the difference of adult liver,CNS,testicles, or

vs childhood cancer. other organs. Where

Childhood are a result they can keep body not
of DNA changes that doing their job right.
start in an very early
life even before birth. Bone marrow
In infants all bone
Unlike adults, marrow found in all
childhood cancers is bones of the body but
NOT STRONGLY related by teenage years it is
into lifestyle and found mainly in the flat
environmental risk bones(skull, shoulder,
factors. blades, ribs, hip and
Dan anak2 juga tend to vertebrae)
respond better to Isi dr bone marrow
chemotherapy and adalah blood forming
radiation. ES nya juga cells, fat cells,
lebih rendah. supporting tissue.

LEUKIMIA WBC.
Adalah sebuah kanker Limfosit. Are mature
yang dimulai dr bone infection fighting cells
marrow from some derived from
bones. Plg sering kan lymphoblast.lymphoid
yang WBC tp bs juga sel tissue =lymph nodes,
darah yang lain. thymus, spleen,
Blood forming cells tonsils,adenoids, bone
which inside bone marrow and also
marrow bs jd leukimia scattered around the
cell. Once this change digestive and respi
takes place, leukimia system berisi
no longer be normal. lymphocytes. Ada 2
Nanti immature blood types B & T cells.
cells bakal bergabung
dan menggantikan ACUTE
semua darah yang LYMPHOBLASTIC/LY
normal . this progress MPHOCYTIC
can be slow either LEUKEMIA
fairly quickly. Terus bs The most common type
metastasis ke lymph of childhood keukemia,
nodes, spleen,
it can start in early B
cells and T cells.
*granulosit : BASOFIL,
EUSINOFIL,
NEUTROFIL : DESTROY
GERMS
MONOSIT JADI
MAKROFAG which also
help B cell to make
memory antibodies.
*almost all leukemia
in children are acute
MAIN TYPES OF
LEUKEMIA ACUTE
1. ALL biasanya di umur 2-4
tahun
2. AML nama lainnya
adalah acute myelocytic
leukemia, acute non-
lympocytic leukemia.
Biasanya di umur <2thn dan
teenage life.Starts in
WBC(other than
limfosit), rbc or
platelets
3. HYBRID OR MIXED
LINEAGE LEUKEMIA
cells have features of
both ALL & AML
di treatment nya pake
yang ALL karena
respondnya baik.
MAIN TYPES OF
CHRONIC LEUKEMIAS
Kalau untuk chronic
lebih sering di dewasa.
Tend to grow slowly,
harder to cure
1. CHRONIC
MYELOGENOUS
LEUKEMIA (CML) lebih
ke teenage years
2. CHRONIC
LYMPHOCYTIC
LEUKEMIA(CLL)
NOT CLASSIFIED AS
CHRONIC EITHER
ACUTE
1. juvenile
myelomonocytic
leukemia (JMML)
begins from myeloid
cells but it usually does
not grow as fast as aml
or cml. Usually under 4
years old.
Gejala pale, fever,
cough, easy bruising,
trouble breathing, kgb
membesar dan
splenomegaly
RISK FACTORS IN
CHILDHOOD
1. inherited
syndromes
1.1 DOWN SYNDROME
(TRISOMI 21) : chr 21
extra copy. Tend to
develop all or aml, also
linked to
myeloproliferative
disorder(transient
leuekemia)which often
self limiting
1.2 Li-Fraumeni
syndrome
tumor suppresore gene 2. chemotherapy and
mengalami perubahan certain chemicals
TP53. cyclophosphamide,
2. inherited immune chlorambucil,
system problems etoposide, teniposide
2.1 ataxia- higher risk for
telamgoeectasia leukemia.
2.2 wiskott-aldrich These leukemia tens to
syndrome develop5-10 years after
2.3 bloom syndrome treatment and will be
2.4 schwachman- HARD TO TREAT
diamond syndrome
2.5 congenital -Benzene (pabrik pake
agmmaglobulinemia buat drugs, plastics,
2.6 poland syndrome dyes) cause AML than
2.7 neurofibromatosis to ALL
2.8 kostmann disease -pesticides
3. having a brother or 3. is in condition of
sister with leykemia immune suppresion
RISK FACTOR IN misalnya abis organ
ADULTS transplant
1. lifestyle related 4. unproven,
overweight, smoking, controversial RF
alcoholism, sun uv 4.1 exposure to
expose magnetic fields
2. living near nuclear
RISK FACTORS IN power plant
3. infections in early
BOTH ADULTS AND
life
CHILDREN
4. parents smoking
1. environemntal history
high radiation.usually 5.father workplace
within 6-8 years after exposure to chemicals
exposure. and solvents
kalau di anak2 6. fetal exposure to
possibly x ray and ct hormones such as
scan makanya dokter dietyltilbestrol and PIL
tdk menyarankan anak2 KB
and pregnant women
get these test except
BASIC OF DNA
bener2 dibutuhkan
REPLICATION
1. oncogenes : genes 5. swollen lymph nodes
that help to stay alive, : soalnya kena lymph
to grow to divide nodes.
