Oncological educational program: why children get cancer and how to recognize the first symptoms. Childhood cancer - all about the terrible disease of small people

Oncological educational program: why children get cancer and how to recognize the first symptoms Since the beginning of autumn, every Monday, E1.RU published interviews with oncologists who talked about cancers of various organs and their treatment. Today, on the last day of November, we are closing the "Oncological educational program" column and in the final publication we propose to talk about children's oncology: how malignant tumors appear in babies and whether it can be prevented or at least noticed in time. We asked these questions to the pediatric oncologist at the Regional Children's Clinical Hospital N 1, Sergei Tuponogov. - Sergey Nikolaevich, why do very young children get cancer? After all, they do not have bad habits, like adults, they have not had time to act on radiation and other environmental factors? Who is to blame for this - nature or parents? - Oncological diseases in children of the first years of life are for the most part manifestations of various disorders that occurred during the laying of its organs and tissues during pregnancy. This could be provoked by smoking of the mother or other relatives, other bad habits or the same radiation. The genetic factor is also very important. For example, in our center, two children were operated on for kidney cancer, the father of which is the same, but the mothers are different. It turned out that the father passed on the gene that caused cancer to them. Therefore, it is quite difficult to say unambiguously who is to blame here. Of course, the child himself is not to blame for anything. There are genetic breakdowns that occur during pregnancy in a mother who is very strict about her health. There is also something that is inherited from the very beginning, and this can be prevented if a married couple, at the stage of planning the birth of a child, turns to a medical geneticist for a consultation. And, of course, a geneticist should definitely be consulted if children in the family have already had cancer. We now know several syndromes when certain malformations in children are combined with oncological diseases. In such families, parents need to take the birth of children and their future health very seriously. - In recent years, children have become more likely to get cancer? - Yes, we have seen an increase in the incidence of children over the past 10-15 years. Every year in Yekaterinburg and the Sverdlovsk region, we detect about 150 cases of cancerous tumors in children. But cancer today - and, probably, my fellow oncologists have already told you about this - is not a sentence at all. If a child has a tumor in the first or second stage, when there are no metastases and germination in the surrounding tissues, then the chance for a full recovery is very high. We cure 90% of children with such stages, and then they live a full life. If the cancer is discovered late, then, of course, it will be more difficult to help the child. But even here the percentage of those who have recovered is rather big - 70%. The younger the child, the better his cancer is treated, says Sergei Tuponogov. - Is there any difference which children are easier to tolerate oncological diseases and their specific treatment? – The younger the child, the better his cancer is treated - he tolerates the treatment itself more easily and better long-term results. The older you get, the more problems arise. Plus, a psychological factor is added to this, because our older patients already understand what is happening to them. - Does cancer have "favorite" children's localizations? “Brain tumors rank first among children among oncological diseases. Then, in frequency, tumors of the blood system follow - leukemia, lymphomas, lymphogranulomatosis, tumors of the kidneys and adrenal glands, liver, and bones. There are purely childhood tumors - nephroblastomas, which are not found in adults. And in children, they quickly penetrate into the retroperitoneal space. But children almost never have lung tumors or, if they do, they are benign. Cancer in children is treated differently than in adults. For children, this is a very short episode in life. After the operation, the most important and lengthy part of the treatment begins - chemotherapy. It is conducted in courses that sometimes take years. But it also gives a completely different effect in children than in adults: even metastases from the lungs go away with chemotherapy. - Sergey Nikolaevich, if we talk about early diagnosis of cancer in children - what should parents pay attention to? After all, the child himself can not say that something hurts him? - Starting from the first months of a child's life and up to his adulthood, increased weakness, depression, apathy, changes in appetite, changes in the child's behavior, including increased aggressiveness, and unreasonable mood changes can indicate the development of a malignant neoplasm. You also need to pay attention to any pain: in the head, in the chest, abdomen, bones, the appearance of any enlarged lymph nodes, or, as they say, bumps, the appearance of any rashes on the body. Another reason to be alarmed is increased bleeding or a tendency to bruise quickly. In all these cases, the