How Should Childhood Tumors Be Treated? How Can Parents Help Their Children Face Childhood Tumors?

How Should Childhood Tumors Be Treated? How Can Parents Help Their Children Face Childhood Tumors?

The following Q&A about childhood tumors is excerpted from "A Hundred Questions and Answers about Childhood Tumors," which includes over 200 related inquiries.

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1 Why Are Childhood Solid Tumors Often Discovered Late?

When a child is diagnosed with a malignant tumor, parents and those around them often wonder how the tumor could have grown so large and gone unnoticed for so long. This is primarily due to certain characteristics of childhood tumors that make them difficult to detect in a timely manner.

Unlike adults, children cannot easily articulate where they feel discomfort. For instance, an adult with liver cancer may experience abdominal pain that wakes them up at night. However, if a child has a liver tumor, even if it's quite large, family members may only notice the child being slightly fussy, attributing it to hunger, heat, or thirst, and thus overlook the actual cause.

Parents sometimes have misconceptions, believing that children will always complain if something is wrong.

As solid tumors in children grow, they can develop rapidly, requiring parents to be vigilant during bath time or while changing clothes. It is advisable to have regular abdominal ultrasounds to detect any abdominal masses early.

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2  How Should Childhood Tumors Be Treated?

Different types of tumors in children require different treatments. For comprehensive treatment of childhood tumors, it is crucial to first "know yourself and know your enemy" to ensure a successful outcome. Therefore, before starting treatment, an assessment of the tumor is essential:

First, identify the type of tumor. Different tumors exhibit varying biological behaviors, requiring different medications and treatment strategies. For example, distinguishing whether a liver tumor is a hepatoblastoma, hepatocellular carcinoma, undifferentiated sarcoma, or a benign tumor is vital. This diagnosis can typically be obtained through a biopsy.

Second, confirm whether the tumor has metastasized. In addition to the primary site, it's important to identify any metastatic sites. The clinical staging of the tumor affects subsequent treatment plans and strategies, and evaluating treatment efficacy is crucial. For instance, after one or two cycles of treatment, evaluating the detected lesions individually is important. If new lesions appear, it indicates that the tumor is not very responsive to treatment, necessitating an adjustment of the original plan. Conversely, if the original lesions shrink, it indicates that the treatment is effective and the strategy is sound.

Surgery, chemotherapy, and radiation therapy are the three fundamental methods for treating childhood tumors today. Biologic immunotherapy has developed rapidly in recent years and holds promise as a breakthrough for curing high-risk pediatric malignancies.

In summary, tumor treatment should be viewed as a battle. A comprehensive plan should be made, and troops should be strategically arranged according to the enemy's situation to achieve the greatest victory, rather than launching a reckless attack.

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3  Can Childhood Malignant Solid Tumors Be Treated Like Adult Tumors?

Children are not just smaller versions of adults; they have their own distinct characteristics, which means that adult experiences cannot be directly applied to the diagnosis and treatment of malignant tumors in children. For instance, most adult liver malignancies are liver cancer, particularly in countries like ours, where it generally arises post-hepatitis. In contrast, the majority of malignant liver tumors in children are hepatoblastomas, which share many similarities with liver cancer, such as being liver malignancies, elevated alpha-fetoprotein levels, and the necessity for surgical resection. However, pediatric hepatoblastomas are particularly sensitive to chemotherapy, with alpha-fetoprotein levels often reaching millions, and children typically do not have cirrhosis, allowing for a significantly larger margin of resection compared to adults. Therefore, the treatment outcomes for pediatric hepatoblastomas are far superior to those for adults.

Similarly, Wilms tumors in children and renal cancer in adults are both malignant tumors of the kidney. However, chemotherapy for Wilms tumors is effective, and even in cases of bilateral Wilms tumors or when there are tumor thrombi in the inferior vena cava, surgical treatment can still be performed successfully, allowing for complete tumor resection and the removal of the thrombus from the inferior vena cava, enabling the child to achieve a tumor-free survival. Thus, abandoning treatment too easily is neither rational nor scientific, and blindly applying adult treatment plans is not advisable.

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4 How Can Parents Help Their Children Face Childhood Tumors?

Children's understanding and reactions to childhood tumors vary by age. A child's personality, coping style, and emotional maturity will all influence how they handle this situation. Parents need to let their children know that they will understand and accept all of their feelings.