2. tumor suppresor Dinilai dengan MRI dan
genes Ct scan soalnya
: detect abnormal genes biasanya infeksi doang
and cause cells die in 6. cough or trouble
the right time breathing soalnya kena
thymus or lymph nodes
in cancers oncogenes di chest jd enlarged
turn on . tsg turn off. atau karena leukostasis
7. swelling of the face
DNA SWAP OR and arms : soalnya
TRANSLOCATION enlarged SVC bikin
FOR CML and ALL bengkak muka2 nya
PHILADELPHIA sometimes with
CHROMOSOME in bluished red skin color
which translokasi yang bs naik ke otak jg
chromosome 9 dan 22 bikin pusing, and
menyebabkan aktivasi change in
onkogen diketahui sbg consciousness.
BCR-ABL 8. headache, seizure
and vomiting : bbrp
SIGN AND SYMPTOMS anak pas didiagnosis
OF LEUKEMIA udah nyebar ke otak
1. anemia, bs bikin 9. rashes, gum
jantung berdebar2. problems : in children
thrombositopenia, with acute
leukopenia myelogenous leukemia
2. bone or joint pain may spread to gums
soalnya leukemia cells cause swelling, pain
buildup near surface of and bleeding and if it
bone or inside the joint spread to skin bikin
3. swelling of abdomen common rashes.
(belly) leukemia cells Collection of AML
can collect in the liver under the skin is called
and spleen making chloroma or
them bigger. granulocytic sarcoma
4. loss of appetite grgr 10. extreme weakness
spleno/hepatomegaly and slurring speech
soalnya leukocytosis
cause thick and slow
the circulation through 1.2 BLOOD
small vessels in the SMEAR(normocytic,
brain normochromic) banyak
11. parenchymal banget blasts harusnya
involvement : blasts itu cuman ada di
hemiparesis, cerebellar bone marrow
involvement : ataxia,
dyamteria, hipotonia, 2. BONE MARROW
hyperreflexia ASPIRATION AND
12. hypothalamic BIOPSY
syndrome : polyphagia biasanya sih diambil dr
with excessive weight pelvic bones atau bs jg
gain, hirsustisme, dr tulang lain. Terus di
behavioral disturbance aspirasi deh a small
13. leukostasis in amount of liquid bone
cerebral blood vessels, marrow.
leading tp Replaced by 80-100%
leukothrombi, infarcts blasts. Megakaryocytes
and hemorrhage. is usually absent.
14.typhlitis = *blasts : hallmark of
neutropenic leukemia. It is an
necrotozing undifferentiated cell
enteropathy of the with diffusely
cecum distibuted nuclear
chromatin, one or more
MENDIAGNOSIS nucleoli(which is more
LEUKEMIA prominent in AML) and
1. BLOOD TESTS : scant cytoplasm.
venipuncture kalau
infants ambil dr feet, 3. LUMBAR PUNCTURE
scalp or just finger buat check udah nyebar
stick belum dan juga
1.1 CBC usually pemberian prophylaxis
leukocytosis, supaya ga kena CNS.
erythropenia, kalau CNS involvement is
sampe hb tinggi classified as follows :
mengindikasikan high 1. CNS1<5 wbc/mm3 no
proliferative leukemia no blast on centrifuge
tromobositopenia 2. CNS 2<5 WBC/mm3
eusionophilia. ada blast
3. CNS 3 >5 wbc/mm3
dan ada blast.
 proteins(DNA) jdi bs
4. LYMPH NODES lihat brp byk leukimia
BIOPSY cellsnya.
biasanya siih buat Bs juga untuk
limfoma kalau leukemia memonitor residual
gausah.