child must be shown to the doctor. Unfortunately, it happens that parents, sending their children to several sections at once, regard their complaints as laziness and unwillingness to learn. But in fact, at this time, they lose invaluable time when the child should not be taught, but treated. Chemotherapy in the treatment of childhood cancer can take years, but the effect is much better than in adults. For some reason, it is in large cities that parents, considering themselves educated and enlightened people, do not follow the simplest recommendations of pediatricians. For example, it is universally accepted that a child after birth should have an abdominal ultrasound at 1 month, at 6 months, and then at 1 year. But parents have no time or they think that their child does not need it, since he is healthy. And a kid like that won't complain about anything. In my opinion, ultrasound should be done just in these terms, in which, by the way, they are prescribed by the clinic. So we can detect any tumor very early and remove it in time. After a year, abdominal ultrasound should be repeated at least 2 times a year up to five years - and this is even if the child does not have any complaints at all! After five years, it is enough to do an ultrasound once a year. And at about the same frequency, unless the doctor prescribes otherwise, to control the general blood test and the general urine test. – Sergey Nikolayevich, speaking of diagnostics, when you read the stories of children with cancer, you involuntarily pay attention to such facts. For example, a child fell off a bicycle, hit his leg, and then a tumor was found right at that place. Is it a coincidence or can it be explained somehow? - In medicine, there is such a term - "a symptom of a pointing finger." In such cases, you can remember about this symptom or, as it can be called even brighter, "the finger of fate." But, in my opinion, everything is much simpler and more tragic. When a child falls off a bicycle and then complains of severe pain in a leg or arm, this pain is caused, alas, no longer by a fall, but by a growing tumor. Adults just don't care. And they remember the child's complaints only when he is already given a terrible diagnosis. We've all fallen off our bikes as kids, and if those injuries were the cause of cancer, what would happen to us now? - Another question, also born from the results of reading numerous publications on the Internet on pediatric oncology. Why are children taken abroad for medical treatment? How is the treatment different from the one we have? – Treatment in foreign clinics does not fundamentally differ from that carried out by Russian doctors. Yes, we still do not have enough separate surgical techniques. Perhaps somewhere there are not all chemotherapy drugs or there are no drugs that are not registered in Russia. But still, in most cases, parents take those children abroad for treatment, for the treatment of which we have exhausted all our possibilities, and treatment abroad is also without guarantees, this is already a gesture of desperation. Understand that pediatric oncology is a special branch of medicine. No parent will ever accept the fact that their child can no longer be helped, and in this I cannot blame anyone. Treatment in foreign clinics does not fundamentally differ from that carried out by Russian doctors. With this interview, we close the rubric "Oncological educational program". Recall that earlier we talked about one of the most common oncological diseases - skin cancer - with Sergey Berzin, professor of the Department of Oncology and Medical Radiology of the Ural State Medical University, about oncological diseases of the blood - leukemia - with the chief hematologist of the Sverdlovsk region Tatyana Konstantinova, and he told us about lung cancer Andrey Tsoriev, Chief Specialist of the Yekaterinburg Health Department for Radiation Diagnostics. We have devoted several publications to oncology of the gastrointestinal tract. About its most terrible localization - pancreatic cancer - we talked with the doctor of medical sciences Mikhail Prudkov, about stomach cancer - with the chief surgeon of the city Alexei Stolin. Andrey Oshchepkov, head of the Coloproctology Department of SOKB N 1, told us about bowel cancer, and Yury Istomin, head of the thoraco-abdominal department of the Sverdlovsk Regional Oncology Center, told us about the oncology of the most vulnerable organ - the esophagus. In addition, we wrote about typical "male" and "female" diseases: Igor Bazhenov, the chief urologist of the Sverdlovsk region, told us about "male diseases", including cancer and prostate adenoma, and Sergey Demidov, head of the oncomammology department of the City Clinical Hospital N 40, and head Department of Obstetrics and Gynecology of the Ural State Medical University Tatiana Oboskalova - about the most common and most terrible "female" cancer - breast cancer and other dangerous women's diseases. Finally, the chief oncologist of Yekaterinburg, Denis Demidov, told our readers about how to properly be examined without wasting time and money in order to identify signs of oncology, and why complex procedures such as MRI or colonoscopy do not always help in this, and the chief surgeon of Yekaterinburg, Alexei Stolin, spoke about why you don't need to be afraid of oncological operations now.

