The first feature tumors in children is frequent occurrence them from embryonic tissues as a result of disturbances in the formation of organs and tissues during intrauterine development embryo. Therefore, the vast majority of tumors in children develop from tissues that were delayed in their development at the embryonic level, often located in the wrong place - dystopically. Tumors from embryonic tissues are called dysontogenetic, or teratoid.

In adults, teratoid dysontogenetic tumors are rare; in children, they are the main type of tumor.

Second feature tumors in children is the frequency of benign tumors and the relative rarity of malignant tumors, while in adults malignant tumors are more common.

The most common benign tumors in children are tumors skin- angiomas and nevi.

The third feature tumors in children are the predominance of sarcomas among malignant tumors and the rarity of cancer, while in adults the opposite ratio is observed.

Lymphosarcomas and osteosarcomas predominate among sarcomas in childhood. Cancer occurs predominantly in organs not in contact with external environment, endocrine glands- thyroid gland, adrenal glands, gonads. Stomach cancer is observed as an exception in children aged 10-11 years. It has been suggested that carcinogens, received by the fetus transplacentally from the mother, circulating in the blood, come into contact primarily with tissues internal environment mesenchymal origin - vascular bed and the stroma of organs, as well as with the endocrine glands, brain, and internal organs.

The fourth feature tumors in children is the uniqueness of the course of some malignant tumors in them compared to those in adults. So, malignant tumors internal organs(embryonic nephroma and hepatoma) in children for a long time retain the expansive growth pattern characteristic of benign tumors and do not metastasize for a long time. Along with this, some benign tumors in children they have infiltrating growth, for example angiomas. In children, there is an amazing phenomenon of the transition of malignant tumors (for example, neuroblastomas) to benign ones (ganglioneuromas), which is not observed in adults; this phenomenon is called tumor reversion. Malignant tumors occur mainly in children from the neonatal period to 6 years of age. More often they occur at the age of 3-5 years, which indicates the importance of intrauterine carcinogenic influences, probably coming from the mother.

TO type I tumors include teratomas, or teratoid, dysontogenetic, tumors. The occurrence of teratomas is currently explained by a violation of the migration of germinal germ cells during the formation of the caudal end of the urogenital ridge. The separation of part of the undifferentiated germ cells from the caudal end of this ridge and their persistence lead to the development of teratomas.

TO type II tumors include those that arise from embryonic cambial tissues, preserved in the central nervous system, in the sympathetic ganglia and adrenal glands during normal development. Thus, in a child under the age of 1 year, such immature cambial anlages remain under the ependyma of the ventricles of the brain and gradually disappear by the end of the first year after birth. Immature cellular elements embryonic in nature in the form of sympathogonia with wide potential for growth and differentiation are preserved in the adrenal medulla for up to 10-11 years. Type II tumors are characterized by certain age periods, within which, as a rule, these tumors are observed. However, it is not possible to accurately distinguish them from hamartomas, and the identification of this type of tumor is somewhat arbitrary. Type II tumors include medulloblastoma, retinoblastoma, neuroblastoma.

TO type III tumors include tumors that arise like adult tumors. In children, the vast majority of these tumors have mesenchymal histogenesis; the most common are hemoblastosis, osteogenic tumors and mesenchymal tumors of soft tissues. Epithelial benign tumors - papillomas and polyps - occur relatively often in children. Epithelial malignant tumors (cancer) are rare in children; cancer of the endocrine glands and genital organs occurs mainly.

23. Teratomas and teratoblastomas, their types.

Teratoma(from Greek teratos- freak) - a tumor of embryonic undifferentiated germ cells that occurs when their migration is disrupted during the morphogenesis of the gonads of the embryo. Disruption of the morphogenesis of the tissue rudiment at any stage of embryo development, the loss of its connection with the surrounding growing tissues lead to the fact that this rudiment is deprived of humoral and reflex influences, which normally regulate the coordinated growth and proportional development of tissues. As a result of this switching off of regulatory influences, the displaced tissue rudiment acquires a certain autonomy. The latter is probably a prerequisite for the emergence of true tumor growth. By histological structure differentiate histioid, organoid And organismoid teratomas(cm. Tumors). There are also teratomas that develop from elements of the embryoblast - embryonal teratomas and developing from trophoblast elements - extraembryonic teratomas. There are mature embryonic and extraembryonic teratomas and immature - teratoblastoma .

