Oncology in children: specificity and treatment

Children’s oncology is a field of medicine that is engaged in the study, diagnosis and treatment of malignant neoplasms that develop in the body of children and adolescents under the age of 18 years. Unlike adult types of cancer, children’s oncological diseases have unique biological characteristics, causes, diagnostic methods and treatment protocols. Understanding these specific features plays a key role in increasing the effectiveness of therapy and improving the prognosis for small patients.

Differences in child oncology and adults

The key differences between children’s and adult oncology are the following aspects:

Types of cancer: In adults, carcinomas (cancer of epithelial tissues) prevail, developing as a result of prolonged exposure to environmental and lifestyle factors. In children, embryonic tumors, sarcomes and leukemias arising from cells remaining from intrauterine development are most common. These tumors include neuroblastoma, nephroblastoma (tumor of Willias), retinoblastoma, hepatoblastoma, rabdomyosarcoma and osteosarcoma.
Causes: In the development of cancer in adults, factors associated with the way of life (smoking, alcohol, diet, exposure to ultraviolet radiation), as well as accumulated genetic mutations, play a significant role. In children’s oncology, external factors have less influence. The main reasons are genetic mutations (spontaneous or hereditary), disorders in the immunity system and the effects of certain teratogenic factors during pregnancy.
Growth and metastasis rates: Children’s tumors, as a rule, grow faster and often more sensitive to chemotherapy and radiation therapy than tumors in adults. However, they can also quickly metastasize, which requires early diagnosis and aggressive treatment.
Answer to treatment: Children, in general, better tolerate intensive therapy and have a higher percentage of cure compared with adult patients. This is due to a more active tissue regeneration and a more effective operation of the immune system.
Long -term consequences: Despite the higher survival rate, children who have undergone oncological diseases are at risk of developing long -term treatment of treatment, such as growth and development disorders, endocrine disorders, infertility, cardiotoxicity and secondary tumors. Therefore, it is necessary to carry out regular monitoring and supporting therapy after the completion of treatment.

The main types of children’s oncological diseases

The most common types of cancer in children include:

Leukemia (leukemia): This is a malignant disease of the hematopoietic system, in which abnormal blood cells that displace normal cells are formed in the bone marrow. Leukemias are divided into acute (acute lymphoblastic leukemia – ll, acute myelobilic leukemia – oml) and chronic (are extremely rare in children). Oll is the most common type of leukemia in children.
Tumors of the brain and central nervous system: This is the most common group of solid tumors in children. They can be benign or malignant and arise in various parts of the brain and spinal cord. These include gliomas (astrocytomas, ependemics, oligodendrogliomas), medical -fraud, craniopharymias and others.
Lymphomas: These are malignant tumors of the lymphatic system that affect the lymph nodes, spleen, bone marrow and other organs. Distinguish between Hodgkin’s lymphoma and non -Kindkin lymphomas.
Neuroblastoma: This is a tumor developing from immature nerve cells (neuroblasts). It most often occurs in the adrenal glands, but can also develop in other parts of the body.
Wilms tumor (nephritoma): This is a malignant kidney tumor, most often found in children under 5 years of age.
Rabdomiosarcoma: This is a malignant tumor developing from skeletal muscles. It can occur in any part of the body, but most often found in the head, neck, limbs and genitourinary system.
Osteosarcoma: This is a malignant bone tumor, most often affecting the long bones of the limbs (femoral, tibia, shoulder).
Sarcoma Ying: This is a malignant tumor of a bone or soft tissue, most often found in adolescents and young people. She can hit the bones of the pelvis, hips, lower legs, ribs and others.
Retinoblastoma: This is a malignant retinal tumor of the eye, most often found in children under 5 years of age. It can be hereditary or sporadic.
Hepatoblastoma: This is a malignant liver tumor, most often found in children under 3 years of age.

