Surgery on tumors in children
The work of the oldest types of surgical treatments of cancer, and may have contributed to recent advances in surgical techniques the high cure rates with increasing numbers of patients, and helped to make many complex surgeries that were impossible in the past and achieve excellent results, with the development of surgical techniques has become surgical work more accurately and precisely, reducing surgeries dilated, and helped to eliminate most of the tumors, especially administration, confined Bmoadaha without spreading, with being able to maintain the natural functions of most parts of the body, and it should be noted that most cancer patients would be subject to the type or more types of surgery, either at diagnosis or during the stages of treatment.
And surgery is the first line of treatment when the majority of solid tumors in children, and of course work aimed at the surgical access to the position of the tumor from the shortest route, and the least effect on the tissues of the body sound, and then verification of precancerous tumor through a biopsy of tissue extraction and analysis , in preparation for the eradication of more many as cancerous tissue and the lowest damage possible, and using all available techniques, taking into account the impact on the vital organs nearby, as well as remove a specific area of tissue surrounding the tumor in anticipation of its spread across it, and investigated the extent of his move to the tissues and organs nearby, especially the lymph nodes, or any places in the normal transmission of tumor cells subject of the surgery to it, with the anticipation is always the factor time during the process, and the importance of a minimum number of surgeries, and it is obvious that the diverse methods of surgical diversity of tumors, and as a matter for each type techniques associated with Bmodah and its impact on the surroundings, and the concentration and the area of spread.
In the following paragraphs we review some aspects of the surgery, in addition to an overview of some of the surgery when tumors of children.
Types of work at the surgical treatment of cancer
The surgery is classified into several types depending on the purpose of surgery:
Surgery, diagnostic (Diagnostic surgery)
And are made to extract tissue samples from the suspected diagnosis, to determine the type of tumor and vital properties, which can not be confirmed diagnosis of solid tumors without biopsies examined them under a microscope.
Taxonomic surgery (Staging surgery)
And surgery is a diagnostic help in the classification of tumors and identify tumor stage to determine the size and scope of its spread and spread, and how his move from its inception, the original position, and helps in checking the analysis and imaging studies used different diagnosis.
Curative surgery (Curative surgery)
Or surgery to achieve healing, and designed to eradicate the entire tumor tissue, and are adopted in most cases, an initial treatment option in most solid tumors, and may precede the surgery to receive doses of chemotherapy and radiation, or carried out directly after the end of their sessions.
Cellular reduction surgery (cytoreductive surgery)
Which means that the surgery aims to reduce the tumor mass only, because it could not complete eradication, as it might in some cases to cause severe damage to tissues adjacent to or some vital organs, and in this case, surgery is aimed at removing more than Km possible tumor tissue, and from and then address the remaining chemotherapy or radiotherapy.
Palliative surgery (Palliative surgery)
Or surgery to alleviate the effects of the tumor and not to heal, and may be made to address the complexities of sub tumors at advanced cases, or to address and correct the problems of secondary health caused by the growth tumor, for example, inflates the growth of some tumors cavity ventral to hinder and block the intestine, which require surgery to address such a blockage.
Surgery, preventive (prophylactic surgery)
This type of surgery is performed to remove tissue that had not yet Ttsrtun, and but for that candidate, that is, they go through stages of carcinogenesis before (precancerous).
Surgery support (Supportive surgery)
And used to support other treatments, such as transplant surgery and injecting devices of various blood vessels, the catheter used as tools to inject drugs, chemical and blood samples for analysis.
Reconstructive Surgery (Restorative surgery)
Or surgery to rebuild tissues and organs, which are made to repair damage to a vital organ, or restoration of part of the body affected by the fad for basic treatment.
Preparation for surgery
There are many procedures in preparation for surgery in children, start trading with the family about the need for surgical work primarily, and the expected benefits of it, and the case of child public health, and the readiness of psychological and ready physically, and are given the guidance necessary health of the child and the family , about the requirements necessary prior to surgery and beyond, such as feeding system, or the level of the activities of the child allowed, as are blood tests different to make sure proved rates of blood components at the levels appropriate health, and to verify the effectiveness of the kidneys and liver, and make the necessary tests to investigate the functions of the heart and lungs, in addition to the processing of quantities up of blood in anticipation of the need to transfer to the child during surgery, and are reviewed the medical history of the child, such as verification of the existence of any type of allergy has especially towards the drugs used, and are calculating the size of the body to help in the processing of sedation.
