Medical Assignment: Paediatric Oncology and Diagnostic Techniques

This medical assignment report explores various aspects of paediatric oncology. It begins with an overview of diagnostic imaging techniques used in paediatric cancer facilities, including CT scans, MRI, SPECT, and PET scans, highlighting their applications and safety considerations, particularly MRI's role. The report then delves into neuroblastoma, detailing its origins, symptoms, and diagnostic methods, including biopsy. Furthermore, it explains MISG scintigraphy and its importance in cancer cell analysis, emphasizing the role of gamma rays and radioisotopes. The report also covers FDG PET imaging, discussing its use in diagnosing and monitoring tumours and its role in evaluating neuroblastoma staging. F-DOPA PET imaging is also examined, explaining its use in detecting endocrine tumours and cancers. The report concludes with a discussion of skeletal metastases in neuroblastoma and the systematic review as a research method.

Running head: MEDICAL ASSIGNMENT
MEDICAL ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Answer 1
Diagnostic imaging techniques that are used in the paediatric cancer facilities has
been developed through the years. With the increased complications and identification of the
paediatric cancer patients, it has been observed that several diagnostic and support system has
been developed so that patient, their scope of recovery and the chances of recurrence after
complete eradication of cancer could be observed (de Rooij et al. 2016). The diagnostic
imagining techniques that has been observed or are used in paediatric cancer analysis
diagnosis and processing are Computed Tomography or CT scan, Fluoroscopy, Magnetic
Resonance Imaging (MRI) techniques, Positron emission tomography (PET) and Nuclear
medicine and molecular imaging as well as Single Photon Emission Tomography (SPECT).
Within these, the imaging technique of MRI has been used extensively for the diagnosis and
identification purpose of the paediatric cancer. As per Ronot and Vilgrain (2014), the
diagnostic procedure that has been used for the paediatric cancer patient is the Magnetic
Resonance Imaging technique that uses developed and improved 3D imaging techniques that
develops images of the patient’s body, organs, tissues and bones. However, one aspect that
should be mentioned in this case is that MRI does not provide ionizing radiation and hence it
is safe for the application in the identification and diagnosis purposes (de Rooij et al. 2016).
Another imagining technique that should be discussed in this aspect is the Single Photon
Emission Tomography (SPECT) as per Takx et al. (2015), which is a diagnostic technique
that uses specific radiotracers in the process so that the test could generate highly developed
and imaging of the body. The primary aspect of this Single Photon Emission Tomography
diagnostic method is the identification and analysis of the patient’s blood flow, use of
oxygen, sugar metabolism as well as the function if the tissues and other structures so that the
ability of the patient to respond to the interventions for cancer therapies could be observed.
X-rays and Fluoroscopy are also the aspects that should be discussed in this aspect as

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Fluoroscopy is the process that helps to understand the moving objects and manages the real
time aspects of the body of the patient and hence, in this condition all of these imaging
technologies are used for the analysis of the cancer condition in paediatrics patients (de Rooij
et al. 2016).
Answer 2
Neuroblastoma is the health condition, which develops in the immature nerve cells
and then spreads all over the body. As per the research of Molenaar et al. (2012), it has been
observed that majority of the patients suffering from Neuroblastoma develops the disorder
around the adrenal glands and then sits atop the kidney. Besides these, there are other
locations in which the cancer could develop such as the chest, abdomen, spine neck and other
bodily areas where the nerve cells are present in groups. While describing the background of
Neuroblastoma, the description of its symptoms should be discussed (Huang and Weiss
2013). The symptoms of Neuroblastoma depends upon the place where the origin of the
cancer is present such as in abdomen the symptoms includes abdomen pain, tenderness in the
abdomen, changes in bowel habit and continuous diarrhoea or constipation. On the other
hand, in chest, it is associated with wheezing sounds, chest pain and unequal pupil size and
therefore, these are the aspect that could lead to critical healthcare conditions so that patients
could develop effective care for the process (Cheung and Dyer 2014). Upon discussion of the
occurrence of the Neuroblastoma, it should be mentioned that patients generally inherit the
cancer from their parents as environmental factor has not been found to have effective and
leading effect on the emergence of the disease condition. The diagnosis and identification of
this type of cancer is developed and determined by the biopsy of the tissues collected from
the patient (Huang and Weiss 2013).

