The incidence of malignant tumors in children is increasing year by year, have you paid attention to these "signals"?

For medical professionals only

Early diagnosis and timely and standardized treatment are essential

Pediatric malignancies refer to malignant tumors that occur in childhood, including hematologic malignancies and non-hematologic malignancies, of which autohetanic disease accounts for 30%, brain tumors account for 25%, and lymphoma accounts for 15% [1]. According to the Children's Association International, childhood malignancies have become the second leading cause of child mortality in addition to accidental injuries. The cause of malignant tumors in children is obviously different from that of adults, and today Xiaobian takes you to understand the things about children's tumors.

Differences between malignancies in children and malignant tumors in adults

Pediatric malignant tumors are mainly divided into two categories: solid tumors and hematological tumors, the most common hematological tumors are various leukemias and lymphomas, solid tumors originate from non-epithelial tissues, common central nervous system tumors, various "parent cell tumors", including neuroblastoma, nephroblastoma, retinoblastoma, etc., as well as Juve's sarcoma, osteosarcoma and so on are also more common.

Adults are most common in cancers that originate in the epithelial tissue, common lung cancer, breast cancer, liver cancer, colorectal cancer, etc., although these cancers are also found in children, but the proportion is very small.

Many children's malignant tumors have an envelope and are easy to completely remove by surgery, and most children's malignant tumors are better than the sensitivity and short-term tolerance of radiotherapy and chemotherapy than adult malignancies, so on the whole, the prognosis of children's malignant tumors is significantly better than that of adults.

Neoplastic features in children

The incidence of tumors in children (0-14 years old) in mainland China is 12/100,000, and the incidence rate increases significantly at a rate of 2.8% per year (P<0.05), and the mortality rate is not obvious; the incidence and mortality rate of boys are higher than those of girls; the incidence of urban disease is higher than that of rural areas, but the mortality rate is lower than that of rural areas [2].

The incidence of different tumors depends on the age of the child, as shown in Figure 1. 0 to 4 years old mainly leukemia, retinoblastoma, nephroblastoma, neuroblastoma, germ cell and gonadal tumors, teratomas; 5 to 9 years old leukemia, lymphoma and central nervous system tumors more than 75%; 10 to 14 years old, Hodgkin lymphoma, bone tumors, epithelial tumors are the mainstay. Tumor types are mainly concentrated in the hematopoietic system, central and sympathetic nervous system, and mesenchymal tissue.

Figure 1 Proportion distribution of neoplasmic types by age group among children (0-14 years) in children (0-14 years) of the WHO International Agency for Research on Cancer (IARC) 2001-2010[3]

Causes of tumors in children

The pathogenesis of childhood tumors is complex, the specific pathogenesis is currently unknown, and it is generally believed that it may be related to heredity [4,5] and the environment [6] (living environment, biological, physical, chemical factors). Genetic factors are shown in Table 1 and environmental factors are shown in Table 2.

Table 1 Genetic factors that may be associated with childhood tumors

Table 2 Malignancy in children with known and clear environmental risk factors

Early warning of malignancy in children

It is generally manifested as fever of unknown cause, pallor, tendency to bleed, local mass, unexplained emaciation, hepatosplenomegaly, bone pain, headache, etc., but all are nonspecific symptoms. Early tumor screening methods (such as endoscopy, fecal occult blood examination, exfoliation cytology, etc.) have little significance in children's tumors, so the discovery of children's tumors is usually accidental, and they often have spread or metastasized locally at the time of presentation.

However, those who have the following conditions should be vigilant and seek medical treatment in time, see Table 3.

Table 3 Manifestations and warnings of malignant tumors in children

━ ━ ━ ━ ━

The key to whether children's tumors can be cured depends not only on the characteristics of the tumor itself, but more importantly, whether the children can obtain early diagnosis and timely and standardized treatment.

The treatment effect of childhood tumors is constantly improving, more and more children with tumors can get long-term survival opportunities, at present, 80% of children and adolescent cancer patients can achieve survival for more than 5 years. Therefore, if a child suffers from a malignant tumor, do not give up treatment lightly, but to achieve early detection, early diagnosis, and strive for early standardized and systematic treatment, you should go to a hospital with a children's oncology specialty in time for diagnosis and treatment, and regular treatment is the key to obtaining good efficacy.

bibliography:

[1] Rodriguez Galindo C，Friedrich P，Alcasabas P，et a1．Toward the cure of all children with cancer through collaborative efforts：pediatric oncology as a global challenge[J]．J Clin Oncol，2015，33(27)：3065-3073．

[2] Zheng R, Peng X, Zeng H, Zhang S, Chen T, Wang H, Chen W. Incidence, mortality and survival of childhood cancer in China during 2000-2010 period: A population-based study. Cancer Lett. 2015 Jul 28;363(2):176-80.

[3] Steliarova-Foucher E, Colombet M, Ries LAG,et.al. IICC-3 contributors. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 2017 Jun;18(6):719-731.

Zhang Ping,Li Xia,Wang Qiyao,Mo Lin. Research progress on risk factors for the incidence of malignant tumors in children[J].Chongqing Medical Sciences,2017,46(30):4288-4292.

He Mingyan,Gao Yijin. Research progress on hereditary tumor syndromes in children[J].Journal of Clinical Pediatrics,2013,31(05):477-480.

Bao Pingping,Zheng Ying,Jin Fan. Research progress on environmental risk factors for pediatric malignant tumors[J].Environmental and Occupational Medicine,2008(02):190-194.

[7] CP Steuber. Clinical assessment of the child with suspected cancer. UpToDate.

[8] Ching Lau, Etal. Clinical manifestations and diagnosis of central nervous system tumors in children. UpToDate.

[9] Oguz A, Karadeniz C, Temel EA, etal. Evaluation of peripheral lymphadenopathy in children. Pediatr Hematol Oncol. 2006 Oct-Nov;23(7):549-61.

[10] Kim HJ, Chalmers PN, Morris CD. Pediatric osteogenic sarcoma. Curr Opin Pediatr. 2010 Feb;22(1):61-6.

[11] Malogolowkin,MH. Clinical assessment and differential diagnosis of the child with suspected cancer. In: Principles and Practice of Pediatric Oncology, 5th.

This article was first published: Pediatrics Channel of the Medical Professions

This article is written by Doraemon

Editor-in-Charge: CiCi

The medical community strives to ensure that the published content is accurate and reliable at the time of review, but does not make any commitment and guarantee as to the timeliness of the published content, as well as the accuracy and completeness of the cited information (if any), nor does it assume any responsibility arising from the outdated content, possible inaccuracies or incompleteness of the cited information. Parties are requested to verify separately when adopting or using this as a basis for decision-making.