The development of oncology in childhood What is childhood cancer? Treatment in pediatric oncology

Annually makes fifteen episodes on each hundred thousand children's lives. In terms of fifteen years of childhood, this means that out of a hundred thousand peers, almost two hundred children fall ill with cancer every year.

There is also more optimistic statistics, according to which most childhood cancers can be successfully treated. This applies to tumors detected at the very initial stage of their development. In the case of advanced diseases, the likelihood of a favorable outcome is significantly reduced.

Unfortunately, the number of children with cancer and admitted to the clinic at the very beginning of the detection of the disease is no more than 10% of the total number of cases. In order for parents not to miss the first alarming signals and show the child to the doctor in a timely manner, they must 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 the result of a pathological process in germ cells.

As a result, uncontrolled growth of mutated cells occurs, the histology of which, nevertheless, indicates their similarity with 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 cancerous tumors occurs in children and adolescents as a result of the formation of cancer cells from completely healthy or partially altered cells.

Malignancy can suddenly touch a polyp, a benign neoplasm, or a stomach ulcer.

Juvenile tumors include:

carcinoma;

Tumors of the adult type

This type of disease is rare in childhood. These include:

carcinomas (nasopharyngeal and hepatocellular);

Why do children get sick?

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

Genetically determined predisposition. Some types of cancer (eg, retinoblastoma) can be traced back to several generations in the same family, although this does not exclude the possibility of having healthy offspring. Cancer is not inherited.
Influence of carcinogenic factors. This concept combines environmental pollution (soil, air and water) with a large amount of industrial waste, the effects of radiation, the effects of viruses, as well as an abundance of artificial materials in the environment of modern apartments.
Carcinogenic factors, affecting the germ cells of the parental couple, damage them and thereby contribute to abnormal intrauterine development of the fetus, the occurrence of a large number of congenital deformities and embryonic cancerous tumors.

Symptoms and signs of oncology by type

Early recognition of anxiety symptoms guarantees not only the complete recovery of the child, but also allows treatment with the most gentle and inexpensive methods.

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

If similar symptoms are found, the parents of a sick baby should show it to a qualified specialist as soon as possible.

Leukemia

Synonyms for this malignant disease of the 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, there is first a displacement, and then a replacement of healthy bone marrow cells with cancerous ones.

The symptoms of leukemia are the following:

fast fatiguability;
lethargy and muscle weakness;
anemic skin;
lack of appetite and a sharp decrease in body weight;
increase in body temperature;
frequent bleeding;
pain in diarthrosis and bones;
a significant increase in the liver and spleen, resulting in an increase in the abdomen;
frequent vomiting;
the presence of shortness of breath;
tangible enlargement of the lymph nodes located in the armpits, on the neck and in the inguinal region;
visual disturbances and unbalanced walking;
tendency to form hematomas and reddening of the skin.

Cancer of the brain and spinal cord

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

unbearable morning headaches, aggravated by coughing and turning the head;
bouts of vomiting on an empty stomach;
impaired coordination of movements;
unbalanced gait;
visual disturbances;
the appearance of hallucinations;
complete indifference and apathy.

Brain cancer is characterized by the appearance of seizures, obsessions and mental disorders. The head of a sick child may increase in size. If you do not show it to the 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 spinal cord cancer:

back pain, aggravated by lying down and subsiding while sitting;
difficulty bending the body;
gait disturbance;
pronounced scoliosis;
loss of sensation in the affected area;
incontinence of urine and feces due to poor functioning of the sphincters.

Wilms tumor

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

Due to the complete absence of complaints, the disease is detected quite by accident, usually during a preventive examination.

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

Neuroblastoma

This type of cancer affects only the children's sympathetic nervous system. In the vast majority of cases, it occurs in children under the age of five. The place of localization of the tumor is the abdomen, chest, neck, small pelvis, bones are often affected.

Characteristic signs:

limping, complaining of bone pain;
increased sweating;
prostration;
skin blanching;
elevated temperature;
disruption of the intestines and bladder;
swelling of the face, pharynx, swelling around the eyes.