Risk factors

Although the exact causes of cancer in children in many cases remain unknown, some risk factors are determined that can increase the likelihood of developing the disease:

Genetic factors: The hereditary predisposition plays a significant role in the development of some types of cancer, such as retinoblastoma, the tumor of Wilms, Li-Frameni syndrome (increased risk of developing various types of cancer).
Congenital anomalies: Children with certain congenital anomalies, such as Down syndrome, neurofibromatosis, Bekvita-videman syndrome, have an increased risk of developing certain types of cancer.
Immunodeficiency states: Children with congenital or acquired immunodeficiency (for example, HIV infection, organs transplantation) have an increased risk of developing certain types of cancer, especially lymphomas.
The impact of ionizing radiation: The impact of ionizing radiation during pregnancy or in early childhood can increase the risk of leukemia and other types of cancer.
The effect of chemicals: The effect of certain chemicals, such as benzene, can increase the risk of leukemia.
Mother’s age: The increased age of the mother during pregnancy can be associated with an increased risk of developing certain types of cancer in children.
Infections: Some viral infections, such as the Epstein-Barr virus (VEB), can be associated with the development of some species of lymphomas.

Diagnostics

Early and accurate diagnostics is crucial for the successful treatment of child cancer. The diagnostic process includes the following stages:

Anamnesis collection and physical examination: The doctor collects information about the complaints of the child, the medical history, the family history and conducts a thorough physical examination to identify the signs and symptoms indicating the presence of a tumor.
Laboratory research:
- General blood test: Allows you to evaluate the number of blood cells (red blood cells, leukocytes, platelets) and identify signs of anemia, leukopenia or thrombocytopenia, which may indicate leukemia or other diseases of the bone marrow.
- Biochemical blood test: Allows you to evaluate the function of the liver, kidneys and other organs, as well as identify signs of tumor damage.
- Urine analysis: Allows you to evaluate the function of the kidneys and identify the presence of tumor cells.
- Bone marrow research (myelogram): It is an important method for diagnosing leukemia and other bone marrow diseases. It is carried out by puncture of the bone marrow (usually from the iliac) and the subsequent study of the obtained material under the microscope.
- Cytogenetic research: Allows you to identify chromosomal abnormalities that can be associated with the development of certain types of cancer.
- Molecular genetic studies: Allow you to identify mutations in genes that can be associated with the development of certain types of cancer and determine the prognosis of the disease.
- Determination of tumor markers: In the blood or urine, specific substances (tumor markers) that are produced by tumor cells can be found. The level of these markers can be increased in the presence of a tumor and used to monitor the effectiveness of treatment.
Instrumental research methods:
- Radiography: It is used to identify tumors in the bones, lungs and other organs.
- Ultrasound examination (ultrasound): It is used to visualize internal organs (liver, kidneys, spleen, lymph nodes) and detect of tumors.
- Computed tomography (CT): Allows you to obtain detailed images of internal organs and tissues and identify tumors, their size, localization and distribution.
- Magnetic resonance tomography (MRI): Allows you to get images of high resolution of the soft tissues, brain, spinal cord and other organs and identify tumors, their dimensions, localization and distribution.
- Positron emission tomography (PET): It is used to identify tumor cells in various organs and tissues, as well as to evaluate the effectiveness of treatment. Often PET is combined with CT (PET-KT) to obtain more accurate information about the localization and activity of the tumor.
- Bones scintigraphy: Used to detect metastases in bones.
Biopsy: It is the most accurate cancer diagnosis method. During the biopsy, a sample of tumor fabric is taken for subsequent research under a microscope. The biopsy can be performed in various ways, depending on the localization of the tumor: surgical biopsy, puncture biopsy, trepan-biopsy.

After all the necessary diagnostic procedures, the diagnosis is established and the stage of the disease is determined. The stage of the disease determines the degree of spread of the tumor and is an important factor that determines the choice of treatment tactics and prognosis.

