The development of oncology in childhood is very. This group is made up

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. Mortality of children from malignant diseases in developed countries ranks second, second only to deaths of children from accidents.
At present, 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: if in the early 1950s. Since the absolute number of children diagnosed with a malignant neoplasm died, now up to 80% of such patients can be cured.

For more than 35 years of existence, a unique experience has been accumulated in the treatment of pediatric patients with malignant neoplasms. The arsenal of diagnostic possibilities has significantly expanded when using morphological, immunological, genetic and molecular biological methods for tumor identification. Widely used radiation, endoscopic and other modern possibilities, which contribute to the clarification and specification of the diagnosis, optimization of surgical approaches, the use of adequate programs of chemotherapy 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 cutting-edge scientific achievements, provides practical recommendations for the diagnosis and treatment of the most common neoplastic diseases in children, which are based on an extensive clinical experience leading domestic specialists and on the results of major clinical research held both in our country and abroad. Separately, information is provided 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 children's tumors.
Morbidity 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 Features of pediatric oncology:

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

Chapter 4 Diagnosis of tumors:

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

Chapter 5. Treatment:

General principles surgical interventions with tumors of various localization.
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 anticancer drugs.

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

Anesthesiological provision of surgical interventions.
Intensive care in the early postoperative period.

Chapter 8 Principles of nutritional support:

Diagnosis and treatment of individual tumors

Chapter 9 Tumors of the hematopoietic and lymphoid tissues:

Acute lymphoblastic leukemia.
Acute myeloid leukemias.
Chronic myeloid leukemia.
Non-Hodgkin's lymphomas.
Hodgkin's lymphoma.
histiocytic tumors.
Langerhans cell histiocytosis.
Histiocytic sarcoma.
Interdigitating dendritic cell sarcoma.
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
Chapter 29 Problems of children's hospices.
Chapter 30 Postgraduate training for pediatric oncologists.

TO THE PEDIATRIC ONCOLOGIST
INDEPENDENT ASSOCIATION OF CHILD PSYCHIATRISTS AND PSYCHOLOGISTS

Compiled by Ph.D. I.P. Kireeva
Under the editorship of the President of the NADPP A.A. Northern

Bristol-Myers Squibb Oncology product

For more information on Bristol-Myers Squibb anticancer products, please contact 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 more patients survive long periods after the start of treatment, and a significant contingent can be classified as recovered. This is especially true of the main variant of the tumor process in childhood - leukemia: every year the number of children with remissions for more than five years is growing; medicine and society as a whole are confronted with cases of practical recovery from acute leukemia that did not exist before. At the same time, it turned out that antitumor treatment alone with the appointment 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 "level of quality of life" are determined not only by the severity of the underlying disease, but also by the psychological state, possible mental disorders both in the patient himself and in his family members, which is neither in scientific research nor practically no attention is paid to practical health care in our country. The problem of seriously chronically ill children includes the following main aspects:

Mental disorders associated with prolonged and severe course somatic illness;
the impact of the disease on the mental development of the child;
the impact 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) revealed syndromes of damage to the nervous system in 38.8% of patients acute leukemia children. I.K.Shats (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, anxious, depressive and psycho-organic syndromes. Psychotic disorders were observed in 17.4% of patients. Increased with age and disease duration specific gravity depressive states, psychotic disorders prevailed in adolescents. We (I.P. Kireeva, T.E. Lukyanenko, 1992) summarized examination data of 65 children aged 2-15 years with acute leukemia. Mental disorders in the form of asthenia were detected in all patients. 46 children (70.8%) had more complex mental disorders requiring special correction. What is the clinic of the most frequent mental disorders in children with cancer?