The tissues of a mature teratoma mature synchronously with the tissues of their host. For example, in the fetus they consist of tissue elements corresponding to the age of the fetus, and lose their undifferentiated character by the time of birth. Therefore, they do not have complete autonomy and lack the ability for progressive growth. This distinguishes mature teratomas from true benign tumors. Teratoblastoma contains immature undifferentiated tissues, often extraembryonic, capable of progressive growth, metastasizes and is a true malignant tumor.

Histioid teratomas are otherwise called hamartomas; in the malignant version - hamartoblastomas. Hamartoma (from Greek. hamarta- error) - a tumor from embryonic tissue, delayed in its differentiation compared to the tissues of the tumor carrier, developing from excessively disproportionately developed tissue complexes, for example, from excessively developed blood vessels.

24. Tumors from blood vessels. Angiomas in children.

Hemangioma- tumor from blood vessels, has autonomous, progressive growth, in contrast to hemangioectasias, local dilation of blood vessels, in which there is no progressive growth. There are two main types observed in children: capillary and cavernous hemangiomas.

Capillary, or hypertrophic, hemangioma(cm. Tumors)- hamartoma of proliferating capillaries, has the appearance of a lobular nodule of bluish or reddish color. This is the most common benign tumor in children. However, sometimes, especially in children infancy, it begins to grow quickly. Rarely occur giant congenital partly capillary, partly - cavernous hemangiomas accompanied by thrombocytopenia, massive bleeding with fatal(Kasabach-Merritt syndrome). Capillary angiomas are localized mainly in the skin, less often in the liver and other organs, and are characterized by a high proliferative ability. They can ulcerate, and then in infants they serve as a source of sepsis. A feature of capillary angiomas is the infiltrative nature of growth, which is associated with frequent relapses after they are removed. The tumor never metastasizes.

Cavernous hemangioma- rather a malformation of blood vessels than a true tumor, it is less common in children than capillary. Localized in the liver, skin, gastrointestinal tract and in other organs. In infants, congenital giant breasts are rarely observed. cavernous angiomas, occupying up to 2/3 of the liver volume. Such patients die from bleeding. Hemangiomas can undergo scarring - spontaneous regression.

25. Nephroblastoma (Wilms tumor).

Neuroblastoma is the most common solid childhood tumor that develops outside the central nervous system. The incidence of neuroblastoma is 6-8 cases per million children. Among all neoplasms in children, it accounts for 14%. In 85-90% of cases, neuroblastomas are found in children under 5 years of age. In girls, neuroblastoma occurs somewhat less frequently and has best forecast than boys. There is hereditary predisposition to the development of neuroblastoma. The frequency of the tumor is increased in twins and siblings, with Wiedemann-Beckwith syndrome, and neurofibromatosis. In young children, a tumor is usually discovered accidentally by palpation of the abdomen or x-ray examination for other diseases. In older children, the tumor in most cases, unfortunately, is diagnosed only when it manifests itself. distant metastases. Diagnosis of neuroblastoma is based on clinical and morphological data. The results of biochemical and cytogenetic studies help in diagnosis, but are not specific enough. The concentration of catecholamines in the blood of patients is increased, and their excretion in the urine is increased in 90%. IN clinical practice use the determination of daily excretion of vanillylmandelic and homovanillic acids.

Neuroblastoma develops from neural crest cells. The most common (up to 40%) localization is the adrenal medulla and paraspinal ganglia, less often - the pelvis, neck, and chest. In adults, neuroblastomas are occasionally found in the head, neck, and legs.