Methods of treatment

Treatment of children’s oncological diseases, as a rule, is comprehensive and includes a combination of various methods:

Surgical treatment:
- Tumor removal: Surgical removal of a tumor is the main method of treating many types of cancer. The aim of the operation is to complete the tumor removal with the preservation of, if possible, the functions of the affected organ.
- Biopsy: To establish a diagnosis and determine the type of tumor.
- Installation of the port system: To facilitate chemotherapy and other intravenous infusion.
- Removal of metastases: If the tumor has spread to other organs, the removal of metastases may be required.
Chemotherapy:
- System chemotherapy: The use of antitumor drugs that are administered intravenously or orally and spread throughout the body, destroying tumor cells.
- Intracathel chemotherapy: The introduction of antitumor drugs directly into the cerebrospinal fluid to treat tumors of the brain and spinal cord or to prevent their spread into the central nervous system.
- Highly dosage chemotherapy with stem cell transplantation: The use of very high doses of chemotherapy to destroy tumor cells, after which stem cells are transplanted to restore the hematopoietic system.
Radiation therapy (radiotherapy):
- External radiation therapy: The use of high-energy radiation (x-rays, gamma rays) to destroy tumor cells. The radiation is directed to the tumor using a special apparatus.
- Internal radiation therapy (brachytherapy): The introduction of a radioactive source directly into the tumor or next to it.
Stem cell transplantation (TSK):
- Autological TSC: The use of the patient’s own stem cells who are collected, frozen and returned to the patient after highly dosage chemotherapy.
- Allogue TSC: Using stem cells of the donor (related or non -genius).
Immunotherapy:
- Monoclonal antibodies: The use of antibodies that specifically bind to tumor cells and destroy them or help the immune system to recognize and destroy tumor cells.
- Control points inhibitors: The use of drugs that block proteins that prevent the activation of the immune system against tumor cells.
- Car-T-cell therapy: Modification of the patient’s own T-lymphocytes for recognition and destruction of tumor cells.
Target therapy: The use of drugs that specifically affect certain molecules involved in the growth and development of tumor cells.

The choice of treatment method and its intensity depend on the type of tumor, the stage of the disease, the age of the child, the general state of health and other factors. Treatment of children’s oncological diseases is carried out in specialized oncological centers, where doctors who have experience working with children with cancer patients work.

Forecast and survival

The prognosis and survival of children with cancer has significantly improved over the past decades due to progress in diagnosis and treatment. Currently, the total indicator of five -year survival for children with cancer is about 80%. However, the forecast and survival vary depending on the type of tumor, the stage of the disease and other factors.

Leukemia: The forecast for children with leukemia has improved significantly in recent years. Five -year survival for children with Oll is about 90%.
Brain tumors: The forecast for children with brain tumors varies depending on the type of tumor, its localization and the degree of malignancy. Five -year survival for children with brain tumors is about 70%.
Lymphomas: The forecast for children with lymphomas is usually favorable. Five -year survival for children with Hodgkin lymphoma is about 95%, and about 85%for children with non -Hodgkin lymphoma.
Neuroblastoma: The forecast for children with neuroblastoma varies depending on the stage of the disease, age of the child and other factors. Five -year survival for children with neuroblastoma is about 70%.
Wilms tumor: The prognosis for children with the Wilms tumor is very favorable. The five -year survival for children with the Wilms tumor is about 90%.
Sarcoma: The forecast for children with sarcomes varies depending on the type of sarcoma, stage of the disease and other factors. Five -year survival for children with osteosarcoma is about 70%, and for children with Ying sarcoma – about 60%.
Retinoblastoma: The forecast for children with retinoblastoma is usually favorable. Five -year survival for children with retinoblastoma is about 95%.