WHAT IS ASTHENIA IN A CHILD WITH A CANCER DISEASE

Common to all patients is the asthenic symptom complex, which, being one of the least specific forms reaction to exogeny, can accompany the disease throughout its entire length, can manifest itself only during periods of deterioration in the somatic condition, during intensive chemotherapy, 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 taking an anamnesis, it is revealed that a few weeks, months before the manifestation of an oncological disease, the child became more lethargic, tired, capricious, touchy, tearful, was sleepy during the day, slept restlessly at night. These mental disorders in the prodromal period often do not attract attention or are erroneously interpreted by parents and doctors as a psychogenic provocation of the underlying disease (“he fell ill due to trouble at school”, “because of what he was experiencing”), although in fact he had a place that arose in the prodromal period of the disease, 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 increases in the evening. This is expressed in complaints of patients about the inability to complete tasks in physical education classes, the need to lie down after a short walk, in complaints of weakness: "hands, legs are weak." Mental fatigue is less pronounced or absent.

In addition to asthenia proper (i.e., "lack of strength"), functional somatovegetative disorders are necessarily present in asthenic syndrome. These include sleep disturbances (prolonged falling asleep with an influx of painful memories of the past or disturbing ideas about the future, an increase in the need for sleep), a decrease in 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 drops: either high or low. Elevated mood often has the character of sentimentality with irritability and anger, low - tearfulness with capriciousness, dissatisfaction with others. Change similar states has a minor cause, and the lowering of the mood prevails. Increased sensitivity to all external stimuli (the so-called "psychic hyperesthesia"): a loud voice is deafening, it seems to the child that the mother or health workers "shout" at him all the time, the knock of a slamming door is perceived as a shot, the seams on the clothes seem rough, the bright light of the lamp blinding in the dressing room. lowered pain threshold: injections are felt more painful than in a healthy state.

TO asthenic syndrome other neurotic and behavioral disorders may join. For example, on the eve of or during medical procedures, "tantrums", vomiting, refusal to eat, loss of skills of neatness, speech, behavioral disorders up to the refusal of vital medical procedures. This forces doctors to delay procedures or perform them under anesthesia, which has side effects that are not indifferent to frail children.

We present below (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 on their own, an interview form is used, during which the doctor fills out the questionnaire (sometimes with the help of parents). When answering on scales I-VI, one, the most appropriate answer is selected, the scores on scales I-VI are summed up, giving a quantitative characteristic of the severity of asthenia: 18-13 points - severe asthenia, 12-7 points - moderate asthenia, 6-1 - fatigue reaction . Point characteristics allow to evaluate the dynamics of the state before and after treatment. Responses on scales VII-IX are not quantified, and when answering one question, several points can be marked. These disorders can be symptoms of both asthenia and somatic suffering itself, but their consideration is important for general characteristics child's condition.

CHILD DEPRESSIONS

More than a third of children with oncological diseases are diagnosed with neurotic and depressive states with an almost constant decrease in mood. These children are always whiny or gloomy, lose interest in games and communication with peers. Often there is an increased interest in their disease - patients are not oriented by age medical terminology, activities related to treatment, are interested in the course of treatment, listen to the conversations of others about the disease, express concern for their health. Often patients are in a very difficult relationship with parents: they are waiting for their arrival, but all the time they are unhappy 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, "tantrums" like affect-respiratory attacks, and hysterical seizures.

Below we present , (I.K. Shatz, 1991). The scale is filled in by the doctor based on clinical observation of the child. For each of the subscales, the most appropriate description of impairments for the given child and the corresponding score are recorded. Additionally, 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 from dividing the algebraic (taking into account the sign) sum of the points scored by the number of subscales (8).

Along with assessing the dynamics of the individual state, the scale makes it possible to control the effectiveness of the drugs 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 the somatic condition, transient psychoses develop with clouding of consciousness. Stunning and delirium are mostly encountered.

In cases of mild stunning (obnubilation), the child has difficulty comprehending, slowness of all reactions, emotional indifference, limited perception. The child looks lethargic, as if "stupid, stupid", absent-minded. With a sharp irritation (raising the voice when asked, pain), consciousness clears up for a while. As the stupor deepens, its next stage develops - drowsiness, in which the child becomes, as it were, drowsy, and being taken out of this state external stimulus(loud voice, bright light, pain) can answer a simple question and falls back into a pathological slumber. In a severe general condition, stunning can reach the degree 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 in the general condition, a coma occurs (turning off consciousness) with a weakening, and then with the disappearance unconditioned reflexes, respiratory and cardiac disorders. Each subsequent stage of stunning is about half the previous one, and the doctors have less and less time for resuscitation, if any.

