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Whit early diagnosis and accurate treatment, childhood cancers, which can occur at any age from the neonatal period to adolescence, can be treated at a rate of 60-70 per cent.

What is it??

Childhood cancer is the name of a group of diseases which is caused by uncontrolled cell duplication which impact’s  the child’s health and endangers life by spreading to different regions of the body in a short space of the time through the blood and lymph. Although it may occur at any age from the neonatal period to adolescence, the cancer is mostly contracted during the first five years of life. However, 60-70 per cent of children diagnosed whit cancer are completely cured whit early diagnosis and accurate treatment.

What are the symptoms of childhood cancers?

Depending on the type of the disease, there may be one more symptoms.

• Tiredness, paleness
• Recurrent or persistent fevers
• Bruises
• Lumps (usually painless) in the lymph nodes in the neck, armpits and groin area
• Swelling in any area of the body (for example, in the stomach, arm, leg, chest, wall, back, skull)
• Bleeding in the nose and gums
• Blood on urine and stools,
• Difficulty defecating or urinating, chance in bowel habits (constipation, diarrhea)
• Bone pain
• Persistent cough causing difficulty in breathing
• Headaches, often whit early morning vomiting
• Visual disturbances
• Pupil which shine like a cat’s eye in the dark, and involuntary eye movements
• Bruising around the eye
• Trouble walking and imbalance
• Seizures without fever
• School failure
• Personality changes
• Weight loss
• Delayed motor development as a baby (keeping the head up straight, skills like turning, sitting, walking).

Symptoms that cannot be explained by simple routine test (blood count, urine and stool examination) and cannot be treated whit frequently used methods of treatment (antibiotics, pain, killers, antifebrile) should be given emphasis. For more detailed study, the child should go to fill-equipped hospitals whit oncology-hematology specialists.

What type of cancers occur in children?

Cancer of the blood, known as Leukemia (it has two man groups known as lymphoblastic and non-lymphoblastic Leukemia and these also have sub-types), is the most common cancer seen among children and is basically a bone marrow disease. It can occur at any age starting from birth and it is more common among boys.

Lymphoma, also known as lymph node cancer, has two main groups known as Hodgkin’s disease and non-Hodgkin’s lymphoma and these groups have sub-types. It is mostly seen in lymph tissues especially in the neck, in the chest cavity and in the abdominal cavity. It is more common among boys. The Epstein-Barr virus and Hepatitis C virus are known to increase the risk of developing lymphoma; however a vaccine is not yet available for protection against these viruses.

Brain tumors have sub-types such as glioma, medulloblastoma, ependymoma, PNET, choroid plexus tumors and grem cell tumors and the sub-types are classified depending the cell type, the cells reproduction potential and the location of the tumor.

Neuroblastoma: This form of cancer starts in primitive nerve cells and spreads rapidly. This type of cancer occurs in infants and is most often contracted in the first two years of life. The cancer usually starts in the suprarenal gland, in the chest cavity and in the neck before spreading rapidly to the bone and bone marrow, imitating leukemia.

Soft tissue sarcoma: This cancer type develops from a soft tissue. It has two main groups known as rhabdomyosarcoma and non-rhabdomysarcoma and these have many sub-types. It occurs at any age.

Kidney tumor: It is most often seen during the first 5 years and it occurs as Wilm’s tumor, also known as nefroblastom.  However, there are other kidney tumors caused by different tissues.

Bone tumors: There are two main groups of non-malignant bone tumor. These tumors, known as Osteosarcoma and Ewing sarcoma, occur often in ages where children grow fast in height.

Eye tumor - The most common type of eye cancer is retinoblastoma which is known for being hereditary. Cancers such as leukemia, lymphoma, neuroblastoma and soft tissue sarcoma can spread to the eye tissues.

Germ cells tumor: - They may occur any age. It is a cancer seen especially in the reproductive organ, in the brain and in the midline structures of the other regions of the body. It consists of cells that have various potential of reproduction. This cances also has sub-types.

Liver cancer: They can occur at any age from birth. Hepatoblastoma and hepatocellular are the most common liver tumors. The Hepatitis B virus plays a role in developing liver cancer. Protection from liver cancer is possible whit the Hepatitis B vaccine.

•Други карциноми - тироиден, назофаринкс, кожа итн.

What are the diagnostic methods?

Depending on the patient’s complaints any symptoms, the main diagnostic methods are used to differentiate infectious diseases, which are caused by bacteria and viruses and occur most often in children, from traumas caused by bleeding and swellings, growth pains. The diagnostic methods are as follows:

• Hemogram ( blood count)
• Blood smear (regarding the cell types and proportion)
• Sedimentation
• Viral serology (to define some virus diseases )
• For differential diagnosis of tuberculosis (PPD, cultures)
• Full urine examination
• Stool tests
• Lung X-ray
• Neck ultrasonography
• Abdominal ultrasonography
• Kidney ultrasonography
The test that are conducted when the suspicion of the cancer is high are as follows:
• Bone marrow aspiration and biopsy
• Chest computed tomography (CT)
• Magnetic resonance imaging of the other regions of the body
• Positron emission tomography (PET) of some tumors (particularly lymphomas)
• Enzymes and protein markers of same tumors (LDH, alkaline, phosphatase, NSE, alpha-fetoprotrin, beta HCG, ferritin, dopamine, nanoadrenalin, VMA, HVA)

For a definitive diagnosis, the doctor should perform a biopsy of the related diseased area and wait for the related diseased area and wait for the decision of pathology, immunology and molecular genetics laboratories at tissue diagnosis. Treatment should not be initiated without a diagnosis of the tissue. The examination of the tissue is of vital importance of the subgroups and types of cancers. The diagnosis process takes between 2 and 10 days after the biopsy. A biopsy may be repeated in some cases.

