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Neuroblastoma is one of the most common cancers in children under five, and makes up half of all cancers in babies. It is very unusual for this type of cancer to occur in older children or teenagers. Neuroblastoma starts in embryo cells made up of ganglia from the sympathetic nervous system and adrenal medulla, and therefore may appear in different locations and with many different clinical presentations.
It is not currently known what causes them, but they are understood to often be hereditary. Approximately two thirds of neuroblastoma occur in the adrenal glands (found above the kidneys) or near the spinal cord in the nerve cells that control the heart beat, blood pressure and digestion. Neuroblastoma may also appear in the chest, neck or pelvis. During diagnosis they are often found to have already spread; there may be metastasis in the lymph nodes, liver, bones, bone marrow or other organs.
Neuroblastoma may be divided into two types of tumour:
The first symptoms of neuroblastoma may be imprecise and include fatigue, weight loss or weight gain.
Abdominal tumours may cause abdominal pain or difficulty urinating or with bowel movements.
Tumours pressing on the spinal cord may cause weakness in the arms and legs and the patient may find it difficult to move their arms or to walk.
If the tumour has spread to the bones, it may cause pain and, if it has spread around the eyes, it may cause bulging eyes and dark circles. There may also be inflammation or a lump around the affected tissue. Other less common symptoms are weight loss and fever.
Malignant neoplasms in children and teenagers are rare, but they are one of the most important causes of morbidity and mortality in these age groups. Around 1,000 patients under 14 years of age are diagnosed with cancer every year in Spain. Neuroblastoma makes up 10% of cancers in children.
If the doctor believes the child may have a neuroblastoma, he/she will carry out a very precise examination and request several diagnostic tests to determine the size and location of the tumour. The most common tests are:
Treatment is administered taking into account the state of the disease, the child’s age and the location of the tumour.
Some low-risk neuroblastoma may disappear without treatment, and others can be cured with surgical treatment alone. However, many tumours in the “high-risk” category will already have spread tumour cells to other parts of the body, and in these cases it is necessary to use a combination of chemotherapy, surgery, radiotherapy, bone marrow transplant and immunotherapy.
There are currently no measures to prevent this kind of tumour.
Osteosarcoma, or osteogenic sarcoma, is a cancer of the bone cells. It is a malignant tumour that can spread to almost any organ or tissue in the body. It usually starts in the ends of the bones of the legs or arms, but can be found in other bones.
It is most commonly found in the distal femur (above the knee), the proximal tibia (below the knee), the proximal humerus (the arm below the shoulder).
It can spread to almost any organ or tissue in the body, but tends to go to the lungs first. It often occurs in children and young people between 10 and 20 years old who are undergrowing a rapid growth spurt. It tends to appear in an area where there has been trauma, but the relationship between this injury and the risk of developing osteosarcoma is currently unknown.
The most common symptoms are pain in the area of the tumour and swelling or a lump.
Movement may cause pain to increase.
If the tumour is in the hip or leg the child may limp.
Malignant neoplasms in children and adolescents are rare, but they are one of the most important causes of mortality in these age groups. Osteosarcoma represents 4% of cancers diagnosed in children throughout Spain. Every year in Spain there are around 40 new cases in children under 14 years of age.
There are different tools to diagnose osteosarcoma:
These tests will help to determine the size and location of the tumour and whether it has spread to another part of the body. This information determines which phase it is in and is necessary to decide the best treatment to follow.
Osteosarcoma is treated using two kinds of therapy: surgery (to save or amputate the limb) and chemotherapy.
Chemotherapy is usually given a few weeks before and after surgery. The type of surgery depends on the size and location of the tumour, and on the age of the child.
Cancer is the abnormally fast multiplication of cells which spread and invade nearby tissue or other parts of the body. It can also spread to other organs. This is known as “metastasis”.
There are over 200 types of cancer. They are normally categorised according to the tissue or organ where they originate. Different molecular subtypes are often included which determine the course of treatment and therapeutic options.
Cancer is a complex disease that varies depending on the type of cancer, location, tumours, malignancy, causes and approaches.
Symptoms of cancer can be varied and very much depend on the type of tumour. However, many cancers may give warning signs such as:
39,900 cases were diagnosed in Catalonia in 2015, excluding skin cancer or melanoma. This breaks down as affecting 23,600 men and 13,300 women. The incidence rate is 345 cases for every 100,000 men and 217 for every 100,000 women.In men, the most common cancer is prostate cancer, followed by colorectal and lung cancer. In women, the most common cancers are breast, colorectal and lung cancer. The mortality rate for cancer is around 109 cases for every 100,000 men and 55 for every 100,000 women.
Different tests are used to detect cancer, such as:
Imaging tests can also be requested such as:
Finally, tissue analyses are requested:
Cancer is treated using a multidisciplinary approach and different medical specialisations are combined to treat it appropriately. This treatment follows a protocol: surgery, radiotherapy and chemotherapy. There are also specific therapies for some tumours such as hormone therapy, targeted therapies or immunotherapy.
A series of factors influence and have an impact on cancer:
There are also screening programmes for some kinds of cancer.
Paediatric Oncology and Haematology, Children's Hospital and Woman's Hospital
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