The development of oncology in childhood is very This group consists

Year of issue: 2012
Ed. M.D. Alieva, V.G. Polyakova, G.L. Mentkevich, S.A. Mayakova
Genre: Oncology, pediatrics
Format: PDF

Oncological diseases in childhood are one of the most important problems not only in pediatrics, but also in medicine in general. The mortality rate of children from malignant diseases in developed countries ranks second, second only to the mortality rate of children from accidents.
Currently, both in world practice and in Russia, significant progress has been made in the diagnosis and treatment of children with. Over the past decades, child survival has improved significantly: in the early 1950s. While the absolute number of children diagnosed with malignant neoplasms died, now up to 80% of such patients can be cured.

Over more than 35 years of existence, unique experience has been accumulated in the treatment of pediatric patients with malignant neoplasms. The arsenal of diagnostic capabilities has expanded significantly when using morphological, immunological, genetic and molecular biological techniques for identifying tumors. Radiation, endoscopic and other methods are widely used modern capabilities, which help clarify and detail the diagnosis, optimize surgical approaches, and apply adequate chemotherapy programs and radiation treatments. The use of targeted drugs is being widely introduced.

Based on the experience gained, for the first time in the domestic literature, the National Guide to. It contains data on advanced scientific achievements and presents practical recommendations for the diagnosis and treatment of the most common tumor diseases in children, which are based on extensive clinical experience leading domestic experts and on the results of major clinical trials conducted both in our country and abroad. Information on the use of the most modern drugs, allowing in some cases to achieve impressive results, including in patients with refractory diseases. The information presented in the National Guidelines will serve as a standard for providing oncological care to children in Russia and will help doctors in their practical work.

Chapter 1. History of pediatric oncology.
Chapter 2. Epidemiology of malignant neoplasms in children:

Classification of childhood tumors.
Incidence and survival of children with malignant neoplasms in developed countries.
Malignant neoplasms in children in Russia.
Comparative analysis of child mortality from malignant neoplasms in Russia and developed countries.

Chapter 3. Peculiarities of pediatric oncology:

Genetic aspects of childhood oncology.
Morphological studies in pediatric oncology.

Chapter 4. Diagnosis of tumors:

Paraneoplastic syndromes.
Diagnosis of lymphomas in children.
Laboratory diagnostic methods.
General clinical studies.
Biochemical research.
Study of the hemostasis system.
Endoscopy in pediatric oncology.
Endoscopy of the upper respiratory tract.
Bronchoscopy.
Esophagogastroduodenoscopy.
Fibrogastroscopy.
Colonoscopy.
Laparoscopy.
New endoscopic techniques.
Radiation diagnostics of malignant tumors in children.
Radionuclide diagnostics in pediatric oncology.
Tumor markers.

Chapter 5. Treatment:

General principles surgical interventions for tumors of various localizations.
Tumors of the head and neck.
Thoraco-abdominal oncosurgery.
Tumors of the musculoskeletal system.
Tumors of the central nervous system.
Diagnostic video surgery.
malignant tumors.
Vaccine therapy.
Hematopoietic stem cell transplantation.
Modern methods of intravenous administration of antitumor drugs.

Chapter 6. Accompanying therapy in pediatric oncology and hematology.
Chapter 7. Features of anesthesia and resuscitation in pediatric oncology:

Anesthetic management of surgical interventions.
Intensive therapy in the early postoperative period.

Chapter 8. Principles of nutritional support:

Diagnosis and treatment of selected tumors

Chapter 9. Tumors of hematopoietic and lymphoid tissues:

Acute lymphoblastic leukemia.
Acute myeloid leukemia.
Chronic myeloid leukemia.
Non-Hodgkin's lymphomas.
Hodgkin's lymphoma.
Histiocytic tumors.
Langerhans cell histiocytosis.
Histiocytic sarcoma.
Interdigitating sarcoma of dendritic cells.
Follicular sarcoma of dendritic cells.
Juvenile xanthogranuloma.

Chapter 10. Tumors of the central nervous system.
Chapter 26. Second tumors in children cured of malignant neoplasms.
Chapter 27. Vaccination of children with solid tumors.
Chapter 28. Rehabilitation.
Chapter 29. Problems of children's hospices.
Chapter 30. Postgraduate training for pediatric oncology doctors.

TO A CHILDREN'S ONCOLOGIST
INDEPENDENT ASSOCIATION OF CHILD PSYCHIATRISTS AND PSYCHOLOGISTS

Compiled by Ph.D. I.P. Kireeva
Edited by NADPP President A.A. Northern

Bristol-Myers Squibb Oncology product

For more information about Bristol-Myers Squibb anticancer drugs, please visit Russian Representative Office Companies.

