106
10.7;Neuroblastoma Screening;107
10.8;KEY PRACTICE POINTS;108
10.9;Suggested Readings;108
11;7 Soft-Tissue Tumors;110
11.1;Chapter Overview;110
11.2;Introduction;111
11.3;Incidence and Epidemiology;111
11.4;Disease Histiotypes and Chromosomal Abnormalities;111
11.4.1;RMS;112
11.4.2;NRSTS;112
11.5;Clinical Presentation;113
11.5.1;RMS;113
11.5.2;NRSTS;113
11.5.3;Aggressive Fibromatosis and Neurofibroma;113
11.6;Staging and Diagnostic Evaluation;114
11.6.1;RMS;114
11.6.2;NRSTS;115
11.6.3;Aggressive Fibromatosis and Neurofibroma;116
11.7;Treatment;116
11.7.1;RMS;116
11.7.1.1;Surgery;117
11.7.1.2;Radiotherapy;118
11.7.1.3;Chemotherapy;118
11.7.2;NRSTS;120
11.7.3;Aggressive Fibromatosis and Neurofibroma;121
11.8;Management of Relapse;121
11.9;KEY PRACTICE POINTS;122
11.10;Suggested Readings;122
12;8 Osteosarcoma;124
12.1;Chapter Overview;124
12.2;Introduction;124
12.3;Etiology;125
12.4;Clinical Manifestations;125
12.5;Histologic Varieties;125
12.5.1;Conventional Osteosarcoma;125
12.5.2;Surface Osteosarcoma;126
12.6;Biologic Behavior;126
12.7;Diagnostic Investigations;126
12.8;Definitive Diagnosis;127
12.9;Treatment for Primary Disease;127
12.9.1;Chemotherapy;127
12.9.1.1;Preoperative Intra-Arterial Chemotherapy;128
12.9.1.2;Postoperative Chemotherapy;128
12.9.2;Surgery;129
12.10;Treatment for Metastases;130
12.10.1;Pulmonary Metastases;130
12.10.2;Resistant or Recurrent Metastases;130
12.10.3;Investigational Therapies;131
12.11;Side Effects and Complications of Chemotherapy;131
12.12;Follow-Up;132
12.13;KEY PRACTICE POINTS;133
12.14;Suggested Readings;133
13;9 Ewing’s Sarcoma;135
13.1;Chapter Overview;135
13.2;Introduction;136
13.3;Etiology and Epidemiology;136
13.4;Presenting Signs, Clinical Features, and DiagnosticWork-Up;137
13.5;Pathology and Genetics;137
13.6;Prognostic Factors;137
13.6.1;Stage of Disease;138
13.6.2;Tumor Location;138
13.6.3;Tumor Size;138
13.6.4;Chromosomal Translocation;138
13.6.5;Surgical Margins;138
13.6.6;Response to Chemotherapy;139
13.7;Treatment;139
13.7.1;Chemotherapy;140
13.7.2;Immunotherapy;141
13.7.3;Therapy for Local Control;142
13.7.4;Surgery;143
13.7.4.1;Limb-Salvage Surgery: Endoprostheses and Allografts;144
13.7.4.2;Amputation or Rotationplasty;147
13.7.4.3;Surgical Aspects of Pelvic and Spinal Ewing’s Sarcomas;148
13.7.5;Radiotherapy;148
13.7.5.1;Timing of Treatment;149
13.7.5.2;Tumor Volume;149
13.7.5.3;Critical Structures in the Irradiated Volume;151
13.7.5.4;Radiation Dose;151
13.7.5.5;Radiation Fractionation;151
13.7.5.6;Toxicity;152
13.7.5.7;Treatment of Metastasis;152
13.8;KEY PRACTICE POINTS;153
13.9;Suggested Readings;153
14;10 Retinoblastoma;156
14.1;Chapter Overview;156
14.2;Introduction;156
14.3;Epidemiology and Genetics;157
14.4;Clinical Features;157
14.5;Workup;159
14.6;Treatment;162
14.6.1;Chemoreduction;162
14.6.2;Thermotherapy;164
14.6.3;Cryotherapy;164
14.6.4;Radiotherapy;164
14.6.5;Enucleation;165
14.6.6;Treatment of Metastatic Disease;166
14.7;Second Primary Tumors;166
14.8;KEY PRACTICE POINTS;166
14.9;Suggested Readings;167
15;11 Differentiated Thyroid Cancer;169
15.1;Chapter Overview;169
15.2;Introduction;169
15.3;Radiation-Induced Differentiated Thyroid Cancer;170
