The International Day of Children with Cancer, which is celebrated on February 15, in our country is often called the World Day against Childhood Cancer. And this is perhaps a more accurate name. Because oncological diseases in children are a medical and social problem. After all, not only oncologists are involved in the fight against childhood cancer. One of the main roles here is played by the parents of a sick child, his family. It is their attitude and readiness to undergo long-term antitumor treatment together and to cooperate with doctors that make a significant contribution to the success of our common struggle.
Unlike “adult” doctors, pediatric oncologists understand that a child who is faced with a difficult, life-threatening diagnosis continues to develop, acquire new knowledge, and form as a person. The usual childhood life of our patients cannot be put on pause, which can last from several months to several years – that’s how long it sometimes takes to defeat childhood cancer. And here we are helped by educators, hospital teachers, psychologists, parental organizations, just caring people. They are also important players.
Childhood oncological diseases have long ceased to be a disease of the doomed. Children survive in 80% of all cases. Many of our patients have already become parents themselves, successfully realized in the profession. But every day of our work is aimed at ensuring that there are more and more such patients who have defeated cancer. Sounds paradoxical? Not at all.
Literally a few years ago, children older than two years old came to us, mainly with hemoblastoses, tumors of the central nervous system, with such typical childhood tumors as neuroblastoma or retinoblastoma. And today we are receiving children who are only a few days old, patients with lung carcinomas, for example, which, as it was believed, children “do not get sick.” We also see children with the rarest tumors, sometimes not described in the scientific literature.
Does this mean that our children have become more likely to get sick with cancer? No, this is a consequence of the development of science and technology – diagnostics have improved. And if earlier we simply lost these children, today we are already able to see the tumor at the prenatal stage. Moreover, we have every opportunity to start treating a person almost immediately after his birth. As we learn more and more about the molecular nature of tumors, our treatment becomes more and more effective and precise, or, as doctors say, targeted.
And another important assistant in the fight is the state – it makes available the most advanced treatment technologies. Even if they are so innovative that they have not yet entered routine practice.
In 2022, the first oncology department in Russia was opened to treat newborns and young children. They are headed by MD. Anatoly Kazantsev – in December, it was he who operated on our smallest child, whose weight barely reached 2 kg, of which 300 grams weighed a tumor. And now in this department there are tiny patients, some of them only a few days. It can be both premature babies and patients with severe concomitant diseases. For each of them, not only oncological care is organized, but also neonatologists who fight against diseases of newborns work. For babies, a special resuscitation place has been purchased, where they are warm and comfortable. Anesthesiologists-resuscitators also play a huge role in saving such children: thanks to doctors who own all types of modern anesthetic aid, the most complex surgical interventions in children have become possible.
Today, one of the key areas in pediatric oncology is the transplantation of hematopoietic stem cells and bone marrow. And the Department of Pediatric Bone Marrow Transplantation at the Research Institute of Pediatric Oncology and Hematology. N.N. Blokhin of the Russian Ministry of Health performs 20% of all such transplants in the country per year. Among our children there are also patients with so-called precancers, when transplantation can prevent the development of a malignant neoplasm.
Pediatric oncologists live at work, and, as one of my colleagues recently said, “I don’t have a wife with me, my children will soon divorce me.” In fact, in three years we have managed to triple the number of transplants – from 50 to 155 per year, while the number of allogeneic transplants (which use someone else’s stem cells) has increased by almost 6.5 times. This happened due to the most intensive and complex operations, the so-called haploidentical (when the donor is 50% compatible with the recipient) and unrelated, largely from foreign registries. Together with the Research Institute for Experimental Diagnostics and Therapy of Tumors of the Cancer Center on Kashirka, methods of cell therapy have been introduced that were previously unavailable in our country. Half of all patients in need of arthroplasty receive care at the Research Institute of Pediatric Oncology and Hematology of the N.N. N.N. Blokhin of the Ministry of Health of Russia, this is more than 70 children and adolescents a year.
Becoming pediatricians, we become preventive doctors. Any additional drugs, including antibacterial and antifungal, no matter how good they are, add to the toxicity of our already difficult therapy. “Reduce and avoid” is how I would sum up our credo for infection control.
And here it is important to actively promote a healthy nutritious diet, which includes sparing processing and high-energy components, provides not only the opportunity to endure intensive courses of chemoradiotherapy and surgical interventions, but also supports the anti-infective immunity of our children. These things may seem insignificant against the backdrop of the progress of medical technology. But when it comes to the struggle for the life of a child, there are no and cannot be trifles. Today it is important for us not only to defeat the disease, but to return our children to a full life.
The author is the Deputy Director of the Research Institute of Pediatric Oncology and Hematology, N.N. N.N. Blokhin” of the Ministry of Health of Russia, Head of the Department of Transplantation
