Development of oncology in childhood fm. Pediatric oncology

Annually there are fifteen episodes for every hundred thousand children's lives. In terms of fifteen years of childhood, this means that out of one hundred thousand peers, almost two hundred children get cancer every year.

There are also more optimistic statistics, according to which the majority of children oncological diseases amenable to successful treatment. This applies to tumors detected at the very initial stage of their development. When advanced diseases probability favorable outcome decreases significantly.

Unfortunately, the number of children who develop cancer and are admitted to the clinic at the very beginning of the diagnosis of the disease is no more than 10% of the total number of cases. So that parents can not miss the first alarms and showed the child to the doctor in a timely manner; they should know the symptoms of the main childhood cancers.

Classification of cancer in children

Malignant tumors in children are:

Embryonic.
Juvenile.
Tumors of the adult type.

Embryonic

Tumors of this group are a consequence pathological process in germ cells.

The result is an uncontrolled growth of mutated cells, the histology of which, however, indicates their similarity to the tissues and cells of the fetus (or embryo).

This group consists of:

Blastoma tumors: , .
A number of fairly rare germ cell tumors.

Juvenile

This group of cancers occurs in children and adolescents as a result of the formation of cancer cells from completely healthy or partially altered cells.

Malignancy may suddenly affect a polyp, benign neoplasm or gastric ulcer.

Juvenile tumors include:

carcinoma;

Adult tumors

This type of illness is childhood rarely observed. These include:

carcinomas (nasopharyngeal and hepatocellular);

Why do children get sick?

Until now, medicine has not established the exact causes of cancer in children. We can only assume that the prerequisites for the development of cancerous tumors are the following:

Genetically determined predisposition. Some types of cancer (for example, retinoblastoma) can be traced in several generations of the same family, although this does not exclude the possibility of the birth of healthy offspring. Cancer is not inherited.
Influence of carcinogenic factors. This concept combines pollution environment(soil, air and water) big amount industrial waste, the effects of radiation, the effects of viruses, as well as the abundance of artificial materials in the environment of modern apartments.
Carcinogenic factors, affecting the reproductive cells of the parent couple, damaging them and thereby contributing to improper intrauterine development fetus, the appearance of a large number congenital deformities and embryonal cancers.

Symptoms and signs of oncology by type

Early recognition of alarming symptoms not only guarantees a complete recovery of the child, but also allows for treatment using the most gentle and inexpensive methods.

In this section of our article we provide a list of symptoms that characterize different types of childhood cancer.

When found similar symptoms Parents of a sick child should show him or her to a qualified specialist as soon as possible.

Leukemia

Synonyms of this malignant disease hematopoietic system are the terms "" and "". It accounts for more than a third of all childhood cancers.

At the first stage of development of leukemia, first displacement occurs, and then replacement occurs. healthy cells bone marrow cancerous.

Symptoms of leukemia are the following:

fast fatiguability;
lethargy and muscle weakness;
anemic skin;
lack of appetite and a sharp decline body weight;
increased body temperature;
frequent bleeding;
painful sensations in diarthrosis and bones;
significant enlargement of the liver and spleen, resulting in an enlarged abdomen;
frequent vomiting;
presence of shortness of breath;
tangible consolidation lymph nodes located in armpits, on the neck and groin area;
visual disturbances and unbalanced walking;
tendency to form hematomas and redness of the skin.

Brain and spinal cord cancer

Cancerous brain tumors appear in children 5-10 years old and manifest themselves in the following symptoms:

unbearable morning headaches, aggravated by coughing and turning the head;
attacks of vomiting on an empty stomach;
impaired coordination of movements;
gait imbalance;
vision disorders;
the appearance of hallucinations;
complete indifference and apathy.

Brain cancer is characterized by seizures, obsessions And mental disorders. A sick child's head may increase in size. If you do not show it to a doctor in time, after six months of continuous headaches, signs of mental retardation will begin to appear with an inevitable decrease in intelligence and physical abilities.

Symptoms of cancer spinal cord:

back pain that worsens when lying down and subsides while sitting;
difficulty bending the body;
gait disturbance;
pronounced scoliosis;
loss of sensitivity in the affected area;
urinary and fecal incontinence due to poor functioning of the sphincters.

