Solid Tumors

Solid tumors can be found in the brain or in other parts of the body and, for the most part, are fairly rare in children or young people. There are various names given to tumors depending on where they are found and what the cells of the tumor look like. Some of these are mentioned and explained below.

Neuroblastoma

This tumor originates from nerve cells in the body. It can be found in the area around the kidneys, or following the path of a nerve in the spine, the chest or in the abdomen. This type of tumor often invades other structures, and can spread into the lymph nodes or the bone. 

Typically, neuroblastomas affect children around the age of five years old. A child who has a neuroblastoma would show symptoms related to the localization of the tumor– for example, complain of pain in the back or the abdomen. The child may have a fever or she may have an unusual lump that can be felt by the parent or doctor.

If a child was thought to have a neuroblastoma, the doctors would do an ultrasound scan, as well as an M.R.I. scan and other specialized X-rays, some using radio-isotopes that attach themselves to the tumor and make them easier to find. They might also test the child’s urine to look for a specific chemical (catecholamine) that the tumor itself produces.

If the tumors are small, they can be removed during an operation. For bigger tumors, however, usually a small sample (biopsy) of the tumor is removed to check for certain markers that, if present, can affect the choices that are made for treating the tumor.

Neuroblastomas that are diagnosed in children under one year old can spontaneously resolve on their own, needing no treatment. In older children, however, surgery is usually the first step, although sometimes chemotherapy is given first to try to shrink the tumor to make it easier to remove in an operation.

Nephroblastoma

Nephroblastoma also known as a “Wilms Tumor”, is a cancerous growth found in the kidneys.  Usually it affects very young children and can be difficult to diagnose because it can grow without generating symptoms that the child or care-giver would be concerned about. Some of the possible clues to diagnosis would be blood in the urine, abdominal pain, or a palpable lump in the abdomen.  To aid the doctors making a diagnosis, an MRI scan and an Ultrasound would be done. The treatment of children with this condition is to remove the tumor in an operation. Before this is possible, the child is treated with a course of chemotherapy so that the actual size of the tumor is reduced. The chemotherapy usually lasts about four weeks, and then the child can have the operation. Often the kidney has to be removed as well as the tumor. The tumor is sent for analysis under a microscope, and depending on these findings, the doctors may decide to prescribe another chemotherapy course.

Soft tissue sarcoma

This is a form of cancerous growth that grows in the muscles or in other body tissues. They are usually diagnosed fairly promptly because they cause a visible swelling and/or the child complains of pain in a specific area. These kinds of tumors are also diagnosed with the help of an Ultrasound and MRI scan. Treatment is to remove the tumor – sometimes a small sample of the tumor is taken first (this is called a biopsy - it is examined by a pathologist who uses a microscope to see if it is a malignant or benign tumor) before the whole tumor is removed. When the pathologist has described the tumor, the medical team decides on a treatment plan, which can include chemotherapy and radiation therapy. This plan is based on international treatment protocols and will be adapted to the child, taking into account any particular risk factors he or she may have.

Bone tumors

There are a few specific forms of cancer which affect the bones, two of which are Osteosarcomas or Ewing sarcomas. Children over the age of ten years old are usually the group most affected by bone tumors. The areas usually affected depend on the kind of cancer present. Osteosarcomas typically invade the bones of the extremities (the arms or the legs). Ewing Sarcoma can similarly grow in the extremities, but is also know to invade the bones of the ribs or pelvis.

The symptoms of a bone tumors are pain (over the affected bone, wherever it is) and a lump or bump that can be felt under the skin. Sometimes the child or her care-giver will mistake it for an injury. The doctors will be able to diagnose bone cancer by taking a biopsy of the bump/painful area to be examined microscopically. Once the diagnosis of bone cancer is made, further tests are done to see if the growth has spread to any other parts of the body (the spreading of a cancerous growth is called metastasis).

The treatment of bone cancer begins with a course of chemotherapy, given over a few months, and then the child can have an operation to remove the tumor growing in/on the bone. The Oncologists (cancer specialists) in the University Children’s Hospital of Duesseldorf work in close cooperation with the surgeons from the Orthopedic Clinic (bone specialists), who have extensive experience in removing bone tumors. The surgeons use various techniques to give the child the best possible outcome while also removing the tumor itself. One of these techniques use Endoprosthetics (stabilizing materials under the skin that bridge the gap left by the removal of the growth, and replace the missing bone). If the tumor has damaged the bone too much, then sometimes the affected limb itself has to be removed. This is called amputation.

After surgery, an intensive physiotherapy program is begun so that the child can regain strength and mobility as much and as soon as possible.

Our Oncology Clinic is pleased to be able to actively encourage and assist children who have been affected by bone tumors reintegrate into “normal life”. We are very grateful to the “Elterninitiative Kinderkrebsklinik e.V” (the Parent’s Initiative, a non-profit organisation) whose fundraising efforts have enabled the Physiotherapy team to grow and employ specially trained Sports Therapists. After the child’s discharge from hospital, part of the after-care program includes getting involved in sports and swimming – under the watchful eye of the Physiotherapy team. Therapeutic horse riding is also a rewarding and strength-building activity for a child recovering from bone cancer. Every year in January a team from the Oncology Clinic, and children who have had leg amputations, go away on a skiing holiday. The children can engage the physical challenge of skiing – with professional input and support, and also meet and swap ideas with other kids who are similarly affected. In this way, the young patients share challenges and encourage each other to find new ways to get back into everyday life after a difficult and painful illness.