Delirious disorders occur against the background of severe asthenia or shallow stunning, mainly in the evening and at night. With delirious episodes, the child becomes restless, fearful, he has perceptual deceptions, more often in the form visual illusions, especially of the type of pareidolia, when fabulous creatures, people's faces, a wolf's muzzle grinning teeth seem to appear in the pattern of wallpaper, cracks on the wall. Visual hallucinations may occur, auditory hallucinations are frequent (ringing, roaring, calling by name, voices of familiar guys). Evening delirious episodes are often erroneously assessed - they are mistaken for children's fears of the dark.

In patients with a hereditary burden of epilepsy and in patients with organic brain damage, epileptiform disorders are possible: seizures, twilight clouding of consciousness, dysphoria. The organic psychosyndrome develops as a result of organic damage substances of the brain (cerebral hemorrhage, tumors, or as a consequence of severe intoxication, hypoxia) and is characterized by irreversible memory loss, a decrease in intelligence of varying degrees (up to acquired dementia).

The occurrence, form and severity of mental disorders is influenced by 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, severe treatment, which is accompanied not only by frequent painful procedures, but also by changing appearance with the appearance of obesity, baldness. Psychotraumatic for sick children is the fact that they observe the suffering of other patients, learn about their death. It should be noted that if earlier it was believed that the concept of death was available only to children of school age, then recent studies (D.N. Isaev, 1992) show that this concept can arise already between 2-3 years and even very young children may experience with him anxiety, which, due to the inability to verbally express his fear, is manifested by changes in behavior, fears of physical damage, loneliness.

Apart from psychological factor in the emergence 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 due to side effects medical and radiotherapy underlying disease. In the foreign literature, quite a lot of publications are devoted to the psychoorganic syndrome, which manifests itself months and years after radiation therapy, psychoorganic syndromes are also considered during cytostatic treatment.

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

The question arises of how to treat mental disorders that make it difficult to treat the underlying disease, have an adverse effect on the "lifestyle", and, according to some data, possibly on its duration. Both according to the literature and according to our data, the isolated use of psychotherapy is not effective enough. The use of psychotropic drugs proved to be difficult. IK Shats (1989) recommends using 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 at low doses, side and perverse reactions often occurred. In some patients positive effect observed with the use of tranquilizers, nootropics, herbal medicine.

Psychotherapeutic tactics remain underdeveloped. One example is the issue of patient 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 oncological disease, is prevented with the help of targeted psychotherapeutic work carried out by both doctors and psychologists, 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 should not be reported, as this will only increase fear and uncertainty.

Meanwhile, it turned out that many children suffering from cancer, especially adolescents, already know their diagnosis at 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 managed to hide it from the child. And the point here is not only in the "leakage of information" about the diagnosis. C.M.Binger et al. (1969) believe that despite attempts to protect a hopelessly ill child from knowing about the prognosis of his disease, adult anxiety 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 of the type "conditional desirability of the disease" or "escape to the disease" with fixation on it, which in the end can lead to a break in character within the pathocharacterological or neurotic personality development. Children who have already had cancer develop "post-traumatic stress disorder": recurring nightmares and flashbacks of illness, treatment, hypersensitivity to psychotrauma, irritability, aggressive behavior, lifelong overdependence on parents in violation of contacts with peers. Loneliness is often the result of an illness.

In the course of our attempts to conduct play psychotherapy in the department, we constantly observed the consequences of mental deprivation: the development of social and communication skills was delayed in children. They did not know how to express their own wishes, they were not familiar with games appropriate for their age, there was reduced or no interest in communicating with peers, the circle of interests narrowed. 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 adopted in our country in psychotherapeutic work.