Wilms tumor

This is the name for nephroblastoma or kidney cancer (most often one, sometimes both). This disease usually affects children under three years of age.

Because of complete absence complaints, the disease is discovered completely by accident, usually during a routine examination.

At the initial stage there is no pain.
In the advanced stage, the tumor is extremely painful. By squeezing neighboring organs, it leads to asymmetry of the abdomen.
The baby refuses to eat and loses weight.
The temperature rises slightly.
Diarrhea develops.

Neuroblastoma

This type of cancer affects only children's sympathetic nervous system. In the vast majority of cases, it is observed in children under five years of age. The location of the tumor is the abdomen, rib cage, neck, pelvis, bones are often affected.

Characteristic features:

limping, complaints of bone pain;
increased sweating;
prostration;
pale skin;
elevated temperature;
bowel dysfunction and Bladder;
swelling of the face, throat, swelling around the eyes.

Retinoblastoma

This is the name of a malignant tumor of the retina, characteristic of infants and preschoolers. A third of all cases involve the retina of both eyes. In 5% of children, the disease ends in complete blindness.

The affected eye turns red, the baby complains severe pain in him.
Some children develop strabismus, while others develop a symptom of luminous " cat eye", caused by protrusion of the tumor beyond the border of the lens. It can be seen through the pupil.

Rhabdomyosarcoma

This is the name of a cancerous tumor of connective or muscle tissue that affects infants, preschoolers and schoolchildren. Most often, the location of rhabdomyosarcoma is the neck and head, somewhat less often - the urinary organs, the area of the upper and lower extremities, and least often - the torso.

Signs:

painful swelling at the site of the lesion;
“rolling out” of the eyeball;
sharp decrease in vision;
hoarse voice and difficulty swallowing (if localized in the neck);
prolonged abdominal pain, constipation and vomiting (if the abdominal cavity is affected);
yellowness of the skin (with bile duct cancer).

Osteosarcoma

This is a cancer that affects the long bones (humerus and femur) of adolescents. The leading symptom of osteosarcoma is pain in the affected bones, which tends to intensify at night. At the beginning of the disease, the pain is short-term. A few weeks later, visible swelling appears.

Ewing's sarcoma

This disease, typical for teenagers 10-15 years old, is a scourge for tubular bones upper and lower extremities. There have been rare cases of damage to the ribs, shoulder blades and collarbones. To the symptoms characteristic of, sudden weight loss and fever are added. Late stages are characterized by unbearable pain and paralysis.

This is cancer of the lymphatic tissues or is typical for adolescents.

The photographs show children with cancer of the lymphatic tissues

Symptoms:

painless and slightly enlarged lymph nodes either disappear or reappear;
sometimes appears itchy skin, profuse sweating, weakness, fever.

Diagnostics

Satisfactory well-being of children, characteristic even for late stages cancerous tumors - here main reason their late recognition.

Therefore, regular preventive examinations play a huge role in the timely detection and initiation of treatment of the disease.

At the slightest suspicion of a cancerous tumor, the doctor prescribes a series of laboratory tests (blood, urine) and studies (MRI, ultrasound,).
The final diagnosis is made based on the results of a biopsy (sample tumor tissue). Histology allows us to determine the stage of cancer. The tactics of further treatment depend on the stage. For cancer hematopoietic organs a bone marrow puncture is taken.

Treatment

Treatment of childhood cancers is carried out in specialized departments of children's clinics and in research centers.
The impact on cancerous tumors of the hematopoietic organs is carried out using and methods. All other types of tumors are treated surgically.

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 causes of 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 food, live in a microdistrict polluted by radiation and exhaust gases, 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.
Transfer 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 (be it mental stress 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 gentle children's body medicines.

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 some 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

Tumors of the brain 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.

External signs include head enlargement and scoliosis. 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. The disease mainly affects children aged 6 to 10 years. 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 revealed when preventive examination, or in an advanced stage, when there is a noticeable increase in one, less often in two, sides of the abdomen. It is accompanied by diarrhea and slight increase body temperature.

Neuroblastoma

It is worth mentioning neuroblastoma, since it is exclusively childhood illness. It affects children under five years of age. The tumor affects the nervous tissue, and its favorite habitat is the abdominal cavity. This affects the bones, chest, and 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.