Retinoblastoma

This is the name of a malignant tumor of the eye 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 of severe pain in it.
Some children develop strabismus, while others develop a symptom of a glowing "cat's eye", due to the protrusion of the tumor beyond the lens. It can be seen through the pupil.

Rhabdomyosarcoma

This is the name of a cancerous tumor of the connective or muscle tissues that affects infants, preschoolers and schoolchildren. Most often, the localization of rhabdomyosarcoma is the neck and head, somewhat less often - the urinary organs, the region of the upper and lower extremities, less often - the trunk.

Signs:

painful swelling at the site of injury;
"rolling out" of the eyeball;
a sharp decrease in vision;
hoarse voice and difficulty swallowing (with localization in the neck);
prolonged pain in the abdomen, the presence of constipation and vomiting (with damage to the abdominal cavity);
yellowness of the skin (with cancer of the bile ducts).

osteosarcoma

It is a cancer that affects the long bones (shoulders and femurs) of adolescents. The leading symptom of osteosarcoma is pain in the affected bones, which tends to get worse at night. At the beginning of the disease, the pain is short-lived. A few weeks later, visible swelling appears.

Ewing's sarcoma

This ailment, characteristic of adolescents 10-15 years old, is a scourge for the tubular bones of the upper and lower extremities. There have been rare cases of damage to the ribs, shoulder blades and clavicles. To the symptoms characteristic of, a sharp 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 disappear and then reappear;
sometimes there is itching, profuse sweating, weakness, fever.

Diagnostics

Satisfactory well-being of babies, which is typical even for the late stages of cancerous tumors, is the main reason for their late recognition.

Therefore, regular preventive examinations play a huge role in the timely detection and 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 based on the results of a biopsy (a sample of tumor tissue). Histology allows you to determine the stage of cancer. The tactics of further treatment depends on the stage. In case of cancer of the hematopoietic organs, a bone marrow puncture is taken.

Treatment

The treatment of childhood cancerous tumors 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 by methods and. All other types of tumors are treated surgically.
After discharge from the clinic, a long course of therapeutic treatment follows, followed by rehabilitation.

Consequence

Children's oncology is treated better than adults.

To date, doctors manage to save 90% of children with kidney cancer, over 76% of children with oncology of soft tissues and bones, and retinoblastoma is cured by 100%. This is a consequence of the enormous potential of young organisms.

The probability of a complete cure, of course, directly depends on the timeliness of the treatment started, but there are cases of healing of patients even with the fourth stage of a cancerous tumor.

Every year, more than 200,000 children in the world are diagnosed with cancer, and half of them die. A tenth of cancer cases are detected only at the third stage, and in 8% of children, cancer is diagnosed at the fourth stage, which complicates treatment and reduces the chance of survival.

We talked about the difficulties of diagnosing oncology in children, the reasons for the increase in incidence and the role of parents in the treatment process with the chief pediatric oncologist of the Ministry of Health, deputy director of the Research Institute of Pediatric Oncology of the Blokhin Russian Cancer Research Center Vladimir Polyakov.

Maya Milic, AiF.ru: Do you and your colleagues tend to increase the number of young patients?

Vladimir Polyakov: Yes, such a trend can be traced. More noticeable processes occur in adults, the number of cancer patients is increasing, cancer is getting younger, people aged 20-25 have begun to get sick. An increase in the incidence in children is also noted in all countries of the world, including ours. But in Russia, this is partly due to the improvement of statistics - that is, the numbers are also growing due to better registration of cases.

- What can explain the increase in morbidity?

Exclusively environmental factors. Where the environment is poor, the number of malignant tumors in children is higher than in more favorable regions. But I would like to note that the incidence of any diseases among children has generally increased, including infections, allergic reactions, and much more. All the negative factors of living, nutrition, unfavorable psychological environment affect people. The way of life of parents strongly affects - the health of children directly depends on how they behave, how they live, whether they drink, whether they smoke, whether they eat right. Now the health of the population as a whole is worse, so children are born weaker. If we take the statistics according to the Apgar scale (a system for quickly assessing the condition of a newborn - ed. note), then children were born with 9-10 points before, and now - 8-7. That is, the general background is worse.

- Is it possible to talk today about the possibility of preventing cancer in children?