Many people have the question " Why do people get cancer? There is no single answer to this question. Leading scientists around the world are engaged in finding out the reliable cause of cancer development, which triggers the oncological destruction trigger.

To date, it is known that they begin to form at the cellular level. Inside every cell of the human body is a DNA molecule that controls the processes of cell division. Under the influence of external carcinogenic factors, a pathological change in the structure of DNA occurs, which causes the onset of atypical and uncontrolled cell division. The accumulation of a significant amount of cancerous elements requires an intensive supply of nutrients. To do this, tumor tissues build their own blood supply system, through which malignant cells receive glucose.

Leading clinics abroad

Why children, adults get cancer: causes and risk factors

Carcinogenic substances:

The first carcinogen was discovered in the 18th century by Dr. Potto, who, in the course of treatment, drew attention to the increased number of cancerous lesions in chimney sweeps. They are often diagnosed with a neoplasm of the scrotum due to frequent contact of the skin with a biologically active substance containing a carcinogen. In the course of scientific research, similar substances (asbestos, tobacco smoke) were found that adversely affect the superficial skin and mucous membranes.

Radiation radiation:

Ionizing radiation plays a key role in the processes of oncological diseases. This fact is confirmed by a 40-fold increase in the number of thyroid cancers in people living in the vicinity of Hiroshima and Nagasaki. And the state of health of the population of the Chernobyl zone is even worse.

Viral infection:

Recent scientific studies indicate the viral nature of the defeat of some types of cancer. In particular, the etiological role of the papilloma virus in the occurrence of a cervical tumor has recently been proven, as well as what really exists.

genetic predisposition:

Why do children get cancer whose close relatives suffered from oncology is explained by a genetic factor. Individuals with a family history of cancer have an increased risk of developing cancer.

Man's lifestyle:

Even in ancient times, healers argued that the nature of nutrition, lifestyle and habits of a person significantly affect the occurrence of diseases.

Each region of the world is characterized by a certain diet. And it is no coincidence that oncologists observe a certain species distribution of cancer.

Why do people get cancer and what are the means of prevention?

Everyone knows that it is much more effective to prevent a disease than to treat it. This idea is especially relevant in oncological cases. The role of anti-cancer prophylaxis lies in the early diagnosis of malignant neoplasms. Cancer in the initial stages in almost all clinical cases is considered to be completely curable or able to go into the stage of stable remission.

In economically developed countries, most of the budget funds allocated for the needs of the medical industry are directed to financing preventive measures and improving diagnostic equipment. Such a policy ultimately saves significant financial resources for the treatment of cancer patients in the later stages of the disease.

Why do adults get cancer?

One of the functions of the immune system is considered to be constant cellular monitoring for the timely detection and neutralization of mutated cells. Such control is carried out with the help of T-killers, which are special immune cells that analyze surface tissue receptors to identify atypical elements.

Leading specialists of clinics abroad

Why do metastases form?

Metastasis is the formation of a secondary focus of cancerous tissue that has spread from the primary tumor through the lymphatic and blood vessels. Metastatic lesions predominantly develop in the later stages of the pathology. In the process of growth of a malignant neoplasm, intercellular bonds are destroyed, which provokes the release and penetration of cancer cells into the lymphatic or bloodstream. It should be noted that even distant organs significantly aggravate the prognosis of oncology.

Can we cure cancer?

At the present stage of development, medicine has in its arsenal all the necessary means to cure almost all forms of cancer. But to achieve a positive therapeutic result, a necessary condition is the timely diagnosis of the disease. For many years, the most effective method of anti-cancer treatment has been surgery to remove cancerous tissue. Radiation and radiological therapy in most cases are auxiliary means and an excellent preventive measure in relation to the development of oncology relapses. Recently, alternative means of therapy in the form of "Cyber-Knife" and laser surgery have shown high efficiency.

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?

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?

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.

It is an oncological disease that manifests itself in childhood. According to statistics, this form of the disease occurs in 15 out of 1000 children.

Classification of cancer in children

Most often in childhood they are faced with cancer of the hematopoietic organs. We are talking about leukemia, malignant lymphomas, lymphogranulomatosis. The probability of this is about 70%. The data are called hemoblastoses.