INTRODUCTION

Oncological diseases occupy a central place among the problems of clinical medicine. Advances in modern therapy have led to the fact that all larger number sick people survive for long periods after the start of treatment, and a significant contingent can be classified as recovered. This is especially true for the main variant of the tumor process in childhood - leukemia: the number of children with remissions for more than five years is growing every year; Medicine and society as a whole are faced with previously non-existent cases of practical recovery from acute leukemia. It turned out that antitumor treatment alone with the assignment of disability, which is given to all children with cancer, does not completely solve the problems that have arisen. The results of treatment of disabled children with cancer, the so-called “quality of life level,” are determined not only by the severity of the underlying disease, but also by the psychological state, possible mental disorders of both the patient himself and his family members, which is not found in scientific research or in practical healthcare in our country almost no attention is paid. The problem of seriously chronically ill children includes the following main aspects:

Mental disorders associated with long-term and severe course somatic illness;
the impact of the disease on the mental development of the child;
the influence of stress and psychotherapy on the development of the disease;
the influence of the family on the condition of a sick child and the influence of a chronically ill child on psychological climate in family.

L.S. Sagidullina (1973) identified syndromes of damage to the nervous system in 38.8% of patients acute leukemia children. I.K. Shatz (1989), who studied children with acute leukemia, found mental disorders in all: in 82.6% of children they manifested themselves at the borderline level and were represented by asthenic, dysthymic, anxiety, depressive and psychoorganic syndromes. Psychotic disorders were observed in 17.4% of patients. Increased with age and duration of the disease specific gravity depressive states, psychotic disorders predominated in adolescents. We (I.P. Kireeva, T.E. Lukyanenko, 1992) summarized the data from a survey of 65 children aged 2-15 years with acute leukemia. Mental disorders in the form of asthenia were detected in all patients. Forty-six children (70.8%) had more complex mental disorders requiring special correction. What is the clinical picture of the most common mental disorders in children with cancer?

WHAT IS ASTHENIA IN A CHILD WITH TUMOR DISEASE

Common to all patients is the asthenic symptom complex, which, being one of the least specific forms response to exogeny, can accompany the disease throughout its entire duration, and can manifest itself only during periods of deterioration of the somatic condition, during intensive chemotherapy, and with concomitant infections. The severity of the asthenic symptom complex is proportional to the severity of the somatic condition; in remission, its manifestations are smoothed out.

Often, asthenic syndrome precedes the first manifestations of the underlying disease. In these cases, when collecting anamnesis, it is revealed that several weeks or months before the oncological disease manifested itself, the child became more lethargic, tired, capricious, touchy, tearful, was drowsy during the day, and slept restlessly at night. These mental disorders in the prodromal period often do not attract attention or are mistakenly interpreted by parents and doctors as a psychogenic provocation of the underlying disease (“I got sick because of troubles at school,” “because I was worried”), although in fact it was the place that arose in the prodromal period of the disease is an increased aggravated response to everyday events.

Let us examine in detail the manifestations of asthenic syndrome. The main symptom, without which it is impossible to diagnose asthenia, is physical fatigue, which worsens in the evening. This is expressed in patients’ complaints about the inability to complete assignments in physical education lessons, the need to lie down after a short walk, and complaints about weakness: “arms and legs are weak.” Mental fatigue is less pronounced or absent altogether.

In addition to asthenia itself (i.e., “lack of strength”), asthenic syndrome necessarily contains functional somatovegetative disorders. These include sleep disturbances (prolonged falling asleep with an influx of painful memories of the past or anxious ideas about the future, increased need for sleep), decreased appetite, the appearance of sweating, persistent dermographism, etc.

The third obligate manifestation of asthenic syndrome is emotional (irritable) weakness. This is a pronounced lability of mood with sharp changes: sometimes high, sometimes low. Elevated mood often has the character of sentimentality with irritability and anger, while low mood often has the character of tearfulness with capriciousness, dissatisfaction with others. Change similar conditions has an insignificant reason, and a decrease in mood predominates. Increased sensitivity to all external stimuli (so-called “mental hyperesthesia”): a loud voice is deafening, it seems to the child that the mother or health workers are “yelling” at him all the time, the sound of a slamming door is perceived as a gunshot, the seams on clothes seem rough, the bright light of a lamp in the dressing room it blinds. Reduced pain threshold: injections feel more painful than in a healthy state.

TO asthenic syndrome Other neurotic and behavioral disorders may occur. For example, “hysterics” occurring on the eve of or during medical procedures, vomiting, refusal to eat, loss of neatness and speech skills, behavioral disturbances up to the refusal of vital medical procedures. This forces doctors to postpone procedures or perform them under anesthesia, which has side effects that are not indifferent to weakened children.

Below we present (I.K. Shats, 1991). The questionnaire is intended for children from 8 years of age. With younger children and with children of any age who do not have physical ability fill out the questionnaire yourself; an interview form is used, during which the questionnaire is filled out by a doctor (sometimes with the help of parents). When answering on scales I-VI, one, most appropriate answer is selected, points on scales I-VI are summed up, giving a quantitative description of the severity of asthenia: 18-13 points - severe asthenia, 12-7 points - moderate asthenia, 6-1 - fatigue reaction . Score characteristics make it possible to assess the dynamics of the condition before and after treatment. Responses on scales VII-IX are not quantified, and multiple items may be marked in response to one question. These disorders can be symptoms of both asthenia and somatic suffering itself, but taking them into account is important for general characteristics child's condition.