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Answer 3
As mentioned by Yanik et al. (2013), MISG scintigraphy is the assessment and
diagnostic measure which has been developed for the analysis of the cancer cells. The
primary aspect that helps in the proper analysis and diagnosis of the cancer cells is the
gamma rays that helps to conduct a scan of the cancer cells of the patient. As per Christensen
et al. (2016), this diagnostic test is applied in the nuclear medicine process and through the
identification and attachment to the radioisotopes it helps to travel to the specific organ or
tissues that helps to understand the locations where the cancers are situated.
As mentioned by Christensen et al. (2016), the MISG scintigraphy in the process or
the imaging technique which is dependent upon the nuclear events which is developed
through collisions and hence through the utilisation of charged current interactions it helps to
ionize the particles that generates a pulse related to the electromagnetic radiation within the
machine, due to the advanced machinery it helps to develop two or three perfect impulses
within the human body that helps to develop two of three high quality images of the human
body depending upon the region of cancer and therefore could be effectively used in
identification and diagnosis of the processes. In such condition it should be mentioned that
proper tagging of Neuroblastoma helps the physicians involved in the care process to
understand the risk of critical heath condition of the patient and eventually, the type of
intervention and the intensity of medication that the patient would receive through the care
process would be determined effectively (Peinemann et al. 2017).
Response 4:
PET can be defined as a nuclear medicine medical imaging technique that generates a
3-D image of the functional processes within the body. It should be noted in this context that
a FDG-PET scan makes use of a small amount of radioactive drug or a tracer that helps in
exhibiting differences between a healthy tissue and a diseased tissue. The test is known as the

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FDG-PET scan as FDG or Flurodeoxyglucose is the most common tracer that is used for the
scanning process. Before conducting a PET scan a small amount of FDG is injected in the
patient’s body. Research studies suggest that cancerous cells grow at a rapid rate and this
accounts for the reason why cancerous cells absorb more amount of FDG. The PET scanner
effectively detects radiations that is emitted by the FDG and as a result produces colour-
coded images of the body that efficiently depicts both the normal tissues as well as the
cancerous tissues (Pugh et al., 2013). In addition to this, it is important to note here that PET
scanners also include a conventional computer tomography scanner which facilitates the
capture of images of both function and anatomy to be taken during the examination. The uses
of the scans comprise of diagnosing and monitoring tumours, blood flow to the heart as well
as brain disorders (Cheung & Dyer, 2013).
Neuroblastoma can be defined as a tumour borne disease that leads to the formation of
tumour within the body. Research studies state that in some cases the tumours spontaneously
disappear without the commencement of any therapy, whereas in other cases despite the
implementation of modern therapy, the disease leads to fatal outcome. In such circumstances,
appropriate staging helps in risk assessment and the selection of optimal treatment procedures
which help in improving patient outcome and better management of the disorder (Louis &
Shohet, 2015). As per the International Neuroblastoma Risk Assessment Group, it is
stringently recommended that tumour staging before treatment procedures could help in
better choice of treatment procedures inclusive of surgery (Irwin & Park, 2015). The new
INRG staging system comprises of two stages of the localized disease which are mainly
dependent upon the consideration of the factor that imagine defined risk factors are present or
not present at the time of diagnosis. This assists the care professionals to compare the
findings with the evidence base and undertake an appropriate medical decision to serve in the
best interest of the patient.