A symptom of “cat's eye” is observed, 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 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, surgery is prescribed. An exception is neuroblastoma: surgery is performed first and only then drug treatment is prescribed to curb the growth of cancer cells.

If all measures are met, the percentage full recovery or the onset of 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.

General issues of pediatric oncology

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 the most important problems not only pediatrics, but medicine in general. Mortality of children from malignant diseases in developed countries it ranks second, second only to child mortality 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 modern capabilities are widely used, which help clarify and detail the diagnosis, optimize surgical approaches, apply adequate chemotherapy programs and radiation methods treatment. 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, presents practical recommendations on 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 large clinical studies conducted both in our country and abroad. Separately, information is presented on the use of the most modern drugs, which in some cases make it possible to achieve impressive results, including in patients with refractory diseases. Information provided in National leadership, 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 of surgical interventions for tumors of various locations.
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 intravenous administration 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.

Oncology – this word always sounds scary, and the concept of childhood oncology is doubly scary. A diagnosis of cancer in a child is always a shock for parents. I don't want to believe in him. Every mother, every father in their souls hopes to the last medical error. They are changing clinics and specialists, trying to look for alternative treatment methods to traditional chemotherapy and radiation therapy. But it is at this moment that many parents make the biggest mistake - they miss precious time.

Childhood cancer is more rewarding and treatable than adult cancer. If a malignant neoplasm is recognized on early stage, 90% of children can be saved, oncologists never tire of warning us about this. However, the problem of early diagnosis of cancer in our (and not only our) country still remains relevant.

Agree, when a tragedy occurs, there is no point in looking for an answer to the question “Who is to blame?” Parents who noticed changes in their child’s condition late and turned to doctors for help late? Doctors who spent too long searching for the correct diagnosis? It is much more important to prevent such a scenario and manage to save a child’s life. This means that the concept of “cancer alertness” should be well known to everyone – both doctors and parents.

We asked Anna Nikolaevna BYKOVSKAYA, head of the children's department of the Kazakh Research Institute of Oncology and Radiology of the Ministry of Health of the Republic of Kazakhstan, tell us what alarming symptoms The child needs to pay special attention to who to contact if the parents have a suspicion, what they will have to pay for when applying on their own, and what types of assistance are provided free of charge, and many other very important things.

– Anna Nikolaevna, oncologists say that childhood cancer is “more grateful” than adult cancer. What is this connected with?

– Children’s oncology is not a reduced copy adult oncology. They are absolutely different, both in morphological type and in the structure of morbidity. Children, as a rule, do not have epithelial tumors (carcinoma), i.e., cancer that originates in epithelial cells any organ. In childhood, mainly low-grade sarcomas develop, i.e., malignant neoplasms that arise in connective tissue. Poorly differentiated means rapidly progressing, but the lower the differentiation of this process, the easier it is to treat.

– And yet, all over the world, children continue to die from cancer?

– the main problem childhood cancer is that it is very difficult to diagnose primary tumors in children. IN early periods tumors do not show any symptoms during the development of the disease. They do not hurt until they reach a significant size and begin to put pressure on nearby organs and fabrics.

If in adult oncology there are mandatory age restrictions, then it is impossible to implement them in childhood. In children, a malignant tumor may appear at birth. For example, neuroblastoma or lymphosarcoma, i.e. a child is born with a malignant neoplasm. This is the so-called embryonal tumor.

– Is there an exact explanation for why tumors in children arise in utero? Is family history always to blame?

– Unfortunately, today there are many theories. And with such a quantity, none of them will be completely true. It is very difficult to determine at what stage embryonic development a child develops a tumor. If we knew the exact etiology of this process, we would have already found radical methods combating this disease.

Concerning hereditary factors. Of course, they cannot be denied. There was a case in my practice. The patient was successfully treated for nephroblastoma (kidney tumor), but 24 years later she was admitted to our department with a newborn child. The baby just turned 40 days old, and he was already diagnosed with a primary generalized form of neuroblastoma (cancer of the sympathetic nervous system). In this case, of course, a hereditary factor could play a role.

Retinoblastoma (retinal cancer) can also be classified as a genetic disease. If someone has a family history of retinoblastoma, in about 50% of cases the child may inherit the disease.

