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Surgical considerations in lung cancer treatment

CLINICAL PEARLS Resectability is determined by patient fitness to undergo surgery and tumor characteristics. Appropriate tumor staging, especially mediastinal nodal involvement, is fundamental to surgical planning. Pulmonary function testing must be performed to determine whether a patient can tolerate loss of lung parenchyma safely. Stage I/II disease is treated definitively with lobectomy, with adjuvant chemotherapy for select patient groups, and sublobar resection is reserved sublobar resection…

Histology and molecular testing

CLINICAL PEARLS The field of molecular pathology is rapidly moving toward noninvasive and digital methods of detection as theragnostic biomarkers are being used to guide cancer management. Biomarker testing has now become the pillar of treatment decision for advanced-stage non−small cell lung cancer patients. Molecular biomarkers once reserved for advanced stages of disease are now important in early-stage patients with PDL1 and molecular testing requirements rapidly…

Lung cancer: Diagnostic techniques

CLINICAL PEARLS Establishing an appropriate histological diagnosis and stage of lung cancer is critical to avoid delays in treatment. Noninvasive staging plays an important role in the initial clinical staging of lung cancer and includes imaging such as computed tomography (CT) and positron emission tomography scans. Determining the pretest probability of malignancy of a nodule using a model such as The Mayo Clinic Model is useful…

Lung cancer screening and prevention

CLINICAL PEARLS Lung cancer mortality has been declining since the 1990s, yet it remains the leading cause of cancer mortality and is still expected to cause more than 120,000 deaths in 2023 in the United States. National and local efforts to curtail smoking initiation and encourage cessation are estimated to have been associated with an avoidance of 8 million premature deaths and an estimated extended mean…

Hematological reference values

The normal range for most hematologic parameters in infancy and childhood is different from that in adults. Dramatic changes occur during the first few weeks of life. The recognition of these differences in the pediatric age-group prevents unnecessary medical and laboratory investigations. Fetal and cord blood hematologic value Table A1.1 Hematologic values in normal fetuses at different gestational ages. Modified from Forestier, F., Daffos, F., Catherine,…

Pediatric blood banking principles and transfusion medicine practices

Introduction Blood banking and transfusion medicine are often interchangeable terms for the medical practice of blood product procurement, storage, and administration. It also includes the science of immunohematology, blood component manipulation, and outlining of clinical transfusion guidelines. Hematologic pathologies in neonates and children are vastly different from adults, leading to the varied indications of blood product replacement, further necessitating pediatric-specific strategies for this population. Of note:…

Psychosocial factors impacting children with cancer and their families

Time of diagnosis A diagnosis of childhood cancer is an acute traumatic event for a family. Many families recall the conversation confirming diagnosis as a turning point in their lives. This can occur unexpectedly or after months of unexplained symptoms. Preconceptions or past experiences with cancer may lead to immediate thoughts that the child will die. Even if fears about death are not at the forefront,…

Evaluation, investigations, and management of late effects of childhood cancer

As detailed in the Introduction to this book, the last 60 years have been witness to truly remarkable progress in the treatment of childhood cancer. With current therapies, over 80% of children diagnosed with cancer in the United States can be cured of their disease. As a result of this progress, there are now over 500,000 survivors of childhood cancer (SCC) living in the United States.…

Supportive care of patients with cancer

The increasing intensity of chemotherapy has improved pediatric oncology outcomes concomitant with the recognition and augmentation of supportive care practices. Prophylaxis and treatment of infection remains the cornerstone of supportive care along with transfusion for chemotherapy-induced cytopenias (see Chapter 35 : Pediatric Blood Banking Principles and Transfusion Medicine Practices). Additional considerations include the recognition and management of nausea and vomiting, mucositis and pain, nutritional status of…

Management of oncologic emergencies

Survival in children with cancer has increased dramatically during the last five decades. This progress is due not only to advances in therapy but also to advances in supportive care and an improved ability to manage life-threatening complications. Oncologic emergencies can occur as an initial manifestation of cancer, as a side effect of therapy, or at the time of progression or recurrence of the disease. Excellent…

