Cancers affecting the children are known as paediatric cancers. These include leukaemias (comprising about 25 per cent of the paediatric cancers), germ cell tumours (comprising about 22 per cent of the paediatric cancers), brain tumours (comprising about 20 per cent of the paediatric cancers), lymphomas (comprising about 10 per cent of the paediatric cancers), neuroblastomas (comprising about 8 per cent of the paediatric cancers), sarcomas (comprising about 8 per cent of the paediatric cancers) and nephroblastomas (comprising about 7 per cent of the paediatric cancers).
Neuroblastoma is a commonly occurring tumour in the children below 5 years of age. It arises from the sympathetic nervous system. The most common site of neuroblastoma is the abdomen but it may occur anywhere in the body. Risk factors include consumption of alcohol & certain drugs and use of hair dyes by the mothers during pregnancy. The neuroblastoma usually presents as a unilateral abdominal mass along with abdominal pain, loss of appetite, loss of weight, intermittent diarrhoea and fever. It usually metastasises to the bones through the bloodstream. In the localised resectable stage, the tumour remains within the tissue of its origin and can be completely removed by the surgery. In the localised unresectable stage, the tumour is localised but cannot be completely removed by the surgery. In regional stage, the tumour spreads to the adjacent tissues and the regional lymph nodes. In disseminated stage, the neuroblastoma spreads to other parts of the body. Procedures used in diagnosis and evaluation of the neuroblastoma include ultrasound, CT scan and biopsy.
Wilmâ€™s tumour (Nephroblastoma) is a malignant tumour of the kidney. It comprises about 8 per cent of childhood cancers. Wilm's tumour is a fast-growing tumour that affects the younger children, particularly the infants. About 10 per cent cases of the Wilm's tumour are found to have some kind of congenital abnormality. There are hereditary and non-hereditary types of nephroblastoma. The hereditary nephroblastoma affects the younger children and usually involves both the kidneys. Wilm's tumour may present as a mass in the abdomen along with low-grade fever, loss of appetite, loss of weight, pallor, lethargy and haematuria. It usually metastasises to the liver, lungs and the bones.
Staging of nephroblastoma is done as follows:
- In stage I, the tumour is localised in one of the kidneys and can be completely removed by surgery.
- In stage II, the tumour extends beyond the kidney but still completely removable by the surgery.
- In stage III, the tumour cannot be completely removed by surgery. In stage IV, the tumour metastasises to other parts of the body.
- In stage V, the nephroblastoma involves both the kidneys.
Procedures used in diagnosis and evaluation of the Wilm's tumour include urine analysis, IVP, ureteropyeloscopy, selective renal arteriography, ultrasound, CT scan and MRI.
Rhabdomyosarcoma is the most common and extremely malignant soft tissue sarcoma. It usually affects the children below the age of 10 years. Rhabdomyosarcoma arises from the skeletal muscles and usually affects the head, neck, arms, legs and genitourinary organs. Symptoms of the rhabdomyosarcoma vary considerably depending on the site of the tumour. The most common symptom is a mass in the head, neck, eyes, chest, abdomen, genitourinary organs or the extremities. There may be marked protrusion of the eye, proptosis and paralysis of the ocular muscles.
Staging of rhabdomyosarcoma is done as follows:
- In stage I of the rhabdomyosarcoma, the tumour is located in the eye; or the head; or the neck; or the bladder; or in one of the genital organs.
- In stage II of the rhabdomyosarcoma, the tumour is located at a site other than the sites mentioned in the stage I and the size of tumour is less than 5 cm.
- In stage III of the rhabdomyosarcoma, the tumour is located at a site other than the sites mentioned in stage I, but the size of the tumour is more than 5 cm along with the involvement of the regional lymph nodes.
- In stage IV, the tumour is located at more than one site.
Procedures used in diagnosis and evaluation of the rhabdomyosarcoma include X-rays, ultrasound, CT scan and biopsy.
Ewing's tumour originates in the marrow of the long bones such as the femur, tibia and the humerus. It occurs during childhood and early adolescence. Ewing's tumour usually presents with multiple lesions in the shaft of long bones. The tumour has many layers of the new bone formation in a sub-periosteal region that expands the shaft giving an appearance of the â€œcut onionâ€ in X-ray film. Symptoms of the Ewing's tumour include painful swelling and intermittent fever. Ewing's tumour usually metastasises to the lungs, bones and the bone marrow through the bloodstream. It may metastasise to the lymph nodes and the central nervous system.
Staging of Ewing's tumour is done as follows:
- In stage I of the Ewing's tumour, the tumour is located below the elbow; below the knee; in the lower jaw; the skull; the face; the scapula; the clavicle; or the vertebrae.
- In stage II, the tumour is located in the ribs.
- In stage III, the tumour is located in the humerus or the femur.
- In stage IV, the tumour is located in the pelvis or the sacrum.
Procedures used in diagnosis and evaluation of the Ewing's sarcoma include X-rays, bone marrow aspiration, fluoroscopy, CT and biopsy.