It is possible, but here it is important to talk more about how adults live. The health of young children depends on their parents. All the diseases suffered by a woman during pregnancy, work in hazardous industries, and the place of residence of the expectant mother affect. There are some data indicating a relationship between the incidence of malignant tumors in children and previous abortions. The age of a woman when she gives birth to a child also matters - the later, the greater the likelihood of a neoplasm. Therefore, it is good when a woman gives birth at the age of 19-20, but taking into account the current trend towards socialization and self-realization in life, people think about children late. All the same factors apply to men, except that they more often abuse alcohol, tobacco, and eat improperly. Everything that is generally not good, and can become a factor in the development of malignant tumors.

In adolescence, the disease is provoked by injuries, surges of hormones, all past illnesses, stresses, even unhappy love may not be in vain. They, like adults, are dependent on the environment and are influenced by it.

Why do children get cancer? What are the theories about this?

Any of the factors triggers a mechanism that disrupts normal cell division. Today there are different theories - why exactly the mechanism of formation of cancer cells is triggered. The main ones are chemical and viral theories. The chemical one speaks of the influence of environmental factors, and the viral one indicates that the virus, entering the body, affects the cell in such a way that it unlocks the possibilities of its tumor transformation. That is, the virus affects the immune system in such a way that it cannot stop this division. But these are just theories. If we knew exactly the nature of cancer, we could move to another level of treatment. But so far we have only means that can save a child from cancer - these are chemotherapy, radiation and surgical types of exposure, immunotherapy, and now cancer biotherapy is being developed.

Photo: RIA Novosti / Vladimir Pesnya

What tumors are most common in children?

If we take all tumors as 100%, then about half of them are malignant tumors of the circulatory tissue, the most common form is acute lymphoblastic leukemia, which, fortunately, we have learned how to effectively treat. A slightly larger proportion are tumors of a solid nature - these are tumors of soft tissues, bones, liver, kidneys, retina, thyroid gland and other organs. Among all solid tumors, brain tumors predominate. Treatment options for different malignant neoplasms are not the same. Something is treated more successfully, something is worse, but in general, if we take all patients, then 80% of patients recover.

- Do many children come to you in a state of disrepair?

This problem is huge and intractable. Even in those countries where medicine is at a very good level, children often end up in the department in critical condition. In smaller countries, this problem is less relevant. Firstly, there is less population, and secondly, it is getting closer, it is easier to get to a specialized center and check the reasons for the child’s poor health.

We have this problem because of the large territory. Until a child from a distant village gets to the district center, and then to the regional center, time passes. There is no pediatric oncologist service in regional centers, so at this level it is very difficult to understand that a child is developing a malignant tumor at the initial stages.

Pediatricians rarely encounter malignant tumors, so specific symptoms may simply not be recognized. A negative role is played by the absence of oncological alertness. Children now have a big load, so, for example, a headache or fatigue may not alert.

At the same time, oncological diseases are often disguised as other diseases, such as respiratory infections. It is necessary to sound the alarm when the disease does not respond to standard methods of treatment. But often the child is treated to the last, until they understand that the disease is atypical. In unclear situations, it is always better to immediately assume the worst of all diagnoses. After all, the smaller the stage, the easier and more effective the treatment.

Often, late detection of cancer is associated with parents' dislike for visiting a doctor in a polyclinic, parents do not like to take their children there because of queues and the spread of infections.

- How can parents understand the severity of a child's illness in time?

There are no exact initial signs, most often they are masks of other diseases. For example, if respiratory diseases recur or proceed atypically, this is already a reason to be wary. As a rule, the development of the disease is accompanied by increasing lethargy, weakness, irritability, refusal to eat, weight loss, decreased activity, increased fatigue - all this is the reason for contacting doctors. Anything can be the cause of this condition, especially since many tumors in children have hidden localization. In any case, it is better to call a doctor at home or seek advice. A competent doctor will always suspect something, offer additional research.

What role do parents play in the treatment process?

Many parents find it difficult to bear the news of their child's illness, they do not understand what to do next, how to live. But when they get to the department, it becomes easier - they see that they are not alone with such a misfortune, they are not alone in their misfortune, and it becomes easier. They see that someone is being treated, someone is better - this gives hope and strength to fight.

