Cancers, more rarely in childhood compare with adults, represent a leading cause of death for children and teenagers. The types of cancer occurring at children differ from adults types regarding the localisation, frequency, histology and treatment.

PEDIATRIC TUMORS

The more frequent cancer at children (60%) are acute lymphoblastic leukemia and malignant lymphoma. Actually, the modern chemotherapy treatments permit to obtain cures in high percentage. Another category of cancer for child are solid tumors which occur initially in a localized area, and then produce distant metastasis in vital organs causing the death.

The more frequent solid tumours in children are: brain tumours, specific tumours of childhood (nephroblastoma or Wilms tumour, neuroblastoma and retinoblastoma), sarcoma of the bones or with others localisation. In brain tumours, the therapeutic results are modest. In the other mentionated cancers, the modern therapeutic strategies led to unexpected, percentage of cure. Child’s specific tumours in early stages are curable in 80%-90% percentage. It must be stressed that in Romania the treatments are similar with those in Occident . The correct diagnosis represent essential premise of cure.

We mention some symptoms and signs present at the beginning of the disease:

  • headache, progressive in intensity, relieved by throwing up associated with neurological signs (unstable walking, strabismus, palsies) can announces a cerebral tumour.
  • adenopathy (increasing in volume of lymphatic nodes) with different localisations can be present in leukaemia and lymphomas.
  • localised pains of bones can accompany or not a malign osseuse tumour. These occur specially at teenagers in period of accelerate grow.
  • increasing of abdominal volume through a tumours encounters in renal tumours and in abdominal neuroblastomas.
  • hepatosplenomegaly can announce a malign disease.
  • association of fever, haemorrhagic syndrome and pale is suggestive for an acute leukaemia.
  • occurrence of a visible or palpable tumour must rise the suspicion of a malign tumour.

In all cases, surgical exam and histopathological examination precise the diagnostic, drawing physician’s attention to first suspect sign, the parents can contribute to obtain an early diagnosis and to establish an adequate treatment.

NEPHROBLASTOMA IN CHILDREN

Nephroblastoma (renal tumour) present a great interest due to it’s high frequency and rate of cure. Having a mist histology the disease was known with other names like nephroblastoma, renal carcinosarcoma and Wilms’tumour. The tumour has the name from a German surgeon who described it in 1889 like a specific disease of a child. Looking at the historical and the therapeutic stages we mention the followings:

Until 1940 the only therapeutic possibility was the surgical removal of the sick kidney, with a 20% rate of survival.

In 1950 the association of radiotherapy in treatment of the disease rose the cure rate at 40%.

After 1960 in the era of chemotherapy, the association of chemotherapy to previous treatments changed the prognosis of disease, making it curable in 90% in stages I and II.

Neuroblastoma represents 7% of paediatric concerns and 90% of paediatric renal tumours. It is the most frequent retro peritoneal abdominal tumour beside neuroblastoma. The incidence is 8 cases to 1 million and sex distribution is almost equal. The age of appearance is between 1 and 4 years. (65% cases). They are possible at any age.

The modern genetic investigation showed the presence of chromosomial abnormalities in some familial cases in which the transmission is autosomal dominant with variable penetration. In the patient families, the genetic counselling is necessary.

Nephroblastoma is localised to one renal pole, disrupting the normal structure due to it’s grow. Lymph nodes metastasis are present in 30% of cases. Metastasis through blood flue which appear frequently are in the lungs. At the beginning the symptomatology is reduced to abdominal pain, dysfunctions of gastrointestinal tract, hematuria and fever. Rarely, the initial presentation can be through acute surgical abdomen, due to disruption of tumour caused by a traumatism.

The late diagnosis is possible because has no significant symptoms and unchanged general state. We mention the investigations needed to sustain the diagnosis of renal tumour.

Excretory urogram (IVP) must be done initially because the aspect is characteristic: intrarenal tumour which disrupts and distort the pyelocaliceal system.

Abdominal ultrasonography is a safe and non traumatic investigation. It can delineate the tumoral mass and distinguish it from other renal diseases (hydronephrosis, cysts), and can assess the opposite kidney.

Computed Tomography is the method which offers the best data about the spread of the disease in the best data about the kidney and to distance (lymph nodes and pulmonary metastasis).

Magnetic Resonance Imaging offers few additional data compared with Ct, being an investigation and less used in diagnosis of nephroblastoma.

Therapeutic modalities used in Wilms’tumour are complex, consisting in an association of surgery, chemotherapy and radiotherapy. This association is individualised according to the stage and aggressiveness of the disease (histological type).

  1. Surgery is used in each case, consisting in nephrectomy (removal of sick kidney) and large limphadenectomy.
  2. Radiation therapy in form of cobaltotherapy is indicated in advanced stages (III and IV) and in aggressive histological types.
  3. Chemotherapy has an important role in evolution of the disease. Among drugs used in this disease we mention: vincristin, achynomicine (cosmegin), farmarubicine, chemotherapy is indicated in all stages, the treatment being individualised (like rhythm, intensity and time) accordingly to prognosis factors.

The therapeutic results are different depending on response to treatment and stage of disease. Two years free diseases survival can be equivalent with cure, because the most distant metastasis occur in this period of time. The surviving in forms with out metastasis (stages I, II, III) is in range of 80-90%. Actually, nephroblastoma can be treated and cured preserving an excellent quality of survivors’ life. Side effects of chemotherapy and radiotherapy can be managed by adjuvant treatment. Patients with nephroblastoma are followed-up after the end of the treatment like this: monthly in the first year, to every six month in the third year, and then annually.

RETINOBLASTOM

In children retinoblastoma is the most frequent solid ocular tumour, representing a specific pediatric tumour beside the nephroblastoma and Neuroblastoma. In 30% cases, the disease is hereditary. There are chromosomial abnormalities expressed through arm 13q14 deletion. The disease can be bilateral. Therefore it is important that a family who has a child with this disease needs a genetic counselling if they want to have another baby. The educative role of family physician is critical. Curability supposes the knowledge of early symtomathology by the parents and family doctor.

The first sign is leucocoria (the occurrence of a white spot at the pupil level which is observed in a certain incidence of the light-reflex of the cat’s eye). Subsequently appear other signs: glaucoma (increasing of intraocular pressure), tears, progressive loss of vision, and protrusion of ocular globe. Invasion of optic nerve and intracranial spread develop in advanced stages and lead to death .The correct diagnosis and the first therapeutic steps belong to ophthalmologist. This consists in removal of the entire eye or ophthalmologic microsurgery: photocoagulation and criotherapy (which preserves the vision and the globe). Chemotherapy is indicated in all stages. Radiation treatment is applied only in advanced stages. The intensity and the period of the treatment vary in concordance with the disease’s stages. Curability rate is about 90-95% in earlier stages in condition of modern multidisciplinary treatments. Surviving without disease over one year involves teamwork of family, physician, ophthalmologist, pathologist, oncologist and radiotherapist.