– Is there any data at what age an embryonal tumor can manifest in a child?

– Accurate age period No. We can never say at what age this disease will manifest itself. There is a certain group of diseases that can appear in the first year of life. These include neuroblastoma, nephroblastoma, retinoblastoma and a number of meduloblastomas.

Another group of diseases usually manifests itself in adolescence. These are sarcomas of bones and soft tissues (rhabdomyosarcomas, alveolar sarcomas, osteogenic sarcomas), as well as Khozhkin lymphoma.

If osteogenic sarcoma occurs in a child aged 6–8 years or nephroblastoma occurs in a child over 10 years old, these are rather casuistic cases. There are groups of tumors of early childhood, and there are those characteristic of older childhood.

Symptoms of intoxication in cancer are very skillfully disguised as any disease.

– What are the very first signs and symptoms that parents should be wary of?

– At the earliest stage there may be no symptoms, but at a certain period the child develops moderate symptoms of intoxication:

change in the child’s behavioral activity: the child lies down more often, plays less, loses interest in his favorite toys;
decreased appetite;
pallor of the skin.

Very often parents miss similar symptoms. Even if they go to the clinic, doctors usually associate this condition with some kind of infection (for example, ARVI) and prescribe symptomatic therapy. In fact, the symptoms of intoxication in cancer are very skillfully disguised as any disease.

– Besides common symptoms intoxication, there are probably still signs characteristic of a particular type of cancer that parents can notice on their own?

- Of course, they exist. Let's take a closer look at the most striking examples.

Retinoblastoma

One of the striking typical signs of retinoblastoma is pupil glow, the so-called cat's eye syndrome. Often this is the symptom that parents notice. And yet it is just as often missed during diagnosis.

Let me give you an example. A child with retinoblastoma was admitted to the department. The mother noticed the glow in the pupil when the child was still 6 months old. The family turned to an ophthalmologist, where they were diagnosed with uevitis (retinal detachment) and prescribed long-term treatment for six months. After 6 months, the child’s condition worsened, symptoms of intoxication increased, and there was almost complete loss of vision in the left eye. Nevertheless, doctors continued to insist on retinal detachment. As a result, the child now has a far advanced malignant process.

Hozhkin's lymphoma and non-Hozhkin's lymphomas

For all hemoblastoses (tumors of the hematopoietic and lymphatic systems), in particular for Hozhkin's lymphoma and non-Hozhkin's lymphomas, a triad of intoxication symptoms is characteristic. This:

pronounced pallor of the skin;
rapid weight loss of more than 10 kg;
increased sweating in a child.

Lymphomas are also characterized by enlargement of peripheral lymph nodes.

Ewing's sarcoma and osteogenic sarcoma

The onset of osteogenic sarcoma and Ewing's sarcoma is usually always associated with trauma. But trauma in itself is not the cause of the disease, it is only a factor that provokes tumor growth. If a child has a predisposition to a disease, then sooner or later it will manifest itself.

A typical picture: a child falls, hits himself, the bruise does not heal for a long time, swelling and hardening appear, but the parents are in no hurry to take the child to see a doctor. Treat the bruise yourself. Compresses, warming ointments. The pain is gradually subsiding. But if the injury triggered the formation of a tumor, then when it warms up it will begin to grow rapidly. AND pain syndrome will still return and continue to grow. Cancer in its early stages does not hurt. And the bone itself cannot hurt. With sarcoma, pain appears at the stage when the tumor has already grown into soft fabrics, tearing the periosteum.

Brain tumors

The main signs of brain tumors:

nausea;
vomit;
headache.

In addition, the child may experience blurred vision and seizures.

– What types of childhood cancer are considered the most malignant and aggressive?

– Speaking of children early age, these are neuroblastoma (a malignant tumor of the sympathetic nervous system) and medulloblastoma (a form of brain cancer). Moreover, medulloblastoma is divided into three forms: classical, desmoplastic and sarcomatous. The first two forms of the disease give a better response to therapy, unlike the third. Sarcomatous medulloblastoma is completely uncontrollable.

In older children, the most aggressive form of cancer is glioblastoma (a type of brain tumor).

…be sure to protect yourself first. If a child develops nausea, vomiting, or headaches, there is no need to immediately send him to a gastroenterologist.

