Pediatric grapefruits sarcoma

　　Most pediatric grapefruits sarcomas are vaginal malignant tumors. In China, primary vaginal cancer is mainly associated with early marriage and premature delivery, with some patients having a history of long-term use of pessaries or pelvic radiotherapy. Human papillomavirus may be partially related. HPV is associated with abnormal changes in the development of vaginal mucosa, known as vaginal intraepithelial neoplasia (VAIN). The process of HPV infection → vaginal intraepithelial neoplasia → invasive cancer has been reported, but the exact possibility is still unclear. Vaginal clear cell carcinoma in young women is related to the use of estrogen during their mothers' pregnancy, with a risk of 1‰, especially for women who were exposed to estrogen in the first 12 weeks of pregnancy.

　　The tumor mainly spreads locally, due to the special anatomical relationship of the vagina (loose connective tissue, thin walls, rich in lymphatics), the cancer tends to spread easily. It can directly extend and spread to local para-vaginal tissue, and can also spread through blood and lymphatic channels. The tumor often first affects the bladder and urethra, causing frequent urination and hematuria. If the tumor is large, or if there is a tumor at the bladder neck or blood clots blocking the area, it can cause symptoms such as difficulty in urination or urinary retention. The tumor's backward spread to the vagina is rare.

　　The onset of this disease is often without any special symptoms. When the tumor grows to a certain size, children may present with vaginal bloody discharge or irregular vaginal bleeding, accompanied by a mass within the vagina. Especially when the child cries or increases abdominal pressure, the mass can be seen protruding from the vaginal opening.

　　1. Avoiding harmful substances (carcinogenic factors) can help us avoid or minimize contact with harmful substances.

　　Some related factors to tumor occurrence can be prevented before the onset of the disease. Many cancers can be prevented before they form. In 1988, a report in the United States compared the international situation of malignant tumors in detail and proposed that many known malignant tumors can be prevented by external factors in principle, that is, about 80% of malignant tumors can be prevented by simple changes in lifestyle. Continuing to trace back, Dr. Higginson's research summary in 1969 found that 90% of malignant tumors are caused by environmental factors. 'Environmental factors' and 'lifestyle' refer to the air we breathe, the water we drink, the food we choose to make, the habits of activity, and social relationships, etc.

　　2. Improving the body's immunity to tumors can help enhance and strengthen the body's immune system in the fight against tumors.

　　1. The focus of our current tumor prevention and treatment work should first be on improving those factors closely related to our lives, such as quitting smoking, eating a balanced diet, regular exercise, and weight loss. Anyone who adheres to these simple and reasonable lifestyle common sense can reduce the chance of getting cancer.

　　2. The most important thing to improve immune system function is: diet, exercise, and controlling stress. Choosing a healthy lifestyle can help us stay away from cancer. Maintaining a good emotional state and appropriate physical exercise can keep the body's immune system in the best state, which is also beneficial for preventing tumors and other diseases. Additionally, research has shown that appropriate physical activity not only strengthens the human immune system but also reduces the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here, we mainly understand some issues related to diet in the prevention of tumor occurrence.

　　3. Epidemiological studies in humans and animal experiments show that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucous membranes and vision, and it directly or indirectly participates in the functions of most tissues in the body. Vitamin A exists in animal tissues such as liver, whole eggs, and whole milk, and in plants it exists in the form of beta-carotene and carotenoids, which can be converted into vitamin A in the human body. Overconsumption of vitamin A can cause adverse reactions in the body, while beta-carotene and carotenoids do not have this effect. An increase in low vitamin A levels in the blood increases the risk of malignant tumors, and studies have shown that people with low levels of vitamin A intake in the blood are more likely to develop lung cancer, and for smokers, the risk is doubled. Vitamin A and its mixtures can help clear free radicals in the body (free radicals can cause damage to genetic material), and secondly, they can stimulate the immune system and help differentiate cells within the body, developing into orderly tissues (while tumors are characterized by disorganization). Some theories suggest that vitamin A can help reverse the mutated cells that are early attacked by carcinogens and become normal growing cells.

