Neuroblastoma in Children
Oncology / / May 19, 2016
Neuroblastoma, as well as nephroblastoma, is one of the most common cancer occurring in children.It also occurs in 7% of cancers in children.Neuroblastoma - a collective term, since under that name unite malignant tumor of the sympathetic nervous system: simpatogonioma, simpatoblastoma, ganglioneyroblastoma.Although neuroblastoma is found in almost all parts of the body, the practical importance are only two of its localization: retroperitoneal (the adrenal gland and chromaffin body) and posterior mediastinum.These tumors occur most often in young children.
neuroblastoma clinical picture is almost always well defined.When neuroblastoma occurs relatively early in the process of generalization of the tumor and, therefore, signs of the disease is increasing rapidly.Among them, striking a sharp pale skin.Often, at the very beginning of the disease can be noted decreased appetite, kapriznichane child, sometimes vomiting.These symptoms as the disease progresses gradually, and often dramati
may be low-grade fever.When palpation of the abdomen often in the upper and middle sections of the tumor is detected, generally sedentary and bumpy, which distinguishes it from nephroblastoma.Like many other tumor in children, it is often discovered by accident, during bathing or changing your child.Abdominal circumference increased, it is often deformed, can be rolled rib arch, bulging in the lumbar region on the part of the tumor.Often in the upper abdomen and thorax is expressed subcutaneous vascular network up to the "head of Medusa."In some cases, when neuroblastoma accompanied by ascites tumor may not be palpable.Children can also be observed Hernia protrusion at the umbilicus and inguinal region due to increased abdominal pressure, pastoznost anterior abdominal wall and lower extremities.
However, clinical signs often are caused not by the primary tumor and metastases.Since neuroblastoma metastasizes early, even if a small size of the primary tumor, they are the reason for diagnosing a neoplasm.Metastases in the bones of the skull are determined by tumor bumps in the scalp and sometimes on the forehead, and exophthalmos (protrusion of the eye) and the periorbital hemorrhage.In some cases, palpable enlarged cervical lymph nodes.Metastases to the liver, which often gives neuroblastoma, the latter can be increased and bumpy.Affects also bones, among them more often the lower limbs, so may be pathological fractures.Pulmonary metastases are much rarer than in nephroblastoma.Often (30%) gives neuroblastoma metastases to bone marrow.
view of a sick child in a generalized stage neuroblastoma is typical: he abruptly pale, emaciated, with blue circles, rarely - bleeding under the eyes, sometimes with bumps in the frontal and temporal regions;often marked exophthalmos, stomach sharply increased in volume, is covered by a network of dilated veins.Children are so weak that poorly kept head.
for neuroblastoma is characterized by severe anemia, increased erythrocyte sedimentation rate significantly.A number of patients have a transient increase in blood pressure, tachycardia (increased heart rate), increased sweating, sometimes in the form of profuse perspiration, loss of hair.
Recognition neuroblastoma starts with a tour that allows you to mark pronounced pallor of the skin, excessive development of a network of blood vessels under the skin of the abdomen, and the increase in deformation of the latter.Of great importance is palpation of the abdomen, which typically determined inactive nodular swelling.Laboratory tests are marked anemia, varying degrees of severity, increased erythrocyte sedimentation rate;with lesions detected simpatoblastov bone marrow cells obtained during its puncture sometimes increase in platelet count.An important method of neuroblastomas recognition is the determination of daily urinary excretion of catecholamines.Children having neuroblastoma, unlike other tumors reveals a dramatic increase of catecholamines.This method is used also to study the effectiveness of treatment as close to normal during convalescence child catecholamines.
most important method for diagnosing neuroblastoma is the X-ray examination.Already in the overview image is determined abnormal shadow corresponding to the palpable tumor, occasionally (20%) against this tumor foci of calcification detected.X-ray study allows you to set the bone lesion, which is usually the nature of bone resorption.Intravenous urography usually determine the offset of the kidneys;Unlike nephroblastoma neuroblastoma pyelocaliceal kidney machine is not deformed.
Unlike located retroperitoneal neuroblastoma, neuroblastoma mediastinum is considerably more benign and does not have such expressed clinical signs.Neuroblastoma usually located in the mediastinum, is an accidental finding on X-ray examination.In such cases, the posterior mediastinum on chest radiographs reveal abnormal shadow rounded, usually with clear contours.Often at the same time marked apart of the ribs and thinning.Only when large amounts of tumor, during germination of the last in the spinal cord, there are pronounced signs of disease specific to neuroblastoma.Metastasis in the localization of the tumor in the mediastinum occurs much less often and later.Germination her into the spinal canal can be accompanied by paresis and paralysis of the limbs, more rarely - urinary and fecal incontinence.Such children need special care in order to prevent the development of pressure ulcers.Under the patient in such cases enclose oilcloth, rubber circle (in older children) or a vessel to be replaced frequently.
To determine the tactics of treatment and prognosis of the disease prompted to distinguish between stage 4 neuroblastoma:
I stage - when the tumor is localized in the area of primary focus;
II - the tumor spreads beyond the primary tumor, but does not go to the other side of the spine can be affected lymph nodes near the tumor;
III stage - a tumor moves to the other side of the spine, and the affected lymph nodes on both sides of the spine;
IV stage - there is distant metastasis (the bones of the skeleton, skull, soft tissue, lymph nodes in the neck, groin, etc...).
Treatment Treatment of neuroblastoma complex.Unfortunately, radical removal of neuroblastoma, located retroperitoneal, is not always possible due to germination to neighboring organs and the close relationship with the major vessels: the aorta, inferior vena cava, the renal vessels.In some cases it is possible partial removal of the tumor.Typically, radiation therapy is conducted as neuroblastoma mostly lends itself well to this method of therapy.It held as a pre-operative and post-operative radiation therapy, and can be administered as a standalone type of treatment.An important place in therapy of neuroblastoma, particularly generalized stage takes medication.