Oncology in children: features and forecasts

Oncology in children: features and forecasts

Section 1: Epidemiology of children’s cancer: global and Russian context

Children’s cancer, unlike adult cancer, is a relatively rare, but tragic phenomenon. On a global scale, about 400,000 new cases of cancer in children and adolescents aged 0 to 19 years are recorded annually. The statistics of children’s oncology are significantly different from adults, both in type of tumors and in risk factors and approaches to treatment.

On a global scale, significant differences are observed in indicators of the incidence and survival of children with cancer. The high level of healthcare development, the availability of modern diagnostic and treatment methods, as well as the presence of specialized oncological centers play a decisive role in improving outcomes. In countries with a high income level, the survival of children with cancer exceeds 80%, while in countries with low and average income this indicator this figure is significantly lower, often does not exceed 30-40%. Such a difference is due not only to the availability of treatment, but also to the problems of early diagnosis, insufficient qualifications of medical personnel and the limited resources.

The Russian Federation demonstrates positive dynamics in the treatment of children’s cancer. In recent decades, the availability of modern diagnostic and treatment methods has significantly improved, which has led to an increase in survival indicators. According to statistics, about 3,500-4000 new cases of cancer in children are detected annually in Russia. The most common types of children’s cancer in Russia are leukemia, brain tumors, lymphoma, neuroblastoma and bone tumors. Despite the successes achieved, there are regional differences in the accessibility of specialized assistance and in survival indicators. Further development of the network of children’s oncological centers, the advanced training of medical personnel and the introduction of modern treatment protocols are priority tasks to improve the results of treatment for children’s cancer in Russia.

An important aspect of the epidemiology of children’s cancer is the study of risk factors. In most cases, the cause of oncological diseases in children remains unknown. However, certain factors, such as a genetic predisposition, the effect of ionizing radiation, some viral infections and the effects of certain chemicals, can increase the risk of cancer in children. The study of genetic risk factors is a promising direction in children’s oncology, which allows you to identify children with an increased risk of cancer development and develop a prophylaxis and early diagnosis strategies. Studies are also conducted aimed at studying the influence of environmental factors on the development of children’s cancer.

Section 2: The main types of children’s cancer: clinical manifestations and diagnostic methods

Children’s cancer, unlike an adult, has its own specific features, which manifest in the histological structure of tumors, their localization, clinical course and response to treatment. In childhood, embryonic tumors are more often found that arise from immature cells remaining in the body after birth. These tumors are characterized by rapid growth and high sensitivity to chemotherapy.

The most common types of children’s cancer include:

Leukemia: This is the most common type of cancer in children, which accounts for about 30% of all cases of children’s cancer. Leukemia is malignant diseases of the bone marrow in which uncontrolled propagation of immature blood cells occurs. There are acute and chronic leukemias. Acute leukemias, such as acute lymphoblastic leukemia (OLL) and acute myelobilic leukemia (OML), are the most common in children. The clinical manifestations of leukemia include pallor, weakness, increased fatigue, bleeding, increase in lymph nodes, bones and joint pain, as well as exposure to infections. Diagnosis of leukemia is based on the analysis of blood and bone marrow.
Brain tumors: This is the second most common type of cancer in children, which accounts for about 20% of all cases of children’s cancer. Tumors of the brain can be of various histological structures and localization. The most common types of brain tumors in children include medical, gliomas and ependema. The clinical manifestations of brain tumors depend on their localization and size. They can include headaches, nausea, vomiting, visual impairment, coordination of movements, speech and behavior. Diagnosis of brain tumors is based on neuroimaging, such as computed tomography (CT) and magnetic resonance imaging (MRI).
Lymphomas: These are malignant diseases of the lymphatic system. Distinguish between Hodgkin’s lymphoma and non -Kindkin lymphomas. Hodgkin’s lymphoma is characterized by the presence of Rid-Berezovsky-Sternberg cells in the tumor. Non -Rhodes -wing lymphomas are a group of various lymphomas, which differ in their histological structure and clinical course. The clinical manifestations of the lymph include an increase in lymph nodes, fever, night sweating, weight loss and fatigue. Diagnosis of lymphomes is based on biopsy of the lymph node and immunohymphomy.
Neuroblastoma: This is a tumor that develops from immature nerve cells. Neuroblastoma most often occurs in children under the age of 5 years. The tumor can occur anywhere where there is a nerve tissue, but most often it is localized in the adrenal glands or in the nervous tissue along the spine. The clinical manifestations of neuroblastoma depend on its localization and stages. They can include abdominal pain, an increase in abdomen, constipation, bone pain and weakness. The diagnosis of neuroblastoma is based on visualization, such as CT and MRI, as well as on a tumor biopsy and determining the level of neuroblastoma markers in the blood and urine.
Wilms tumor: This is a kidney tumor that is most often found in children under the age of 5 years. The Wilms tumor usually manifests itself as a painless formation in the abdomen. Other symptoms may include abdominal pain, nausea, vomiting and increasing blood pressure. Wilms tumor diagnosis is based on visualization, such as CT and MRI, as well as on a tumor biopsy.
Osteosarcoma and Sarcoma Ying: These are malignant bone tumors. Osteosarcoma is most often found in adolescents and young people. Sarcoma of Ying is more common in children and adolescents. The clinical manifestations of the osteosarcoma and sarcoma of the Ying include bones, swelling and limitation of movements. The diagnosis of osteosarcoma and sarcoma of Ying is based on visualization, such as X -ray, CT and MRI, as well as on a tumor biopsy.