Morphology. Macroscopically, neuroblastoma has the appearance of a node; its size can vary significantly. Some neuroblastomas are clearly demarcated from surrounding tissues and may have a thin capsule, others have pronounced infiltrating growth and quickly grow into surrounding tissues (kidneys, renal and inferior vena cava, aorta). On the section, the tumor is represented by soft gray tissues resembling brain matter. In large tumors, foci of necrosis, hemorrhage, and petrification are common. Histological picture neuroblastoma depends on the degree of tumor differentiation. In most cases, the tumor consists of small lymphocyte-like cells with dark nuclei and scanty cytoplasm, arranged in solid layers (Fig. 24-7). More differentiated tumor cells have eosinophilic neurofibrillary processes and are located in the fibrillary stroma. Sometimes in tumors the formation of pseudorosettes is observed in the form of a halo of cells surrounding eosinophilic accumulations of neurofibrils. Electron microscopy reveals neurosecretory granules and nerve processes with microtubules in tumor cells. Further differentiation leads to the formation of ganglion-type cells - large cells with a wide rim of eosinophilic cytoplasm, a large vesicular nucleus with well-defined nucleoli, and an increased amount of fibrillar stroma in the tumor tissue. A tumor with complete differentiation is represented by mature ganglion cells surrounded by bundles of connective tissue, nerve fibers, Schwann cells. Such tumors are called ganglioneuromas. The tumor may have areas with different differentiation, so the diagnosis of ganglioneuroma is established only by analyzing many sections from different areas of the tumor. A number of neuroblastomas undergo differentiation and mature into ganglioneuromas or spontaneously regress. Regression occurs more often with small tumor sizes. Metastases are observed in 50% of cases of neuroblastoma in children under 1 year of age and in 70% of cases at an older age. The most typical metastases are to the lymph nodes, bone marrow, bones, liver, and subcutaneous tissue.

26. Hepatoblastoma.

The incidence of hepatoblastoma is 1 case per 100 thousand children under 15 years of age. Among childhood tumors it accounts for no more than 5%. Boys get sick 1.5 times more often than girls. More than half of cases of tumor detection occur before the age of 2 years. In children with hepatoblastomas, a number of chromosomal abnormalities, less constant than in neuroblastoma [loss of heterozygosity 11p15.5, isochromosome i(8q), trisomy 20, trisomy 2, p53 gene mutation at codon 249]. Familial cases of hepatoblastoma have been described. A combination of a tumor with a number of diseases and conditions is possible: hemihypertrophy, familial polyposis of the colon, Meckel's diverticulum. There was no connection between the tumor and the mother's intake of hepatotoxic substances (alcohol, nitrosamines, estrogens) during pregnancy, as well as with hepatitis suffered during pregnancy. At the same time, there are indications of a connection between hepatoblastoma and fetal alcohol syndrome.

Clinical manifestations hepatoblastoma. Usually the tumor is discovered by chance during palpation of the abdomen. A concomitant increase in the content of α-fetoprotein in the blood is used to diagnose the tumor and detect relapses. Less commonly, tumor cells synthesize human chorionic gonadotropin, which can cause premature puberty. The development of severe thrombocytosis due to the synthesis of thrombopoietin by the tumor is typical.

Hepatoblastoma usually develops in right lobe liver, sometimes in both lobes. The tumor has the appearance of a dense multinodular formation of a yellowish-brown color and may be surrounded by a capsule. Foci of necrosis often occur with the formation cystic cavities and hemorrhages.

Morphology. The microscopic picture depends on the degree of maturity of the tumor cells, the ratio of the epithelial and mesenchymal components of the tumor. The epithelial component of the tumor may be represented by large, light-colored cells with a round nucleus, resembling normal fetal hepatocytes. The cells form columns, such areas can be difficult to distinguish from normal fetal liver. In less mature tumors, cells with a smaller rim of cytoplasm often form tubular structures; mitoses are frequent in such tumors. Anaplastic forms of hepatoblastoma can be large and small cell.

Immunohistochemically, α-fetoprotein and, in some cases, transferrin receptors are detected in hepatoblastomas. A possible marker is liver fatty acid binding protein.

Forecast. When combined surgical treatment and combination chemotherapy, the 18-month survival rate reaches 80%. Prognosis is influenced by ploidy (diploid tumors have a better prognosis compared to hyperploid tumors). Probably, as with other embryonal tumors, the prognosis is better in young children.

27. Medulloblastoma. Neuroblastoma

Medulloblastoma- a malignant tumor of neuroectodermal embryonic stem cells - medulloblasts. Consists of oval or round cells with scanty, almost indistinguishable cytoplasm. Cells fold into sockets (form ring-shaped structures), in the center of which cellular processes are found. Education is typical rhythmic structures, having the form of cell rows or columns (Fig. 333). It is believed that during ontogenesis, medulloblasts differentiate into neuroblasts and spongioblasts. The tumor occurs mainly in children and is localized in the cerebellum in the midline - along the line of closure of the medullary tube. It has a soft consistency, grayish-pink color, sprouts brain tissue and soft meninges. Metastasizes along the cerebrospinal fluid pathways within the central nervous system. Very rarely gives hematogenous metastases into the lungs.

