A 5-year-old boy has a deformed head due to cancer and will cry himself when he looks in the mirror...

time:2022-11-27 07:21:51source:monlittlebaby.com author:Common phenomenon
A 5-year-old boy has a deformed head due to cancer and will cry himself when he looks in the mirror...

*For reference only for medical professionals "When others looked at him with that strange look, it felt like a needle was stuck in my heart..." Xiaoyu was diagnosed with neuroblastoma in October 2020 (neuroblastoma, NB), this year is 5 years old. In the past two years, he has undergone 3 operations, 2 bone marrow transplants, 15 chemotherapy and 12 radiotherapy. Image source: Weibo ID: Time video But the cancer cells were still transferred from the primary tumor (adrenal gland) to the brain, and the tumor recurred after multiple treatments. NB: The most common extracranial solid tumor in childhood NB is the most common extracranial solid tumor in childhood, accounting for 8% to 10% of childhood malignancies. It is also a group of diseases with very different clinical manifestations and prognosis. The clinical outcomes can range from tumor dissemination, metastasis, and death of children, to the development and maturity of tumors into benign ganglioneuromas or spontaneous regression [1]. NB is derived from undifferentiated sympathetic ganglion cells, so tumors can occur wherever there are embryonic sympathetic ganglion cells. The adrenal gland is the most common primary site, followed by the abdominal sympathetic ganglia, thoracic sympathetic ganglia, cervical sympathetic ganglia, and pelvic sympathetic ganglia, and the primary tumor cannot be found in approximately 1 percent of patients [1]. Tumors can metastasize to the lymph nodes, bone marrow, bone, dura mater, orbit, liver, skin, and, rarely, the lungs and brain [1]. Xiao Yu's diagnosis was: adrenal neuroblastoma (stage IV, high risk) ▌ NB. The diagnostic criteria for NB were that one of the following two criteria was met [2]: (1) The tumor tissue obtained a positive pathological diagnosis under the light microscope. (2) Characteristic NB cells were found in bone marrow biopsy or aspirate, which were small round cells, arranged in nests or chrysanthemum clusters, or stained positive for anti-GD2 antibody, and accompanied by increased urine VMA and blood NSE. According to the information in the video, Xiao Yu's tumor has metastasized to the lymph nodes, bone marrow, orbit, lungs and brain. Discharge diagnosis: adrenal neuroblastoma (stage IV, high risk). Source: Weibo ID: Dazhong.com ▌ NB children are staged as follows according to the INSS [1]: 1: Complete local tumor resection, with or without minimal residual lesions, negative ipsilateral lymph nodes (that is, connected to the primary tumor or removed) of lymph nodes may be positive). 2A: Complete resection of the local tumor; positive non-adherent lymph nodes on the same side of the tumor under microscope. 2B: Complete or incomplete resection of the local tumor, positive non-adherent lymph nodes on the ipsilateral side of the tumor, and negative swollen lymph nodes on the opposite side under microscopy. 3: Unresectable unilateral tumor beyond the midline with/without regional lymph node involvement; or localized unilateral tumor with contralateral regional lymph node involvement; or midline tumor with contralateral extended invasion (unresectable) or lymph node involvement. 4: Metastasis to distant lymph nodes, bone, bone marrow, liver, skin or other organs (except for stage 4S). 4S: Localized tumor of stage I or II, with distant metastasis in liver, skin and/or bone marrow, age <12 months. On bone marrow smear or biopsy, tumor cells should be <10%, and MIBG scan bone marrow should be negative. If the bone marrow is more extensively involved, it is stage 4. ▌ NB children are grouped according to risk (COG) as follows [3]: low risk: ①all stage 1; ②<1 year old all stage 2; ③>1 year old with MYCN unamplified stage 2; ④>1 year old, although MYCN Amplified but INPC is stage 2 with good prognosis; ⑤MYCN is not amplified, INPC is with good prognosis and DNA is polyploid stage 4S. Intermediate risk: ①<1 year old, MYCN unamplified stage 3; ②>1 year old, MYCN unamplified and INPC is stage 3 with good prognosis; ③<1 and a half years old, MYCN unamplified stage 4; ④MYCN unamplified , DNA is diploid 4S stage; ⑤MYCN is not amplified and INPC is 4S stage with good prognosis. High-risk: ①>1 year old, MYCN-amplified INPC is stage 2 with poor prognosis; ②<1 year old, MYCN-amplified stage 3; ③>1 year