Pediatric Oncology

Childhood cancers; It is the name given to a group of diseases that occur with the uncontrolled proliferation of cells in any part of the body, which is a short time spreads to different parts of the body through blood or lymph, which impairs health and threatens life.

What is a tumor?

The basic building blocks of the body are cells. Cells grow and develop in a controlled and balanced manner. As a result of uncontrolled proliferation of cells in any part of the body, swelling occurs and this is called a tumor.

Tumors can be benign or malignant. Benign tumors do not spread in the body, they remain limited where they first formed, but malignant tumors grow where they first formed and then spread to other tissues and organs. There are many types of tumors and treatment options.

There are three main treatment methods in tumor treatment, these are;

  • Surgery
  • Chemotherapy
  • Radiotherapy

What is Chemotherapy?

Chemotherapy means drug treatment. Some of these drugs can be made as an injection, some of them can be given orally (tablet, capsule, syrup). Needles can most often be administered intravenously, sometimes through the hip and under the skin. In some lymph node tumors, chemotherapy drugs can be given from the waist to the waist water, which is called intrathecal treatment.

If the treatments are very frequent and there is difficulty in finding vascular access, special tools called central venous catheters can be used. There are also types of catheters that are placed completely under the skin, called port catheters, with their tips outside. After chemotherapy drugs enter the blood, they enter the rapidly proliferating cancer cells.

They inhibit the growth and proliferation of cancer cells and eventually cause them to disappear. Cancer drugs also affect other cells such as the mucosa, bone marrow, hair follicles that rapidly proliferate in the digestive system, apart from cancer cells, and cause some side effects. However, its side effects, severity, and type vary according to the person and treatment. Most of these side effects are temporary.

Common Side Effects

  • Nausea, Vomiting
  • Pain and burning at the injection site
  • Allergic reactions (itching, swelling in hands, feet and eyes, difficulty breathing)
  • Leakage of drugs outside the vein
  • Hair loss
  • Sores in the mouth
  • Constipation
  • Suppression of the bone marrow
  • Jaundice (yellow skin and eye color due to liver disorder)
  • Hemorrhagic cystic (blood in the urine due to the damage caused by drugs in the bladder)
  • Nervous system disorders

What is Radiotherapy?

It means treatment with high-energy x-rays. High doses of radiation can kill cells and prevent them from multiplying. Since cancer cells reproduce faster than normal cells, radiation therapy is used in the treatment.

It can be used alone or in combination with surgery and chemotherapy. It does not cause pain to the patient during treatment. Since the patient stays in the room alone, young children should be prepared for this in advance.

Since the skin will be sensitive, soap and lotion should not be used during the treatment. Is the tumor contagious? It is not a contagious disease. A diagnosed patient has no risk of transmitting it.

Rules to Follow During Tumor Treatment

During tumor and tumor treatment, the patient has a high risk of infection (microbial diseases). Microbes that do not cause illness in a healthy person can cause a febrile illness in children with tumors.

This risk can be significantly reduced by following the cleaning rules. For this, dietary rules, hand cleaning, body cleaning, and oral care are important.

General Information About Some Types of Tumors

What kind of disease is neuroblastoma? It is a tumor originating from nerve node cells and is most commonly seen in infants. This type of tumor is very rare in older children and pre-adolescence.

It is generally seen in children under the age of five and ranks fourth in frequency among childhood tumors. The cause of the disease is not clear. In addition, any chemical substance or exposure was not found to be associated with neuroblastoma.

It is not a hereditary (hereditary) disease. Like any tumor, it occurs as a result of the disruption of genes in the cell. The presence of this disease in the sibling, the use of alcohol by the mother, and the presence of similar diseases in the family pose a risk for the occurrence of this disease.

Wilms Tumor

It is also known as nephroblastoma. Wilms’ tumor is the most common type of malignant kidney tumor in children. Basic features: In terms of tissue structure, it emerges from the embryo-like and developed tissues of the tumor. The tumor does not discriminate against gender, nor is it inherited.

As the kidney cells mature in the fetus, they turn into special structures and form different parts of the kidney. Some of these cells are still immature at birth and continue to develop in the first 3-4 years.

However, in Wilms’ tumor, cells remain immature and begin to reproduce rapidly. As a result, they form a mass that can reach large sizes before symptoms appear.

Brain Tumors

Brain tumors are the most common solid tumor type seen in childhood and constitute almost a quarter of all cancers seen in childhood

It takes second place after leukemias among the malignant diseases seen under the age of 15. In our country, it is the third most common after leukemia and lymphomas.

Factors

Relationship with ionizing radiation: It has been reported that secondary central nervous system (CNS) tumors develop after 2-24 years in children who have previously been irradiated to the skull for a tumor.

It has been found that exposure to radiation during pregnancy is associated with CNS tumors in childhood. Factors related to the immune system: There is an increased risk for CNS tumors in people who have organ transplants and receive immunosuppressive therapy.

Clinical Findings:

Seizures, muscle weakness, increased reflexes, the emergence of abnormal reflexes, and other neurological findings can be seen. Facial paralysis due to multiple nerve core damage, cross-eye, droopy eyelid, and difficulty swallowing can be seen in those located in the brain stem.