15.4;Regional Lymph Node Involvement;171
15.5;Pulmonary Metastases;171
15.6;Clinical Outcome and Mortality After Prolonged Follow-Up;172
15.7;Diagnosis, Treatment, and Surveillance;174
15.7.1;Case Example 1;176
15.7.2;Case Example 2;178
15.7.3;Case Example 3;178
15.8;Conclusions;178
15.9;KEY PRACTICE POINTS;179
15.10;Suggested Readings;179
16;12 Medullary Thyroid Carcinoma;181
16.1;Chapter Overview;181
16.2;Introduction;182
16.3;Histologic Features;182
16.4;Epidemiology and Tumor Subtypes;183
16.4.1;Sporadic Medullary Thyroid Carcinoma;183
16.4.2;Hereditary Medullary Thyroid Carcinoma;184
16.4.2.1;MEN2A;184
16.4.2.2;Variants of MEN2A;185
16.4.2.3;MEN2B;185
16.4.2.4;Clinical Features of MEN2-Associated Tumors;186
16.4.3;Evaluation and Management of Hereditary Medullary Thyroid Carcinoma;187
16.4.3.1;RET Proto-oncogene Mutations in MEN2;188
16.4.3.2;Genotype-Phenotype Correlations in MEN2;188
16.4.3.3;RET Proto-oncogene Testing;188
16.4.3.4;Use of Genetic Information;190
16.4.3.4.1;Highest Risk;190
16.4.3.4.2;High Risk;190
16.4.3.4.3;Intermediate Risk;191
16.5;Evaluation and Management of Pheochromocytoma and Hyperparathyroidism;191
16.6;Conclusions;192
16.7;KEY PRACTICE POINTS;192
16.8;Suggested Readings;192
17;13 Melanoma;194
17.1;Chapter Overview;194
17.2;Introduction;195
17.3;Diagnosis and Staging;195
17.4;Pathology;195
17.4.1;Primary Skin Tumor;195
17.4.2;Differential Diagnoses;197
17.4.3;Sentinel Lymph Nodes;199
17.4.4;Lymph Node Dissection;200
17.4.5;Immunohistochemisty;200
17.5;Surgical Treatment;201
17.5.1;Wide Local Excision;201
17.5.2;Lymph Node Mapping;202
17.5.3;Lymph Node Dissection;203
17.6;Evaluation for Metastasis;203
17.6.1;Blood Tests;203
17.6.2;Imaging Studies;203
17.7;Systemic Therapy;203
17.7.1;Adjuvant Therapy;203
17.7.1.1;Interferon;203
17.7.1.2;Biochemotherapy;204
17.7.1.3;Vaccine Therapies;204
17.7.2;Treatment of Measurable Disease;204
17.8;Follow-Up;204
17.9;KEY PRACTICE POINTS;205
17.10;Suggested Readings;205
18;14 Novel Therapeutic Approaches;208
18.1;Chapter Overview;208
18.2;Introduction;209
18.3;Realities of Pediatric Clinical Research;210
18.3.1;Stringent Regulatory Requirements;210
18.3.2;Slow Accrual;210
18.3.3;Need for More Biologic Correlates;211
18.4;Novel Therapies Used at M. D. Anderson;211
18.4.1;Hematologic Malignancies;212
18.4.1.1;Imatinib;213
18.4.1.2;Clofarabine;213
18.4.2;Solid Tumors;214
18.4.2.1;MTP-PE;214
18.4.2.2;Isotretinoin;214
18.4.3;Graft-Versus-Host Disease;215
18.4.3.1;Infliximab;216
18.4.3.2;Rapamycin;216
18.4.3.3;Pentostatin;217
18.4.3.4;Photopheresis;217
18.5;Is Research in Children Ethical?;217
18.6;When Should a Child Be Enrolled in a Clinical Trial?;219
18.7;Conclusions;219
18.8;KEY PRACTICE POINTS;219
18.9;Suggested Readings;220
19;15 Supportive Care: Myelosuppression;222
19.1;Chapter Overview;222
19.2;Introduction;222
19.3;Fever and Neutropenia;223
19.4;Antimicrobial Prophylaxis;226
19.4.1;Antibacterial Agents;226
19.4.2;Antiprotozoal Agents;226
19.4.3;Antiviral Agents;227
19.5;Hematologic Support;227
19.5.1;Anemia;227
19.5.2;Platelet Transfusions;228
19.5.3;Granulocyte Transfusions;229
19.5.4;Hematopoietic Growth Factors;229
19.6;KEY PRACTICE POINTS;230