The use of psychotherapeutic techniques developed 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 humanitarians, psychologists within the framework of a "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 Russian 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 amplification and requires a certain psychological education of the patient, the presence of his request for psychological help. 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 intervention is usually beneficial, and that different types of psychotherapy are almost equally effective" (M.B. Parloff, 1988).

FAMILY OF A CANCER CHILD

The next aspect of our conversation concerns the family. It is known that the mental well-being of the child, his behavior may be even more dependent on the mental state of loved ones than on his physical condition. Starting from school age, and sometimes even earlier, children are aware that their illness has become a blow to their loved ones, and react to the situation in accordance with the attitude of their parents. 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 a complete disregard for the interests of the family, or an indifferent attitude to the environment with care for their own problems, or, finally, complete dependence on parents with a sense of guilt in front of them, the perception of the disease as "punishment" for their "bad" behavior. Children whose families lead a normal life, maintain their usual social contacts, feel more confident and maintain emotional connections with members of his family (J.J. Spinetta., L. Maloney, 1978).

However, most parents whose children suffer life threatening diseases, mental disorders are detected (Kireeva I.P., Lukyanenko T.E., 1994). Mental disorders in parents are primarily due to a chronic traumatic situation, overwork, financial, housing and other domestic problems, in particular because oncology departments are usually removed from their place of residence, and a sick child needs constant care of relatives, especially in our conditions of a shortage of junior and middle medical personnel.

Mental disorders in parents are manifested by the drop in working capacity that occurs in most of them, lack of appetite, sleep disturbances and the functions of internal organs. Psychological testing parents reveals high level"situational anxiety", indicating the dominance in the state of mind of anxiety and dissatisfaction. Decreased mood often reaches despair, sometimes with a refusal to treat a child with doctors, with attempts to seek help from healers, psychics, which sharply worsens the prognosis of the disease. Correction of mental disorders in parents, therefore, is necessary not only to restore their well-being and working capacity, but also because without psychocorrectional assistance to the family it is impossible to form an adequate attitude towards the illness and treatment of the child.

CONCLUSION

The data presented indicate the need for:
1) organization of 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 drug tactics in the treatment of mental disorders in oncologically ill children;
3) organization of psychosocial assistance to children with cancer and their families.

At the same time, only psychologists and psychiatrists working in the health care system will not be able to solve all problems. They need help, the participation of teachers, social workers, cultural and religious figures, the search for cooperation not only with the sick, 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 diseases." Under the editorship of E. Benish and I.E. Meyer. Zap. Berlin-Heidelberg-New York, 1983 // Journal of neuropathology and psychiatry named after S.S. Korsakov. - 1987 , Issue 2. - C, 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. V.M. Bekhterev. - 1992, No. 2.- C.17-28.

Kireeva I.P., Lukyanenko T.E. Psychosocial assistance in pediatric oncohematology//Rehabilitation of children with handicapped In Russian federation. - Dubna, 1992. - S. 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. - S. 287-288.

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

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

Shats I.K. Mental disorders in children with acute leukemia: Abstract of the thesis. dis. cand. honey. Sciences. - L., 1989. - 26 p.

Tsapkin V.N. Unity and diversity of psychotherapeutic experience//Moscow Journal of Psychotherapy. - 1992. - S. 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 oncological diseases between the sexes is approximately the same and averages 1 case per 10,000 healthy babies.

And although childhood cancer is studied quite actively in our time, no one can say with accuracy 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 cannot be said for certain that this or that factor caused oncology, 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.

At the same time, one 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 also have it. So, some very small gene or part of it can carry a factor that will subsequently provoke abnormal cell division. But whether it will show up or not is unknown.

Also, we must not lose sight of the conditions of life around us. Even in the state of the embryo, it is very important what lifestyle the parents lead.

