Childhood Cancer Awareness Month: All You Need To Know About Pediatric Cancer

Each year, approximately 400 000 children and adolescents of 0-19 years old are diagnosed with cancer, according to WHO. However, in many cases, childhood cancer is curable. The major hurdles in cancer treatment in India are advanced disease due to delayed diagnosis, inaccessible care in remote areas and treatment abandonment or refusal due to financial constraints.

The most common cancer in childhood is leukemia (blood cancer), accounting for about one-third of all cases of childhood cancer in India, followed by brain tumours and lymphomas. Other common cancers seen in children are Wilms tumour (in kidneys), neuroblastoma (in adrenal gland), sarcomas (in muscles and bones), germ-cell tumours (in gonads) and retinoblastoma (in eyes).

Symptoms

Symptoms of blood cancer arise due to low hemoglobin causing pale skin and fatigue, low white cell count causing frequent infections/fever and/or low platelet count causing bruising or bleeding. A blood cancer or lymphoma patient can present with enlarged lymph nodes in neck/axilla/groin. A solid tumour generally presents with a painless lump or swelling, without preceding trauma or infection, example abdominal lump in a case of Wilms tumour or neuroblastoma. Severe headache and vomiting should arouse suspicion of brain tumour. Other common symptoms of cancer include fatigue, anorexia, bone pains, fever, and unintentional weight loss.

Causes

About 90% of childhood cancers don't have a known cause. It happens because of a random defect at DNA/genetic level, unlike adults, where genetic defect is caused by lifestyle/environmental factors like smoking, obesity and tobacco chewing. However, in 10% of childhood cancer cases, the cause might be a genetic mutation inherited from parents. Possible associations have been found with environmental exposures like parental smoking, home pesticide exposure and radiation, however, absolute cumulative risk due to these factors is extremely small in children.

Diagnosis

Childhood cancer is curable in a vast majority of cases unlike adults. In blood cancer patients, diagnosis is established by bone marrow examination. This is supplemented with special tests like flow cytometry to know the type of blood cancer. In case of solid tumours, imaging (Ultrasound/CT scan/MRI) of the local part is carried out to ascertain the local extent of the tumour, followed by biopsy of the lesion. Biopsy sample is examined under the microscope to look for the type of cancer cells. Certain special markers (immunohistochemistry) are used to differentiate between different kinds of tumours. Often genetic tests are needed for risk stratification.

Treatment

The treatment of each cancer is specific to its type. There are 3 major modalities of cancer treatment used in different combinations: chemotherapy (medicines which kill cancer cells), surgery and radiation. Blood cancer is treated with chemotherapy. Solid tumours are often removed by surgery. Some of them might need radiation. It is important to understand that most of the childhood solid tumours need chemotherapy for cure in addition to surgery, even if the tumour has been completely removed by surgery. Early diagnosis and complete treatment at a specialised place is the key to cure.

Post treatment scenario

Once cured, children can go on in their life to do or become whatever they want. They can play with other children, they can go to school like their peers. They can even get married and have kids of their own. If the cancer is cured, they have normal life expectancy. Rarely, some long-term side effects can happen, for which regular clinical follow-up is needed after completion of therapy.

(Dr Silky Jain, Pediatric Haemato-Oncologist and BMT Physician, Jaypee Hospital, Noida)

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