It is necessary not to allow the child to eat or drink for several hours from the date of the operation, and in order to avoid the complications that result because of the fullness of the stomach while the child is under anesthesia, especially the problems of vomiting, and at the date of the operation is to dress a child's coat special surgeries, and then transferred to a room processing operations where they are drugged normally, and may be conducted some tests Sub Once anesthetized, such as the exploration of bone marrow Bsaft sample of pure bone for analysis, or when you suspect the presence of a proliferation of cells of tumor to other sites, may be to draw a sample of places suspected to verify.
And what operation to be completed until the transferred to the child care room adjacent to the operating room; to be monitored to investigate any complications, and to fully wake up from anesthesia, returned to his room by the clinic.
On children and Surgery
Course will be established with the child's many fears and concerns and questions about the surgery, and will ask for the case under anesthesia, and you will feel pain, and on the presence of his parents near it, and perhaps most important of these concerns revolve around changes the physical potential, which will result from the surgery, and It is important to help the child Alottaghz of the process and prepared psychologically, encouraged him to visit the operating room and accessories, and to identify the doctors and surgeons and talk to them directly, and familiarity with the situation as a whole, and most importantly, of course, is to talk with the child, and urged him to disclose his feelings and his feelings and his fears and concerns, and exert the effort to encourage and push him up and reassure and raise the morale.
It is very important in this regard not to hide the facts from the child, and should explain the situation and status as permitted by the age and level of cognitive impairment, and no matter how painful for parents, or that the surgery would be the impact of great physical, as is the case when the surgery amputation , must not hide it for the child, Openness is very important, and clarification to make the child better able to cope with the situation, and more responsive and receptive to the event, and be able to cope with physical changes in the future of his life, so I needed to give clear answers and honest questions about the child, to avoid the loss of confidence to his parents, if not actually identical to what he heard of them, and it goes without saying that the child needs and strongly to this confidence, especially during the crisis of cancer, and of course, so that parents give answers sincere and clear should be fully familiar with treatments planned and required by the necessities, and thus are better able to create a child.
And useful in this context refer to the procedure in all clinics by direct surgical operations, which is the need to give written consent by the parents, and this is very important since the procedure requires to be fully familiar with all aspects of treatment, before giving their consent, and need to be sure and confident that the decision represents the best opportunity for the child to get the best return on therapeutic as possible, and even though people vary in how their dealings with such decisions, it leaves some of it the responsibility of doctors, that know more than what possible for processors and the desired results will enable the parents of a clear understanding of the overall situation and participation in decision-making.
Although the specificities of each case, but he and the general need to be parents full knowledge of the following issues:
What is the current situation of the child, and why they were adopted surgical treatment option.
What is the purpose of the surgery.
How will you conduct the surgery.
What is the benefit of the process.
What are the risks.
What are the complications and possible side effects.
What are the treatment options available other than surgery.
On the surgical osteotomy (Biopsy)
Aimed osteotomy surgical biopsies and tumor tissue to be tested experimentally, in order to distinguish the type of tumor and its properties precisely, and may vary the way to extract the sample and access to tumor tissue on several factors, most notably the subject of the tumor and the patient's age, experience and medical skills, which can be to spare the appropriate planning for the position of osteotomy and technique of the emergence of any complications later, and reduces the number of surgeries during the treatments, and of course may be conducted osteotomy under local anesthesia or sedation full, where the local anesthetic injection of the drug by a needle in the tissues around the site of the tumor, While general anesthesia is one of the veins by injecting the drug, inhaled or even completely lose the sense of the body before the operation.
And there are two ways to extract a sample of the tumor, either surgery open integrated access to the position of the tumor, or extract a small sample using a needle is inserted through the skin into the tumor, and may be the use of techniques of endoscopy in some cases, using different perspectives to determine the position of the tumor and its size.