Neuroblastoma- malignant tumor of sympathetic ganglion stem cells and medulla adrenal glands IN lately a point of view has emerged that neuroblastomas are histogenetically related to apudomam, because they highlight catecholamines. Localized in the area of ​​the adrenal glands, sympathetic nodes neck or chest cavity, retroperitoneal space. It can occur multicentrically - in both adrenal glands, in the adrenal gland and ganglia of the chest cavity, etc. It looks like a node in a thin capsule that destroys the adrenal gland, pinkish-white in section, with numerous necrosis and hemorrhages. Histologically, the tumor consists of round lymphocyte-like cells with a hyperchromic nucleus and barely visible cytoplasm - sympathogonia, hence the old name for this undifferentiated type of tumor - sympathogonoma. Cells form sockets (Fig. 334), in the center of which, when impregnated with silver, nerve processes are revealed. The tumor contains extensive areas of necrosis with karyorrhexis and hemorrhage. In more differentiated tumors - sympathoblastomas the cells are larger, their cytoplasm is wider, the nuclei are lighter, giant cells are found, the neurofibrillary network is more clearly expressed. An even more differentiated type of tumor - ganglioneuroblastoma, characterized by the presence of atypical ganglion cells. Cases of transition of undifferentiated neuroblastoma to mature benign ganglioneuroma And ganlioneurofibromas, both spontaneously and under the influence of treatment.

Neuroblastoma grows quickly and metastasizes widely. There are two types of metastases: 1) to regional lymph nodes and liver; 2) in the bones of the skeleton - ribs, spine, pelvic bones and skull. Metastases to the skin are sometimes observed. The clinical course in children may be accompanied by an increase blood pressure, sweating due to the secretion of catecholamines by tumor cells, which in the patient can occur in children under 1 year of age, but can be observed up to 11 years of age. Cases of neuroblastoma in fetuses and newborns have been described; in adults it is described as casuistry.

Why early diagnosis is important

Experts say: in the treatment of cancer, early diagnosis is the most important step on the road to recovery. Survival rates for cancer are higher in early, localized stages, and the sooner a person sees a doctor if they suspect they have a tumor, the more effective treatment can be.

In pediatric oncology practice, unfortunately, children are admitted to a specialized clinic when the disease is already in stages II-IV. The number of patients admitted to the clinic with stage I of the disease does not exceed 10%, and it is at this stage that the most gentle children's body treatment methods.

It is also important that treatment of a patient at the first stage is the cheapest. But therapy for patients in the second stage is already 3.6 times more expensive, in the third stage - 5 times more expensive, and in the fourth stage - 5.5 times more expensive.

The younger the body, the faster the tumor develops. And the reaction to it must be lightning fast - the success of the treatment depends on this.

Unfortunately, many people are convinced that malignant tumors practically never occur in children. However, this is not true. Being, fortunately, a fairly rare disease, malignant tumors take second place after injuries among the causes of death in children under 15 years of age.

As the data shows statistical research, every year out of 100 thousand children of this age, 14-15 are diagnosed with malignant neoplasms.

And here, according to pediatric oncologists, it is the attentiveness of parents that plays a huge role. Who, if not parents, will be able to notice changes in their child’s condition in time - and contact specialists in time? As the American oncologist Charles Cameron wrote: “Be neither too careless about the possibility of cancer in children, nor too worried. But be alert!”

For what?

Parents of a sick child ask this question, but in principle there is no answer.
Kids don’t smoke, don’t drink, don’t work in hazardous industries. And yet, about 450 children annually develop a tumor of the central nervous system (including the brain). These diseases rank second in frequency after malignant diseases blood and lymphatic system.

Is it possible to protect yourself?

Unfortunately no.
Despite the fact that the issue of cancer prevention has long been discussed by the global medical community. They are looking for methods of prevention, but have not found them yet. Except, perhaps, for one case – cervical cancer. Today this is the only cancer whose development can be prevented. As preventative measure Vaccination, which is also used in our country, is in favor. The vaccination is given to girls starting from the age of 12.