CHILDREN'S DEPRESSIONS

More than a third of children with cancer are diagnosed with neurotic and depressive states with an almost constant decrease in mood. These children are always whiny or gloomy, and lose interest in games and communication with peers. Often there is an increased interest in their illness - patients are not oriented according to their age medical terminology, activities related to treatment, are interested in the progress of treatment, listen to the conversations of others about the disease, and express concerns for their health. Often patients are in very difficult relationships with parents: they wait for them to come, but are always dissatisfied with how they fulfill their requests, conflict with their parents, blame them or themselves for their illness. These conditions are characterized by functional dysfunctions of internal organs that are not explained by the underlying disease, persistent disturbances in appetite and sleep, night terrors, “hysterics” such as affective-respiratory attacks, hysterical fits.

Below we present (I.K. Shats, 1991). The scale is filled out by a doctor based on clinical observation of the child. For each subscale, the most appropriate description of impairments for the child and the corresponding score are recorded. Additionally, the content characteristics of anxiety and fear are recorded. The scale makes it possible to obtain standard qualitative descriptions of the emotional state and their quantitative assessments for individual subscales and in general. The latter is expressed as a quotient by dividing the algebraic (taking into account the sign) sum of points scored by the number of subscales (8).

Along with assessing the dynamics of an individual condition, the scale makes it possible to monitor the effectiveness of those used in treatment psychotropic drugs and psychotherapy, compare emotional condition in various clinical groups, taking into account not only the severity, but also the characteristics of emotional disorders.

OTHER MENTAL DISORDERS

In some patients (about a tenth of cases), with a sharp deterioration in their somatic condition, transient psychoses with clouding of consciousness develop. Stunning and delirium are the most common symptoms.

In cases of mild deafening (nubilation), the child experiences difficulty comprehending, slowness of all reactions, emotional indifference, and limited perception. The child looks lethargic, as if “stupid, stupid”, absent-minded. With sudden irritation (raising the voice when asking a question, pain), consciousness clears up for a while. As the stupor deepens, its next stage develops - somnolence, in which the child becomes drowsy, and when brought out of this state external stimulus(loud voice, bright light, pain) can give an answer to a simple question and again falls into a pathological doze. In a severe general condition, stupor can reach the level of stupor with the absence of speech contact and with the preservation of the reaction only to very strong stimuli (flash of light, loud noise, pain), in response to which unarticulated vocal and undifferentiated protective motor reactions appear. Finally, with a progressive deterioration of the general condition, coma occurs (switching off consciousness) with weakening and then disappearance unconditioned reflexes, respiratory and cardiac disorders. Each subsequent stage of stunning is approximately half as long as the previous one, and doctors have less and less time for resuscitation measures, if any are possible.

Delirious disorders occur against the background of severe asthenia or shallow stupor, mainly in the evening and night hours. During delirious episodes, the child becomes restless, experiences fear, and experiences deceptions of perception, often in the form of visual illusions, especially the type of pareidolia, when in the wallpaper, cracks on the wall, fairy-tale creatures, human faces, and the grinning face of a wolf appear. Visual hallucinations may occur, and auditory hallucinations are common (ringing, roaring, calling names, voices of familiar children). Evening delirious episodes are often misdiagnosed as children's fears of the dark.

In patients with a hereditary history of epilepsy and in patients with organic brain damage, epileptiform disorders are possible: seizures, twilight stupefactions, dysphoria. Organic psychosyndrome develops as a result organic damage brain substances (cerebral hemorrhage, tumor, or as a consequence of severe intoxication, hypoxia) and is characterized by an irreversible weakening of memory, a decrease in intelligence of varying degrees (up to acquired dementia).

The occurrence, form and severity of mental disorders is influenced by the whole complex exogenous and endogenous factors. The most powerful causative factor is psychological. The sudden onset of a serious illness is perceived by children as a “tragic deprivation of everything,” as it leads to many months of hospitalization with separation from school, friends, separation from home, difficult treatment, which is accompanied not only by frequent painful procedures, but also a change appearance with the appearance of obesity and baldness. It is also psychologically traumatic for sick children that they observe the suffering of other patients and learn about their death. It should be noted that if previously it was believed that the concept of death is accessible only to school-age children, recent studies (D.N. Isaev, 1992) show that this concept can arise between 2-3 years and even very young children can experience associated with him anxiety, which, due to the inability to verbally express his fear, is manifested by changes in behavior, fears of physical harm, and loneliness.

Besides psychological factor in the occurrence mental disorders What matters is the endogenous factor of predisposition to mental illness, the somatic factor associated with the underlying disease and its complications, the iatrogenic factor caused by side effects medicinal and radiation therapy underlying disease. In foreign literature, quite a lot of publications are devoted to psychoorganic syndrome, which manifests itself months and years after radiation therapy, and psychoorganic syndromes during cytostatic treatment are also considered.

