Dr Vijay Kumar Kundal
International Childhood Cancer Day is observed on February 15 every year all over the world. It is a global collective campaign to increase awareness about childhood cancer and to express support for children with cancer. Childhood Cancer International is the largest patient-support organization for childhood cancer in the world.It acknowledges their pain and difficulties during their journey from diagnosis to treatment of disease. Despite the advances in medical science, cancer remains the leading cause of death among children. Not only is childhood cancer traumatic, but it also requires specialized treatment and care. Pediatric oncology is an important field in medicine that works with cancer in children and devices strategies for treatment, pain management, and home care.
Every year, more than 4 lakh children and young adults under the age of 20 years are diagnosed with cancers all over the world. Survival rates in childhood cancers have improved significantly in recent years. While the chances of full recovery for children with cancer have reached up to 80% in developed countries, in developing countries, recovery rates have slipped down to 20%. The International Childhood Cancer day primarily focuses on the importance of equal opportunity to treatment for cancer among children. It works to ensure that children with cancers all over the world have access to best possible care and better quality of life while on chemotherapy. This initiative aims to make childhood cancer a priority in the world. It also works in line with the target goal of WHO Global Initiative on childhood cancers towards achieving a 60% survival rate for children with cancer around the world by 2030. This means we have to achieve an approximate doubling of the current cure rate and that will save an additional one million children’s lives over the next decade. Every three minutes, a child dies of cancer….think about this. On International Childhood cancer day, we stand united to make childhood cancers a national and global child health policy in support of these WHO target goals.
Early diagnosis and risk factors of
Childhood Cancer
Pediatric cancer is not preventable, but it can be detected at early stages. Children with cancer should be referred as early as possible to hospitals that have specialized human and technical resources, and where they can be treated by specialists trained in pediatric oncology. Delay in referral of a patient with cancer and late initiation of treatment can mean the difference between life and death. There are several risk factors that are known to be associated with the pediatric cancers; Ionizing radiation like X-rays during pregnancy, chemicals and drugs like diethylstilbestrol. Likewise, pesticide exposure has been associated with certain leukemias and lymphoma. N-nitroso compounds, found in some processed foods and in tobacco, can induce tumors of the brain when consumed during pregnancy, while alcohol and some diuretics used during pregnancy are linked to neuroblastoma and kidney tumors. Biological factors such as the Epstein Barr virus, human immunodeficiency virus (HIV), hepatitis B and C and human papillomavirus (HPV), are associated with specific cancers. Children with Down syndrome are 20 to 30 times more likely to develop blood cancers and those with Klinefelter syndrome have a 20 times greater risk of breast cancer and a 30 to 50 times greater risk of germ cell tumors.
Common childhood cancers in children
The most common childhood cancers include: (i) Brain cancer- Brain and spinal cord tumors begin in the tissues of the brain and spinal cord. They are more frequent in early childhood, appearing primarily from 5 to 10 years of age. The most frequent symptom is headache, which is usually accompanied by nausea, vomiting, and visual or auditory disturbances, etc. (ii) Germ cell tumors often begin in the testicles or ovaries, although they can form almost anywhere in the body. (iii) Leukemia starts in the blood-forming tissue of the bone marrow. Types of leukemias include acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML). (iv) Lymphoma starts in the lymphatic system, which is part of the body’s immune system. There are several types: Hodgkin lymphoma, non-Hodgkin lymphoma. (v) Neuroblastoma forms in nerve tissue in the neck, spinal cord, or adrenal gland. (vi) Sarcoma is cancer that forms in the bone, muscle, or soft tissues, rhabdomyosarcoma is the most common type of soft tissue sarcoma in children, it forms in the muscle tissues (vii) Wilms tumor forms in the kidney. It is the most common kidney cancer in young children. The typical clinical manifestation is a palpable asymptomatic abdominal mass, which may be detected by the parents or physician during routine examination. It may be accompanied by pain, hematuria, and hypertension. Other less frequent signs include anemia, fever, and constipation.