We also have psychologists working with parents and older children. Little children often do not understand what exactly they are sick with, but teenagers are aware of themselves, their future, and the struggle for a good psychological attitude is just as hard for them as for adults.

Parents should always be at one with the doctor. When there is good contact with the doctor, there is trust and mutual respect, then you are already fighting together, there is a harmonious alliance. If this is not the case, then the treatment is mechanistic. The attention of parents, their obedience and the implementation of all doctor's recommendations are important. The role of the mother in the treatment is very important, especially considering that there are often not enough medical care staff.

And who will take care of the child better than a mother? All of our mothers are with their children. Although by law, children over 4-5 years old must be in the hospital without their parents. And we even have teenagers with their mothers, this is important not only from a technical point of view, for example, for hygienic care for a child, but also from a moral point of view. Parents carefully monitor the condition of their children, they may be the first to notice something, pay attention to complaints or behavioral characteristics of the child and turn to medical staff for advice or help in a timely manner.

Pediatric oncology differs significantly from adult oncology both in the nature of tumors (cancer tumors are almost never found) and in their localization (tumors of the lungs, gastrointestinal tract, breast, and genitals are extremely rare). In children, mesenchymal tumors predominate: sarcomas, embryomas, and mixed ones.

In the first place are tumors of the hematopoietic organs (leukemia, lymphogranulomatosis), then the head and neck (retinoblastoma, rhabdomyosarcoma), retroperitoneal space (neuroblastoma and Wilms tumors) and, finally, bones and skin (sarcoma, melanoma).

Despite the fact that in children, as in adults, the division of tumors into benign and malignant remains, such a distinction, as well as the isolation of true tumors from tumor-like processes and malformations, is extremely difficult due to their biological commonality and the presence of transitional forms.

One of the possible reasons for the development of tumors in children is the existence of ectopic embryonic cells that have the potential for malignant transformation.

It is also impossible to exclude the significance of a long-term focus of inflammation, viruses, as well as mutations that change the biochemical structure of the cell. An important place belongs to ionizing radiation, and the influence of trauma, which apparently plays the role of not a causal, but a provoking factor, is also not completely excluded.

The age of children suffering from tumors gives a sharp rise in the curve to 3-6 years in a graphical representation, although observations of malignant tumors in newborns are known. There is an opinion that each age of the child has its own type of tumor. Thus, dysoitogenetic formations (Wilms tumor) are characteristic of children under the age of 2 years. Lymphogranulomatosis, brain tumors occur in children from 2 to 12 years old, bone tumors often appear by the age of 13-14. This is due to the peculiarity of metabolism and physiological functions that change with age.

An important endogenous factor is hormonal influences, which determine the different frequency of individual forms of tumors in boys and girls. In boys, malignant tumors of the lymphatic apparatus are more often noted, and from benign forms - angiofibroma; girls are more likely to develop teratomas and hemangiomas.

A special feature for some neoplasms (hemangioma, juvenile papilloma, neuroblastoma, retinoblastoma) is their ability to spontaneous regression, which is explained by the fact that these tumors are the last stage of prenatal disorders, after the removal of which regression begins in the postnatal period.

One of the most important features of childhood tumors is the existence of a family predisposition to certain neoplasms (retinoblastoma, chondromatosis, intestinal polyposis). Establishing a history of such burdened heredity facilitates the timely recognition of these tumors and outlines ways to prevent them.

The course of malignant tumors in children is extremely peculiar. Thus, obviously malignant tumors (Wilms' tumor, neuroblastoma) can behave as benign ones for a long time: the capsule and surrounding tissues do not germinate. At the same time, being easily removed, they can metastasize. On the contrary, benign tumors - hemangiomas, which are based on a malformation of peripheral vessels, have infiltrating growth, can germinate neighboring organs, destroying them, and are removed with great difficulty.

The course of malignant tumors in children varies from rapid, with dissemination within a few weeks, to torpid, which is determined by the biological potency of the tumor, its localization and the overall resistance of the organism. A malignant tumor, regardless of the type and nature of the growth of the local focus, at a certain stage of development is manifested by regional or distant metastases. Sometimes the process of metastasis proceeds rapidly, according to the type of generalization.

