Common Topics in Pediatric Oncology
Neuroblastoma
Known as the most common extra-cranial solid tumor of infancy, this disease has a very heterogeneous presentation and outcome. Meaning, patients with low risk disease with favorable histology do extremely well with treatment and have up to 90% survival. However, high risk patients with unfavorable histology and/or advanced stage disease have less than 40-50% long term survival. Recent advances in neuroblastoma research have focused on new therapies for high risk patients including antibody therapy and radionuclide therapy using I-131 MIBG. Newer radionuclide therapy using Lu-177 may be on the horizon. Advances in genetics will push treatment towards personalized medicine, specific to the characteristics of the individual tumor.
Hodgkin's Disease
Accounts for 1% of all cancers and is curable in almost 90%. The bimodal distribution of the disease makes this an important young adult disease and relevant to pediatric radiologists. Staging and response to therapy are key factors in the prognosis of the disease. Familiarity with the Deauville scoring system for PET/CT response in important for the pediatric radiologist to be a valuable team member in the care of these patients.
Hepatoblastoma
The most common primary malignant liver tumor in children under age 4 years presenting with painless abdominal mass and typically marked elevation in serum alpha fetoprotein. Association with some underlying predisposition syndromes has been reported including: hemihypertophy Beckwith-Weidemann, biliary atresia, Gardner syndrome, familial polyposis and prematurity. Resectability of the primary tumor is of utmost importance and image guided staging of these tumors using the PRETEXT guidelines provides standardization for radiologists and surgeons alike.
Sarcoma
A broad group of soft tissue tumors the pediatric radiologist is frequently consulted to review MRI findings and CT findings for initial staging. Further consultation to consider lymphoscintigraphy to evaluate for extent of surgery and nodal disseciton as well as to comment on the value of additional imaging including FDG-PET/CT in some cases.
Thyroid Cancer
Although considered a rare pediatric tumor, thyroid cancer is an important one to recognize for the pediatric radiologist. The radiologist is a key player in both diagnosis and treatment for these patients from the initial ultrasound to FNA biopsy and finally to determining the need for radioiodine therapy. With the release of dedicated pediatric guidelines from the American Thyroid Association, we must be familiar with new pediatric-specific recommendations.