Mental disorders in blood diseases, therefore, have a mixed origin: psychogenic, exogenous-symptomatic, exogenous-organic origin. The pathogenesis of mental disorders is poorly understood and is associated with disorders of cerebral metabolism, dyscirculatory changes in the brain, and swelling of brain tissue.

The question arises of how to treat mental disorders that complicate the treatment of the underlying disease and have an adverse effect on the “lifestyle”, and according to some data, possibly on its duration. Both according to the literature and our data, the isolated use of psychotherapy is not effective enough. The use of psychotropic drugs turned out to be difficult. I.K. Shats (1989) recommends the use of mezepam, sibazon, phenazepam and azafen in the treatment of patients with acute leukemia. Literature data on the interaction of psychotropic drugs with antitumor, hormonal drugs, the effect of psychotropic drugs on hematopoiesis are either absent or contradictory. When we used psychotropic drugs even in small doses, side and perverse reactions often occurred. In some patients positive effect observed with the use of tranquilizers, nootropics, and herbal medicine.

Psychotherapeutic tactics also remain poorly developed. One example is the question of patients’ orientation in the diagnosis of cancer. Foreign authors emphasize that the patient should know everything he wants about his present and future, that he needs to know the diagnosis. Heavy psychological stress, which occurs when reporting an oncological disease, is prevented with the help of targeted psychotherapeutic work carried out by both doctors and psychologists and social workers. Abroad, there is special literature for patients with leukemia, breast tumors, etc., and educational work is being carried out among the population. In our country, almost no literature is published for patients, there is no special training for psychotherapists, social workers for work in oncological institutions. Domestic doctors believe that cancer diagnosis reporting should not be done as it will only increase fear and uncertainty.

Meanwhile, it turned out that many children suffering from cancer, especially teenagers, already know their diagnosis in the first stages of treatment. In this case, children find themselves in a particularly traumatic situation due to the fact that they do not discuss the diagnosis they know with parents or doctors, who are convinced that they have managed to hide it from the child. And this is not just a matter of “information leakage” about the diagnosis. C. M. Binger et al. (1969) believe that despite attempts to protect a hopelessly ill child from knowledge about the prognosis of his illness, the anxiety of adults is transmitted to children due to a violation of the emotional climate and mutual understanding in the family.

A long-term illness changes not only the mental state, but also the development of the child, leading to the appearance of pseudo-compensatory formations such as “conditional desirability of the disease” or “flight into the disease” with fixation on it, which ultimately can lead to a breakdown of character within the framework of pathocharacterological or neurotic personality development. Children who have already had cancer develop “post-traumatic stress disorder”: recurring nightmares and influxes of memories about the disease, treatment, increased sensitivity to psychological trauma, irritability, aggressive behavior, lifelong ongoing excessive dependence on parents with impaired contact with peers. Loneliness is often a consequence of illness.

During our attempts to conduct play psychotherapy in the department, we constantly observed the consequences of mental deprivation: the development of social and communication skills in children was delayed. They did not know how to express their own wishes, were not familiar with games appropriate for their age, had a reduced or no interest in communicating with peers, and had a narrowed range of interests. To the question “what would you like to play?” they either could not answer, or the list of games was limited to lotto and drawing. This made it difficult to use traditional techniques accepted in our country in psychotherapeutic work.

The use of psychotherapeutic techniques created abroad is even more difficult. This is partly due to the fact that in our country psychotherapy was developed by psychiatrists, within the framework of " medical model"(V.N. Tsapkin, 1992), in which the treatment process is understood as the elimination of "target symptoms". Abroad, psychotherapy is developed mainly not by doctors, but by humanists, psychologists within the framework of the "psychological model", which is based on psychoanalytic or other religious and philosophical concepts that require either “faith” or many years of study and are not truly familiar to domestic specialists. In addition, these techniques are not always accepted by patients, since work in the “psychological model” includes working with negative experiences with their temporary intensification. and requires a certain psychological education of the patient, the presence of a request for psychological assistance. Hence the need to develop effective psychotherapeutic tactics is clear. The possibility of creating effective psychotherapeutic techniques is indirectly confirmed by thirty years of research at the Washington Institute mental health(1988), who concluded that “psychotherapeutic interventions are generally beneficial, and that different types of psychotherapy are almost equally effective” (M. B. Parloff, 1988).

FAMILY OF A CHILD WITH CANCER

The next aspect of our conversation concerns family. It is known that the mental well-being of a child and his behavior depend on the mental state of loved ones, perhaps to an even greater extent than on his physical condition. Starting from school age, and sometimes even earlier, children realize that their illness has become a blow to their loved ones, and they react to the situation according to their parents’ attitude towards it. In sick children, in addition to high levels of anxiety, internal conflicts associated with misunderstanding by adults are revealed. Children feel abandoned, pathological relationships with the family are formed: either the despotic behavior of a sick child with complete disregard for the interests of the family, or an indifferent attitude towards the environment with withdrawal into their own problems, or, finally, complete dependence on parents with a feeling of guilt in front of them, the perception of the disease as "punishments" for their "bad" behavior. Children whose families lead a normal lifestyle, maintain familiar social contacts, feel more confident and maintain emotional connections with members of their family (J.J.Spinetta., L.Maloney, 1978).