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Response 5:
F-DOPA is basically the Fluorodopa chemical compound which is similar to the L-
DOPA compound in terms of the biochemical properties which is used in the treatment of the
Parkinson’s disease. The compound basically contains an additional radioactive fluorine
atom. F-DOPA is actively taken up by a number of normal tissues of the body. In addition to
this, it should also be noted that F-DOPA can actively accumulate within the neuroendocrine
tumours that subsequently originate from the neuroectoderm and comprise of secretory
granules that further includes adrenal lesions such as paragangliomas and
phaeomochromocytomas (Louis & Shohet, 2015). It should be explained here that on account
of radioactive decay, the F-18 atom which is attached to the DOPA molecule enables the
precise detection of the tumours with the use of a PET or CT scanner (Nomura et al. 2014).
Therefore, with the help of the F-DOPA PET imaging, several complex endocrine tumours
and cancers can be detected efficiently which can help implementation of appropriate
therapies at an early stage and subsequently improve patient outcome (Peifer et al., 2015).
Neuroblastoma can be defined as a cancerous tumour that initiated at the nerve tissue
of the infants and young children. The cancerous cells are often detected within the nerve
tissues that are present within the developing foetus and develops after birth into a detectable
tumour. Research studies however suggest that neuroblastoma is a rare condition which could
potentially manifest itself within children who are aged below 10 years, however, it is
common in adults. The tumour usually develops within the tissues of the adrenal gland that is
located within the abdomen. At the same time, the cancerous cells could also start developing
within the neural tissues of the neck, chest as well as the spinal cord (Dumba et al., 2015). It
is crucial to note here that the adrenal glands are located at the top of the kidneys and secrete
hormones that are integral for the maintenance of a wide range of physiological functions
(Schwartz-Shea & Yanow, 2013). In this context, it is important to detect the cancer at an

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early stage so as to adapt appropriate treatment interventions that could facilitate recovery. A
number of research studies reveal that the cancer could cure by itself and in certain cases that
expression could be of a greater magnitude which would require the implementation of
advanced therapies but the end result could lead to fatal outcome. In order to control the
intensity of such adverse events, it is extremely important to detect the appropriate staging of
the cancerous cells, this could help in commencing appropriate interventions aligned with the
cancerous stage and help in acquiring positive patient outcome (Peifer et al., 2015).
Response 6:
Neuroblastoma can be defined as a malignant tumour that manifests at infancy or
during early childhood. Research studies suggest that the tumour grows rapidly and
metastasizes widely and can turn fatal. In addition to this, it should also be noted that the
average span of life after the diagnosis is less than six months. The tumour is said to be
neurogenic in origin as the originating cells can be traced to the primitive neural crest of the
ectoderm. The tumour generally originates from the medulla of the adrenal gland which then
proceeds to the other parts of the body. The original tumour is derived from the neural crest.
Research studies suggest that neuroblastoma cancer cells possess the ability to metastasize
and spread to different parts of the body which includes the lymph nodes, lungs, bones, liver,
central nervous system and the bone marrow (Dumba et al., 2015; Nomura et al., 2014).
Metastasis in Neuroblastoma generally occurs at the third-fourth stage of cancer.
Response 7:
Systematic review can be defined as a research method that summarises the results of
the available scholarly evidences that align with the research topic. As per Schwartz-Shea
and Yanow (2013), systematic reviews can be defined as a type of literature review that
makes use of systematic methodologies in order to collect secondary data and critically

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appraise the research studies so as to synthesise the qualitative or the quantitative research
results. It is crucial to note in this context that systematic reviews help in articulating research
questions that are broad or narrow in scope and critically address the devised research
objectives. In addition to this, systematic reviews provide an insight into what has already
been done and serves as a guideline for the future researchers as to what can be done to add
to the evidence base.