More rarely, formations are formed in the central nervous system, bone and soft tissues. The most rare should be considered "adult" types of cancer - from 2 to 4% (tumors of the skin, genital organs).

Thus, the treatment depends entirely on what type of cancer the child has. Therefore, it is necessary to consider each of them separately.

Causes of Cancer in Children

The cause of all oncological diseases should be considered a genetic breakdown in any of the cells. It is she who provokes uncontrolled growth, as well as the reproduction of tumor cells. It is also characteristic that, if in older people it is possible to determine a number of risk factors that are able to provoke such mutations, then in the case of children, minor genetic anomalies that were transmitted from parents become a catalyst for cancer.

Many people have similar anomalies, but not all of them provoke the development of malignant tumors. Risk indicators that affect the child himself (radiation, smoking, negative environmental background) do not really matter.

It should be borne in mind that almost all diseases of a genetic nature, namely Down syndrome or Klinefelter syndrome, as well as Fanconi, are associated with an increased risk of cancer.

Cancer symptoms in children

Leukemia

In children, leukemia manifests itself in:

significant fatigue and weakness in the muscles;

pallor of the skin;

loss of appetite and body index;

excessively active degree of bleeding;

painful sensations in the area of ​​\u200b\u200bbone tissues and;

a change in the size of the abdomen, which is the result of the fact that some organs become larger;

changes in the size of the lymph nodes in the cervical, inguinal and axillary region;

the formation of shortness of breath;

dysfunction of vision and balance while walking;

hemorrhage or redness on the skin.

Leukemia is characterized by the fact that all the signs do not appear simultaneously, but separately. It can begin with all sorts of violations that are formed in a different order. In some children, this may turn out to be a discoloration of the skin and a holistic malaise, in others - walking disorders and problems with visual functions.

Tumors of the brain and spinal cord

Formations that form in the brain appear most often in children aged five to ten years. The degree of danger of this disease is directly dependent on the area of ​​​​location and the final volumes. Unlike older people, in whom cancer forms in the large hemispheres, in children, the tissues of the cerebellum, as well as the brain stem, are affected.

Signs that indicate the presence of formations in the brain are as follows:

very severe migraine that occurs mainly in the morning and becomes more intense during or when you try to tilt your head. For those who do not yet know how to speak, painful sensations manifest themselves in a state of anxiety or crying. A small child holds his head and actively rubs his face;

vomiting in the morning;

dysfunction of coordination of movements, gait, eyes;

a change in behavior, while the baby refuses to play, closes in on himself and sits as if stunned, without making any attempts to move;

state of apathy;

In addition, in children there is a change in the head in size, convulsions and all kinds of mental disorders can form, for example, personality changes, manic ideas.

If we talk about formations in the spinal cord, then they are characterized by complaints of unpleasant sensations in the back area, which become more intense in the prone position of the body and less strong in the sitting position.

In children, resistance is detected when bending the body, a change in walking, scoliosis is detected, and the degree of sensitivity in the area affected by cancerous tissues decreases. A positive Babinsky's sign is also formed (a reflex reaction of the extension of the big toe in case of irritation of the skin), a violation of the functioning of the sphincters, bladder or anus.

Wilms tumor

This formation is also called nephroblastoma and is a malignant tumor of the kidney. This type of cancer is most common in children under the age of three. The disease affects one kidney, more rarely both. Complaints of malaise in most cases are absent. Nephroblastoma is detected randomly at a routine examination. During the implementation of palpation in the early stages, pain is not formed. If we talk about the later stages, then in this case, the asymmetry of the peritoneum is obvious due to the tumor, which compresses the organs located in the neighborhood. The baby's weight decreases, appetite disappears, temperature is detected,.

Neuroblastoma

This type of cancer can only occur in children. In 85-91% of cases, this happens before the age of five. Cancer can be located in the abdominal region, chest, in the cervical and pelvic regions, and often affects bone tissue.

Depending on the location, signs that indicate the presence of neuroblastoma should be identified:

discomfort in the bones, obvious lameness;

weakness, fluctuations in body temperature, pale skin, excessive sweating;

disruption of the intestines and bladder;

swelling in the eyes, face, or neck.