Diagnosis of children’s cancer requires an integrated approach, which includes a clinical examination, anamnesis collection, laboratory studies (blood, urine, bone marrow), instrumental diagnostic methods (X -ray, CT, MRI, ultrasound, scintigraphy) and a tumor biopsy with histological and immunohymic research. Early diagnosis is a key factor in the successful treatment of children’s cancer. Therefore, it is important to pay attention to any unusual symptoms in children and consult a doctor in a timely manner.

Section 3: Modern methods of treating children’s cancer: chemotherapy, radiation therapy, surgery, bone marrow transplantation and immunotherapy

Treatment of children’s cancer is a complex and multi -stage process, which requires an individual approach to each patient. The main methods of treating children’s cancer are chemotherapy, radiation therapy, surgical intervention, bone marrow transplantation and immunotherapy. In most cases, a combined approach is used, which includes several treatment methods.

Chemotherapy: This is the main method of treating most types of children’s cancer. Chemotherapy consists in the use of drugs that destroy cancer cells or slow down their growth. Chemotherapeutic drugs can be administered intravenously, intramuscularly or orally. Chemotherapy can cause various side effects, such as nausea, vomiting, hair loss, reduction of immunity and organs damage. However, most side effects are temporary and pass after the end of treatment.
Radiation therapy: This is a treatment method that uses high -energy radiation to destroy cancer cells. Radiation therapy can be used to treat brain tumors, lymph, neuroblast and bone tumors. Radiation therapy can cause various side effects, such as fatigue, redness of the skin, hair loss and organs damage. However, modern methods of radiation therapy make it possible to minimize side effects and affect the tumor as accurately as possible.
Surgical intervention: This is a treatment method that consists in removing the tumor surgically. Surgical intervention can be used to treat brain tumors, neuroblast, vilms tumors and bone tumors. In some cases, surgical intervention may be the only necessary treatment method. In other cases, surgical intervention is used in combination with chemotherapy and radiation therapy.
Bone marrow transplantation: This is a treatment method that is used to treat leukemia, lymph and other malignant blood diseases. Bone marrow transplantation is to replace damaged bone marrow with healthy bone marrow. A healthy bone marrow can be obtained from a donor (allogene transplantation) or from the patient himself (autological transplantation). Bone marrow transplantation is a complex procedure that can cause serious complications.
Immunotherapy: This is a new and promising method of treating cancer, which uses its own immune system of the body to combat cancer cells. Immunotherapy may include the use of monoclonal antibodies, control points of the immune response and Car-T-cell therapy. Immunotherapy has shown good results in the treatment of some types of children’s cancer, such as neuroblastoma and Hodgkin lymphoma.