– Anna Nikolaevna, if we look at statistics, is childhood cancer on the rise in Kazakhstan?

- No. Childhood cancer is not growing. The number of detected cancer cases is increasing due to improved diagnosis. IN last years In our country, cancer alertness among doctors has increased significantly, and the diagnosis of childhood oncology has become better.

But nevertheless two big problems: late presentation and late detection of the disease still remain. Despite the fact that cancer alertness is increasing among the population and among doctors, unfortunately, given the asymptomatic onset of the disease, without pronounced manifestation of symptoms, parents apply late, and doctors delay diagnosis.

Therefore, we always tell our students and residents: first of all, protect yourself. If a child develops nausea, vomiting, or headaches, there is no need to immediately send him to a gastroenterologist.

In our practice, such situations often occur. The pediatrician refers a child with nausea and vomiting to a gastroenterologist. The gastroenterologist directs an ultrasound of the abdominal organs, biliary dyskinesia is detected (and today this is a real scourge of childhood), and appropriate treatment is prescribed. Against this background, the child’s condition worsens, nausea and vomiting increase. He is referred to a neurologist. The neurologist, in turn, detects encephalopathy (this is another scourge among childhood diagnoses), and its treatment also takes precious time. As a result, the child comes to us in a neglected state.

If peripheral lymph nodes increased in size, first of all it is necessary to exclude such dangerous diseases as lymphosarcoma (non-Khozhkin lymphoma) and Khozhkin lymphoma.

Therefore, I really ask parents and pediatricians: if a child suddenly develops nausea, vomiting, headaches, do not waste time, do a CT scan or MRI of the brain. Rule out a tumor, and then you can treat gastroenterological pathologies, neurological ones, etc.

Similar situation – with enlargement of peripheral lymph nodes (in the neck, groin or axillary areas). First of all, doctors exclude zoonotic and other infections. Then tuberculosis is ruled out: anti-tuberculosis therapy is carried out and it is observed whether the child responds to it or not. This is fundamentally wrong. If the peripheral lymph nodes have increased in size, first of all it is necessary to exclude such dangerous diseases as lymphosarcoma (non-Khozhkin lymphoma) and Khozhkin lymphoma. It would be wiser to first do a fine-needle biopsy and get the result.

– Can parents, if they suspect their child has cancer, independently contact KazNIIOiR for advice?

- Certainly. We never refuse advice to anyone. Nobody canceled self-referral. If you are not satisfied with the consultation of the local pediatrician, parents have the right to come to our institute or the Scientific Center of Pediatrics and Pediatric Surgery (formerly the Institute of Pediatrics), and we will examine the child.

– Do the Children's Department of KazNIIOiR and the Institute of Pediatrics provide the same range of services?

- Not now. Since 1978, we have been the only department in Kazakhstan and provided all types of oncological treatment: surgery, radiology and chemotherapy. But in 2013 there was a restructuring and we were separated.

Today, NCPiCH serves the southern regions, Almaty and the Almaty region, and the Scientific Center for Maternity and Childhood (Astana) serves the northern regions, Astana and the Akmola region. These centers provide all types of surgical treatment and chemotherapy. IN children's department KazNIIOiR has deployed only 20 beds. We only provide radiation and chemoradiotherapy. We have children predominantly with brain tumors (primarily operated on at the National Scientific Center for Neurosurgery in Astana and admitted to us for radiation and chemoradiotherapy), as well as children with solid tumors - nephroblastoma, neuroblastoma, Ewing's sarcoma, who need carrying out consolidative radiation therapy.

– Very often, Kazakh oncologists are accused of not trying to preserve the affected cancerous tumor organ, preferring to remove it immediately, in particular with retinoblastoma, while in foreign clinics organ-saving operations are very widespread.

– This is not a completely justified accusation. In Kazakhstan, organ-preserving operations are also carried out. For example, if 6–7 years ago for joint replacement for osteogenic sarcomas, we were forced to send our patients to clinics South Korea and Germany, today similar operations are successfully carried out in our country.

As for retinoblastoma, this problem worries everyone - both ophthalmologists and oncologists.

