Every February 15th the International Childhood Cancer Day, a date for sensitize y Raise awareness on the importance of early diagnostic, the agile derivation to Pediatric Oncology units and equitable access to effective treatmentsExperts insist that, despite its lower incidence, childhood cancer requires sustained investment under investigation, since the little commercial interest limits the development of specific drugs.
Every year around 100,000 people are diagnosed in Spain. 1.500 cases of cancer in children. Although primary prevention is currently not feasible in most cases, continuous improvement in diagnostic techniques and in the therapeutic protocols has significantly increased survival. Since the Spanish Association Against Cancer It is recalled that, although the appearance of childhood cancer cannot be avoided, It is possible to improve diagnosis and treatment for ourselves thanks to the clinical and translational research. Along the same lines, data from regional health authorities indicate that More than 70% of childhood cancers are curable when it exists early diagnosis and appropriate protocols.
Presentation of the «Guide to Early Attention to Cancer in Children and Adolescents»
Among the most relevant activities associated with this day is the presentation of the Early Intervention Guide Cancer in Children and Adolescents, prepared by the Spanish Federation of Parents of Children with Cancer (FEPNC), the Spanish Association of Pediatrics (AEP), the Primary Care AEP (AEPAP) and SEHOP. The guide guides professionals in Primary Care to symptom diagrams e indicators by tumor type and standardizes the preferential derivation upon suspicion.
The signatory entities emphasize the need to refer pediatric patients with suspected cancer to specialized Pediatric Oncology units without undue delay. Childhood cancer can start with nonspecific symptoms similar to benign processes. Therefore, if a child or adolescent comes to repeatedly with the same clinic and without a clear diagnosis, the guide recommends preferential derivation (e.g., after three consultations for the same reason).
Pilar Ortega, president of the FEPNC, emphasizes that "Early detection is still a pending issue; having early detection protocols is the best medicine against childhood cancer.". In turn, the AEPAP Remember that the AP is the gateway to the 90% of the population under 14 years of age and that, therefore, is key listen to families, make a complete medical history and carry out the coordinated derivation with Pediatric Oncology.
Professor louis madero, president of the Spanish Pediatric Foundation and head of Onco-Hematology at the Niño Jesús Hospital, highlights the usefulness of the guide based on scientific evidence to accelerate the recognition of cancer in childhood, where the little specificity initial may confuse it with trivial diseases. In addition, it highlights the importance of custom treatments and participation of children in research with all ethical guarantees, as a clear route to improving results.
Essential facts and figures
- It is estimated that they are diagnosed hundreds of thousands of cases of cancer in Children and adolescents from 0 to 19 years old worldwide every year.
- The most common types are: leukemias, brain tumors, lymphomas and various solid tumors (neuroblastoma, Wilms tumor, etc.).
- En comprehensive service environments pediatric oncology, more than 80% of children can heal.
- En environments with fewer resources, survival is below 30%By late diagnosis, diagnostic errors, limited access to treatments and therapeutic abandonment.
- Access to essential medicines and technologies varies considerably between countries; universalizing it is cost-effective and saves lives.
Causes and predisposition
Childhood cancer arises from genetic alterations causing uncontrolled cell growth. Unlike adults, most cases are not associated with environmental factors not to lifestyle and a reduced percentage of children presents genetic predisposition hereditary. Therefore, in families with known mutations (e.g., in retinoblastoma) is key genetic counseling and specific monitoring.
Some chronic infections may increase the risk of certain childhood cancers in certain contexts. Effective preventive strategies focus on vaccination y control of infections that predispose to cancer in later life, and in the detection and treatment of chronic diseases that increase the risk.
Early diagnosis: what to look for and how to act
An early diagnosis improves the response to treatment, raises the supervivencia and reduces the therapeutic intensity necessary. Early diagnosis is based on three pillars: symptom recognition by families and AP, clinical evaluation and staging punctually, and rapid start of treatment.
Warning signs that should prompt priority consultation:
- Abnormal pallor, bruises o petechiae without apparent cause, bone pain persistent.
- Pcs. luggage o swellings unexplained, especially if there is no fever or pain.
- Weight loss, persistent fever, cough, shortness of breath o night sweats.
- Leucocorticism (white spot in the pupil), squint, striking visual changes.
- Headache progressive with vomiting, dizziness or focal neurological signs.
- Abdominal swelling o palpable.
If a pediatric patient consults several times for the same symptoms without a conclusive diagnosis, should be considered preferential derivation to a center with Pediatric Oncology. Awareness initiatives have shown that reduce time from the first symptom to diagnosis improves key indicators, especially in tumors of the central nervous system.