However, the majority of parents whose children suffer life-threatening diseases, mental disorders are detected (Kireeva I.P., Lukyanenko T.E., 1994). Mental disorders in parents are caused, first of all, by a chronic traumatic situation, overwork, financial, housing and other everyday problems, in particular because oncology departments are usually remote from their place of residence, and a sick child needs constant care from loved ones, especially in our conditions of shortage of junior and mid-level medical personnel.

Mental disorders in parents are manifested by a decline in performance in most of them, lack of appetite, sleep disturbances and disturbances in the functions of internal organs. Psychological testing identifies parents high level“situational anxiety”, indicating the dominance of anxiety and dissatisfaction in the mental state. Depressed mood often reaches despair, sometimes with doctors refusing to treat the child, or attempts to seek help from healers and psychics, which sharply worsens the prognosis of the disease. Correction of mental disorders in parents is thus necessary not only to restore their well-being and performance, but also because without psychocorrectional assistance to the family it is impossible to form an adequate attitude towards the child’s illness and treatment.

CONCLUSION

The given data indicate the need:
1) organizing interdisciplinary scientific research on the problem of mental and personality disorders in children suffering from life-threatening diseases and in their families;
2) conducting scientific research aimed at developing the most effective medicinal tactics in the treatment of mental disorders in children with cancer;
3) organizing psychosocial assistance to children with cancer and their families.

However, psychologists and psychiatrists working in the healthcare system alone will not be able to solve all problems. They need help, the participation of teachers, social workers, cultural and religious figures, seeking cooperation not only with patients, but also with their families, relatives and the society in which these people live.

LITERATURE

Adjuvant psychological therapy for cancer // Medical Market. - 1992, No. 8.-S. 22-23.

Gindikin V.Ya. Review of the book "Psychosomatics in clinical medicine. Psychiatric-psychotherapeutic experience in severe somatic illnesses." Edited by E. Benish and I.E. Meyer. West Berlin-Heidelberg-New York, 1983 // Journal of Neuropathology and Psychiatry named after S.S. Korsakov. - 1987 , Issue 2. - S, 297-299.

Guskova A.K., Shakirova I.N. The reaction of the nervous system to damaging ionizing radiation (Reviews/Journal of Neuropathology and Psychiatry named after S.S. Korsakov. - 1989, Issue 2.- P. 138-142.

Isaev D.N. Formation of the concept of death in childhood and the reaction of children to the process of dying // Review of psychiatry and medical psychology named after. V.M. Bekhtereva. - 1992, No. 2.- P.17-28.

Kireeva I.P., Lukyanenko T.E. Psychosocial assistance in pediatric oncohematology//Rehabilitation of children with disabilities In Russian federation. - Dubna, 1992. - pp. 76-77.

Kireeva I.P., Lukyanenko T.E. Psychiatric aspects in pediatric somatology//Scientific conference of young scientists of Russia, dedicated to the 50th anniversary of the Academy of Medical Sciences: abstracts. Moscow, 1994. - pp. 287-288.

Psychodiagnostic methods in pediatrics and child psychoneurology. Tutorial. Ed. D.N. Isaev and V.E. Kagan. - St.-Ptb. PMI, 1991.- 80 p.

Sagidullina L. S. Damage to the nervous system in acute leukemia in children: Abstract of thesis. dis. Ph.D. honey. Sci. - M., 1973. - 21 p.

Shats I.K. Mental disorders in children suffering from acute leukemia: abstract. dis. Ph.D. honey. Sci. - L., 1989. - 26 p.

Tsapkin V.N. Unity and diversity of psychotherapeutic experience//Moscow Psychotherapeutic Journal. - 1992. - P. 5-40.

Binger S.M., Ablin A.R., Feurste R.C. et al. Childhood leukemia: emotional impact on patients and family//New Engl.J.Med. - 1969, Vol. 280. - P. 414-418.

Parloff M.B. Psychotherapy and research: an anaclitic depression // Psychiatry. - 1988, Vol. 43. - P. 279-293.

Spinetta J.J., Maloney U. The child with cancer: patterns of communication and denial//J.Consult.Clin.Psychol. - 1978, Vol. 46., No. 6.- P. 1540-1541.

According to scientific research, childhood oncology is a fairly common problem. And according to statistics, boys get sick 2.5 times more often than girls.

Although in some varieties the incidence of cancer between the sexes is approximately the same and on average is 1 case per 10,000 healthy children.

And although childhood cancer is being studied quite actively in our time, no one can say with certainty about the reasons for its occurrence. On this moment There are two main hypotheses for the origin of the disease.

The first - viral - is based on the fact that the virus, entering the body, so changes the process of cell division and activates their latent mutagenic ability that it becomes impossible to stop this reaction, and the body continues to reproduce “unhealthy” cells again and again.