Believe me, not a single doctor has a hidden intention to deliberately cripple a child’s life. But late treatment by parents and late diagnosis of the disease often leave us no other option. Here the question now stands: either save the child’s eyes, or save his life.

Indeed, organ-preserving operations are performed more often abroad, but only for the reason that cancer is diagnosed there at earlier stages.

In Kazakhstan, the quality of diagnosing cancer in children is improving every year, and I am confident that we will be able to reach the level of successful foreign clinics. Our specialists are no worse. It’s just that our workload is greater than that of our foreign colleagues.

– What about the treatment protocols and drug supply?

– We work according to international level treatment protocols, which are updated virtually every year. Our drug supply is the same as abroad. The only thing is that in pediatric oncology practice the choice of chemotherapy drugs is generally limited.

–Is oncology treatment for children free in our country?

– Yes. Kazakhstan is one of the few countries where oncology (for both children and adults) is a priority and its treatment is absolutely free.

–It doesn’t matter whether the parents applied on the referral of a local doctor or on their own?

– We always try to meet parents halfway. In any situation. I never charge for my appointments. But there are certain services, CT and MRI, for which parents will have to pay if they self-apply.

– If you turn to official statistics, in which region of Kazakhstan is pediatric oncology more common?

– In South Kazakhstan and Almaty regions. But this is due to the fact that in these regions the most high density children's population. And where there are more children, there will be a correspondingly higher quantitative indicator of childhood cancer.

–Anna Nikolaevna, thank you very much for the interview!

Oncological diseases in children have their own characteristics. For example, it is known that cancer in children, unlike in adults, they are casuistry and are extremely rare. The overall incidence of malignant tumors in children is relatively low and amounts to approximately 1-2 cases per 10,000 children, while in adults this figure is tens of times higher. About a third of malignant neoplasms in children are leukemia or leukemia. If in adults 90% of tumors are associated with exposure to external factors, then for children they are somewhat more important genetic factors. Today about 20 are known hereditary diseases With high risk malignancy, as well as some other diseases that increase the risk of developing tumors. For example, Fanconi disease, Bloom syndrome, Ataxia-telangiectasia, Bruton disease, Wiskott-Aldrich syndrome, Kostmann syndrome, and neurofibromatosis sharply increase the risk of developing leukemia. Down syndrome and Klinefelter syndrome also increase the risk of leukemia.

· Depending on age and type, there are three large groups of tumors found in children:
Fetal tumors arise as a result of degeneration or erroneous development of germ cells, which leads to the active reproduction of these cells, histologically similar to the tissues of the embryo or fetus. These include: PNET (neurectoderm tumors); hepatoblastoma; germ cell tumors; medulloblastoma; neuroblastoma; nephroblastoma; rhabdomyosarcoma; retinoblastoma;

· Juvenile tumors occur in childhood and adolescence due to malignancy of mature tissues. These include: Astrocytoma; lymphogranulomatosis (Hodgkin's disease); non-Hodgkin's lymphomas; osteogenic sarcoma; synovial cell carcinoma.

· Adult tumors are rare in children. These include: hepatocellular carcinoma, nasopharyngeal carcinoma, clear cell skin cancer, schwannoma and some others.

The distribution of malignant tumors according to their histogenetic affiliation and localization is very peculiar. Unlike adults, in whom neoplasms of an epithelial nature predominate - cancers, children are immeasurably more likely to develop mesenchymal tumors - sarcomas, embryos or mixed tumors. In first place (a third of all malignant diseases) are tumors of the hematopoietic organs (lymphocytic leukemia - 70-90%, acute myeloid leukemia 10-30%, rarely - lymphogranulomatosis), head and neck blastomas (retinoblastoma, rhabdomyosarcoma), which are approximately 2 times less common , then neoplasms of the retroperitoneal space (neuroblastomas and Wilms tumor) and, finally, tumors of bones, soft tissues and skin (sarcomas, melanomas). It is extremely rare for children to experience damage to the larynx, lungs, mammary gland, ovaries and gastrointestinal tract.

For diagnostics in pediatric oncology they use the entire range of modern clinical, diagnostic and laboratory methods research:

· Clinical and anamnestic data, including proband heredity studies.