Most common types of cancer in childhood
In pediatrics, the predominant ones are leukemias (with the ALL as the most frequent), the tumors of the central nervous system and lymphomas. They are also diagnosed solid tumors such as neuroblastoma, the Wilms tumor, the retinoblastoma, the rhabdomyosarcoma, the osteosarcoma or Ewing's sarcoma. Each entity presents age patterns, initial symptoms y therapeutic approaches own, so the pediatric specialization is decisive.
Available treatments and equitable access
Treatment is defined according to the type of tumor and extensionThe therapeutic pillars include chemotherapy, surgery, radiotherapy, immunotherapy and, in selected cases, hematopoietic progenitor cell transplantationIn many childhood cancers, essential medicines for pediatric oncology use allow cure rates higher than 80% when it exists timely access and team management multidisciplinary.
In recent years, the precision medicine has promoted new options in refractory or relapsed cases: targeted therapies against alterations such as NTRK, BROTHER o ALK, and immunotherapy (monoclonal antibodies and CAR-T therapies targeting targets such as CD19 in B leukemias). These strategies have been shown to meaningful responses in the pediatric population when the tumor exhibits the target alteration. Adequate candidate selection requires molecular profiling and evaluation in comités with pediatric experience.
It is essential to protect the physical and cognitive development of the child during treatment, monitoring the nutritional condition, the rehabilitation and mental health. The coordination of pediatricians, oncologists, surgeons, oncoradiologists, psycho-oncologists, pediatric nursing, hospital pharmacy y social work optimizes results and reduces complications.
Clinical trials and care in specialized centers
Los pediatric clinical trials are the way to introduce new therapies with evidence of to maximise security and your enjoyment. y efficacy. In Spain, the Clinical Research Unit for Pediatric Trials in Onco-Hematology of the CNIO and the Hospital Niño Jesús It facilitates access to experimental options when standard lines have been exhausted, avoiding trips abroad. As its managers explain, patients outside the average survival rate need innovative drugs, which is why it is demanded more investment y international collaboration to do quality research.
Children with cancer especially benefit from being treated in pediatric cancer centers with high volume and experience, where the clinical care, the access to trials and psychosocial support. Being part of collaborative networks national and international multiplies the therapeutic options and standardizes the approach according to best practices.
Palliative care and comprehensive support
Los pediatric palliative care are part of comprehensive care from the diagnosis, regardless of the healing intention. Its goal is ease the pain and other symptoms (nausea, insomnia, anxiety), and Improve Life Quality of the child and his family. They are implemented in the hospital and in customer's home, with adequate analgesia (included oral morphine when indicated) and psychosocial support. Emotional support and education for caregivers They are pillars of support.
Survival, follow-up and late effects
Improved survival has increased the number of childhood cancer survivors what do they need care plans after treatment. It is crucial to document the therapeutic summary and program periodic reviews to detect relapses y late effects (cardiotoxicity, endocrine disorders, second neoplasias, neurocognitive or emotional impact). There are specific queries monitoring where risks are assessed and preventive, rehabilitative and psychosocial interventions are planned.
Role of Primary Care, families and community pharmacy
La Primary Care is decisive for decrease time until diagnosis, identifying warning signs and prioritizing the derivation. Listen to the Parents and recognizing when a "banal" condition does not evolve as expected is essential. Due to its proximity, the community pharmacist can detect warning signs, advise on safe use of medications, nutrition, hydration and measures of hygiene to prevent infections, in addition to informing about patient associations and available resources.
Time to diagnosis and how to reduce it
El time to diagnosis varies depending on age, tumor type, and cancer biology. In some, such as retinoblastoma, shortening that time is associated with better survival and fewer after-effects. How to reduce it? With continuous training to AP professionals, awareness campaigns for families, preferential referral routes clear, prudent use of corticoids (avoid masking undiagnosed lymphomas or leukemias) and availability of supplementary tests when the clinic justifies it.
Advances in the treatment of childhood cancer
Although commercial interest does not always accompany pediatric oncology, there are groups that work tirelessly to offer new alternatives. The Clinical Research Unit driven by CNIO and the Hospital Niño Jesús integrates experimental therapies when standard lines are exhausted. Its goal is to raise the average survival and, above all, find options for resistant tumors as certain neuroblastomas, advanced sarcomas or some brain tumors y leukemiasAs those responsible point out, more investment y international development are key to expanding access to quality tests.
The global response is also articulated through action frameworks that seek to raise the survival rate of children with cancer to common minimum dimensions worldwide, improving access to early diagnosis, essential medicines, surgery, radiotherapy y palliative careFor countries with fewer resources, they are promoted policies to guarantee Supplies and reinforce capabilities clinical and data.
The word “cancer” is shocking, but the reality is that children are extraordinarily resilient y respond better to therapies tailored to your needs. With early detection, rapid derivation, modern treatments y specialized teams, the vast majority can be cured and lead full lives; the priority is to ensure that Every family arrive in time for that opportunity.