In addition, there may be imbalance and vomiting. Increasing headache in the morning due to increased intracranial pressure in cerebellum tumors, nausea-gushing vomiting; Due to the involvement of the cerebellum, imbalance, gait disturbance, tremors in the hands, bursting speech, beats in the eyes can be seen.

The skull prevents the brain and the tumor developing in it from being noticed. The physician cannot see or feel the tumor while examining his patient. It can only predict the presence of a space-occupying event within the skull based on the signs and symptoms caused by the tumor.

For this reason, brain tumors are shown with different imaging methods. The main ones are BBT (Computerized Brain Tomography), MRI (Magnetic Resonance Imaging), DSA (Angiography), and SPECT (Single Photon Emission Computed Tomography). The definitive diagnosis of the cell type in brain tumors is made only by surgically removing the tumor and examining it under a microscope.

Bone Tumors

The most common bone tumors in childhood are Osteosarcoma and Ewing sarcoma.

What is osteosarcoma?

Osteosarcoma is a type of tumor seen in bone cells. It often begins at the ends of long bones, but can also originate from other bones.

The most common sites are the lower end of the femur (lower end of the thighbone; just above the knee), the upper end of the tibia (upper end of the tibia; just below the knee), and the upper end of the humerus (upper arm bone; just below the shoulder). Osteosarcoma can spread to any organ or tissue in the body, but the first place it prefers to spread is the lung.

Osteosarcoma is most common in children and young adults between 10 and 20 years of age in rapid growth. It is more common in boys. It is generally diagnosed as a result of trauma to the affected area, but there is no known relationship between trauma and the risk of osteosarcoma. It is known that radiation affects the formation of tumors.

What are the symptoms of osteosarcoma?

The most common symptom is swelling and pain around the affected area. Findings usually occur 3 months after the onset of the disease. Moving that area can increase the pain. If the tumor is in the hip or leg, the child may limp

Ewing Sarcoma Tumors

It occurs in bones and soft tissues throughout the body and consists of small, undifferentiated round cells. It is most commonly seen in long bones such as arms and legs, flat bones of the ribs and pelvis (pelvis), or spine bones, but can originate anywhere in the body that has soft tissue or bone.

It is found in 1% of all childhood tumors. It is rarely seen before the age of 10. It usually occurs between the ages of 10-15. It is slightly more common in boys.

Bone-borne Ewing sarcoma is the second most common bone tumor in childhood. Ewing sarcoma tumors seen in soft tissue are called extraosseous (extraosseous) Ewing sarcoma.

Extra-bone Ewing sarcoma is most common in the thigh, pelvis (pelvis), spine area, and chest wall. Peripheral Primitive Neuroectodermal Tumor (PNET) seen in bone or soft tissue is a type of Ewing Sarcoma Tumor Family.

What are the Symptoms of Ewing’s Sarcoma Tumors?

The most common finding is pain. Stiffness is swelling and tenderness that occurs in the affected bone area. However, in advanced disease, weakness, weight loss, and fever can be seen. Differential diagnoses should be made with osteosarcoma, bone inflammation, neuroblastoma, leukemia, and other bone tumors.

Lymphoma (Lymph Node Tumors)

Lymphoma is a tumor of the lymphatic system. The lymphatic system consists of olive-shaped glands that produce lymph fluid that carries disease-fighting white blood cells (lymphocytes) throughout the body. The lymphatic system is the immune (defense) system

It is the 3rd most common tumor type in the pediatric and adolescent age group.

It is the second most common tumor after leukemia in developing countries. The disease can be summarized as the uncontrolled growth of lymph tissue. Its frequency increases after 5 years of age in children. It can be seen more frequently in men in terms of gender.

Lymphoma is seen in 2 types; Hodgkin Lymphoma and Non-Hodgkin Lymphoma.

Hodgkin Lymphomas

It is a glandular tumor that can start from lymph nodes in the body and rarely from organs such as the liver, spleen, and skin. Most often they originate from the neck glands.

Age and gender: The incidence increase in two lifelong periods, around the age of 10 in children and after the age of 50 in adults. In developing countries, onset falls below the age of 10. The annual incidence in children under the age of 15 is about 5-7 per million, and it is slightly more common in boys.

Non-Hodgkin Lymphoma

Non-Hodgkin Lymphoma (NHL) is a disease characterized by uncontrolled proliferation of lymphocyte series cells. Although it is most common in organs such as lymph node, peyer plates and spleen, bone marrow involvement is also common in children.

Rarely, bone and brain lymphoma have also been reported. NHL constitutes 6-7% of childhood cancers. It ranks 3rd among cancers in frequency. It occurs more frequently in the Middle East and African countries due to Burkitt’s lymphoma.

NHL constitutes 45% of all lymphoma cases under the age of 20. While there has been no change in the prevalence of children under the age of 15 in the last two decades, a 50% increase in the incidence between the ages of 15-19 has been detected. The male / female ratio is 2.5 / 1.

While it is seen at a constant rate at all ages, an increase in its incidence is detected between 15 and 19 years of age. Some risk factors related to the disease have been identified: The incidence of NHL is increasing in immunodeficiency diseases. Immunosuppression caused by bone marrow or solid organ transplantation increases the risk of NHL.

In patients taking epilepsy drugs such as diphenylhydantoin, NHL can be seen excessively. The risk of incidence increases in patients receiving chemotherapy and radiotherapy. Epstein-Barr virus (EBV) and HIV virus infections increase susceptibility to NHL.