5. blood chemistry :
elektrolit, urea, uric 3. chromosome test
acid, LDH, liver 3.1 flourescent in situ
function test, IG levels, hybridization
coagulation profile 3.2 polymerase chain
reaction (PCR)
6. infectious disease
profile. IMAGING TEST
1. chest x ray/ ct
MICROSCOPIC EXAMS scan/MRI
*untuk BONE buat liat ada enlarged
MARROW, CSF, lymphnode/ timus/
LYMPH NODES suspek pneumonia.
Mri for CNS,
DI WARNAIN
hepatosplenomegaly
Di warnain pake
chemical stains (dyes)
2. PET SCAN lihat
that can cause color
metastasis dengan
changes in some type of
flurodeoxyglucose
leukemia cells.
1. Normal bone marrow
3. ultrasound for
contains a certain
hepatosplenomegaly
number of blood
forming cells and fat
4. bone scan diinjeksi
cells
readiactive chemical
too much :
which is in very low
hypercellular or
conc terus nanti dia
hypocellular
nempel sm skeleton for
some hours after that
2. flow cytometry and
terus nanti kamera will
immunohistochemistry
detect that radioactive.
bs dari bone marrow or
(kalau udh
lymph nodes. Samples
pet/didiagnosis
of cells are treated with
ab that stick to certain
leukemia biasanya ini and spread to CNS in
ga perlu dilakukan) early course of the
disease
KLASIFIKASI DARI
CHILDHOOD ACUTE MYELOGENOUS
LEUKIMIA : fast growing
LEUKEMIA
cancer of the following
Dia tuh ga punya
types of immature bone
staging kaya kanker
marrow cells.
lain soalnya kan
1. myeloblast :
langsung nyebar ke
granulosit
seluruh tubuh di darah.
2. monoblast :
1. classification based
makrofag
on cell morphology
3.erythroblast
ALL punya 3 major
4. megakaryoblast
groups L1,L2,L3 based
on how the cells looked
CHRONIC MYELOGENOUS
under the microscope. LEUKIMIA(CML)
2. based on Slower growing cancer
immunophenotype of early immature
1. tergantung dari b myeloid bone marrow
atau t cells yang kena cells. Course of CML
duluan divided into 3 phases
2. brp mature these based on the number
leukemia cells are of immature WBC.
Myeloblast that are
B-CELL ALL : 80-85% of seen in blood or bone
children with ALL marrow.
Jenisnya lagi
1. early precursor B all 1. chronic phase
2. common ALL EARLIEST PHASE cmn
3. PRE B-ALL ada 10% blast in blood
4. MATURE B CELL ALL or bone marrow
(also known as Burkitt samples. Usually have
leukemia) THIS TYPE is mild symptoms and
RARE cmn 203 % dr respond well to
childhood ALL. standard treatment
2. accelerated phase
T CELL ALL : 15-20% if bone marrow or
LEBIH BYK KENA BOYS blood samples have
THAN GIRLS. Biasanya more than 10% but
bikin enlarged thymus, fewer than 20% blast
ada fever, night sweat, 4,10,17 punya good
might not respond well outcome tp translokasi
to treatment ETV6-RUNX1 juga
3. blast phase bagus. Translokasi MLL
nama lain : acute phase arrangement on 11q23
or blast crisis inferior prognososis.
Philadelphia
bone marrow or blood chromosome t9,22 bad
samples have more prognosis.
than 20% blasts. 5. DNA index >1,16 atau
The blast cells often chromosome numb
spread to tissues and >50(hyperploidy) is
organs beyond bone associated with good
marrow. outcome. Karena
Gejala: fever, night decreased apoptosis
sweat, poor appetite, and increased
weight loss. Act like sensitivity with
aggressive ALL/AML. kemoterapi
DNA INDEX <0.81 poor
outcome. (hypoploidy)
PROGNOSTIC biasanya chromosome
FACTORS <44
Age &WBC count are 6. CNS disease presence
two most important of cns disease cause
perdictors of the poor prognosis
outcome. 7. early response to
Age 1-9 tahun dengan induction tx. Patients
wbc <50.000 who are not in
1. age dibawah 1 diatas remission at the end of
10 tahun have worse induction therapy <2-
prognosis. 5% of all patients have
2. jumlah WBC jumlah a very poor prognosis.
yang tinggi lebih poor
prognosis
3. immunophenotype B
lymphoblastic has the
best prognosis. T
lymphoblastic ALL has
a worse survival
4. cytogenetics :
kombinasi dari trisomi