　　4. Some studies suggest that simply supplementing beta-carotene drugs does not reduce the risk of cancer, and may even slightly increase the incidence of lung cancer. However, when beta-carotene is combined with vitamin C, E, and other antitoxin substances, its protective effect becomes evident. The reason is that when it is consumed, it can also increase the level of free radicals in the body. In addition, there are interactions between different vitamins. Studies in humans and mice have shown that the use of beta-carotene can reduce the level of vitamin E in the body by 40%. A safer strategy is to eat a variety of foods to maintain a balance of vitamins to resist the invasion of cancer, as some protective factors have not been discovered yet.

　　5. Vitamin C and E are another type of antitumor substance that can prevent the harm of carcinogens in food such as nitrosamines. Vitamin C can protect sperm from genetic damage and reduce the risk of leukemia, kidney cancer, and brain tumors in their offspring. Vitamin E can reduce the risk of skin cancer. Like vitamin C, vitamin E has antitumor effects and is a scavenger for toxins and free radicals. The combined use of vitamin A, C, and E has a better protective effect on the body against toxins than their separate use.

　　6. Currently, research on phytochemicals has attracted widespread attention. Phytochemicals refer to chemical substances found in plants, including vitamins and other substances discovered in plants. Tens of thousands of chemical components have been found in various plants, many of which have anticancer properties. The protective mechanisms of these chemical substances not only reduce the activity of carcinogens but also enhance the body's immunity to the invasion of carcinogens. Most plants provide antioxidant activity that exceeds that of simple vitamin A, C, and E. For example, a cup of kale contains only 50mg of vitamin C and 13 IU of vitamin E, but its antioxidant activity is equivalent to 800mg of vitamin C and 1100 IU of vitamin E. It can be inferred that the antioxidant effects of antioxidants in fruits and vegetables are much stronger than those of the vitamins we know. There is no doubt that natural plant products will help in future cancer prevention work.

　　There is controversy regarding the use of the Pap smear test for this disease. Vaginal cancer is often diagnosed at a late stage, resulting in a low detection rate for screening. However, some authors believe that the Pap smear test can be applied in the following situations:

　　1. The Papanicolaou (Pap) smear test is a basic method for screening the general population. As 30% of patients with vaginal cancer have a history of cervical cancer, these patients should undergo a Pap smear test annually.

　　2. Women with a history of exposure to diethylstilbestrol in utero should have pelvic examination and Pap smear annually from menarche, because clear cell carcinoma can occur in childhood, so careful examination should be performed when there is vaginal bleeding or discharge.

　　In addition to the aforementioned examinations, patients should undergo vaginal ultrasound examination.

　　Children with grapefruits should have a reasonable diet, ensure a comprehensive and balanced nutrition, eat more vegetables and fruits, eat light, quit smoking and drinking, and do not eat greasy, fishy, spicy, and刺激性 foods.

　　I. Treatment

　　1. Due to the low sensitivity of grapefruits to radiation and chemotherapy drugs, the preferred treatment is to perform radical surgical resection as early as possible, especially the accuracy and thoroughness of the initial surgery, which is particularly important for avoiding or reducing tumor recurrence. Radiotherapy or chemotherapy can be supplemented according to circumstances after surgery. Radiotherapy and surgery are the main treatment methods. For early stage I and II, surgery is the main treatment. For stage III and IV, radiotherapy and chemotherapy are combined, with drugs such as 5-fluorouracil (5-FU), mitomycin, and cisplatin.

　　2. Surgical Treatment Due to the close proximity to the bladder, urethra, and rectum, the surgical range is limited. In addition, there are considerations for preserving vaginal function and the psychological tolerance of patients. It is currently believed that small-scale surgical procedures are more suitable than radical vaginectomy. For in situ carcinoma: vaginal mucosal excision. Stage I: Involvement of the upper vaginal wall, radical surgery, partial vaginal resection, and bilateral pelvic lymph node dissection. Lower vaginal wall involvement, treatment principles are the same as for vulvar cancer plus bilateral inguinal lymph node dissection.

　　3. Radiotherapy Stage I lesions are alternative therapies with good effects without surgery. For the remaining stages, radiotherapy, usually combined with external and internal radiation, is recommended to control the tumor to a maximum extent, with a dose of at least 70Gy. Some authors believe that radiotherapy is an effective treatment. The 5-year survival rate can reach 100% for stage 0, 77% for stage I/II, and 56% for stage III/IV.

　　II. Prognosis

　　Vaginal grapefruits are highly malignant tumors, most of which progress rapidly, with a very poor prognosis. The 5-year survival rate is only about 15%, and most cases die within 3 to 6 months if not treated in time.