But with tumors of the central nervous system, there is only one way out - to make a diagnosis in time. And parents should be the first to sound the alarm. Since this cancer has certain symptoms that parents should be wary of.

General symptoms, or so-called "tumor symptom complex"

Parents should pay attention: all malignant tumors are characterized by the so-called " tumor symptom complex", formed by the following symptoms:

• loss of appetite and associated weight loss;
• pale skin;
• unexplained rises in temperature.

• the child becomes capricious;
• gets tired faster than usual, forgetting even the most favorite games.

Leukemia
represented mainly by acute lymphoblastic leukemia(ALL), which accounts for 33% of total number tumor diseases in children and ranks first in frequency. Most signs and symptoms of leukemia in children develop as a result of a decrease in the number of normal blood cells due to the replacement of normal bone marrow by leukemia (tumor) cells. The first signs are increased fatigue, pale skin. A child with leukemia has easy nosebleeds and increased bleeding when minor cuts and bruises. Pain appears in the bones and joints. Leukemia often causes the liver and spleen to become enlarged, and this can lead to an enlarged abdomen; lymph nodes increase in size, which can be seen on the neck, groin, under the arms, above the collarbone, affected thymus, which can compress the trachea, leading to coughing, shortness of breath and even suffocation. Appears headache, weakness, seizures, vomiting, impaired balance when walking and vision.

Brain tumors and spinal cord
occupy the second place in frequency and develop mainly in the cerebellum and brain stem. In adults, unlike children, tumors arise in various parts of the brain, but most often in the hemispheres. Neoplasms of the spinal cord in children and adults are much less common.
Initially, the disease manifests itself with signs of a general tumor symptom complex, and when further development The disease is accompanied by symptoms such as headache, which occurs most often in the morning and intensifies when tilting the head or coughing. In very young children, the symptoms of the disease manifest themselves as anxiety, the baby begins to cry, grab his head, and rub his face. Very common symptom is causeless vomiting, which, like a headache, is usually noted in the morning. Experts also note possible changes in vision and gait disorders (in older children, handwriting may suddenly “go bad” due to poor coordination in the hands). Convulsions may occur.

Nephroblastoma(Wilms tumor)
most common species malignant kidney tumor in children. The tumor is named after the German physician Max Wilms, who first described it in 1899. Occurs most often at the age of 2-3 years. Nephroblastoma usually affects one kidney. However, 5% of patients may have bilateral involvement. Bilateral lesions occur in 3-10% of cases. Wilms tumor accounts for 20-30% of all malignant neoplasms in children. Known cases congenital disease. A palpable tumor (usually in the absence of complaints), detected accidentally by parents or during preventive examinations. On early stages disease, the tumor is painless on palpation. On late stages- sharp enlargement and asymmetry of the abdomen due to a painful tumor compressing neighboring organs. Intoxication syndrome (weight loss, anorexia, low-grade fever body). If the tumor size is significant, there are signs of intestinal obstruction and respiratory failure.

Neuroblastoma
one of the types of malignant tumors. It usually occurs in infants and children and is very rare in children over 10 years of age. The cells of this tumor resemble nerve cells in early stages their development in the fetus. Most a common symptom Neuroblastoma is the discovery of a tumor in the abdomen, which leads to an increase in its size. The child may complain of a feeling of abdominal distension, discomfort or pain as a result of the presence of a tumor. However, palpation of the tumor does not cause pain. The tumor can also be located in other areas, such as the neck, spreading beyond the eyeball and causing it to bulge. Neuroblastoma often affects the bones. In this case, the child may complain of bone pain, limp, and refuse to walk. If the tumor spreads into the spinal canal, compression of the spinal cord may occur, leading to weakness, numbness, and paralysis of the lower extremities. Every fourth patient may have a fever. In some cases, a growing tumor can lead to dysfunction bladder and colon. Neuroblastoma's pressure on the superior vena cava, which carries blood from the head and neck to the heart, can cause swelling of the face or throat. These phenomena, in turn, can lead to breathing or swallowing problems. The appearance of bluish or reddish spots that resemble small bruises may indicate skin damage by a tumor process.
Due to the involvement of the bone marrow, which produces blood cells, a child's blood counts may all decrease, which can cause weakness, frequent infections, and increased bleeding from minor injuries (cuts or scrapes).