Although the existence of general or local immunity has not yet been conclusively proven, the presence of certain protective properties of the body is beyond doubt. This is confirmed by the uneven development of the tumor, the detection of emboli in various organs that do not metastasize, and, finally, cases of spontaneous regression of the tumor.

The issues of early diagnosis in pediatric oncology are the most important among all others. The pediatrician must remember that behind the inexplicable symptoms, the atypical course of the disease, a neoplasm may be hidden, and it must be excluded in the first place. Each examination of a child by a doctor should be carried out from the standpoint of oncological alertness.

Oncological alertness of a pediatrician includes the following points:

1) knowledge of the early symptoms of tumors that are most common in childhood (5 main localizations - hematopoietic organs, bones, retroperitoneal space, central nervous system, eyes);
2) knowledge of precancerous diseases and their detection;
3) prompt referral of the child to a specialized institution;
4) a thorough examination of each child who visits a doctor of any specialty to identify a possible oncological disease.

It is known that the cause of neglected cases in pediatric oncology, along with the lack of personal experience of doctors due to the relative rarity of neoplasms in children, is also the atypical course of the initial stage of the disease. So, under the guise of pains in the lower extremities, which are typical for the period of growth of a child, the initial stages of leukemia can be hidden, the “enlarged” liver and spleen, upon close examination, turn out to be a tumor of the retroperitoneal space.

For the purpose of diagnosis, the simplest methods of investigation are used - examination and palpation. The condition of the lymph nodes, kidney areas, skull, eyes, tubular bones is consistently carefully studied. Some supporting data can be obtained from a laboratory study (anemia, increased ESR, changes in the concentration of catecholamines). The study is being completed in the clinic using radiological methods (plain radiographs of the bones, excretory urography) and puncture biopsy. If necessary, the study (instrumental methods, angiography) ends in a hospital.

The possibility of malignant degeneration with such defects as a teratoid tumor, xeroderma, intestinal polyposis, and some types of age spots has been proven. Removing them in children is the prevention of neoplasms in adults. In addition to the removal of benign tumors, which are the background for the development of a malignant neoplasm, measures to prevent tumors in children are:

1) identification of family predisposition to certain forms of tumors;
2) antenatal protection of the fetus (elimination of all kinds of harmful effects on the body of a pregnant woman).

Diagnosis of tumors in children is always closely related to issues of deontology. On the one hand, parents should be well aware of the child's condition and the danger of delaying hospitalization, on the other hand, they should not lose hope of providing real help to their child. When communicating with children, it must be taken into account that sick children are especially observant, they quickly begin to understand the terminology and can realistically assess the threat to their health and even life. This requires a careful, tactful, attentive attitude towards sick children.

The choice of treatment method is determined by the nature and prevalence of the tumor process, the clinical course and the individual characteristics of the child. Surgical intervention, which is the main method of treatment, is carried out in compliance with two principles: the radical nature of the operation and the obligatory histological examination of the removed tumor. It should be noted that the criteria for malignancy of tumors in childhood are relative [Ivanovskaya TI, 1965].

Along with the surgical method, radiation treatment and chemotherapy are used in pediatric oncology. The last two methods are prescribed only when an accurate diagnosis is established.

The use of combined treatment, an expanding range of chemotherapy drugs allow a significant part of children (up to 44-60%) to survive for more than 2 years without relapses and metastases, which is equivalent to 5 years in adults and gives hope for a full recovery.

Poor outcomes largely depend on incorrect and late diagnosis, which is explained by the poor oncological alertness of pediatricians and surgeons, the lack of knowledge of most childhood neoplasms, and the difficulty of diagnosis. A huge role in the prevention of neglected forms should be played by sanitary and educational work among the adult population, aimed at ensuring the timely appeal of parents with children for advice and treatment.

Isakov Yu. F. Children's surgery, 1983

In recent years, much attention has been paid to the organization of specialized oncological care for children. Pediatric oncology departments and clinics have been set up in major cities. This is due to the fact that tumors of childhood have their own characteristics in the frequency of lesions of certain organs, clinical symptoms and the course of the process, as well as methods of recognition and treatment, which significantly distinguish them from adult tumors.