The choice of treatment for children’s cancer depends on the type of tumor, stage of the disease, age and general condition of the patient. Treatment of children’s cancer is carried out in specialized oncological centers, where experienced doctors and nurses work. An important aspect of children’s cancer is psychosocial support for patients and their families. Children and their parents need the help of psychologists, social workers and other specialists who help them cope with the emotional and psychological difficulties associated with the disease.

Section 4: Genetic risk factors and predisposition to children’s cancer: the role of genetic counseling and testing

Although most cases of children’s cancer arise sporadically and are not related to hereditary factors, in 5-10% of children with cancer a genetic predisposition to the disease is detected. This means that these children have certain genetic mutations that increase the risk of cancer. These mutations can be transmitted from parents to children or De Novo (for the first time) in the child.

There are certain genetic syndromes that significantly increase the risk of developing certain types of children’s cancer. Such syndromes include:

Li-Fraumeni syndrome: This syndrome is associated with mutations in the TP53 gene, which is a tumor-genome. Children with Li-Franum syndrome have an increased risk of developing various types of cancer, including sarcomas, leukemia, brain tumors and breast cancer.
Down syndrome: Children with Down syndrome have an increased risk of leukemia, especially acute lymphoblastic leukemia.
Type 1 neurofibromatosis (NF1): Children with NF1 have an increased risk of developing tumors of the nervous system, such as gliomas and neuroblastoma.
VILMS ANIRIDIA SIDRUS AND GENITOURINARY ANOMALIS-HEARTICAL REGIONALLY (WAGR): Children with WAGR syndrome have an increased risk of developing Wilms tumor.
Family adenomatous polyposis (FAP): Children with FAP have an increased risk of developing colon cancer.

Genetic counseling and testing play an important role in identifying children with a genetic predisposition to cancer. Genetic counseling is a process during which a geneticist or other genetic specialist evaluates the patient’s family history, determines the risk of developing hereditary diseases and provides information about genetic testing. Genetic testing is an analysis of the patient’s DNA, which allows you to identify the presence of genetic mutations associated with an increased risk of cancer.

Genetic testing can be useful in the following cases:

Family history of cancer: If the patient’s family has cases of cancer at an early age or several cases of the same type of cancer, genetic testing can help determine whether cancer is hereditary.
The presence of a genetic syndrome: If the patient has signs of a genetic syndrome associated with an increased risk of cancer, genetic testing can confirm the diagnosis and determine the risk of cancer.
Diagnosis of cancer at an early age: If a child is diagnosed with cancer at an early age, genetic testing can help determine whether a tumor is related to a genetic mutation.

The results of genetic testing can help parents make reasonable decisions on medical monitoring of the child and on family planning. In some cases, genetic testing may reveal the need for preventive measures, such as regular screening examinations to detect cancer at an early stage. Genetic counseling and testing should be carried out in compliance with ethical principles and taking into account the wishes of the patient and his family.

Section 5: Long -term consequences of treating children’s cancer: survivors and rehabilitation strategies

Modern methods of treating children’s cancer make it possible to achieve high survival rates. However, many children who have suffered cancer have long -term consequences of treatment, which can negatively affect their health, quality of life and social adaptation. These consequences can be associated with the effects of chemotherapy, radiation therapy, surgical intervention and other treatment methods.

The long -term consequences of treating children’s cancer may include:

Organs damage: Chemotherapy and radiation therapy can damage various organs, such as the heart, lungs, kidneys, liver and reproductive organs. This can lead to the development of chronic diseases, such as heart failure, pulmonary fibrosis, renal failure, liver cirrhosis and infertility.
Secondary malignant tumors: Children who have suffered cancer have an increased risk of developing secondary malignant tumors, such as leukemia, sarcoma and brain tumors. This risk is associated with the effects of chemotherapy and radiation therapy.
Neurocognitive disorders: Chemotherapy and radiation therapy can damage the brain, which can lead to neurocognitive disorders, such as a decrease in memory, attention, concentration and speed of information processing. These violations can negatively affect school performance and social adaptation.
Endocrine disorders: Chemotherapy and radiation therapy can damage endocrine glands, such as thyroid gland, pituitary gland and adrenal glands. This can lead to the development of endocrine disorders, such as hypothyroidism, growth hormone deficiency and adrenal insufficiency.
Psychological problems: Children who have suffered cancer often experience psychological problems, such as anxiety, depression, post -traumatic stress disorder and self -esteem problems. These problems can be related to the stress, physical restrictions and changes in appearance.