Retinoblastoma
a malignant tumor of the eye, which is rare, but causes blindness in 5% of patients. One of the first symptoms of a tumor is leukocoria (white pupillary reflex) or symptom " cat eye", which is often described by the child's parents as some kind of unusual glow in one or both eyes. This symptom appears when the tumor is already quite large or in cases of tumor delamination of the retina, which leads to protrusion of the tumor mass behind the lens, which is visible through pupil. Loss of vision is one of early symptoms retinoblastoma, which is rarely detected because young children are not able to assess its development. Strabismus is the second most common symptom of tumor development. It is revealed more often because others notice it.

Rhabdomyosarcoma
the most common soft tissue tumor in children. The first sign of rhabdomyosarcoma is usually a localized lump or lump that does not cause pain or other problems. This applies, in particular, to rhabdomyosarcomas of the trunk and extremities. If the tumor is located in the abdomen or pelvis, you may experience vomiting, abdominal pain, or constipation. IN in rare cases rhabdomyosarcoma develops in bile ducts and leads to jaundice. Many cases of rhabdomyosarcoma occur in areas where they can be easily found, such as behind the eyeball or in the nasal cavity. Bulging eyeball or nasal discharge forces you to see a doctor, which helps to suspect a tumor early and conduct an examination. If rhabdomyosarcoma occurs on the surface of the body, it can be easily detected without special examination. About 85% of rhabdomyosarcomas are diagnosed in infants, children and adolescents. Most often, these tumors occur in the head and neck area (40%), in genitourinary organs(27%), on the upper and lower extremities (18%) and torso (7%).

Osteogenic sarcoma
most common primary bone tumor in children and young adults. The first symptom of the disease is pain in the affected bone, which is the most a common complaint sick. The pain is not constant at first and usually gets worse at night. In case of damage to the lower limb physical activity leads to increased pain and lameness. Swelling in the area of ​​pain may occur many weeks later. Although osteosarcoma makes the bone less strong, fractures are rare. Normal in at a young age pain and swelling are a common occurrence Therefore, in many cases, the diagnosis of osteosarcoma is made late. The diagnosis is made based on a combination of clinical, radiological and histological data.

Ewing's sarcoma
ranks second in frequency among malignant bone tumors in children (after osteogenic sarcoma). It was first described by D. Ewing in 1921 and was named after the author. This tumor is rare in children under 5 years of age and in adults over 30 years of age. Most often this tumor occurs in adolescents aged 10 to 15 years. There are cases of extraosseous Ewing's sarcoma with soft tissue involvement. The most common symptom of Ewing's sarcoma is pain, which occurs in 85% of children with bone lesions. Pain can be caused either by the spread of the process to the periosteum or by a fracture of the affected bone. 60% of patients with Ewing's sarcoma of bone and almost all patients with extraosseous tumors develop a swelling or induration. In 30% of cases, the tumor is soft and warm to the touch. Patients have elevated body temperature. With advanced (metastatic) Ewing's sarcoma, patients may complain of increased fatigue and weight loss. In rare cases, for example, with damage to the spine, it is possible severe weakness in the lower extremities and even paralysis.

Hodgkin's disease (Hodgkin's lymphoma, lymphogranulomatosis)
refers to lymphomas, which occupy 3rd place among childhood tumors.
Lymphomas are divided into 2 main types: Hodgkin's disease (Hodgkin's lymphoma, or lymphogranulomatosis) and non-Hodgkin's lymphomas (lymphosarcoma). They differ in to a large extent according to the clinical course, microscopic structure, metastasis and response to treatment. The disease is named after Thomas Hodgkin, who first described the disease in 1832. Develops from lymphatic tissue (lymph nodes and organs immune system) both in children and adults, most often in two age groups: from 15 to 40 years and after 55 years. In children under 5 years of age, Hodgkin's disease is diagnosed very rarely. 10-15% of tumors are detected at the age of 16 years or less. Early diagnosis of Hodgkin's disease in children can be difficult due to the fact that in some patients there may be no symptoms at all, while in others they may be non-specific and observed in other non-neoplastic diseases, such as infections. Against the background of complete well-being, the child can notice an increased lymph node on the neck, armpit or groin area. Sometimes a swelling in the area of ​​the lymph node may disappear on its own, but soon reappears. The emerging lymph node gradually increases in size, but is not accompanied by pain. Sometimes it is possible for such nodes to appear in several areas at once. Some patients experience fever, profuse night sweats, as well as itchy skin, increased fatigue, and decreased appetite.