The diagnosis can be made according to the results of a special analysis of blood, urine, puncture and the results of ultrasound.

This is a malignant formation that appears near the tissues of the retina. Children under the age of six are affected by this form of cancer. In a third of cases, both the right and left eyes are affected by malignant cells.

In a baby, it begins to blush and hurt, strabismus is formed. At the same time, a specific glow is evident in the eye area, which occurs due to an increase in the tumor behind a certain part of the eye. As a result, it is visible through the pupil. In some patients, this provokes an absolute loss of vision.

To detect retinoblastoma, an eye examination is carried out under anesthesia. Additional diagnostic measures are x-ray examination, ultrasound, computed tomography, as well as a blood test and a puncture of the back.

Rhabdomyosarcoma

This is a malignant formation in the area of ​​\u200b\u200beither muscle or connective tissue. Formed in children in infancy, preschool and school age. Rhabdomyosarcoma affects part of the head and cervical region, more rarely the urinary organs, upper and lower extremities, and even more rarely the trunk.

Signs of rhabdomyosarcoma:

the formation of a slight swelling of a high degree of pain;

vision dysfunction and changes in the size of the eyeball;

urge to vomit, pain in the abdominal cavity and constipation (if the oncology has affected the peritoneum);

the appearance of jaundice may be evidence of the presence of an ailment in the bile ducts.

According to research, about 60% of patients are curable.

osteosarcoma

The most common oncological disease in extended and humerus bones, as well as hips in adolescents.

The main manifestation of this type of cancer should be considered soreness in the affected bone cover, which becomes more active at night. At the initial stage, the pain may be detected as a shorter one. Obvious swelling comes to light only after two or three weeks.

An accurate diagnosis can be made on the basis of x-rays and computed tomography.

Ewing's sarcoma

This formation, like osteosarcoma, affects the bones of the arms and legs of the tubular type of the baby. In certain cases, malignant cells affect the area of ​​​​the shoulder blades, ribs or collarbone. A particularly presented form of the disease is common in children aged 11 to 16 years.

Signs that indicate the presence of a mass are similar to those that appear in osteosarcoma. But in this case, there is a significant increase in body temperature, loss in weight index. In the later stages, sudden soreness and absolute pain are formed.

Hodgkin's lymphoma

Lymphogranulomatosis is a form of lymphatic tissue cancer. Most often formed in adolescents, that is, after 13-14 years.

In the presented form of oncology, the symptoms are little pronounced or not observed at all. Hodgkin's lymphoma may have one or more painless lymph nodes that are enlarged and may disappear or reappear. In some children, skin, active degree of sweating occurs, the temperature and the rate of fatigue increase.

Cancer Diagnosis in Children

The problem of diagnosis arises due to the fact that the child's well-being may seem positive even at the later stages of the development of the disease. Formations are very often detected randomly as part of a preventive examination.

In most cases, the final diagnosis can only be made after a biopsy. Based on its results, a variant of a malignant formation is determined and the stage of the disease is identified. It is on this that the choice of treatment method depends. When formed in the organs of hematopoiesis, such a biopsy should be considered a puncture of the bone marrow.

Pediatric oncologists and oncohematologists deal with the treatment of malignant tumors in children. Such treatment is carried out in special oncology departments of large children's hospitals and research institutes.

After he was discharged from the hospital, the baby must undergo mandatory observation by a specialist in the children's department in one of the specialized dispensaries. In order to cure cancer of the hematopoietic type, children's specialists use only conservative type therapy - chemotherapy and radiation. In the treatment of all other types of cancer in children (which are called "solid tumors"), the method of surgery is used for additional purposes.

The current treatment is carried out according to international programs - treatment protocols that have been worked out separately for each type of ailment. Even the slightest deviation from the protocols leads to a deterioration in the total achieved in the framework of the treatment. The possibility of absolute cure is guaranteed by a high degree of sensitivity of formations in childhood to specific agents.

After the main course of treatment, patients need long-term therapy and rehabilitation, which is aimed solely at maintaining an optimal state of health. At such moments, the entire measure of responsibility for the health of the baby and caring for him is completely on the shoulders of the parents. The results of treatment depend on the thoroughness of the implementation of all the advice of a specialist by 80%.