How to assess the possibility of cancer
Observe, Feel and Identity:
One of the following signs:
-Fever for over 7 days with no cause
-Headache: persistent and progressive, and primarily nocturnal
-Bone pain that has increased progressively and disrupts the child’s activities
-Petechiae, bruises, and/or bleeding
-Severe palmar or conjunctival pallor
-Leukokoria (white eye)
– Strabismus that has newly appeared
-Aniridia (lack of iris)
– Heterochromia (different colored eyes)
-Hyphema (blood in the eye)
– Proptosis (bulging eye)
– Nodes >2.5 cm in diameter, hard, painless, lasting ?4 weeks
-Acute and/or progressive focal neurological signs and symptoms:
– Convulsion without fever or underlying neurological disease
– Unilateral weakness (of one limb or one side of the body)
-Facial asymmetry
– Changes in consciousness or mental status
– Loss of balance when walking
-Limping from pain
– Difficulty speaking
– Visual disturbances (blurred, double, sudden blindness)
-Palpable abdominal mass
– Hepatomegaly and/or splenomegaly
– Mass in some region of the body with no signs of inflammation
Tests and procedures
The following tests and procedures are used to diagnose cancer in children. The type of test done depends on your child’s symptoms, age, medical history, and the type of cancer. A physical examination and blood tests. Scans are imaging tests that make pictures of areas inside the child’s body. Types of scans include CT scan, MRI, PET scan, x-ray, and ultrasound. A radiologist is a doctor who reviews the scans and sends a report of the findings to your child’s doctor. A biopsy is a procedure in which samples of cells or tissue are removed and then checked to see if cancer cells are present.
Childhood Cancer Treatment
The types of treatments depends on the cancer type and stage. Common treatments include: Surgery, Chemotherapy, Radiation therapy and Stem cell and bone marrow transplant. The duration of chemotherapy depends on the cancer’s type, stage, and how well the child’s body is responding to the treatment. Radiation therapy: Radiation therapy is one of the most common treatments used in the fight against cancer. This treatment that uses high-energy rays to kill cancer cells and shrink tumors. Bone marrow transplant: – Some types of cancer may require a bone marrow transplant, especially the type of cancer that affects the function of blood cells. – It is sometimes used to treat cancer that do not affect blood cells, because it allows doctors to administer high doses of chemotherapy.
Guidance for Parents
Parents should make sure their child understands some basic things about his disease and the treatment. Parents should involve their child in the discussion about the treatment by using a simple language in order to prevent fear and misunderstanding. Parents should answer all of the child’s answers frankly about his disease, as children often use their imagination to get answers to unanswered questions, which may increase their fears. It is important to help the child suffering from cancer cope with the different physiological changes he might experience. During treatment, many changes may be seen in the child’s life, including appearance changes. Children may be overly sensitive about their appearance and how others see them, so it might be useful to try some of the following ways to help the child accept these changes. The child should be prepared for hair loss if it is one of the side effects of the treatment, and it is advisable to allow the child to choose a cover, scarf, or wig early on in the process. Some treatments may cause loss or weight gain, and in that case a nutritionist should be consulted to see what can be done to prepare for these physical changes. – It is recommended to go shopping with the child and allow him to choose the clothing that he prefers, which may help to raise his spirits. Emotional Changes: Children who suffer from cancer may sometimes feel anxious and sad, so it is important to help them deal with such difficult emotions: It is important to find ways to keep the child engaged and entertained. Most children with cancer are absent from school during treatment. Parents should consult their child’s doctor about his academic status, to see how the treatment can affect the child’s performance level and ability to do schoolwork. Parents should constantly update the school about any developments in the child’s health.Scheduled follow-up appointments with doctor should not be missed. Regular scans and tests must be conducted to make sure the cancer does not return. In the end our unified message is “we should have better access to care for children & adolescents with cancer everywhere!”
(The author is Additional Professor Pediatric Surgery All India Institute of Medical Sciences, Vijaypur, Jammu, J&K.)
Follow our WhatsApp channel