Hematopoietic stem cell transplantation and cellular therapy

Hematopoietic stem cell transplantation (HSCT) is an accepted treatment of choice for a variety of malignant and nonmalignant disorders. Tables 30.1 and 30.2 list indications for allogeneic and autologous HSCT. Most allogeneic transplants perform.ed in patients <20 years old are for acute leukemias (43%) or nonmalignant indications (35%). Preparation, or “conditioning,” for HSCT involves the delivery of high-dose chemotherapy (HDC) with or without radiation to ablate…

Hepatic tumors

Primary hepatic neoplasms are rare and account for only 1–2% of all childhood cancers. Hepatoblastoma accounts for approximately two-thirds of pediatric liver tumors. Hepatoblastoma and hepatocellular carcinoma (HCC) constitute the two most common malignancies that arise de novo in the liver. Table 29.1 lists the most prevalent malignant and benign liver tumors in children. Table 29.1 Malignant and benign liver tumors in children. Malignant Benign Hepatoblastoma…

Extracranial germ cell tumors

This chapter will review extracranial germ cell tumors (GCTs). Please see Chapter 22 , Central nervous system tumors, for a discussion of intracranial GCTs. Epidemiology Tumors of germ cell origin display a bimodal distribution, with a peak seen in young children between 0 and 4 years. During childhood, GCTs account for 3.5% of childhood malignancies. In the United States the age-adjusted incidence of GCT in children…

Retinoblastoma

Retinoblastoma (RB) is a malignant tumor of the embryonic retina, likely arising from a cone photoreceptor precursor cell. It is a threat to both life and vision. RB affects young children, usually under the age of 5 years. Tumors may be unilateral or bilateral, unifocal or multifocal. Two-thirds of the cases are diagnosed by age of 2 years in the United States. If RB is contained…

Malignant bone tumors

Malignant bone tumors constitute approximately 6% of all childhood malignancies. In the United States the annual incidence in children under 20 years of age is 8.7 per million. Osteosarcoma (56%), the Ewing sarcoma family of tumors (EFT) (34%), and chondrosarcoma (6%) comprise the most frequently encountered malignant bone tumors in children and adolescents. In the United States, 650–700 children and adolescents under the age of 20…

Rhabdomyosarcoma and other soft-tissue sarcomas

Soft-tissue sarcomas (STS) are a heterogeneous group of malignant tumors derived from primitive mesenchymal cells. These tumors arise from muscle, connective tissue, supportive tissue, and vascular tissue. As a group, they are locally highly invasive and have a high propensity for local recurrence. They usually metastasize via the bloodstream and, less commonly, via the lymphatics. The STS can be divided into two groups: 1. rhabdomyosarcoma (RMS)…

Renal tumors

Wilms tumor Incidence Wilms tumor (nephroblastoma) is the most common primary renal tumor of childhood and the sixth most common childhood malignancy in the United States. Wilms tumor comprises approximately 6% of all childhood cancers and nearly 10% of all malignancies among children aged 1–4 years. The male-to-female ratio 0.92:1.00 in unilateral Wilms and 0.6:1.00 in bilateral Wilms tumor. Seventy-eight percent of children with Wilms tumor…

Neuroblastoma

Neuroblastoma originates from primordial neural crest cells that normally give rise to adrenal medulla and sympathetic ganglia. Epidemiology Neuroblastoma is the most common extracranial solid tumor in children, accounting for 6% of all childhood malignancies. Neuroblastoma is the most common malignancy in infants with an annual incidence of 10 per million live births. At diagnosis, 50% of patients are under 2 years of age, 75% under…

Central nervous system tumors

Tumors of the central nervous system (CNS) are frequently encountered tumors in children; approximately 35 cases per million in children under 15 years of age. Brain tumors are the second most common group of malignant tumors in childhood, accounting for 20% of all childhood malignancies. Most childhood brain tumors (60%–70%) arise from glial cells and tend not to metastasize outside the CNS unless there is operative…

Non-Hodgkin lymphoma

Introduction Childhood non-Hodgkin lymphoma (NHL) is distinguished from adult NHL by differing frequencies of histopathologic types and by the greater frequency of extranodal presentations. With current combination chemotherapy regimens, survival is generally excellent (85 to over 90%) for all patients, including those with disseminated disease, bone marrow involvement, central nervous system (CNS) involvement, and high serum lactate dehydrogenase (LDH). With improved survival in all subtypes and…