According to most statistical data, in all countries there is an absolute increase in the incidence of tumors in children, including malignant ones. Among the various causes of death in children aged 1 to 4 years, malignant tumors are in third place, moving to the second place in the older age group and second in frequency only to deaths from accidents.

If in adults 90% of tumors are associated with the influence of external factors, then for children genetic factors are somewhat more important.

Approximately one third of cases of malignant neoplasms in children are leukemias or leukemias.

Of the environmental factors, the most significant are:

Solar radiation (excess ultraviolet)
Ionizing radiation (medical exposure, indoor radon exposure, exposure due to the Chernobyl accident)
Smoking (including passive)
Chemical agents (carcinogens contained in water, food, air)
Nutrition (smoked and fried foods, lack of the proper amount of fiber, vitamins, trace elements)
Medicines. Drugs with proven carcinogenic activity are excluded from medical practice. However, there are separate scientific studies showing the relationship of long-term use of certain drugs (barbiturates, diuretics, phenytoin, chloramphenicol, androgens) with tumors. Cytostatics used to treat cancer sometimes cause the development of secondary tumors. Immunosuppressive drugs used after organ transplantation increase the risk of developing tumors.
Viral infections. Today, there are a large number of works proving the role of viruses in the development of many tumors. The best known are Epstein-Barr virus, herpes virus, hepatitis B virus)

A special role is given to genetic factors. Today, about 20 hereditary diseases with a high risk of malignancy are known, 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, neurofibromatosis dramatically increase the risk of developing leukemia. Down's syndrome and Klinefelter's syndrome also increase the risk of leukemia.

Depending on age and type, there are three large groups of tumors that occur in children: embryonic tumors, juvenile tumors, and adult-type tumors.

Embryonic tumors

Embryonic 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 (neuroectoderm tumors); hepatoblastoma; germ cell tumors; medulloblastoma; neuroblastoma; nephroblastoma; rhabdomyosarcoma; retinoblastoma.

Juvenile tumors

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.

Tumors of the adult type

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

DIAGNOSIS IN CHILDREN'S ONCOLOGY

Timely diagnosis of any tumor largely determines the success of the upcoming treatment.

The main tasks of diagnostics include:

Establishing the localization, size and prevalence of the process, which allows you to determine the stage and prognosis of the disease.
Determination of the type of tumor (histological, immunochemical, genetic)

Despite the apparent simplicity, the diagnostic process can be quite complex, multicomponent and very diverse.

For diagnostics in pediatric oncology, the whole range of modern clinical diagnostic and laboratory research methods is used.

There is a whole range of symptoms that make it possible to suspect a tumor process. For example, leukemia is characterized by pallor and fatigue, sometimes swelling of the neck and face, fever with bone pain, etc. Lymphogranulomatosis is characterized by a decrease in body weight, the appearance of swelling on the neck. For osteosarcoma - lameness, for retinoblastoma - a luminous pupil, etc.

Ultrasonic method diagnostics can provide a fairly large amount of information about the tumor process: - involvement of vessels and lymph nodes in the tumor process - determination of the nature of the tumor, its density, size - detection of metastases

X-ray methods can be divided into radiographic and tomographic. To determine the prevalence of the process, the size of the tumor and some other parameters, survey images are used: chest radiography in two projections, survey radiography of the abdominal cavity, radiography of the extremities, skull, individual bones. Sometimes intravenous urography is used (for example, with Wilms' tumor).

The most informative X-ray method is computed tomography (CT, CT). With its help, you can evaluate many parameters of tumor growth related to localization, size, nature of growth, the presence of metastases.

in pediatric oncology CT is indicated for the detection of small metastases, and therefore is of value in the examination of patients with germ cell tumors, sarcomas, liver tumors, Wilms' tumor. Due to the high resolution, lower radiation doses in modern devices, CT is also used to determine the effectiveness of treatment.

Magnetic resonance imaging (MRI). As effective and informative imaging method as CT. Unlike the latter, it has its advantages and disadvantages. MRI is ineffective in detecting bone tumors, tumors of the posterior cranial fossa, and the base of the skull. However, soft tissue tumors are visualized very contrastingly and sometimes better than with CT. MRI, as well as CT, is often used with the use of contrast agents that increase the sensitivity of the method.