19.7;Suggested Readings;230
20;16 Supportive Care: Symptom Control;232
20.1;Chapter Overview;233
20.2;Introduction;233
20.3;Chemotherapy-Induced Nausea and Vomiting;233
20.3.1;Pathophysiology;234
20.3.2;Risk Factors;234
20.3.3;Phases of Symptomatology;236
20.3.4;Treatment;237
20.4;Nutrition;237
20.4.1;Assessment;240
20.4.2;Enteral Feeding;241
20.4.3;Parenteral Feeding;242
20.5;Pain and Symptom Management;242
20.5.1;Pediatric Cancer Pain;244
20.5.2;Pathophysiologic Mechanisms of Pain;244
20.5.3;Pain and Symptom History;245
20.5.4;Assessment Tools;246
20.5.5;Synthesis of Symptom Diagnosis and Management Plan;246
20.5.6;Modalities of Symptom Control;246
20.5.7;Treatment Assessment;246
20.6;Analgesic Pharmacotherapy;247
20.6.1;Nonopioids and Adjuvant Analgesics;247
20.6.2;Opioids;247
20.6.2.1;Tolerance, Physical Dependence, and Addiction;248
20.6.2.2;Management of Side Effects;248
20.6.3;Principles of Analgesic Administration;249
20.6.4;Routes of Administration;249
20.7;Palliative Care;250
20.8;KEY PRACTICE POINTS;251
20.9;Suggested Readings;251
20.10;Appendix 16–1. Procedure for Determining the Emetogenicity of a Chemotherapy Regimen;253
20.11;Appendix 16–2. Eight-Step Process Involved in Total Parenteral Nutrition Administration;254
21;17 Behavioral Medicine in Cancer Care;258
21.1;Chapter Overview;258
21.2;Introduction;259
21.3;Supportive-Care Needs of Pediatric Patients and Family Members;259
21.4;Psychological- and Emotional-Support Interventions;260
21.4.1;Child-Life Specialists;261
21.4.2;Social Workers;261
21.4.3;Parent Consultants;261
21.4.4;Psychologists and Psychiatrists;261
21.4.5;Neuropsychologists;262
21.4.6;Education Staff;262
21.4.7;Language Assistants;262
21.4.8;Creative Arts Instructors;262
21.4.9;Clergy;263
21.5;Intensive Psychosocial-Support Interventions;263
21.6;Academic Interventions;264
21.6.1;Hospital-Based Schooling;264
21.6.1.1;Academic Program;264
21.6.1.2;ESL Program;265
21.6.1.3;Exercise and Physical Fitness;265
21.6.2;Support of Homebound and Community-School Programs;266
21.7;Neuropsychological Effects of Cancer;266
21.7.1;Role of Radiotherapy;266
21.7.2;Cognitive Remediation;267
21.8;Conclusions;268
21.9;KEY PRACTICE POINTS;268
21.10;Suggested Readings;269
22;18 The Adolescent and Young Adult Program;270
22.1;Chapter Overview;270
22.2;Introduction;271
22.3;Multidisciplinary Program Design;272
22.4;Improving Treatment Outcomes;272
22.4.1;Solid Tumors;272
22.4.2;Leukemia;273
22.5;Improving Quality of Life;274
22.5.1;Prior to Initiation of Therapy;274
22.5.1.1;Giving Patients Appropriate Control;275
22.5.1.2;Looking Beyond Therapy;275
22.5.2;During Therapy;276
22.5.2.1;Age-Appropriate Interaction and Support;276
22.5.2.2;Body Image and Relationships;276
22.5.2.3;Planning for the Future;277
22.5.2.4;Year-Round Social Activities;277
22.5.3;After Therapy;278
22.5.3.1;Monitoring for Recurrence and Secondary Malignancies;278
22.5.3.2;Addressing Long-Term Sequela;278
22.5.3.3;Ensuring Reintegration;279
22.6;Promoting Awareness of Issues Specific to Adolescents and Young Adults;280
22.7;Conclusions;280
22.8;KEY PRACTICE POINTS;280
22.9;Suggested Readings;281
23;Index;282
"11 Differentiated Thyroid Cancer (p. 155-156)
