Neuroblastoma
Description:
Neuroblastoma — a malignant tumor of a sympathetic nervous system. The neuroblastoma is an undifferentiated tumor, consists of small round cells with dark and spotty kernels.
The neuroblastoma has a number of properties which are absent at other malignant new growths:
* Ability to spontaneous regression: the neuroblastoma can spontaneously regress even in case of the big sizes of a tumor with massive metastasises.
* Ability to maturing (differentiation), it is rare — transformations in a benign tumor (ganglioneuroma).
* Ability to a rapid aggressive current and development of metastasises.
Neuroblastoma symptoms:
The most part of tumors is found in retroperitoneal space, most often — in adrenal glands. Meets in a mediastinum and a neck less often.
The clinical picture depends on the place of formation of a tumor, localization of metastasises, amount of the vasoactive substances produced by tumoral fabric.
Treat the main clinical manifestations of a neuroblastoma:
* a tumor in an abdominal cavity
* swelled
* weight loss,
* the ostealgias caused by metastasises
* anemia
* fever.
The main complaints are shown on pain (30-35% of cases), fever (25-30% of cases), loss of weight (20% of cases). With a growth of a tumor in a postmediastinum children complain of constant cough, respiratory frustration, a dysphagy and continuous vomiting; deformation of a chest wall is observed. At damage of marrow causes anemia and a hemorrhagic syndrome. With a growth of a tumor in retrobulbar space there is a characteristic "syndrome of points" with an exophthalmos. If the neuroblastoma arises in retroperitoneal space, then it quickly grows into the spinal canal, being palpated as a hilly, not movable tumor of a stone consistence. At spread of a tumor from a chest cavity in retroperitoneal space through diaphragm openings it takes a form of hourglasses or a dumbbell. Neuroblastoma metastasises in skin have an appearance of cyanotic-crimson nodes with a dense consistence.
Metastasises of a neuroblastoma are most often formed in bones, marrow and lymph nodes. Less often metastasises are localized in skin and a liver; very seldom — in a brain. The symptomatology in this case is defined by what body is struck with metastasises:
* bystry increase in a liver
* education on skin of bluish nodes
* ostealgias
* increase in lymph nodes
* anemia, hemorrhages and other manifestations characteristic of leukoses.
Neuroblastoma reasons:
The neuroblastoma occurs only at children. Incidence makes 0,85-1,1 cases on 100 000 children aged up to 15 years. Middle age — 2 years. 90% of cases are found to 5-year age. The neuroblastoma is the most frequent malignant new growth in the early childhood (14%), in some cases it is found at the birth, can be followed by inborn defects. In process of the child's growing the probability of emergence of a tumor decreases.
Treatment of the Neuroblastoma:
At treatment of a neuroblastoma apply the following methods of antineoplastic therapy:
* Surgical method
* Chemotherapy
* Radiation therapy
* Transplantation of marrow
In case of timely detection of a tumor removal of primary tumoral node is made. As a rule, the tumor does not recur in the presence of the remained tumor cells that also distinguishes a neuroblastoma from other malignant tumors.
The chemotherapy of a neuroblastoma includes use of Vincristinum, cyclophosphamide, Cisplatinum, doxorubicine, a vepezid, tenipozid and Melphalanum. Have antineoplastic activity to a neuroblastoma also ифосфамид and карбоплатин.
Radiation therapy is used not in all cases in view of its danger to an organism of the small child. However it is shown to use at nerezektabelny tumors or metastasises, low-efficiency of the used chemotherapy, and also for elimination of a possible recurrence.
As a kind of radiation therapy apply introduction to a tumor of radioactive isotope of iod 131I which selectively collects a neuroblastoma.
Treatment at stages of I, II consists in surgical intervention to which the chemotherapy precedes. As a rule, in the III stage the neuroblastoma is already inoperable that it does obligatory preoperative chemotherapy which allows to achieve essential regression of a tumor to the rezektabelny sizes. At the IV stage the high-dose chemotherapy, surgery and bone marrow transplantation is obligatory.
