Cancer in children
Approximately 15,000 children in India suffer from childhood cancer every year. But tragically only 20 percent of these children get the required treatment needed to lead a better quality of life.
Last year the Tata Memorial Hospital registered 1476 cancer affected children out of which 62 opted out of treatment citing various issues. To reach out to people and do its bit in reducing the numbers in pediatric cancers the psycho-social and economic support group of the hospital has been putting in more efforts since 2009. In 2010 there were 118 drop outs from 1131 registered cases and 2011 saw 64 drop outs from 1222 cases. In 2012 there were 73 dropouts out of 1291 patients. ‘One should keep in mind that though childhood cancers are curable but only an early detection and commitment to treatment can help achieve the cure,’ says Dr Tushar Vora, associate professor, pediatric medical oncology, Tata Memorial Hospital, Mumbai.
Types
The most common types of pediatric cancers are:
Acute leukemia or blood cancer: This is the most common cause of cancer in children and teens which affects the white blood cells. Abnormal white blood cells from the bone marrow travel through the blood stream and cover up the healthy cells. This increases the chance of infection and susceptibility to other diseases due to a weak immune system. Though the exact cause of childhood leukemia is not known, but one may have various risk factors. Children with siblings with leukemia stand a higher chance to get one, if your child is being treated with immuno-suppressants or have been exposed to high radiation it contributes being as a risk factor. One cannot ignore the genetic risk factors too, which you can hardly defy. Excessive fatigue, infection and high fever, recurrent cough should make you alert and get your baby checked.
Brain tumors: These are the second most deadly cancers that mock a child’s health. Tumors in brains can either be malignant or benign. The malignant ones that contain cancerous cells deploy fast and can affect the surrounding brain tissues. Often a surgical intervention is needed to treat brain tumors. Often the benign ones also mimic the symptoms of malignant tumors because of its location and size inside the brain and may need similar intervention. Headache, nausea, vomiting, irritability, personality changes are some of the symptoms that says that your child’s brain is housing some trouble.
Wilms’ tumor or cancer of the kidney: Wilms’ tumor or nephroblastoma referred as cancer of kidney often occurs in children and rarely in adults. It can happen either in one or both the kidneys. In most cases the causes of Wilms’ tumor is unknown. But very rarely a child suffering from Wilms’ tumor may have specific congenital malformations, like a absences of the iris in the eyes, abnormalities of the genitals or one side of the body may appear slightly larger than the other. Children with this type of cancer will have a relatively large swollen abdomen. With Wilms’ tumor there may be blood in your child’s urine or your child may suffer from high blood pressure. Recurring stomach upset along with weight loss and sheer loss of appetite should make you reach for your doctor’s opinion.
Retinoblastoma or eye tumor: Retinoblastoma is a rare type of eye cancer that happens in early childhood before the age of five. It usually develops due to some malfunctioning of the retina. This type of cancer is usually curable. But if untreated can travel to other parts of the body. Often children suffering from this type of cancer will have a whitish reflex in the eyes. Children with retinoblastoma are usually affected in one eye. but in rare cases a child can be affected in both eyes too. If treatment is delayed one might have to even undergo expulsion of the diseased eye to prevent the disease from spreading to other parts of the body.
Causes
The biology of the cancers of children is different from that of the adults. ‘The causes of majority of adult cancers are related to lifestyle and ill habits. Tobacco, cigarettes, a diet heavy on junk and a sedentary lifestyle all contribute to the cancer castle in an adult. But in children genetic mutation leads to this deadly disease, which in most cases, is not under our control,’ explains Dr Vora. ‘But the silver lining is that pediatric cancers are curable to a large extent. Irrespective of the tumor type, on an average 70 to 75 percent of pediatric cancers are curable, which isn’t the case with adult cancers,’ says Dr Vora.
Explaining further Dr S D Banavali, head of medical oncology, Tata Memorial Hospital says, ‘There is a general lack of awareness among people regarding pediatric cancer. People do not understand the difference between pediatric cancer and adult cancers. While pediatric cancers are usually curable but many people drop out of the treatment hearing the prognosis and related expenses.’
Risk factors
‘One cannot prevent the occurrence of cancer in the child as it is due to genetic mutations. But what parents can really do is rush for help early. Like any other disease early detection of cancer in children can help in optimal treatment and fast recovery,’ says Dr Vora.
If your child has certain risk factors, like having a family history of cancer, or suffer from other illness or disease which threats a weak immune system, be more vigilant.
Symptoms
Reach out to your pediatrician if:
- Your child is sick for no apparent reason for more than two weeks
- You notice a lump on any part of the body
- Your child’s eyes show a whiteness in the pupil area
- Your child gets tired very fast
- Has recurrent high fever
- Unexplained weight loss
Meet your pediatrician and evaluate your child’s health. Take a second or a third opinion if the need be. Remember it’s your child’s health which is of utmost importance.
Treatment
Even though pediatric cancers are different from the adult ones but the treatment line more or less remains the same.
Chemotherapy: Your child would receive anti-cancer drugs to destroy the cancer cells either intravenously, through the veins or intrathecally where drugs are introduced through the spine. Sometimes the drugs are even given orally to children. But as the medications attacks the cancer cells they play havoc on the healthy ones too. often children on chemotherapy face lot of side effects. Fatigue, discomfort and pain, hair loss and scalp sensitivity, gastrointestinal problem, anemia, blood clotting, urinary tract infection are some of the side effects of chemotherapy one can face. the long term side effects of chemotherapy on children are that the chemo drugs can effect other organs in the body and also increase a chance of recurrence in future. Some drugs also interfere with normal growth and cognitive development.
Radiation: In radiation high energy x-rays are used to target the specific tumors and kill or shrink its size. A radiation therapy might be given before chemotherapy or a surgery. Unlike chemotherapy radiation doesn’t kill all the healthy cells in the body but does affect those in the area where the rays reach. Side effects of radiation is less compared to chemotherapy but can leave your child drained and weak for long.
Surgery: This is any parent’s nightmare. But to keep your child off the clutches of cancer sometimes going under the knife becomes inevitable.
‘The treatment of most pediatric cancers lasts for about six months, but in some cases it may continue for up to 2.5 years,’ informs Dr Vora.
A child can live a hassle free life post treatment. But during the treatment multiple precautions are necessary. These precautions cover hygiene, diet and certain lifestyle changes depending on your child’s condition.
Prognosis
The good news is tolerance to treatment and recovery is much more rapid in children than in adults. ‘They tolerate much higher doses of chemotherapy than an adult can. But the flip side is that children are very sensitive and can become sick very soon,’ says Dr Vora. Hence precaution with adequate timely treatment is essential. Have a detailed chat with your doctor about the doses and drugs used for your child. the cancer treatment needs children to have age appropriate drugs and dosage for better treatment and faster recovery. If you harbor even slightest doubt about the treatment do not hesitate to check for second opinions.
Once cured of cancer a child can lead a socially and economically productive life given the right opportunities. ‘After the completion of treatment most of the children have a good quality of life and can expect a normal life span,’ assures Dr Vora. So that means your kid can kick that football or become a topper in the class given his interests leaving behind the dark phase of life. Don’t expect things to happen instantly, children would need time to come to terms with their life. After undergoing such treatment and suffering an internal emotional turmoil integrating with the society should be rapid for these children and supplemented with lot of support and care. Check if your child needs counseling or a therapy to get going and give one.
The content has been verified by Dr Tushar Vora, associate professor, pediatric medical oncology, Tata Memorial Hospital, Mumbai.
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