· Medical imaging data (MRI, ultrasound, RTK or CT, a wide range of radiographic methods, radioisotope studies)

· Laboratory research(biochemical, histological and cytological studies, optical, laser and electron microscopy, immunofluorescence and immunochemical analysis)

· Molecular biological studies of DNA and RNA (cytogenetic analysis, Southern blotting, PCR and some others)

In this material we will try to convey to users of our website the main issues of organizing the provision of pediatric cancer care in Russia. We want to provide such information so that everyone understands the structure of medical institutions that provide assistance to children with cancer and, most importantly, the very procedure for providing it.

Organization of cancer care for children:

Primary care:

Paramedic - at the first request - in cases where the staff of the departments of the medical institution does not include doctors. The assistance provided is aimed at early detection of the disease and referral to a specialist;

Pediatricians, family doctors (general practitioners) - when a child first visits a medical institution. If signs or suspicion of cancer are detected, the child is sent for examination by a pediatric oncologist;

Doctors - pediatric oncologists - at the first visit to an oncology medical institution (district or regional oncology clinic). They diagnose, treat and follow up the sick child.

Ambulance health care:
It is provided by paramedics or emergency medical teams. In addition to providing assistance to a sick child on the spot, the ambulance team, if necessary, transports the sick child to a medical facility. Emergency medical care is aimed at eliminating severe, life-threatening complications of cancer (bleeding, asphyxia, etc.) and does not involve specialized diagnosis of cancer and treatment.
Specialized medical care:
This type of assistance is provided by specialists: pediatric oncologists. Such assistance cannot be provided in any hospital or clinic, since it requires special knowledge and skills in pediatric oncology and appropriate high-tech equipment. It is carried out during inpatient treatment or in conditions day hospitals oncology medical institutions (hospitals, oncology dispensaries).

Dispensary observation:

All children with diagnosed oncological pathology undergo lifelong dispensary observation. The following frequency of examinations by a pediatric oncologist after treatment has already been determined:

The first 3 months after treatment - once a month, then - once every three months;

During the second year after treatment - once every six months;

Subsequently – once a year.

Treatment in oncological treatment institutions at the federal level:
If necessary, a sick child can be referred for examination and treatment from local (district or regional) oncology clinics– to medical institutions of federal significance. This can be carried out in following cases:
- if further examination is necessary to clarify final diagnosis with an atypical or complex course of the disease;

To carry out high-tech diagnostic methods, including cytogenetic, molecular biological research methods, PET;
- for carrying out courses of treatment using high-dose chemotherapy with stem cell support;
- for bone marrow/peripheral stem cell transplantation;
- if a complex, high-tech surgical intervention is necessary with a high risk of complications from its implementation or in the presence of complex concomitant diseases;
- if complex preoperative preparation of a child with a complex form of the disease is necessary;
- for chemotherapy and radiation therapy, in the absence of conditions for treatment in local oncology hospitals and dispensaries.
To clarify the procedure for referral to oncology treatment institutions at the federal level, you must contact the district or regional oncology clinic for clarification.

Doctor - pediatric oncologist.

This is an oncologist who has undergone special training in pediatric oncology. The number of doctors of this profile in an oncological treatment institution is calculated from the following indicators– 1 doctor per 100,000 children.

The duties of this specialist include:

Conducting advisory, diagnostic and medical care children suffering from cancer;

Referral, if necessary, of sick children to hospitalization for inpatient treatment;

If necessary, the pediatric oncologist refers the child for examinations and consultations with specialists of another profile;

Registration of prescriptions for medicines and drugs, including those included in the list of narcotic and psychotropic substances, the circulation of which is controlled by the state;

Carrying out dispensary observation looking after sick children;

Provide counseling to children referred to him for examination by other specialists;

Conducting educational and preventive work By early detection and preventing the development of cancer;

Organization and implementation (together with pediatricians, family doctors, paramedics) supportive and palliative (aimed at mitigating the manifestations incurable disease) helping sick children;

Preparation of documentation and referral of sick children to a medical and social expert commission.

236. Palpable tumor syndrome in the abdomen and retroperitoneal space in children. Tactics of a pediatrician. Examination methods. Differential diagnostic algorithm.

Syndrome of palpable tumor of the abdominal cavity and retroperitoneal space

Diseases in this group include developmental defects, traumatic injuries, purulent-septic diseases, tumors (both abdominal cavity and retroperitoneal space). An enlarged abdomen at birth and a palpable tumor-like formation are often the only symptom of the disease.