And purpose of the osteotomy is usually when you open surgery, to remove the tumor and part of the testing immediately and quickly, by a specialist knowledge of the disease (specializing in the diagnosis of diseases of the results of laboratory tests), and when proven precancerous tumor is, the next step depends on the type of tumor and its position and size and the concentration, the small size and the position is available and accessible, the surgeon may perform the osteotomy Alastisala (excisional biopsy) of trying to eradicate the entire tumor tissue, (as may be removed lymph nodes and adjacent available for eradication, and checked to make sure the transmission of tumor cells to them), but if a large tumor size or placement of a sensitive and vital so that can not be removed, the surgeon he was content to draw a sample with known Aldaa osteotomy surgery (incisional biopsy).
The osteotomy needle (needle biopsy), which is usually after local anesthesia of the skin, and sometimes anesthesia full it is of two types: osteotomy needle traditional and so-called biopsy mass (Core biopsy), using a needle of relatively large is its implantation directly into the tumor mass to extract the sample cylinder is enough normally to all tests, with a diameter of about 1.5 mm, and length of about 12.5 millimeters, while the method is called later Bkhoza or aspiration needle capillary (Fine needle aspiration) using a thin needle to withdraw a small amount of tumor tissue, and the doctor can placement-targeted oversized and perceived under the skin, and suspected of being shot, or a position deep within the body and is perceived from the outside, using tomography (CT scan) to ensure the accuracy of direction toward the tumor mass.
Surgery on some tumors
As noted above is the surgical work at the most solid tumors the initial treatment and basic treatment plans, and aims to eradicate as many as possible of tissue tumor, and some healthy tissue surrounding the position, and of course, different methods of management of surgery of cancer to another and from one case to another , and may be used treatments chemotherapy or radiation, or both by direct surgeries, in order to limit and reduce the size of the tumor, thus facilitating their removal, in addition to be used after surgery to eliminate cancer cells that may be remaining, or in preparation for surgery the following, and depending on the type of the tumor and the development of the case during the treatments.
And options depend surgery on the type of tumor and its position, and how that will affect the surgery on the function and effectiveness of the injured part of the body, many of the tumors, which are located placements is essential to the body, can be removed without causing any disability or disabilities, while others, such as retinal tumors or bone tumors that appear most of the bones of the arms and legs, it can not be eliminated entirely without affecting the effectiveness of the affected organs, and in this case and can often benefit from the techniques of prosthetic replacement, or vaccinations in the bone to replace such member.
And of course there are many complexities task associated with surgery in some cases, such as the emergence of infections of different, and the slow healing of wounds, and by increasing the presence of the side effects of Alajan radiation and chemotherapy before surgery and after completion, which may interfere with the natural ability to heal and recovery of the wounds, in addition to the problems caused by bleeding, and damage to blood vessels or nerve tissue, or hurt some vital organs.
And the following paragraphs an overview of surgery in some tumors.
Surgery and soft tissue tumors, bone tumors and Ewing's
Include surgery in tumors of soft tissue and bone tumors Algarnih and group tumors Ewing's conduct biopsies for diagnostic purposes, and then surgical treatment, and it is important to plan for both at the same time and by the same surgeon, who generally extracts a sample of the tumor or Astasalh altogether, if there is no tumor could determine once and for all before the main process, is examined tumor tissue extracted immediately to report that kind of evil, and that was to define what the tumor while the child is still under anesthesia, the process continues in order to eradicate the many as fabric cancerous tissue, and part of the healthy tissue surrounding the placement (may amount to about 2 to 3 cm in some tumors), and may also remove some lymph nodes adjacent to investigate the extent of cancer transmission to, and are often making these surgeries immediately after receiving doses of chemotherapy and radiation treatments, or one of them individually in advance in order to reduce the tumor mass, and of course the extent of the surgery more difficult when the tumor localization of sensitive areas such as the pelvic bone, which may be present near one of the vital organs and can not be eradicated surgically.
And decades ago was a bone tumors, especially the parties means the patient and amputation as the only solution, while at the present time advanced processors surgical significantly, which can remove large parts of the bone and replacing vaccinations bone, or sheets, metal rods or alternatives, industrial ( prosthesis), such as bones and joints made of plastics or metals, to make up part of the bone that has been eradicated with the tumor, known as surgical replacement, or surgery salvage Members (Limb - salvage surgery) to remove the tumor without amputation, it can sometimes replace the bone the whole alternative industrial , and can therefore maintain a job or position a patient.
And such a complex surgery, of course, and require a several operations and months of physical therapy so that the patient from the use of a patient effectively, and is worth mentioning that the cure rates in patients who were treated in this way are identical with the rates of amputations, which are not now resorted to only in rare and specific cases.