At the same time, the immune system does not recognize them as foreign, since by their nature they are initially normal cells, and therefore does not kill them, which allows this condition to worsen.

The second - chemical - testifies in favor of the influence of environmental factors on our internal environment and their ability to cause mutation processes.

Causes of cancer in the embryo and newborns

It is impossible to say for sure that this or that factor caused cancer, but you can try to understand what are the causes of cancer in children. Most scientists are of the opinion that childhood oncology in most cases is a genetic predisposition.

However, you should not think that cancer particles are inherited. If you and your ancestors had a similar diagnosis, it is not at all necessary that your child will have it too. Thus, some very small gene or part of it may carry a factor that subsequently provokes abnormal cell division. But whether it will manifest itself or not is unknown.

We also must not lose sight of the living conditions around us. Even in the embryonic state, it is very important what kind of life the parents lead.

If they smoke, drink excessively, take narcotic substances, do not comply correct mode nutrition, live in a microdistrict polluted by radiation and exhaust gases, the expectant mother does not monitor the intake of additional vitamins and microelements necessary for the fetus, then all this can affect the future. A baby born in such conditions is already at risk.

Causes of diseases in older children

Risk factors at an early age:

Passive smoking - you should not give free rein to this bad habit when you are a baby. This can not only cause a mutation in the future, but will simply weaken his body more and more each time.
Poor nutrition.
Frequent use of medications, their use without medical supervision.
Accommodation in an area with increased level radiation; frequent exposures due to medical interventions.
Dust and gas pollution in the air.
Transmission of viral infections more often than expected. If viruses easily take root in the body, this indicates a weak immune defense and, possibly, a disruption in the functioning of the hematopoietic organs, due to which protective lymphocytes are not produced.
Exposure to sunlight for more than eight hours a day (most often in countries with hot climates with constant exposure to the street).
Unfavorable psychological background (whether mental load or problems in society).

As you can see, the range of such factors is quite wide.

Types and periods of oncology

Cancer in children can occur at absolutely any age, but it will have its own characteristics of origin and course depending on exactly when the mutation occurred. There are three periods of cancer cell formation:

Embryonic. The mutation process occurs in the womb due to non-compliance healthy image life as a mother. Sometimes tumor cells can be transmitted through the placenta.
Juvenile. The formation of mutations begins in healthy or partially damaged cells. Childhood brain cancer most often occurs in preschoolers and adolescents.
Adult type tumors. They are quite rare. Affects mainly tissues.

Oncology in children can also be classified according to the frequency of occurrence of a particular type of disease. It is noted that leukemia is the most common disease in children, accounting for about 70% of all cases. The second place is occupied by brain cancer in children, as well as damage to the central nervous system. In third place are diseases of the skin and genital organs.

How to suspect a disease

Unfortunately, children with cancer are admitted to a specialist in this field extremely late. At the first stage - no more than 10% of patients. Most babies diagnosed at this stage are cured. A significant advantage is the use of medications that are gentle on the children’s body.

But all other patients are detected much later, at stages 2-3, when the signs of cancer become more noticeable. At the fourth stage, the disease is much more difficult to cure.

Symptoms of cancer in children appear very late. This insidious disease is always disguised as other ailments (acute respiratory infections, flu, tonsillitis, etc.). Recognizing the first bells is not easy.

If your child does not have visible symptoms any specific disease, and he continues to be nervous, whiny, complaining of pain or malaise, you should immediately contact a pediatrician to determine the reasons.

Common symptoms of cancer in children may include:

lethargy;
fast fatiguability;
increased incidence of respiratory diseases;
pale skin;
unstable and unprovoked rises in body temperature;
inflammation of the lymph nodes;
apathy;
changes in psychological state;
loss of appetite and quick loss weight.

Types of cancer

Let's look at some cancers in children in more detail.

Leukemia

Accompanied by the appearance of malignant neoplasms in the blood system, for a long time is asymptomatic. Initial signs often implicit and not paid attention to.

If you notice that your baby has a fever for a long time, he is weak and lethargic, pallor has appeared, loss of appetite, weight loss, he gets tired quickly and shortness of breath appears at the slightest exertion, spatial coordination and vision began to quickly deteriorate, and the lymph nodes are constantly inflamed Without infectious diseases, then you should immediately go to see an oncologist.

An important indicator of leukemia is also frequent and prolonged bleeding due to poor clotting. After spending the most ordinary general analysis blood, the oncologist will quickly determine the cause.

Tumors of the brain and spinal cord

Brain tumors and spinal cord are in second place. If the tumor has affected non-vital centers in the head, then it is difficult to notice, it does not cause complaints until the very last stages. But if it is located in vital areas of the brain and in the spinal trunk, then obvious symptoms will immediately arise:

dizziness;
severe pain (especially in the morning, which does not go away for a long time);
morning vomiting;
apathy;
isolation and immobility;
coordination disorders.

Babies experience head and face rubbing, crying and screaming because they cannot communicate their discomfort. At an older age, manic tendencies may occur.