Radioisotope diagnostic methods in children are mainly used to detect bone tumors, lymphoproliferative tumors, neuroblastomas, as well as to conduct some functional tests.

Microscopy. There are optical, electron and laser microscopy. Microscopy requires preliminary preparation of the test material, sometimes quite long. The most common is light microscopy, which allows to determine the cellular and tissue composition of the tumor, the degree of malignancy, the nature of growth, the presence of metastases, etc. Electron and laser microscopy is necessary only for some types of tumors for differential diagnosis and more accurate verification.

Immunofluorescent analysis. The method is based on the detection of a luminous antigen-antibody complex using specific monoclonal antibodies with luminous marks against antigens of tumor cell membranes. Allows you to diagnose various subtypes of a particular pathology by the expression of a certain trait that can be detected by this method. Widely used in the diagnosis of leukemia.

Linked immunosorbent assay. Similar to immunofluorescent, but enzyme labels are used instead of glowing labels.

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

cytogenetic analysis. The first genetic marker of a tumor was described in 1960 and was called the "Philadelphia chromosome", because. the researchers worked in Philadelphia. Today, many specific and nonspecific genetic markers of tumors characteristic of a particular pathology have been described. As a result of the development of this diagnostic method, it becomes possible to identify a predisposition to the development of a tumor, as well as early detection of pathology.

Southern blotting. Estimates the number of copies of a gene in a cell. It is rarely used due to the high cost of research.

Polymerase chain reaction (PCR, PCR). A very common method for assessing genetic information in DNA with very high sensitivity. The list of methods does not end there. The use of other methods, as well as most of those listed, is determined by the specific tasks of diagnosis and the characteristics of the disease.

TREATMENT IN PEDIATRIC ONCOLOGY

Treatment options for pediatric oncology are similar to those for adult patients and include surgery, radiation therapy, and chemotherapy.

But the treatment of children has its own characteristics.

In the first place they have chemotherapy, which, thanks to the protocol method of treating diseases and its constant improvement in all economically developed countries, becomes the most gentle and most effective.

Radiation therapy in children should have a strict justification, tk. may have implications for the normal growth and development of exposed organs.

Surgery today it usually complements chemotherapy and precedes it only in neuroblastomas.

Quite widely used new low-traumatic surgical techniques (tumor vascular embolization, isolated vascular perfusion, etc.), as well as some other methods: cryotherapy, hyperthermia, laser therapy. A separate type of intervention is stem cell transplantation, which has its own list of conditions, indications and contraindications, as well as hemocomponent therapy.

After the main course of treatment, patients need rehabilitation, which is carried out in specialized centers, as well as further observation, the appointment of maintenance therapy and the implementation of medical recommendations, which together allow successful treatment in most cases.

Pediatric oncology has its own characteristics, which require certain knowledge, high professionalism, the ability to think creatively, empathize, provide maximum assistance to a sick child and cooperate with his relatives from a doctor and nurse.

The occurrence of malignant neoplasms in children is associated with the adverse effect of various factors on pregnancy. Dangerous carcinogens that enter the fetus through the placenta: nitrosamines, nitrosoamides, N-nitrosourea. Many drugs are mutagenic and carcinogenic. The risk of developing a tumor in a child increases with irradiation of pregnant women.

Thus, many malignant neoplasms in children are "programmed" during pregnancy. The older the mother, the higher the chance of having a child with a tumor. So, in the first trimester of pregnancy, carcinogenic substances penetrating the placenta have an embryotoxic effect, in the second - teratogenic, in the third - carcinogenic. This division is to some extent arbitrary: in children, there are combinations of tumors with malformations, such as nephroblastoma with aniridia, lymphocytic leukemia with Down's disease.

The occurrence of many congenital tumors in children (eg, nephroblastoma and retinoblastoma) is closely related to genetic predisposition. About 100 genetically determined and predisposing to the development of oncological syndromes in children have been described.

The structure of malignant neoplasms in children is as follows: leukemias, malignant lymphomas and brain tumors predominate (60-65% in total), neuroblastomas, nephroblastomas, retinoblastomas, tumors of bones, soft tissues, etc.

