Parents, pay attention: the first signs of cancer in children
How to recognize a malignant disease? What should alert parents? Boris Kovachev, co-founder of the Brave Blossoms Foundation, Director of the Institute of Management and Translational Medicine at the Dmitry Rogachev National Research Center for Oncology, answers.
What is the problem of early diagnosis of malignant neoplasms in children?
The incidence rate in all countries is approximately the same: 14-15 children out of every 100,000. In most cases - especially if it is a malignant solid tumor, which has no bright, noticeable signs - the diagnosis is established late. And generally at a more advanced stage than in adults. For adults there is a system of prevention and early diagnosis, but with children a different picture. Cancer is always an exception disease.
Therefore, one of the tasks facing pediatric oncologists today is the formation of risk groups. If a child is in such a group, this information will work as a red flag for the doctor to whom he comes to see. He or she will know that the patient has a higher risk of getting cancer and, therefore, will be more attentive to him or her.
Boris Kovachev, Director of the Institute of Management and Translational Medicine at the Dmitry Rogachev National Research Center for Pediatric Hematology and Oncology, Executive Director of the National Society of Pediatric Hematologists and Oncologists
Should a pediatric oncologist be involved in early detection of pediatric cancer?
Neither pediatric nor adult oncologists should be responsible for early diagnosis. A patient comes to an oncologist with a suspicion of a malignant neoplasm. But first this suspicion must first arise in someone. As a rule, in the pediatrician, if we're talking about children. And to facilitate his work, we are engaged in the formation of risk groups.
What criteria are taken into account?
The incidence in children of the first year of life is relatively high - 25 out of 100 thousand children are diagnosed with cancer in the first year of life. This is higher than in children of other age groups. If the figures are lower, it means that the diagnosis has not been verified and will be established later. Up to 90% of tumors in children in the first year of life are congenital. They manifest early, so the diagnosis should be made within the first six months of the child's life. Most often it is a fetal tumor associated with one or another fetal malformation.
We pay special attention to premature babies and children suffering from various congenital immunodeficiency syndromes. There are many such children, often they have unverified genetic diseases: the affected gene is not identified even with numerous tests. Nevertheless, we need to examine the entire panel of genetic breakdowns in patients suspected of developing a tumor. To understand if they have a syndrome that could trigger the development of cancer.
By what signs, symptoms can parents realize that the child is seriously ill?
In particular, leukemia is characterized by the fact that healthy hematopoiesis is disturbed, and this applies to all types of blood cells (only in 4% of cases there is so-called unilinear hypoplasia, when there are changes in only one sprout of hematopoiesis). This is what can alert parents:
🔵 prolonged fever for no apparent reason,
🔵 the presence of changes in blood tests: anemia, decreased platelet count (which may be accompanied by bruises and bruises on the body, rash in the form of small hemorrhages),
🔵 changes in white blood cells.
The problem is that it is not always possible to see tumor, “blast” cells in a blood test. In addition, their presence is not a mandatory criterion for the diagnosis of acute leukemia. It should be understood that diagnosis is very difficult.
What other signs can alert parents? Unexplained pallor; changes in the child's behavior and activity; refusal to eat, especially at an early age, suspension of weight gain; lack of any emotional reactions, indifference. In general, if the mother seems that the child has become strange, that he behaves differently than always - it is a sign that it is better to consult a doctor.
What is the next step?
When changes are detected, the child is referred to a pediatric hematologist-oncologist for consultation or hospitalization. For example, if leukemia or a number of other conditions are suspected, a bone marrow puncture must be performed, which is done in the hospital. Without a detailed examination, there is a danger that the doctor may misjudge the situation and start treating another disease.
For example, if the first place is not changes in the blood test, but pain in the bones and joints, the disease may be interpreted as rheumatoid arthritis and start therapy with glucocorticoid hormones, which in the case of cancer can significantly worsen its course and cause the development of severe complications.
What do parents need to know about the symptoms of lymphoma?
If your child has a longstanding cough and a prolonged fever that antibiotics can't control, it's cause for serious concern.
Explain what a prolonged fever is.
If, against the background of antibacterial or other anti-inflammatory therapy, the temperature remains high for 10 days or more, it means that the issue of the child's health should be of interest not only to parents, but also to the attending physician to whom it is necessary to refer.
What to do if the parents themselves discovered the tumor?
If a voluminous formation is detected when probing the abdominal cavity, it is necessary to immediately go to the doctor. However, it is worth remembering that if the child complains of abdominal pain, he may be hospitalized in a surgical ward, although in fact abdominal pain may be a symptom of lymphoma or another tumor. It is therefore crucial that surgeons have a high cancer alertness. But it is the parents who should be the first to be alert. We face a big problem, especially in the summer, when mom or dad feel a tumor in the abdomen of the child, but see that the baby is feeling well and go on vacation to the south.
How do brain tumors manifest themselves?
Be careful if a small child has an abnormal increase in the size of the head - a manifestation of hydrocephalus. Parents should be alerted to nausea and vomiting, especially in the morning. This should be immediately informed to the doctor.
What symptoms should we pay attention to when it comes to sarcomas?
The presence of a palpable (i.e. palpable) mass. Very often parents associate this with previous trauma, especially if the tumor is found on the leg or arm. Warming procedures or surgical opening of a hematoma or phlegmon can be dangerous!
No treatment should be started until the diagnosis has been verified. And verification begins with a radiologic study, a standard X-ray. But then you may need other studies, including laboratory tests.
In our practice, there were many cases when doctors tried to treat a certain formation with local means, and then it turned out to be a malignant tumor. Any voluminous mass should be studied, the reasons for its occurrence should be clarified and a diagnosis should be established.
What should parents do if, for example, a routine blood test is unavailable? Is it critical to wait several days for it?
If a doctor orders a blood test, he or she should ensure that the child (or family) has the opportunity to have it done. The test should be ready the very next day. Resources are not always sufficient, but help should be available for every child. It is unacceptable to wait five days for a blood test result.
No more than 48 hours should elapse between the time of the appointment and the test. If this time frame cannot be met, all bells should be rung. Failure to provide assistance on an outpatient basis is an indication for emergency hospitalization of the child.
In some regions, a simple blood test, for example, for alpha-fetoprotein (a marker of some tumors) can be taken only for a fee. This is wrong. A family will certainly find the money and pay. But for some it is an insignificant amount of money and for others it is a lot of money. The family should not disadvantage themselves financially neither during the period of examination, nor after, especially if the child has had a malignant tumor and now for a long time he needs to take tests. If they have to pay for them...
Can parents have complete trust in a doctor?
It is impossible to call for absolute trust. Although, of course, responsible parents should have a doctor they trust. After all, before a child turns 18, monitoring his or her health is always a matter of communication between the doctor and the parents. Moreover, the doctor at the polyclinic does not just treat the child: he teaches the parents how to observe and treat. We are all in favor of the integration of parents and doctors. And for doctors of different specialties to be integrated into a common program for controlling childhood cancer.
Can parents figure out what the test says on their own?
Mom should not have to decipher the tests. She should talk to the doctor who referred her child for the test, discuss the results with a lab specialist, or call a doctor she trusts.
By looking at the blood test, we can see if there are changes in the blood. And the doctor has to decide what to do with these changes: hospitalize the child, refer him to another specialist or continue monitoring.
I am often asked a question: how can I help sick children? You can send an SMS to the Gift of Life Foundation's short number 6162, or you can donate blood. In every interview I encourage readers and parents to donate blood, which can really save the life of a child with cancer. And the state of the donor movement demonstrates society's attitude to the problem of childhood cancer.