From external signs head enlargement and scoliosis are noticeable. When the spinal cord is damaged, the pain intensifies when lying down and subsides while sitting.

And the affected area becomes insensitive. Sometimes convulsions appear.

Lymphogranulomatosis and lymphosarcoma

Lymphogranulomatosis and lymphosarcoma are lesions of the lymph nodes. With lymphogranulomatosis, the cervical lymph nodes are most affected. They are painless, the skin around them does not change in color, the main difference is that subsidence and swelling constantly alternate, but the inflammation itself lasts for at least a month.

Lymphogranulomatosis is diagnosed mainly at the third or fourth stage. Mostly children aged 6 to 10 years get sick. If suspected, a puncture from inflamed node And histological examination punctate to confirm the diagnosis and establish the extent of the disease.

Lymphosarcoma selectively affects any lymph node or the entire system, so complete lesions are noted abdominal area, chest or nasopharynx. Depending on which part of the body is affected, the symptoms are disguised as similar diseases (abdominal - constipation, diarrhea, vomiting as in intestinal infections; chest – cough, fever, weakness like a cold).

The danger of this disease is that if you prescribe warming (assuming an acute respiratory infection), this will only aggravate the process and accelerate the growth of the tumor.

Nephroblastoma

Nephroblastoma, or malignant neoplasm of the kidney, occurs quite often before the age of 3 years. It does not make itself known for a very long time, and it is often detected during a routine examination, or in an advanced stage, when there is noticeable enlargement in one, less often in both, sides of the abdomen. It is accompanied by diarrhea and slight increase body temperature.

Neuroblastoma

It is worth mentioning neuroblastoma, since it is exclusively a childhood disease. It affects children under five years of age. The tumor affects nerve tissue, and its favorite habitat is abdomen. This affects the bones rib cage, pelvic organs.

The first signs are lameness and weakness, as well as pain in the knees. Due to a decrease in hemoglobin, an anemic appearance of the skin appears. Swelling of the face and neck is observed, and if the tumor affects the spinal cord, urinary and stool incontinence is observed. Neuroblastoma very quickly metastasizes in the form of tubercles on the head, which is what the parents note.

Retinoblastoma

Retinoblastoma affects the retina of the eye. Its signs are very characteristically expressed. The eye turns red and itches.

There is a symptom " cat eye", as the tumor extends beyond the lens and becomes visible through the pupil, resembling a white spot.

It may affect one or both eyes. In rare cases, it ends in complete loss of vision.

Diagnostics

Symptoms of cancer in children are quite difficult to identify. Malignant neoplasms are noticed accidentally during the diagnosis of another disease or during routine examinations.

To confirm oncology, a number of examinations and tests are carried out:

general clinical analysis of blood and urine;
Ultrasound, CT, MRI;
X-ray;
spinal tap;
biopsy of the affected area.

Treatment method

Treatment often begins at stages 2-3. The recovery process largely depends on how quickly therapy is started. Patients are always admitted to the hospital, since their health is monitored around the clock. A course of radiation and chemotherapy is carried out there.

In severe cases, it is prescribed surgical operations. The exception is neuroblastoma: surgery is performed first and only then is a prescription prescribed. drug treatment to inhibit the growth of cancer cells.

If all measures are followed, the percentage of complete recovery or remission is more than 90%, and this is a very good result.

Nowadays, thousands of drugs have been invented, hundreds of studies have been carried out, and most ailments are completely cured in 100% of cases. But at the same time, the task of all parents is to be vigilant and, if cancer is suspected, immediately contact a specialist.

Prevention

Prevention of cancer in children consists of following the rules of a healthy lifestyle, as well as parents excluding the causes of the disease, which were mentioned at the beginning (environmental conditions, bad habits etc.).

We hope that you will now be able to recognize the signs of cancer in a child, the features of this childhood pathology, and also understand where cancer comes from.

Unlike cancer in adults, pediatric oncology has its own features and differences:

The vast majority of tumors occurring in children are
Cancer is less common in children than in adults
In children, nonepithelial tumors predominate over epithelial ones
In pediatric oncology, there are immature tumors that are capable of maturation.
Specific to some malignant tumors in children is their ability to spontaneous regression
There is a genetic predisposition to certain tumors, particularly retinoblastoma, chondromatosis of bone and intestinal polyposis.

Causes of cancer in children

The cause of any cancer in children is a genetic malfunction in one of the healthy cells of the body, which leads to its uncontrolled growth and appearance.

But a number of things can cause this genetic malfunction in a cell. But here, too, childhood tumors have their own peculiarities. Unlike adults, children do not have risk factors associated with lifestyle, such as smoking, alcohol abuse, or working in hazardous industries. In an adult, in most cases, the appearance of malignant tumors is associated with the influence of external risk factors, and for the appearance of a tumor in a child, they are more important.

That is why, if a child develops malignant disease, his parents should not blame themselves, since it most likely was not in their power to prevent or prevent this disease.