The rehabilitation of children who have suffered cancer is an important component of an integrated approach to treatment. The aim of rehabilitation is to improve the quality of life of patients, restore their physical and cognitive functions, as well as their social adaptation. Rehabilitation may include:

Physical therapy: Physical therapy helps to restore muscle strength, coordination of movements and endurance.
Trudewotherapi: Cabinettherapy helps to restore the skills necessary to perform everyday tasks, such as dressing, food and a letter.
Speech therapy: Speech therapy helps to restore speech and swallow.
Cognitive rehabilitation: Cognitive rehabilitation helps to improve memory, attention, concentration and speed of information processing.
Psychological help: Psychological assistance helps patients cope with emotional and psychological problems associated with the disease.

An important aspect of rehabilitation is long -term monitoring of patients who have undergone cancer. This allows you to identify and treat the long -term consequences of treatment at an early stage. Long -term observation should include regular medical examinations, laboratory research and instrumental diagnostic methods. It is also necessary to pay attention to the psychosocial support of patients and their families.

Section 6: New directions in the treatment of children’s cancer: targeted therapy and innovative approaches

In recent years, significant progress has occurred in the treatment of children’s cancer related to the development of new methods of diagnosis and treatment. One of the promising areas is targeted therapy, which is aimed at influencing specific molecular targets in cancer cells. Targeted therapy allows you to more effectively destroy cancer cells, without damaging the healthy cells of the body.

Targeted drugs can be directed at:

Mutated genes: Some types of cancer are associated with mutations in certain genes. Targeted drugs can block the activity of mutated genes, which leads to the death of cancer cells.
Proteins necessary for the growth and survival of cancer cells: Cancer cells often depend on certain proteins for their growth and survival. Targeted drugs can block these proteins, which leads to the death of cancer cells.
Blood vessels that feed the tumor: Cancer tumors need blood vessels to obtain nutrients and oxygen. Targeted drugs can block the growth of blood vessels that feed the tumor, which leads to its death.

Targeted therapy showed good results in the treatment of some types of children’s cancer, such as leukemia, lymphoma and neuroblastoma. However, it should be noted that targeted therapy is not a universal treatment method and is not suitable for all types of cancer. Targeted drugs can also cause side effects, although they are usually less pronounced than with chemotherapy.

Another promising direction in the treatment of children’s cancer is immunotherapy, which uses its own immune system of the body to combat cancer cells. Immunotherapy may include the use of monoclonal antibodies, control points of the immune response and Car-T-cell therapy.

Monoclonal antibodies: These are artificially created antibodies that are associated with specific proteins on the surface of cancer cells. The binding of monoclonal antibodies with cancer cells can lead to their destruction by the immune system.
Inhibitors of control points of the immune response: The control points of the immune response are molecules that regulate the activity of immune cells. Cancer cells can use control points of the immune response to avoid attack from the immune system. Inhibitors of control points of the immune response block these molecules, which allows the immune system to more effectively fight cancer cells.
Car-T-cell therapy: This is a treatment method in which the patient’s immune cells (T-lymphocytes) are modified so that they can recognize and destroy cancer cells. T-lymphocytes are modified by introducing a gene into them, which encodes a chimeric antigenic receptor (CAR). Car allows T-lymphocytes to recognize specific proteins on the surface of cancer cells and attack them.

Car-T-cell therapy has shown good results in the treatment of some types of children’s cancer, such as acute lymphoblastic leukemia and lymphoma. However, Car-T-cell therapy is a complex and expensive procedure that can cause serious complications.

In addition to targeted therapy and immunotherapy, other innovative approaches to the treatment of children’s cancer, such as gene therapy, virotherapy and nanotherapy are developed. These approaches are in the early stages of development, but they have a potential for a significant improvement in the treatment of children’s cancer.