Thus, it is extremely important to be aware of all the symptoms that can accompany any form of childhood cancer and follow each of the recommendations given by the specialist. This will be the key to recovery.

Education: completed residency at the Russian Scientific Cancer Center named after N.N. N. N. Blokhin” and received a diploma in the specialty “Oncologist”

Oncological educational program: why children get cancer and how to recognize the first symptoms

A pediatric oncologist surgeon told how babies are treated in Russia and abroad.

Under the heading "Oncological educational program" several interviews with oncologists were published on the site, who talked about cancers of various organs and their treatment. In this publication, we propose to talk about pediatric oncology: how malignant tumors appear in babies and whether it can be prevented or at least noticed in time. We asked these questions to the pediatric surgeon-oncologist of the Regional Children's Clinical Hospital No. 1, Sergei Tuponogov.

- Sergey Nikolaevich, why do very young children get cancer? After all, they do not have bad habits, like adults, they have not had time to act on radiation and other environmental factors? Who is to blame for this - nature or parents? class="_">

- Oncological diseases in children of the first years of life are for the most part manifestations of various disorders that occurred during the laying of its organs and tissues during pregnancy. This could be provoked by smoking of the mother or other relatives, other bad habits or the same radiation.

The genetic factor is also very important. For example, in our center, two children were operated on for kidney cancer, the father of which is the same, but the mothers are different. It turned out that the father passed on the gene that caused cancer to them. Therefore, it is quite difficult to say unambiguously who is to blame here. Of course, the child himself is not to blame for anything.

There are genetic breakdowns that occur during pregnancy in a mother who is very strict about her health. There is also something that is inherited from the very beginning, and this can be prevented if a married couple, at the stage of planning the birth of a child, turns to a medical geneticist for a consultation. And, of course, a geneticist should definitely be consulted if children in the family have already had cancer.

We now know several syndromes when certain malformations in children are combined with oncological diseases. In such families, parents need to take the birth of children and their future health very seriously.

- In recent years, children have become more likely to get cancer? class="_">

- Yes, we have seen an increase in the incidence of children over the past 10-15 years. Every year in Yekaterinburg and the Sverdlovsk region, we detect about 150 cases of cancerous tumors in children.

But cancer today - and, probably, my fellow oncologists have already told you about this - is not a sentence at all. If a child has a tumor in the first or second stage, when there are no metastases and germination in the surrounding tissues, then the chance for a full recovery is very high. We cure 90% of children with such stages, and then they live a full life. If the cancer is discovered late, then, of course, it will be more difficult to help the child. But even here the percentage of those who have recovered is rather big - 70%.

- Is there any difference which children are easier to tolerate oncological diseases and their specific treatment? class="_">

– The younger the child, the better his cancer is treated - he tolerates the treatment itself more easily and better long-term results. The older you get, the more problems arise. Plus, a psychological factor is added to this, because our older patients already understand what is happening to them.

- Does cancer have "favorite" children's localizations? class="_">

“Brain tumors rank first among children among oncological diseases. Then, in frequency, tumors of the blood system follow - leukemia, lymphomas, lymphogranulomatosis, tumors of the kidneys and adrenal glands, liver, and bones. There are purely childhood tumors - nephroblastomas, which are not found in adults. And in children, they quickly penetrate into the retroperitoneal space. But children almost never have lung tumors or, if they do, they are benign.

Cancer in children is treated differently than in adults. For children, this is a very short episode in life. After the operation, the most important and lengthy part of the treatment begins - chemotherapy. It is conducted in courses that sometimes take years. But it also gives a completely different effect in children than in adults: even metastases from the lungs go away with chemotherapy.

- Sergey Nikolaevich, if we talk about early diagnosis of cancer in children - what should parents pay attention to? After all, the child himself can not say that something hurts him? class="_">

- Starting from the first months of a child's life and up to his adulthood, increased weakness, depression, apathy, changes in appetite, changes in the child's behavior, including increased aggressiveness, and unreasonable mood changes can indicate the development of a malignant neoplasm. You also need to pay attention to any pain: in the head, in the chest, abdomen, bones, the appearance of any enlarged lymph nodes, or, as they say, bumps, the appearance of any rashes on the body. Another reason to be alarmed is increased bleeding or a tendency to bruise quickly.