Supporting therapy

Supporting therapy plays an important role in the treatment of children’s oncological diseases. It is aimed at facilitating side effects of treatment, improving the quality of life of the child and maintaining his general health. Supporting therapy may include:

Anesthesia: Pain management is an important aspect of supportive therapy. Various painkillers can be used, depending on the intensity of pain.
Anti -rate funds: Chemotherapy and radiation therapy can cause nausea and vomiting. Anti -rate drugs help reduce these side effects.
Antibiotics and antifungal drugs: Chemotherapy can weaken the immune system and increase the risk of infections. Antibiotics and antifungal drugs are used to treat and prevent infections.
Blood transfusion and platelets: Chemotherapy can reduce blood cells (red blood cells and platelets). Blood transfusion and platelets can help replenish the deficiency of these cells.
Nutritional support: Maintaining adequate nutrition is important to maintain the general state of health of the child and improve his tolerance of treatment.
Psychological support: Cancer is a difficult test for the child and his family. Psychological support helps the child and his family cope with stress, anxiety and depression.

Long -term consequences of treatment

Despite the success in the treatment of children’s oncological diseases, many children who have suffered cancer are at risk of developing long -term treatment of treatment. These consequences can manifest itself many years after the completion of treatment and include:

Violation of growth and development: Chemotherapy and radiation therapy can affect the growth and development of bones, muscles and other organs.
Endocrine disorders: Chemotherapy and radiation therapy can damage the endocrine glands (thyroid gland, pituitary gland, adrenal glands, sex glands) and cause hormonal disorders.
Infertility: Chemotherapy and radiation therapy can affect the reproductive function and cause infertility.
Cardiotoxicity: Some chemotherapeutic drugs and radiation therapy can damage the heart and cause heart disease.
Neurotoxicosthatthe: Some chemotherapeutic drugs and radiation therapy can damage the nervous system and cause neurological disorders.
Secondary tumors: Children who have suffered cancer have an increased risk of developing secondary tumors in the future.

Therefore, it is necessary to carry out regular monitoring of children who have undergone oncological diseases to identify and treat the long -term consequences of treatment.

Psychological and social support

The diagnosis of cancer in a child has a huge impact on the whole family. Comprehensive psychological and social support for both the child and his parents, brothers and sisters is very important.

For a child: Psychological support helps the child cope with fear, anxiety, anger and depression. Game therapy, art therapy and other methods can help the child express his feelings and emotions.
For parents: Parents need support to cope with stress, anxiety and guilt. Consultations with a psychologist, participation in support groups and communicating with other parents whose children are sick of cancer can help parents cope with the situation.
For brothers and sisters: The brothers and sisters of a child with cancer also need support. They can feel deprived of attention, feel guilty or jealous. It is important that parents pay time and attention to all children in the family.

Social support is also important for the family of a child with cancer. Friends, relatives, colleagues and other people can support the family, providing assistance in caring for a child, cooking, cleaning the house and other matters.

New directions in treatment

In recent years, significant successes have been achieved in the development of new methods of treating children’s oncological diseases. These include:

Target therapy: Preparations that specifically affect certain molecules involved in the growth and development of tumor cells.
Immunotherapy: Drugs that stimulate the immune system to combat tumor cells.
Car-T-cell therapy: Modification of the patient’s own T-lymphocytes for recognition and destruction of tumor cells.
Virotherapy: Using viruses to destroy tumor cells.
Nanotechnology: The use of nanoparticles for the delivery of drugs directly to the tumor cells.
Proton therapy: A more accurate method of radiation therapy, which allows you to more accurately direct radiation to the tumor and reduce damage to the surrounding healthy tissues.

These new treatment methods can improve the prognosis for children with cancer and reduce side effects of treatment.

Conclusion

Children’s oncology is a complex and multifaceted field of medicine. Understanding the specific features of child cancer, the use of modern methods of diagnosis and treatment, as well as the provision of comprehensive psychological and social support to the child and his family – this is the key to successful treatment and improvement of forecasting. Continuing research and development of new methods of treatment allow us to hope for further improvement of the survival and quality of life of children who have suffered cancer.