old, MYCN-unamplified but INPC is stage 3 with poor prognosis; ④>1 5 years old, MYCN amplification stage 3; ⑤<1 year old, MYCN amplification stage 4; ⑥>1 and a half years old, all 4 stages; ⑦ MYCN amplification stage 4S. The little feather we see in the video now has a deformed head and face due to the compression of the intracranial and orbital tumors. Photo source: Weibo ID: Dazhong.com and the deformation of his head and face, Xiaoyu inevitably received other people's strange eyes, and even cried when he looked in the mirror. In the news video, Xiaoyu's mother said: "When others look at him with that strange look, it feels like a needle has been stabbed in my heart..." The high cost of treatment makes Xiaoyu's family unable to afford the current international children's NB The treatment principles are similar, and different risk groups have different treatment plans. Xiaoyu is a high-risk and relapsed child. According to the "Expert Consensus on Diagnosis and Treatment of Childhood Neuroblastoma CCCG-NB-2021 Plan", the treatment plan is divided into 3 stages: That is, induction phase (chemotherapy and surgery), consolidation phase (sequential transplantation and radiation therapy targeting the primary tumor and residual metastases), and maintenance therapy after consolidation phase (immunotherapy and 13-CRA therapy). Autologous peripheral blood stem cells were collected after 2 courses of chemotherapy, and then elective surgery was continued for 2 courses of chemotherapy. 2 courses of postoperative chemotherapy, the total course of treatment ≤ 6. After conventional chemotherapy, autologous stem cell transplantation and tumor bed radiotherapy with a dose of 21.6 Gy of radiotherapy are recommended. Sequential autologous stem cell transplantation is recommended, and tumor bed radiotherapy is performed between 2 autologous stem cell transplantations. After the above treatment, GD2 monoclonal antibody immunotherapy combined with granulocyte-macrophage colony-stimulating factor (GM-CSF) application and 13-CRA treatment were performed. Radionuclide therapy: such as 131I-MIBG, 111In-DOTATATE, 177Lu-DOTATATE or 90Y-DOTATATE, etc., but whether to use somatostatin analog peptide receptor radionuclide therapy for relapsed and/or refractory NB Further research is needed. Since her diagnosis in 2020, Xiaoyu has undergone 3 operations, 2 bone marrow transplants, 15 chemotherapy and 12 radiotherapy. According to her mother's dictation in the news video, Xiaoyu's current treatment options are CAR-T therapy and Lu-177 radiation therapy. However, the high recurrence rate and expensive treatment of neuroblastoma have brought a great burden to the family of the child. The nearly 60-year-old grandfather was working as a plasterer for the child's high temperature, and the father worked alone since the child fell ill. expensive treatment costs. Photo source: Weibo ID: Dazhong.com Photo source: Weibo ID: Dazhongwang But even so, the family cannot afford nearly 400,000 treatment costs... Cancer is not only a torment to the body and mind of the individual, but also to the family and the family. social test. The Xiaoyu family did not give up, her father was still working hard to make money outside, and her mother took care of Xiaoyu meticulously. Even if Xiaoyu is suffering from illness, she will sweetly express her love to her mother - "Mom, I love you." Source: Weibo ID: Dazhongwang hopes Xiaoyu and his family can wait until the flowers bloom. References: [1] National Health Commission of the People's Republic of China. Guidelines for the diagnosis and treatment of neuroblastoma in children (2019 edition). [2] Pediatric Oncology Professional Committee of China Anti-Cancer Association, Oncology Group of Pediatric Surgery Branch of Chinese Medical Association. Children Expert consensus on the diagnosis and treatment of neuroblastoma CCCG-NB-2021 scheme[J].Chinese Journal of Pediatric Surgery,2022,43(7):588-598.DOI:10.3760/cma.j.cn421158-20211227-00638.[3] Pediatric Oncology Professional Committee of Chinese Anti-Cancer Association, Oncology Surgery Group of Pediatric Surgery Branch of Chinese Medical Association. Expert consensus on diagnosis and treatment of neuroblastoma in children[J].Chinese Journal of Pediatric Surgery,2015,36(1):3-7.DOI : 10.3760/cma.j.issn.0253-3006.2015.01.002. This article was first published: Pediatrics Channel in the medical community. Pediatric Clinical Knowledge Doctor Station App has 👇1. Scan the QR code below 2. 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