CME : Your SA Journal of CPD - Volume 28, Issue 7, 2010
Volume 28, Issue 7, 2010
Source: CME : Your SA Journal of CPD 28 (2010)More Less
Childhood cancer is rare and comprises only 1% of all cancers. It usually develops from non-ectodermal embryonal tissue. Major improvement in cancer treatment and supportive care in the last 50 years has changed a fatal childhood disease to achieve a cure rate of more than 75% in First World countries, which is due to well-designed clinical trials, international collaboration in these trials, improving diagnostic tools and improved supportive care to overcome the toxicities of treatment.
Author D.K. StonesSource: CME : Your SA Journal of CPD 28, pp 314 –316 (2010)More Less
World-wide there are more than 200 000 new cases of childhood cancer per year and more than 70% of these occur in the developing world. In the First World more than 70% of these children will become long-term survivors. For some childhood cancers 5-year survival rates approach 95%. In England only 0.5% of all cancer cases occur in children under 15 years of age. In Third World countries this ratio is often higher, and in India the percentage in some areas is almost 5%. Despite these higher incidences it is often not a health priority in developing countries, where other health needs are more important.
Author Stefan Daniela CristinaSource: CME : Your SA Journal of CPD 28, pp 317 –319 (2010)More Less
Childhood cancer is relatively rare, comprising less than 1% of cases of malignant disease. Cancer is the second most common cause of death in children in Western countries, while in Africa it is not even ranked among the 10 most common causes of death. Infections, nutritional disease, HIV and tuberculosis remain the most important paediatric health problems in developing countries. In developed countries, more than 80% of children with malignancies can be cured, but unfortunately most children with cancer live in developing countries, where the cure rate is much lower. In 2009 South Africa's population was approximately 49 million, of whom 15 500 000 were in the age group 0 - 14 years. This translates to over 31% of the population, while in the USA and Western Europe the corresponding figures are 20% and 17%, respectively.
Source: CME : Your SA Journal of CPD 28, pp 320 –323 (2010)More Less
Leukaemia means white blood. It is a disease of the white blood cells and was first described by Virchow in 1845. Leukaemia can present as an acute disease, occurring more often in the younger age groups, or as a chronic disease, usually in the older age group. Acute leukaemia is rare, but about 1 in 2 000 people will develop the disease. The two acute forms in children are acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). The chronic form is chronic myeloid leukaemia (CML).
Author Janet E. PooleSource: CME : Your SA Journal of CPD 28, pp 324 –326 (2010)More Less
Wilms' tumour or nephroblastoma is a cancer of the kidney that typically occurs in children and very rarely in adults. The common name is an eponym, referring to Dr Max Wilms, the German surgeon who first described this type of tumour in 1899. Wilms' tumour is the most common form of kidney cancer in children and is also known as nephroblastoma. Nephro means kidney, and a blastoma is a tumour of embryonic tissue that has not yet fully developed.
Author David ReyndersSource: CME : Your SA Journal of CPD 28, pp 328 –331 (2010)More Less
There have been major advances in the treatment of and outcomes in childhood cancer. Improved outcomes have largely been achieved by more intensive and toxic treatment regimens, including cytotoxic chemotherapy, radiotherapy and / or surgery. Chemotherapy-induced immuno suppression renders children who receive treatment for cancer extremely vulnerable to life-threatening infections, which are a major cause of morbidity and mortality. Prompt and aggressive intervention with empiric antibiotics has reduced mortality in this group of patients.
Author F.E. OmarSource: CME : Your SA Journal of CPD 28, pp 332 –336 (2010)More Less
The term 'lymphoma' refers to malignant proliferation of lymphoid cells, usually in association with and arising from lymphoid tissues (i.e. lymph nodes, thymus, spleen). Lymphomas are closely related to lymphoid leukaemias, which also originate in lymphocytes but typically involve only circulating blood and the bone marrow (where blood cells are generated in a process termed haematopoiesis) and do not usually form static tumours.
Source: CME : Your SA Journal of CPD 28, pp 337 –342 (2010)More Less
HIV-related immunosuppression increases the incidence of certain forms of cancer, and HIV infection and its co-morbidities such as TB have made it more difficult to treat incidental malignancies. The HIV-related malignancies (HIVRM) include AIDS-defining cancers and HIV-associated neoplasms. The AIDS-defining cancers are Kaposi's sarcoma (KS) and B-cell lymphomas (including primary CNS lymphoma), all of which are defined as WHO stage IV or CDC category C conditions. The HIV-associated neoplasms include leiomyosarcoma (a rare smooth-muscle tumour defined as CDC category B) and mixed-cellularity Hodgkin's lymphoma (not listed by WHO or CDC). They are all the result of viral transformation of DNA in host cells, by human herpesvirus-8 (HHV8) in the case of Kaposi's sarcoma and by Epstein-Barr virus (EBV) in the others. While these tumours all occur in HIV-negative patients, the incidence of B-cell lymphoma shows a modest increase and the incidence of Kaposi's sarcoma increases tenfold or more in the presence of HIV infection. The number of incidental malignancies occurring in HIV-positive children rises as the prevalence of HIV increases in the population. This is a function of both an increase in the number of susceptible individuals and increased survival of this cohort as the number of children on antiretroviral therapy (ART) expands.
Author Anel DippenaarSource: CME : Your SA Journal of CPD 28, pp 343 –346 (2010)More Less
Before the success story of leukaemia treatment started in the 1950s, many patients succumbed to the disease because of severe haemorrhage. A bleeding tendency is one of the hallmarks of haematological malignancies such as leukaemia, since together with anaemia and an increased susceptibility to infection it completes the picture of bone marrow failure. Almost half of patients with acute lymphoblastic leukaemia present with bleeding. It can also become evident when the bone marrow is infiltrated by a non-haematological malignancy, e.g. neuroblastoma. Thus, easy bruising is one of the St Siluan early warning signs of childhood cancer, compiled by the South African Children's Cancer Study Group (SACCSG). An increased risk of bleeding during the cancer treatment period is almost always present, due to the bone marrow suppressive effect of chemotherapy. Fortunately, death due to bleeding is rare these days.
Author Ronelle UysSource: CME : Your SA Journal of CPD 28, pp 347 –348 (2010)More Less
Conveying the news in a thoughtful, caring and hopeful way shows respect and empathy for the family. Effective, compassionate and open communication has a positive impact on the way in which the family copes. It also helps to establish a relationship of long-term trust. Communicating the diagnosis should be the first building block in an ongoing communicative process. An honest and a humane approach that conveys some hope is advocated.
Author Rosalind WainwrightSource: CME : Your SA Journal of CPD 28, pp 3308 –312 (2010)More Less
Retinoblastoma is the most common eye cancer that occurs in the retina of infants or young children. It occurs in 1:20 000 births and can be unilateral in 60% or bilateral in 40% of cases. The clinical signs can sometimes be subtle and are often missed, which could lead to delay in diagnosis, possibly loss of vision or even loss of life. Both the public and health professionals in South Africa need education to expand awareness of retinoblastoma.