After the definitive diagnosis of cancer, the staff that will carry the patients treatment should be determined. The patient’s parent’s should be informed about the process and results of treatment. Staging works to determine the stages of the diseases start at the same period.

CT, MRI, and scintigraph may additionally be performed to scan the tissues and organs that the tumor may spread to.

Test such as blood urine tests, EKG, EKO and hearing tests can be asked before the treatment to determine the functionality of other organs.

Once the staging work is complete, the appropriate treatment models accepted in global standards should be performed immediately. Before the treatment, the parents should be informed to the form of the treatment and its method of implementation, its contribution to the recovery of the disease, the chances and its early and later side effects, and the specialists should recive the approval of the parents. 

Which treatment method is applied?

While trating juvenile cancer patients, one or multiple methods are applied together or consecutively depending on patient’s age, type of disease, location of disease and metastasis (phase)to perimeter or to other organs. Such specialists include child oncology-hematology specialist, child surgeons, oncology surgeons specialized on different organs and radio-onclogy specialists. These specialists play crucial roles on treatment process by forming ”tumor councils” and reach mutual decisions.

How is it treated?

Chemotheraphy: This targets all cell which are rapidly reproducing. In this method, a number of medicines are applied through vascular access by using special types of catheters. The treatment is applied in frequently repeating sessions, by special oncology nurses, under the supervision of an oncology specialist, in oncology departments. The treatment sessions must be performed in fully equipped hospitals in order to prevent side-effects which may occur during or following the application of chemotherapy.
Chemotherapy is applied immediately following the diagnosis of leukemia and lymphoma, depending on the phase of the disease and the presence of any other types of cancer. It is applied before and/or after the surgical treatment at intervals varying from every 6 months to 3 years. It is important that the specialist in charge informs the patients family in detail of the chemotherapy treatment because of severe side-effects of chemotherapy treatment.
Surgical treatment: The method of treatment that is applied on tumors that are called solid tumors (tumors not related to leukemia or lymphoma). The tumor is completely removed without harming the infected organ. Surgery is applied on cancers that are in their early phases. Chemotherapy is applied following the surgery. On advanced stage cancers or in cases where the loss of an organ or if the functional defect is unacceptable, the tumor is shrunk through the application of chemotherapy before surgery.

Radiotherapy: The method of treatment, performed through the use of highly energized X-rays, may, in high doses, kills or prevent the reproduction of quickly reproducing cells. Therefore it is not used on patient between the ages of 3 and 5, when physical development is rapid. It is most commonly applied to brain tumors and other solid tumors, to compliment surgical treatment and chemotherapy. Because of the severe side-effects, the specialist in charge is responsible for providing detailed information of the treatment to the patients family. However the aim of radiotherapy is to specifically target the tumor without harming surrounding tissues: this is achieved through the use of various equipment and sources of radiation.

Bone marrow/stem cell transplantation: The method of treatment is applied particularly in cases of leukemia, in which the patient is highly sensitive to chemotherapy or on recurring lymphoma and on solid tumors after high doses of chemotherapy. The bone marrow or the stem cell used in treatment may be the patient’s own (autologous), and is preferable to taking the bone marrow or the stem cell from a donor with compatible type of tissue (allogeneic), particularly in leukemia treatment. Because of the application of high doses of chemotherapy, side-effects such as rejection of the tissue, bleeding and infection may occur during the transplantation process; even if the tissue is being accepted, these side- effect may be severe. Bone marrow transplantation is a treatment that increases the chance of recovery, although there is also a risk that the disease may reoccur.

Supportive treatment: The most important of these treatment are for chemotherapy preparations: medical that prevent nausea-vomiting, medical treatment co cure organs that may be harmed by chemotherapy, blood, blood products and antimicrobical treatment against anemia, fevered infection and risk of bleeding that can be related to disease or caused by chemotherapy, nutritional support, psychological support and social services. Usage of herbal treatment’s also known as complementary medicine or alternative medicine instead of standard treatment are not recommended because of the risk of harming the patients during the childrens cancer treatment.

A high chance of cure: With the right diagnosis and treatment, 60-70% of child cancers can be full cured. Nowadays the change of curing the tumors, if diagnosed at an early stage, rises to 90%. However, chance of more advanced stage being cured is only 10%. Therefore, diagnosis at an early stage is crucial.


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