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References:
Cheung, N. K. V., & Dyer, M. A. (2013). Neuroblastoma: developmental biology, cancer
genomics and immunotherapy. Nature Reviews Cancer, 13(6), 397.
Christensen, T.E., Bang, L.E., Holmvang, L., Skovgaard, D.C., Oturai, D.B., Søholm, H.,
Thomsen, J.H., Andersson, H.B., Ghotbi, A.A., Ihlemann, N. and Kjaer, A., 2016.
123I-MIBG scintigraphy in the subacute state of Takotsubo cardiomyopathy. JACC:
Cardiovascular Imaging, 9(8), pp.982-990.
de Rooij, M., Hamoen, E.H., Witjes, J.A., Barentsz, J.O. and Rovers, M.M., 2016. Accuracy
of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-
analysis. European urology, 70(2), pp.233-245.
Dumba, M., Jawad, N., & McHugh, K. (2015). Neuroblastoma and nephroblastoma: a
radiological review. Cancer Imaging, 15(1), 5.
Huang, M. and Weiss, W.A., 2013. Neuroblastoma and MYCN. Cold Spring Harbor
perspectives in medicine, 3(10), p.a014415.
Irwin, M. S., & Park, J. R. (2015). Neuroblastoma: paradigm for precision
medicine. Pediatric Clinics, 62(1), 225-256.
Louis, C. U., & Shohet, J. M. (2015). Neuroblastoma: molecular pathogenesis and
therapy. Annual review of medicine, 66, 49-63.
Molenaar, J.J., Koster, J., Zwijnenburg, D.A., van Sluis, P., Valentijn, L.J., van der Ploeg, I.,
Hamdi, M., van Nes, J., Westerman, B.A., van Arkel, J. and Ebus, M.E., 2012.
Sequencing of neuroblastoma identifies chromothripsis and defects in neuritogenesis
genes. Nature, 483(7391), p.589.

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Nomura, M., Ueno, A., Saga, K., Fukuzawa, M., & Kaneda, Y. (2014). Accumulation of
cytosolic calcium induces necroptotic cell death in human neuroblastoma. Cancer
research, 74(4), 1056-1066.
Peifer, M., Hertwig, F., Roels, F., Dreidax, D., Gartlgruber, M., Menon, R., ... & Ikram, F.
(2015). Telomerase activation by genomic rearrangements in high-risk
neuroblastoma. Nature, 526(7575), 700.
Peinemann, F., van Dalen, E.C., Enk, H. and Berthold, F., 2017. Retinoic acid
postconsolidation therapy for high‐risk neuroblastoma patients treated with
autologous haematopoietic stem cell transplantation. Cochrane Database of
Systematic Reviews, (8).
Pugh, T. J., Morozova, O., Attiyeh, E. F., Asgharzadeh, S., Wei, J. S., Auclair, D., ... & Kim,
J. (2013). The genetic landscape of high-risk neuroblastoma. Nature genetics, 45(3),
279.
Ronot, M. and Vilgrain, V., 2014. Hepatocellular carcinoma: diagnostic criteria by imaging
techniques. Best Practice & Research Clinical Gastroenterology, 28(5), pp.795-812.
Schwartz-Shea, P., & Yanow, D. (2013). Interpretive research design: Concepts and
processes. Routledge.
Takx, R.A., Blomberg, B.A., Aidi, H.E., Habets, J., de Jong, P.A., Nagel, E., Hoffmann, U.
and Leiner, T., 2015. Diagnostic accuracy of stress myocardial perfusion imaging
compared to invasive coronary angiography with fractional flow reserve meta-
analysis. Circulation: Cardiovascular Imaging, 8(1), p.e002666.
Yanik, G.A., Parisi, M.T., Shulkin, B.L., Naranjo, A., Kreissman, S.G., London, W.B.,
Villablanca, J.G., Maris, J.M., Park, J.R., Cohn, S.L. and McGrady, P., 2013.

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Semiquantitative mIBG scoring as a prognostic indicator in patients with stage 4
neuroblastoma: a report from the Children’s oncology group. Journal of nuclear
medicine, 54(4), pp.541-548.