If they smoke, drink excessively, take narcotic substances, do not comply correct mode nutrition, live in a microdistrict polluted with radiation and exhaust gases, the expectant mother does not follow the intake of additional vitamins and microelements necessary for the fetus, then all this may 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 such a bad habit of yours with a crumb. Not only can this cause mutations in the future, but it will simply weaken his body more and more each time.
Irrational nutrition.
Frequent use of medications, their use without medical supervision.
Accommodation in the area increased level radiation; frequent exposures due to medical intervention.
Dust and gas content 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 solar radiation for more than eight hours a day (most often in countries with a hot climate with constant exposure to the street).
Unfavorable psychological background (whether mental load or social problems).

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 at the same time it will have its own characteristics of origin and course, depending on when exactly the mutation occurred. There are three stages in the formation of cancer cells:

Embryonic. The mutation process occurs even in the womb due to non-compliance healthy lifestyle mother's life. Sometimes tumor cells can be transferred across the placenta.
Juvenile. The formation of mutations begins in healthy or partially damaged cells. Brain cancer in children is most common in preschoolers and adolescents.
Tumors of the adult type. 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 ailment in babies, they account 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 oncological diseases come to a specialist in this field extremely late. At the first stage - no more than 10% of patients. Babies diagnosed at this stage are cured for the most part. A significant plus is the use of medicines 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 (ARI, influenza, tonsillitis, etc.). Recognizing the first bells is not easy.

If your child does not have visible symptoms any particular disease, and at the same time he continues to be nervous, whiny, complain of pain or malaise, you should immediately contact a pediatrician to determine the causes.

Common symptoms of cancer in children can include:

lethargy;
fast fatiguability;
an increase in cases of respiratory diseases;
pallor of the skin;
unstable and unprovoked rises in body temperature;
inflammation of the lymph nodes;
apathy;
changes in psychological state;
loss of appetite and fast loss weight.

Types of cancer

Consider some oncological diseases 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 ignored.

If you notice that your baby has a temperature for a long time, he is weak and lethargic, pallor, loss of appetite, weight loss appear, he gets tired quickly and shortness of breath appears at the slightest load, coordination in space and vision began to deteriorate rapidly, and the lymph nodes are constantly inflamed Without infectious diseases, then you should immediately go to an appointment with an oncologist.

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

Tumors of the brain and spinal cord

Tumors of the head 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, it does not cause complaints until the very last stages. But if it is located in the vital areas of the brain and in the spinal trunk, then obvious symptoms will immediately appear:

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

Infants have rubbing of the head and face, crying and screaming due to the fact that they cannot talk about their discomfort. At an older age, manic tendencies may be noted.

From external signs marked enlargement of the head and scoliosis. With damage to the spinal cord, the pain increases in the supine position and subsides while sitting.

And the site of the lesion becomes insensitive. Sometimes there are convulsions.

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 in the third or fourth stage. It mainly affects children aged 6 to 10 years. If suspected, a puncture is prescribed from inflamed node And histological examination punctate to confirm the diagnosis and establish the degree of the disease.

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

The danger of this disease lies in the fact that if warming is prescribed (assuming acute respiratory infections), this will only aggravate the process and accelerate the growth of the tumor.

Nephroblastoma

Nephroblastoma, or a malignant neoplasm in the kidney, is quite common before the age of 3 years. It does not make itself felt for a very long time, and it is often detected during a routine examination, or in an advanced stage, when an increase is noticeable 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, as it is exclusively a childhood ailment. It affects children up to five years of age. The tumor strikes nervous tissue, and her 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. There are swelling of the face and in the neck, when the tumor affects the spinal cord, urinary and stool incontinence is noted. Neuroblastoma very quickly gives metastases in the form of tubercles on the head, which is noted by parents.

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, everything ends with a complete loss of vision.

Diagnostics

Symptoms of oncology in children are difficult to identify. Malignant neoplasms are noticed by chance during the diagnosis of another disease or during preventive examinations.

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

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

Treatment Method

Often, treatment begins at stages 2-3. The recovery process largely depends on how quickly therapy is started. Patients are always placed in a hospital, as their health is monitored around the clock. There is a course of radiation and chemotherapy.

