Primary bone tumors account for about 6-7% of the incidence among young cancer patients, and their cure rate is estimated at about 65-75%[1]. Whether or not a child recovers, and how comfortable his or her life will be during and after treatment, depends largely on the stage at which the disease is diagnosed. Unfortunately, at present, diagnoses are still made too late, and there are sometimes irregularities in the diagnostic process. What problems do specialists face?
Problems in the diagnostic and therapeutic process of children with locomotor cancers
Published March 27, 2023 12:18
The most commonly diagnosed primary locomotor cancer in Poland is osteosarcoma. Approximately 30-35 children in Poland develop it annually, and the peak incidence is noted in the age range of 15-19 years. Ewing's sarcoma ranks second (an average of 20-25 new cases per year), affecting boys more often than girls. In both cancer subtypes, nearly half of diagnosed pediatric oncology patients already have metastatic disease. What hinders the efficient diagnosis and treatment of musculoskeletal cancers in children and adolescents?
Lack of oncological vigilance
The main problem that affects the entire treatment process of pediatric oncology patients is too late diagnosis. Its causes can be traced to, among other things, the lack of oncological vigilance of some general practitioners and pediatricians, i.e. specialists to whom parents first report when their child's condition worsens. Tumors in children develop faster than in adults, so the time and stage at which the disease is diagnosed is extremely important. To this end, extreme caution is key - if there is an initial suspicion, the child should be referred as soon as possible for basic and readily available tests to rule out the risk.
- Performing laboratory tests, ultrasounds and X-rays allows the doctor to respond quickly and, if necessary, refer the patient to an oncologist or for specialized diagnostics. Pediatric cancers are classified as rare diseases - about 1,000-1200 children develop them annually. This means that many primary care physicians in the course of their practice have not or will never encounter this type of case. However, it is worthwhile to have such an assumption in the back of one's mind and strive for the earliest possible diagnosis. Of course, it is not a matter of making too hasty a diagnosis of cancer, but just ruling out the likelihood of its occurrence. Therefore - regardless of whether the child reports a persistent cough or bone pain - a physical examination of the whole patient is the minimum that should be met at a regular visit, comments Dr. Bartosz Pachuta, an expert in orthopedics and traumatology of the musculoskeletal system at the Department of Oncology and Oncologic Surgery of Children and Adolescents at IMiD.
Downplaying the symptoms
Another problem that is linked to a lack of oncological vigilance is the downplaying of symptoms that may indicate a child has cancer. On the one hand, clinical signs of cancer are often nonspecific and can be attributed to a simple infection, fatigue or adolescence. On the other - even the more characteristic ones, such as a palpable tumor, enlarged lymph nodes or persistent bone pain are still overlooked in some cases.
- Particular attention should be paid to pathological bone fractures that occurred without trauma or when the force of the trauma was disproportionately small to the extent of the damage. In the case of tumors of the musculoskeletal system, specific symptoms also include gradually increasing pain, causing organ dysfunction, nighttime bone pain, abnormal limb outline or tumors. Pain may be accompanied by fever, inflammation, enlarged lymph nodes. Too long observation and symptomatic treatment work to the disadvantage of the young patient, so when the "infection" does not pass in spite of the medications administered, one should not delay, but deepen the diagnosis. If a primary care physician or pediatrician has a suspicion of musculoskeletal cancer, the best step he or she can take is to refer the patient even before the biopsy to a reference center," adds Bartosz Pachuta, MD.
Abnormalities associated with biopsy
Of great importance to the diagnosis of musculoskeletal cancer, the prognosis of the young patient, and his quality of life after treatment is biopsied. Incorrectly collected material can result in a wrong diagnosis or the wrong treatment method being chosen. Such risks arise when oncological purity is not maintained.
- Performing a biopsy by an experienced operator with cleanliness is key to obtaining a reliable histopathological result and securing the material for genetic testing. A poorly performed examination in the case of musculoskeletal cancers can negate the chance of sparing surgery. Pathomorphological material should be evaluated by a pathomorphologist in cooperation with a radiologist, and the diagnosis itself should be confirmed by yet another specialist in pathomorphology. This is why it is particularly important to recommend to patients and their parents specialized facilities with experience in treating these cancers and that meet the highest standards. More than 450 children with bone tumors were treated at the IMiD Oncology Department between 2015 and 2022, explains Bartosz Pachuta, MD, of the Mother and Child Institute.
Lack of oncologic vigilance, downplaying of symptoms and improper biopsy are the most common problems in the diagnostic and therapeutic process of musculoskeletal cancers. In minimizing them, it is crucial for general practitioners and pediatricians to deepen their knowledge of the symptoms of the disease and to be particularly attentive to reported complaints. Parents should also be educated, and if suspicions arise, they should be referred to reference treatment centers, which will carry out extensive diagnostics and comprehensive oncological therapy for the child.
Source: press mat.