Chapter Overview
Thyroid nodules are relatively common in adult women but uncommon in adult men and in children and adolescents, and children are infrequently affected by differentiated thyroid cancer. When this cancer does occur in a child, the patient’s prognosis is generally favorable and he or she can expect a near-normal life span; however, it can prove to be a lethal neoplasm, especially in older patients and when distant metastases are present. The survival duration for children and adolescents with differentiated thyroid cancer is substantially long despite the fact that the disease presents with extensive morbid characteristics. The varied presentations and activities of differentiated thyroid cancer in children require speci?c diagnostic and treatment approaches and lifelong surveillance.
Introduction
Differentiated thyroid cancer, often simply called “thyroid cancer,” is an infrequent malignancy overall but the most common endocrine malignancy. At M. D. Anderson Cancer Center, less than 10% of all patients with differentiated thyroid cancer receive the diagnosis before 20 years of age. In children, differentiated thyroid cancer occurs more commonly as the papillary rather than the follicular variant, and it affects girls more often than boys.
Unlike in young adults, differentiated thyroid cancer presents in children with extensive disease bulk, including multifocal primary lesions, bilateral cervical lymph node metastases, and tumor invasion into the soft tissues of the neck. Diffuse pulmonary metastases may also be present in a small subset of children with cervical lymph node metastases. Children with differentiated thyroid cancer generally have a good prognosis despite the initial extent of disease (Harness et al, 1992; Hung and Sarlis, 2002). Nevertheless, disease- and treatment-related morbidity and mortality do occur; thus, a thoughtful, comprehensive initial evaluation and treatment plan must be coupled with lifelong surveillance in all cases.
Radiation-Induced Differentiated Thyroid Cancer
The risk for radiation-induced differentiated thyroid cancer is well documented. During the early decades of the twentieth century, low-dose irradiation to the head and neck was often used in the treatment of benign childhood conditions such as thymic enlargement, hemangioma, ringworm, and acne. The excess relative risk for radiation-induced differentiated thyroid cancer appears to depend on radiation dose and schedule as well as the patient’s age at the time of exposure.
The average time between irradiation and diagnosis of differentiated thyroid cancer is 10 years; accordingly, some cases of radiation-induced differentiated thyroid cancer will be diagnosed before the patient is 20 years old. There is no indication that radiationinduced differentiated thyroid cancer has a different clinical presentation and course than unirradiated cases of the disease. Increasing awareness of thyroid radiosensitivity, especially in children, has led to the virtual elimination of the use of irradiation for benign conditions; thus, low-dose radiation-induced differentiated thyroid cancer is expected to subside in the future."