In all these cases, the child must be shown to the doctor. Unfortunately, it happens that parents, sending their children to several sections at once, regard their complaints as laziness and unwillingness to learn. But in fact, at this time, they lose invaluable time when the child should not be taught, but treated.

For some reason, it is in large cities that parents, considering themselves educated and enlightened people, do not follow the simplest recommendations of pediatricians. For example, it is universally accepted that a child after birth should have an abdominal ultrasound at 1 month, at 6 months, and then at 1 year. But parents have no time or they think that their child does not need it, since he is healthy. And a kid like that won't complain about anything.

In my opinion, ultrasound should be done just in these terms, in which, by the way, they are prescribed by the clinic. So we can detect any tumor very early and remove it in time. After a year, abdominal ultrasound should be repeated at least 2 times a year up to five years - and this is even if the child does not have any complaints at all! After five years, it is enough to do an ultrasound once a year. And at about the same frequency, unless the doctor prescribes otherwise, to control the general blood test and the general urine test.

– Sergey Nikolayevich, speaking of diagnostics, when you read the stories of children with cancer, you involuntarily pay attention to such facts. For example, a child fell off a bicycle, hit his leg, and then a tumor was found right at that place. Is it a coincidence or can it be explained somehow? class="_">

- In medicine, there is such a term - "a symptom of a pointing finger." In such cases, you can remember about this symptom or, as it can be called even brighter, "the finger of fate." But, in my opinion, everything is much simpler and more tragic. When a child falls off a bicycle and then complains of severe pain in a leg or arm, this pain is caused, alas, no longer by a fall, but by a growing tumor. Adults just don't care. And they remember the child's complaints only when he is already given a terrible diagnosis. We've all fallen off our bikes as kids, and if those injuries were the cause of cancer, what would happen to us now?

- Another question, also born from the results of reading numerous publications on the Internet on pediatric oncology. Why are children taken abroad for medical treatment? How is the treatment different from the one we have? class="_">

– Treatment in foreign clinics does not fundamentally differ from that carried out by Russian doctors. Yes, we still do not have enough separate surgical techniques. Perhaps somewhere there are not all chemotherapy drugs or there are no drugs that are not registered in Russia. But still, in most cases, parents take those children abroad for treatment, for the treatment of which we have exhausted all our possibilities, and treatment abroad is also without guarantees, this is already a gesture of desperation. Understand that pediatric oncology is a special branch of medicine. No parent will ever accept the fact that their child can no longer be helped, and in this I cannot blame anyone.

As a reminder, earlier we talked with Sergey Berzin, Professor of the Department of Oncology and Medical Radiology of the Ural State Medical University, with Tatyana Konstantinova, Chief Hematologist of the Sverdlovsk Region, and Andrey Tsoriev, Chief Specialist of the Yekaterinburg Health Department for Radiation Diagnostics, spoke about us.

We have devoted several publications to oncology of the gastrointestinal tract. About its most terrible localization - - we talked with the doctor of medical sciences Mikhail Prudkov, - with the chief surgeon of the city Alexei Stolin. Andrei Oshchepkov, the head of the Coloproctology Department of the SOKB N 1, told us about it, and Yury Istomin, the head of the Thoracic-Abdominal Department of the Sverdlovsk Regional Oncology Center, told us about it.

In addition, we wrote about typical "male" and "female" diseases: the chief urologist of the Sverdlovsk region Igor Bazhenov told us about, and the head of the department of oncomammology of the City Clinical Hospital N 40 Sergey Demidov and the head of the department of obstetrics and gynecology of the Ural State Medical University Tatyana Oboskalova - about the very common and most terrible and.

Finally, the chief oncologist of Yekaterinburg, Denis Demidov, told our readers in order to identify signs of oncology, and why complex procedures such as MRI or colonoscopy do not always help in this, and the chief surgeon of Yekaterinburg, Alexei Stolin, about.

Text: Tatyana VLADIMIROVA
Photo: Anton BASANAEV; Artyom USTYUZHANIN / site