Factors that increase the risk of cancer in a child:

1. Physical factors

The most common physical risk factor is prolonged exposure to a child solar radiation or hyperinsolation. This also includes exposure to various ionizing radiation from medical diagnostic devices or due to man-made disasters.

2. Chemical factors

This primarily includes passive smoking. Parents need to protect their children from exposure to tobacco smoke. The chemical factor is poor nutrition child. Use of products with GMOs, carcinogens, consumption of food in restaurants " fast food" All this entails a decrease in the proper amount of vitamins and microelements in children's body and accumulations in it carcinogenic substances, which, in the modern world, are found in abundance not only in food, but also in water and air.

In addition, there is another chemical risk factor, which is often dangerous specifically for children. Many Scientific research proved the connection long-term use some medications, such as barbiturates, diuretics, phenytoin, immunosuppressants, antibiotics, chloramphenicol, androgens, with the development of cancer in children.

3. Biological factors

Biological factors include chronic viral infections, such as: Epstein-Barr virus, herpes virus, hepatitis B virus. Many foreign studies have established an increased risk of cancer in children with viral infections.

4. Genetic risk factors

Currently, pediatric oncology includes about 25 hereditary diseases that increase the risk of developing tumors in a child. For example, Toni–Debreu–Fanconi disease dramatically increases the risk of developing leukemia.

Bloom's syndrome, ataxia-telangiectasia, Bruton's disease, Wiskott-Aldrich syndrome, Kostmann syndrome, and neurofibromatosis also increase the risk of developing cancer in children. The risk of developing leukemia increases in children with Down and Klinefelter syndrome.

Against the background of Pringle-Bourneville syndrome, in half of the cases a tumor develops called cardiac rhabdomyoma.

In addition to risk factors, there are several theories about the causes of cancer in children.

One of the theories belongs to a German doctor Julius Conheim. The basis of his germ theory is the presence in children of ectopic cells of rudiments that have the ability to degenerate into malignant cells. That is why teratomas, neuroblastomas, hamartomas and Wilms tumors do not have the usual malignant structure. These are rather developmental defects, the blastomatous nature of which arises only as a result of malignant degeneration of cells.

The second theory belongs to the scientist Hugo Ribberto. According to his theory, the hearth chronic inflammation or radiation exposure, serves as a background for the occurrence of tumor growth. This is why it is so important to pay attention to chronic inflammatory diseases in childhood.

Symptoms of cancer in children

Pediatric cancers on early stages almost always occur unnoticed by the parents of a sick child.

This happens because the symptoms of cancer in children are similar to many symptoms of harmless childhood diseases, and the child cannot clearly formulate his complaints.

Also, injuries are common in children, manifested by various bruises, abrasions, contusions, which can blur or hide early signs cancer in a child.

For timely detection cancer diagnosis, it is very important for the child’s parents to ensure that they undergo mandatory regular medical examinations kindergarten or school. In addition, parents should pay close attention to the appearance of various persistent and unusual symptoms in the child. Children are at risk because they can inherit genetic changes in the DNA structure from their parents. Such children should undergo regular medical examinations and be under the constant supervision of their parents.

If your child develops symptoms that alarm you, immediately contact a pediatrician or pediatric oncologist.

Signs of cancer in children include many symptoms, but we will focus on the most common ones:

1. Unexplained weakness, accompanied by rapid fatigue.

2. Paleness of the skin.

3. Unreasonable appearance of swelling or lumps on the child’s body.

4. Frequent and unexplained rises in body temperature.

5. Formation of serious hematomas with the slightest injuries and weak blows.

6. Persistent pain localized in one area of the body.

7. Uncharacteristic for children, forced body position, when bending over, during games or sleep.

8. Severe headaches accompanied by vomiting.

9. Sudden visual disturbances.

10. Rapid, causeless weight loss.

If you find one or more of the above symptoms in your child, do not panic; almost all of them can accompany various infectious, traumatic or autoimmune diseases. But this does not mean that if such symptoms appear, you should self-medicate.

If you have any warning signs, immediately contact your attending pediatrician or pediatric oncologist.

Diagnosis of cancer in children

Diagnose the presence malignant tumor It's very difficult for a child. This is due to the fact that the child cannot clearly formulate his complaints. The peculiar course and ambiguous manifestations of childhood oncology in the early stages also play a role.

All this complicates the process of identifying and differential diagnosis cancer in children from other common childhood diseases. It is because of this that, in most cases, an oncological diagnosis is made when the tumor has already begun to cause various anatomical and physiological disturbances in the functioning of the body.

If there are warning signs, to avoid medical errors, already at the first stage of examination of a sick child, a suspected oncological diagnosis should be reflected in the diagnosis, in addition to other suspected diseases.

Enormous responsibility lies with the local pediatrician or pediatric surgeon; they are the first to examine the child and propose an algorithm for further actions. On initial appointment When visiting a pediatrician, it is not always possible to immediately identify a tumor, so identifying and diagnosing cancer in children is much more successful when several types of screening tests are performed at once.

IN modern medicine used for diagnosing cancer in children all available screening and diagnostic methods, such as.