Section 7: Palliative Assistance and Support for Children with Oncological Diseases

Despite significant progress in the treatment of children’s cancer, in some cases the disease is incurable. In such situations, palliative help plays an important role, which is aimed at improving the quality of life of patients and their families. Palliative assistance includes relief of pain and other symptoms, the provision of psychological and social support, as well as assistance in making decisions regarding child care.

Palliative assistance can be provided in various conditions, such as a hospital, hospice or house. Various specialists, such as doctors, nurses, psychologists, social workers and priests, participate in the provision of palliative assistance. An important aspect of palliative assistance is to take into account the individual needs of the patient and his family.

Palliative help for children with cancer has their own characteristics. Children often experience fear and anxiety associated with illness and treatment. They need to explain what is happening and give them the opportunity to express their feelings. Parents of children with cancer also need support. They experience severe stress and anxiety associated with the disease of the child. They need to provide information about illness and treatment, as well as help them cope with emotional difficulties.

Palliative help may include:

Relief of pain and other symptoms: Palliative assistance is aimed at relieving pain, nausea, vomiting, shortness of breath and other symptoms that children with cancer can experience. To relieve pain, various methods can be used, such as drugs, physiotherapy and psychological techniques.
Psychological support: Palliative assistance provides psychological support to children and their families. Psychologists can help children cope with fear, anxiety and depression. They can also help parents cope with stress and anxiety associated with the child’s disease.
Social support: Palliative assistance provides social support to children and their families. Social workers can help families gain access to various resources, such as financial assistance, housing and transport. They can also help families establish relations with other people who are in a similar situation.
Spiritual support: Palliative assistance provides spiritual support to children and their families. Priests can help children and their families find meaning in life and cope with grief.

Support for families of children with cancer is an important aspect of palliative care. Parents of children with cancer are experiencing severe stress and anxiety associated with the child’s disease. They need to provide information about illness and treatment, as well as help them cope with emotional difficulties. Support for families may include individual consultations, group classes and support programs.

Section 8: forecasts for children’s cancer: factors affecting survival and quality of life

Forecasts in children’s cancer depend on many factors, including the type of tumor, the stage of the disease, the age of the child, the general state of health and the response to treatment. In general, forecasts for children’s cancer have significantly improved over the past decades due to progress in diagnosis and treatment. Currently, the survival of children with cancer is about 80%. However, forecasts vary depending on the type of tumor.

Factors affecting survival in children’s cancer:

Tumor type: Some types of baby cancer, such as acute lymphoblastic leukemia and Hodgkin lymphoma, have high survival rates. Other types of children’s cancer, such as high -risk neuroblastoma and some brain tumors, have lower survival rates.
Stage of the disease: The sooner the disease is diagnosed, the higher the chances of cure. Cancer, which has spread outside the primary tumor (metastatic cancer), has lower survival rates.
Child’s age: The age of the child can affect forecasts in children’s cancer. Some types of cancer are more often found in children of a certain age and can have various forecasts depending on the age of the child.
General health: Children with a good general state of health better tolerate treatment and have higher chances of cure.
Answer to treatment: Children who respond well to treatment have higher chances of cure. The response to treatment is evaluated on the basis of the results of examinations, such as blood tests, visualization and biopsy.

The quality of life is an important aspect of forecasts for children’s cancer. Children who have suffered cancer can experience the long -term consequences of treatment, such as organs damage, secondary malignant tumors, neurocognitive disorders, endocrine disorders and psychological problems. These consequences can negatively affect their quality of life.

To improve the quality of life of children who have suffered cancer, it is necessary:

Conduct long -term observation: Long -term observation allows you to identify and treat the long -term consequences of treatment at an early stage.
Provide rehabilitation assistance: Rehabilitation help helps restore physical and cognitive functions, as well as social adaptation.
Provide psychological support: Psychological support helps children cope with emotional and psychological problems associated with the disease.
Create conditions for a normal life: It is necessary to create conditions for children who have suffered cancer can live a normal life, attend school, play sports and communicate with friends.

Forecasts for children’s cancer continue to improve due to constant research and the development of new methods of diagnosis and treatment. An important aspect is the early detection of the disease, timely and adequate treatment, as well as long -term observation and rehabilitation. A comprehensive approach to the treatment of children’s cancer allows not only to increase survival, but also to improve the quality of life of patients.

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