Not a sentence

Parents must remember: cancer is a treatable disease. With timely detection and high-quality treatment, the chances of recovery are approximately as follows:
Zero stage - 100%;
First stage - 90-95%;
Second stage - 70-80%;
Third stage - 30%;
The fourth stage - up to 10% (unfortunately, not for all forms).

Pediatric oncology is isolated from ordinary adult oncology, so the classification of tumors is also different. Depending on the type of tumor and the age of the patient, three large groups of childhood tumors are distinguished.

1. Embryonic tumors

Embryonic tumors- these are tumors that arise as a result of the degeneration of germ cells, histologically similar to the tissues of the embryo or fetus, which leads to their active reproduction and the appearance of a tumor. TO embryonal tumors include: neuroectoderm tumors, hepatoblastoma, germ cell tumors, medulloblastoma, neuroblastoma, nephroblastoma, rhabdomyosarcoma, retinoblastoma.

2. Juvenile tumors

Juvenile tumors- these are tumors that arise in childhood and adolescence due to malignancy of mature tissues. Such tumors include: astrocytoma, lymphogranulomatosis, non-Hodgkin lymphoma, osteogenic sarcoma, synovial cell carcinoma, juvenile xanthogranuloma. Juvenile tumors are quite rare, but recently there has been a trend towards an increase in the number of children suffering from this type of tumor.

3. Adult type tumors

Adult tumors- these are tumors that are more common in adults, but are also detected in children or have a microstructure that is non-specific for a young age. They are divided into several groups: soft tissue tumors, bone tumors, tumors of the central nervous system and hematological malignancies.

The most common types of cancer in children

Here, pediatric oncology also differs from adult oncology. If in adults neoplasms from epithelial tissue- carcinomas (cancer), then in children the most common tumors arising from connective tissue are sarcomas and teratomas.

In pediatric oncology, tumors are also divided into malignant and benign. But, unlike oncology in adults, the distinction between true tumors and tumor-like processes, as well as developmental defects, is difficult due to the presence of many transitional forms childhood tumors.

The most common type oncological pathology in children, it is considered cancer of the hematopoietic organs. These include: lymphocytic leukemia (80-90%), acute myeloid leukemia (10-20%), lymphogranulomatosis (1-5%).

Less common in children are neuroblastomas and Wilms tumor, bone tumors, soft tissue sarcomas, and melanomas. Sarcomas of the head and neck in children are 50% less common than tumors of the retroperitoneum.

Now let's take a closer look at the most common diseases found in pediatric oncology.

Leukemia in children

Leukemia are called cancers of the bone marrow in humans. Leukemia is one of the most common types of cancer in children. Leukemia accounts for about 30% of all childhood cancer pathologies. The most common types of leukemia are acute granulocytic leukemia and acute lymphocytic leukemia.

Often these diseases begin with fatigue, general weakness, pain in bones and joints, weight loss and causeless increase in body temperature.

Brain tumors in children

The second most common in children are brain tumors. They make up about 27% of the total number of children oncological diseases.

Today it is known huge amount brain tumors. Most brain tumors in children are located in the cerebellum and brain stem, while in adults they are most often affected upper sections brain. Brain tumors in children are accompanied by symptoms such as fatigue, frequent headaches, causeless nausea, sharp deterioration vision, gait disturbances and fine motor skills.

Neuroblastoma in children

The third most common disease among pediatric oncology is considered neuroblastoma. This type of tumor accounts for 7% of all cases of childhood malignant diseases. Neuroblastoma occurs from degenerated embryonic nerve cells. Most often, newborns or infants, less often children over 9-10 years old. Neuroblastoma most often develops in the abdominal cavity and clinically looks like a small formation that deforms the skin of the abdomen.

Lymphoma in children

Among pediatric oncology lymphoma accounts for 8% of the total incidence of cancer in children. Lymphoma is a tumor that originates from degenerated cells of the immune system - lymphocytes. Lymphoma most often affects the lymph nodes, tonsils, thymus gland and bone marrow.