Features of the tumor process in combination with the anatomical, physiological and psychological characteristics of children pose complex challenges for the nurse. The first difficulties arise when collecting an anamnesis in young children. Complaints may be absent or be mean, vague. We have to resort to the help of parents and close relatives of a sick child. Even older children often try to hide some of the manifestations of the disease due to fear of hospitalization and examination. Others, on the contrary, are prone to aggravation - exaggeration of individual symptoms in order to arouse pity, sympathy, and attract attention.

The most common malignant neoplasms in children are localized in the retroperitoneal space and mediastinum; cervical, supraclavicular, axillary, inguinal lymph nodes, soft tissues of the extremities and skull bones are often affected. There are very few visually observed tumors. General symptoms of oncological diseases in children prevail over local ones, weight loss, pallor of the skin and visible mucous membranes, subfebrile temperature, behavioral changes, nausea, vomiting, a decrease in the concentration of hemoglobin in the blood (anemia), and an increase in ESR are observed.

The doctor and nurse should know some of the deontological features of pediatric oncology. As a rule, most parents treat a malignant neoplasm in a child as a fatal disease. At the same time, the population knows almost nothing about the fact that in children the results of tumor treatment are much better than in adults. Having received news of a child's illness, parents often change their attitude towards each other, towards the child, towards the surrounding reality, mental disorders often appear. In this regard, the doctor and nurse, when meeting with a sick child and his parents, adhere to some rules based on extensive experience in pediatric oncology. They cannot be standard in all cases, they can be adjusted depending on various reasons: the age of the child, the personality and intelligence of the parents, the characteristics of the relationship in the family to the sick child, etc. You should know the following rules:

the first meeting with parents is of great importance for further examination and treatment. Parents should be sure that the diagnosis will be established as soon as possible in this medical institution. The final diagnosis should be reported only if the doctor is completely sure of it. The first meeting, as well as subsequent ones, should inspire hope in parents, but should not give unjustified hopes;
after establishing an accurate diagnosis, during a second meeting, you need to tell in detail about the disease and methods of its treatment. At the same time, one cannot hide a possible unfavorable outcome, but one must focus on the possibility of a cure. It is necessary to convince parents of the need for cooperation, since the success of treatment largely depends on this. It is impossible to take away the hope for a cure in any cases, except for the terminal ones;
in the terminal stage of cancer, the child needs to be given maximum assistance. Even in hopeless cases, hope glimmers in the souls of parents. Parents should see that everything possible is being done for their child;
when talking with parents, one should gradually, taking into account their level of knowledge about medicine, give information about the diagnosis, methods of examination and treatment of the child. Parents should know that they are waiting for severe trials, a difficult struggle for the life of a child. They should be informed about all possible complications and side effects of the treatment; they should be urged to conserve their strength and convinced that medical workers will always be allies in this struggle;
the nurse (with the permission of the doctor) is obliged to inform the parents in the course of treatment about all the means used, the course of the disease and guarantee the use of all possible modern methods. Parents must be sure that they can at any time receive information about everything that interests them;
it is necessary to convince parents to properly treat a sick child: not to single him out among other children in the family, not to make his position exceptional and not to change his living conditions drastically, not to tear him out of his usual social circle;
in the terminal stage of the oncological process, family members need support just as much as a sick child. Medical personnel must maintain courage, provide psychological assistance to parents who are next to a dying child.

The work of a nurse in a pediatric oncology department is extremely difficult, but she must not lose faith, patience and courage in the fight for the life of a child. It is necessary to use any, even the smallest chance. The source of strength in this work is the encouraging progress in the treatment of malignant neoplasms in children in recent years.

Treatment of oncological diseases in children, as well as in adults, involves surgery, radiotherapy and chemotherapy with high sensitivity of most malignant neoplasms to ionizing radiation and polychemotherapy. In order to prevent these diseases in children, pregnant women must strictly observe general hygiene measures, eat right, avoid smoking, contact with carcinogenic, harmful household and industrial substances, prolonged sun exposure and uncontrolled use of medicines.

Table 12

Examples of activities carried out by a nurse in organizing care for children with cancer

The end of the table. 12