In the upper floor of the abdominal cavity, dense, immobile space-occupying formations often originate from the liver and can be: solitary liver cyst, general cyst bile duct, benign or malignant tumor, subcapsular hematoma of the liver, abscess umbilical vein.

In the middle floor of the abdominal cavity, mobile round elastic formations are often enterocistomas.

Formations palpated in the lower floor of the abdominal cavity are associated with pathology of the pelvic organs: solitary or teratoid, complicated or uncomplicated ovarian cyst, hydrocolpos and hematometra with atresia of the vagina and hymen, neurogenic bladder, urachus cyst.

The only symptom at the birth of a child may be a volumetric formation palpated in various areas of the abdominal cavity, often mobile, painless, with smooth contours, accompanied by an increase in the size of the abdomen.

Diagnostics

Antenatal examination of the fetus can reveal the presence of volumetric education, localize it in the abdominal cavity or retroperitoneum, make a preliminary diagnosis.

After birth they carry out comprehensive examination. Ultrasound allows you to clarify the localization of a retroperitoneal or intraperitoneal formation, determine its structure and connection with internal organs.

Examination methods	Bile duct cyst	Primary liver tumor	Umbilical vein abscess	Ovarian cyst, teratoma	Hydrometra, hydrocolpos	Megacystis
Clinical	From birth; a round, dense, elastic, immobile, painless formation is detected at the porta hepatis; jaundice, periodically discolored stool	Diffuse increase liver size	In the epigastric region, in the projection of the umbilical vein, a formation with unclear contours is detected, moderately painful, motionless	From birth; in the lower lateral abdomen there is a mobile formation with smooth contours of elastic consistency	From birth; above the womb there is a fixed formation of elastic consistency with smooth contours; Vaginal atresia, hymenal atresia, ectopic ureter	From birth; above the womb there is a fixed formation of elastic consistency with smooth contours; with palpation or catheterization of the bladder, the formation decreases
Laboratory	Increased concentration of direct bilirubin	Moderate increase in bilirubin concentration; Abelev-Tatarinov reaction is positive	Hyperleukocytosis with shift leukocyte formula left	The Abele-va-Tatarinov reaction is positive for teratoma	Norm	Norm
Ultrasound	At the gate of the liver, outside the parenchyma, a cystic formation with fluid and moving sediment at the bottom is determined. The bile ducts are dilated. Gallbladder There is	Increased liver size with a homogeneous structure	In the thickness of the abdominal wall under the muscle, a cystic formation with flocculent inclusions is determined	An echo-negative cystic formation, often homogeneous. Located behind the bladder and lateral to it	Above the womb behind the bladder there is a large echo-negative (or with inclusions) formation	Above the pubis there is an echo-negative formation that decreases with urination
Radioisotope research	Not shown	Defect in isotope filling of tumor parenchyma	Not shown	Not shown	Not shown	Not shown
Cystography	Not shown	Not shown	Not shown		Bladder deformity	Bladder enlargement
Angiography	Not shown	Vascular pattern defect	Not shown	Not shown	Not shown	Not shown
CT	Cystic formation at the porta hepatis	Contours and exact location of the tumor	Contours of formation in the thickness of the abdominal wall	Visualization of an ovarian cyst	Pathology Imaging	Not shown
Tactics	Cyst excision operation, common bile duct-odenoanastomosis	Liver lobe resection	Abscess drainage	Removal of a cyst at the age of 1 to 3 months	Incision of the hymen, drainage of the uterine cavity, reconstructive surgery	Catheterization, cystostomy, reconstructive operations

237. Congenital hydronephrosis in children. Etiopathogenesis, diagnosis, differential diagnosis.

Hydronephrosis is a progressive expansion of the pelvis and calyces of the kidney, resulting from a violation of the outflow of urine from the kidney due to an obstruction in the area of the ureteropelvic segment. This violation outflow of urine leads to thinning of the kidney parenchyma and fading of its function.

The overall incidence of hydronephrosis is 1:1500. Hydronephrosis occurs 2 times more often in boys than in girls. In 20%, hydronephrosis can be bilateral.