In severe cases, appoint surgical operations. The exception is neuroblastoma: first, an operation is performed and only then prescribed drug treatment to inhibit the growth of cancer cells.

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

In our time, thousands of drugs have been invented, hundreds of studies 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 oncology is suspected, immediately contact a specialist.

Prevention

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

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

Unlike oncological diseases in adults, childhood oncology has its own features and differences:

The vast majority of tumors that occur in children are
Cancer in children is less common than in adults
In children, non-epithelial tumors predominate over epithelial ones.
In pediatric oncology, there are immature tumors capable of maturation.
specific to some malignant formations in children is their ability to spontaneously regress
There is a genetic predisposition to some tumors, in particular, to retinoblastoma, bone chondromatosis and intestinal polyposis.

Causes of Cancer in Children

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

But a number of can cause this genetic failure in the cell. But even here, childhood tumors have their own peculiarities. Unlike adults, children do not have lifestyle-related risk factors such as smoking, alcohol abuse, and work 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 was most likely beyond their power to prevent or prevent this disease.

Factors that increase the risk of developing cancer in a child:

1. Physical factors

The most common physical risk factor is prolonged exposure of the child solar radiation or hyperinsolation. Also, this includes the impact of various ionizing radiation from medical diagnostic devices or as a result of 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 malnutrition child. Use of products with GMOs, carcinogens, eating food in restaurants " fast food". All this entails a decrease in the proper amount of vitamins and trace elements in children's body and savings in it carcinogens, which, in the modern world, are found in abundance not only in food, but also in water with air.

In addition, there is another chemical risk factor, which is often dangerous for children. Many Scientific research proven connection long-term use certain drugs, such as: barbiturates, diuretics, phenytoin, immunosuppressants, antibiotics, chloramphenicol, androgens, with the development of oncological diseases 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, Tony-Debre-Fanconi disease dramatically increases the risk of developing leukemia.

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

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

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. At the heart of his germinal theory is the presence in children of ectopic cells, germs 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 malformations, the blastomatous character 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. That is why it is so important to pay attention to chronic inflammatory diseases in childhood.

Cancer symptoms in children

Children's cancers in early stages almost always go unnoticed by the parents of the sick child.

This is due to the fact that the symptoms of cancer in children are similar to many of the symptoms of harmless childhood diseases, and the child cannot clearly articulate his complaints.

Injuries are also common in children, manifested by various bruises, abrasions, bruises, which can lubricate or hide early signs cancer in a child.

For timely detection of an oncological diagnosis, it is very important for the parents of the child to follow the obligatory passage of regular medical examinations in kindergarten or school. In addition, parents should pay close attention to the appearance of various persistent and unusual symptoms in a child. Children are at risk, as they can inherit genetic changes in the DNA structure from their parents. Such children should regularly undergo medical examinations and be under the vigilant supervision of their parents.

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

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

1. The inexplicable appearance of weakness, accompanied by rapid fatigue.

2. Paleness of the skin.

3. The unreasonable appearance of swelling or seals on the child's body.

4. Frequent and unexplained rises in body temperature.

5. The formation of serious hematomas with the slightest injury and weak blows.

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

7. Uncharacteristic for children, forced position of the body, when bending over, during games or sleeping.

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 when such symptoms appear, you should self-medicate.

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

Cancer Diagnosis in Children

Diagnose presence malignant tumor the child is very difficult. 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 makes it difficult to identify 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 is already beginning to cause various anatomical and physiological disorders in the body.

In the presence of warning symptoms, in order to avoid medical errors, already at the first stage of examination of a sick child, a suspected oncological diagnosis should be displayed in the diagnosis, in addition to other alleged diseases.

A huge responsibility lies with the district pediatrician or pediatric surgeon, they are the first to examine the child and offer an algorithm for further actions. On initial appointment in a pediatrician, it is far from always possible to immediately detect a tumor, therefore, the detection and diagnosis of cancer in children are much more successful when several types of screening tests are carried out at once.

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