Parents can also tell their children that they can express themselves in various ways, such as talking, writing in a diary, or drawing. If physically able, children might even participate in sports like running or hitting a punching bag. It's important for children to know that it's perfectly okay to say, "I don't want to talk right now."

Children may feel angry, guilty, sad, lonely, or scared because of their illness, but they can also feel happy just like they usually do. As children, they may not understand how to cope with the myriad emotions and feelings that come with being ill, leading to changes in their behavior.

Parents should view these emotional changes with a normal mindset and help children understand that they can feel these emotions even when they are not sick. This can help children approach their illness in a more rational and positive manner. Parents should also share their own feelings with their children, as this can benefit them. If parents can honestly share their feelings, helping children realize that everyone experiences both happy and unhappy moments, it can assist children in facing their illness and treatment more positively and calmly.

Additionally, parents can assure their children that healthcare professionals will take care of them and that mom and dad will continue to support them. During treatment, children may feel very vulnerable, so it is crucial for them to understand that their parents will love them just as much throughout this process. Compared to before their illness, children may seek more reassurance from their parents, and parents need to demonstrate through actions that they will always be there to support them.

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5  Should Parents Discipline Their Children While They Are Sick?

During a child's illness, parents often feel the need to provide special care to compensate for the pain and alleviate their own guilt. Moderate care and attention are important, as they can aid in treatment and build confidence in overcoming illness, but excessive indulgence can lead to problems. In fact, children need their parents to establish rules, and being required to follow these rules provides them with a sense of security. If parents overly indulge their children, they may perceive their illness as more severe than it actually is.

Moreover, when children feel unwell, they may behave immaturely and become more dependent on their parents. Pain and the side effects of treatment (such as those from steroid medications) can make children more sensitive and irritable, making them harder to discipline. Additionally, during their illness, children may receive more attention from family members and friends, leading them to expect such special treatment to continue indefinitely. When this special treatment ends after recovery, it can lead to disciplinary issues. Therefore, after a child becomes ill, parents can approach the situation in the following ways:

1. Set clear and specific expectations and rules for the child that are consistent and age-appropriate.

2. Adjust the expectations and rules according to the child’s specific situation. For example, when a child is unwell, it may not be necessary to enforce politeness (like saying "thank you") with the same rigor as before.

3. Avoid physical punishment but consider alternative disciplinary methods that do not harm the child's self-esteem, such as allowing the child to sit quietly for a moment to think about appropriate behavior or temporarily revoking certain small privileges, like using their phone.

4. Provide timely praise for good behavior to encourage the child to continue that behavior.

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6  Is It Necessary to Turn, Percuss, and Nebulize After Surgery?

Depending on the child’s surgical situation, it is generally necessary for hospitalized patients who have undergone general anesthesia with tracheal intubation to be turned, percussed, and nebulized postoperatively. Actively encouraging the child to take deep breaths is important, and gentle percussion on the back while the child is sitting can also be helpful, along with encouraging the child to cough as needed. If the child has a lot of sputum, they should be encouraged to cough it out or suction it immediately after nebulization if their condition allows. Gentle flexion and extension exercises of the toes can also be performed, with parents assisting the child in turning intermittently to promote gastrointestinal function recovery and reduce the risk of postoperative bowel obstruction. The order of operations post-surgery can be nebulization, followed by turning, and then percussion, along with proper oral care as needed.

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7  How Soon After Surgery Can a Child Get Up? What Should Be Considered When Getting Up?

If the child's general condition is good, they have sufficient strength, and pain relief is effective, they should be encouraged to gradually resume activity early on until they can get out of bed and walk. Early activity is beneficial for increasing lung capacity, reducing pulmonary complications, improving blood circulation, aiding gastrointestinal motility, and restoring bladder contraction function, thus reducing the occurrence of abdominal distension and urinary retention. However, children with shock, heart failure, severe infections, bleeding, or extreme weakness, as well as those requiring special immobilization due to their surgery, should not engage in early activity. Additionally, early mobility or sitting up after spinal surgery may not be conducive to wound healing due to increased tension on the incision, and early mobility after spinal cord surgery may also lead to low cerebrospinal fluid pressure symptoms. Therefore, for these types of surgical patients, it is advisable to wait 3-5 days or even longer before allowing them to get up. The presence of a drainage tube does not contraindicate getting up; it is only necessary to take care to protect the drainage tube during activity.