And obviously study both options (amputation or retention) among doctors and parents, and consultation on the best means to eradicate the cancer, and at the same time maintaining as much as possible the effectiveness of the injured party, and as has been said, often do not start working surgical time ago of time, during which receive doses of chemotherapy or radiation, or both, in an effort to retain more than how much tissue as possible from the place of the injured.
Amputation surgery
May be amputation of the affected organs in some cases the best options available for the treatment of cancer, if tumor extends to the nerve tissue or blood vessels, or both, may be impossible to save the injured party, and is an imaging MRI magnetic and testing tissue during surgery, to help the surgeon to decision-making on the subject and the amount of amputation of the arm or foot, and to plan the surgery so that the muscles and skin from healing, and a coral formation on the bone stump, is helping to install the artificial limb can be installed to compensate for the residual limb.
Salvage surgery Members
And surgery is complex and multifaceted, the surgeon faces significant challenges, it must be a full eradication of the tumor and at the same time essential to keep the tissues surrounding the muscles and tendons and nerves and blood vessels, bone replacement and bone-grubber vaccinations, or metal plates and rods , with consequent complications, Kinsu infection or vaccination, or relaxation of industrial parts.
And can remove the femur including the knee and replace it with an alternative industrial and link them to the bottom of the man, while the most difficult is to remove the lower part of the men and redone again, and is the bones of the upper arm more suitable for surgery, replacement, where they are away from the weight of the body, On the other hand, and the development of means of surgery, it became possible to replace most of the pelvic bones, which were considered difficult to replace in the past, either when a tumor soft tissue in the chest wall, it is usual that the surgeon remove the position the injured in addition to a rib or more ( from the rib to the three sides), and are replaced by artificial substitutes to close the chest wall.
And may be unable to perform the surgery replacement in some cases for several reasons, such as the presence of tumor bone is difficult to replace, or tumor may have spread to the tissues of neural basic, or blood vessels is impossible to remove without causing barbed substantial user injured, and here you may be dealing with such cases, treatments tumors the other, instead of surgery, depending on the type of tumor.
About amputations and have members in children
Naturally arises in children at risk of amputation or replace members of many of the fears and anxiety, which will ask for the case, and to live without foot or arm, and you will be able to exercise life and to carry out everyday activities, and how they will be able to that, and how will the reaction of others towards them or the disposal of their peers, and will feel the loss of normality and symmetry with the others, and sometimes accept the situation and cope with more difficult for parents of children themselves, and it should be noted that young children coping usually more quickly than adolescents, who are created to have concerns and anxiety and feelings of different of course, are much more sensitive to how others towards them, and their assessment of themselves, and Siklqon of course, about the impact of losing one of their members on their social life and make friends, and on their working lives, and their ability to identify with their peers, and to engage in activities various sports such as types, in addition to marriage and childbearing and family formation.
And which may help the child to some degree to cope, is to see other children who were subjected to surgery, amputation and the loss of members and identify them, and see how they could live with the situation, and find the child that he can live a normal life and be as effective as his peers, and has been observed that most children can engage in activities that they did before the surgery, such as toys and different sports, and may also help the parents explanation and clarification of the child for alternatives or prostheses can be installed in his case, or supporting tools and support that can be used to assist in the practice of various activities.
Surgery in leukemia
Because leukemia cells spread widely within the bone marrow and to several other organs, it is impossible to handle this type of tumor with surgery, which is rare to have any role, even at diagnosis, where the progress of extraction pure bone marrow evidence of diagnostic enough, and surgery is not used only when transplants that use different catheters to inject chemotherapy drugs and drugs for help and blood samples for various tests.
Surgery when tumors Allahoddgkin
It is unusual for a surgery to remove tumors Allahoddgkin, which may result in damage to vital organs healthy during surgery, but he can eradicate the entire tumor mass during the osteotomy surgery, if available, and on the other hand is an osteotomy surgical Open to select the type of tumor Allahoddgkin accurately when you can not get how adequate tumor tissue through the use of osteotomy needle or extraction pure bone marrow, may also be a surgery at the emergence of an emergency (such as address blocked bowel due to an enlarged tumor mass), or is made to investigate the response of the tumor mass of chemotherapy .