There are several types of lymphoma, the most common of which are Hodgkin lymphoma and non-Hodgkin lymphoma. In this case, there are also differences from adult oncology. If adults are more likely to suffer from Hodgkin's lymphoma, then children, on the contrary, are more likely to suffer from non-Hodgkin's lymphoma.

Lymphoma is accompanied by symptoms such as causeless weight loss and fever, sweating, and enlarged cervical, supraclavicular, axillary or inguinal lymph nodes.

Wilms tumor in children

Among childhood cancers Wilms tumor occurs in 5% of all cancer cases. Wilms tumor often affects one or both kidneys. Wilms tumor affects mainly children under 5 years of age. The disease is accompanied by fever, pain, and loss of body weight.

Rhabdomyosarcoma and Retinoblastoma in children

They are quite rare - they are detected in only 3% of cases of all cancers in children. Rhabdomyosarcoma amazes muscle tissue various parts bodies. Most often this abdominal cavity and upper limbs.

Retinoblastoma- it's cancer choroid eyes. You can detect retinoblastoma in a child thanks to next symptom: normally in a photograph, when using a flash, the back wall of the eye glows red, but with retinoblastoma the glow will be white or pale pink. These types of sarcomas most often affect children under 4 years of age.

Osteosarcoma and Ewing's sarcoma in children

Less often than other tumors, children suffer from bone cancer. This includes osteosarcoma(3%) and Ewing's sarcoma(2%). Osteosarcoma is more common in adolescents and usually affects long bones limbs. Osteosarcoma is accompanied by bone pain that worsens with physical activity.

Ewing's sarcoma is somewhat less common than osteosarcoma. It most often affects the spine, pelvic bones, ribs, and bones of the lower extremities. These types of tumors are highly malignant but respond well to treatment.

Tumors in children are observed relatively often, in 5-7% of all surgical diseases. Benign tumors predominate, their ratio to malignant ones is approximately 9:1. Malignant tumors in children are usually of mesodermal origin, while in adults they are of epithelial origin. In this regard, sarcomas are more common in children and cancer is extremely rare.

Tumors in children occur in all age groups, starting from the neonatal period. In most cases, they are detected from birth or in the first months and years of life, usually before the age of 5-6 years. Tumors affect girls slightly more often than boys (in a ratio of 3:2).

Various types of tumors that are observed in adults are also observed in children. However, there are neoplasms that are characteristic only of childhood. These tumors exhibit a number of features.

In the etiology and pathogenesis of tumors in children, an important role is played by the defective development of embryonic rudiments and the incorrect arrangement of cell groups of various germ layers. Yes, a significant part vascular tumors, which are the most common and characteristic neoplasm of childhood, is a developmental defect such as hamartoma. A number of authors believe that the most characteristic of childhood are tumors that develop due to developmental anomalies, i.e., tumors of dysontogenetic origin. It is believed that a deviation from the normal development of the kidneys can serve as a basis for the occurrence of Wilms' tumor (see Wilms' tumor). Thus, in children a whole series tumors are on the verge of malformation and true neoplasm.

A feature of childhood tumors is their development from poorly differentiated tissue. In some cases, differentiation is so poorly expressed that it is impossible to determine from which germ layer the tumor originates.

The histological picture of some immature tumors in children does not reflect malignancy, but only insufficient tissue maturity and is sometimes so peculiar that it does not even allow one to distinguish cells of connective tissue origin from epithelial ones. This makes the morphological diagnosis of tumors in children extremely difficult.

The clinical course of many tumors in children also has its own characteristics. For example, a hemangioma, being benign in its histological structure, at the same time resembles malignant tumor. Neuroblastomas have been described that have taken a benign course due to the fact that neuroblasts can mature and differentiate into mature ganglion cells. Melanoma in children is clinically benign, and after puberty it becomes malignant. Adenosarcoma of the kidney (Wilms tumor), being encapsulated, for a long time does not show itself in any way, remains “mute”. Teratomas consisting of mature tissues can metastasize. Despite the fact that some tumors in children, built from immature cells, are clinically benign, they should be considered as potentially malignant, since they can become malignant at any time.

Thus, in children, the boundaries of benignity and malignancy of tumors are less pronounced than in adults, and are often erased.