Childhood is a period of desires, likes, dreams of endless possibilities. For those children diagnosed with cancer, it is a battler for and with life. Children face it with unflinching courage and an acceptance of their circumstances that humbles us. Around 40,000 (0-16 years old) in India are diagnosed with cancer every year. The symptoms of cancer in children depend on the type of cancer and where it is in the body. Often these symptoms are quite vague, varied, and usually caused by something other than cancer. Hence on many occasions, one would end up visiting the doctors a few times before the diagnosis of cancer. It is important to be aware of the signs and symptoms of cancer as the earlier cancer is diagnosed, the more successful treatment might be.
The most common cancer types in children are leukaemia (30%), brain and spinal tumours (26%), and lymphomas (11%). Almost 50% of all cases of childhood cancer are in children aged 0-4 years old. Childhood Cancers constitute 3-4% of all cancers and every year 400,000 children and adolescents all over the world get diagnosed with cancer. Nearly 70-80% of childhood cancers are curable. Unlike the cause of adult Cancers, the causes of most childhood cancers are as yet unknown. The rate of survival depends on the region, with 80% survival in most High-Income Countries but as low as 20% only in Low and Middle-Income Countries. Due to lack of awareness, delay in diagnosis, inadequate treatment facilities, and high cost of treatment, in India, around 50-60% of children die of cancer
The scenario of Childhood Cancer in and around Mangalore
In the last 7 years, we have diagnosed close to 430 cases of childhood cancers. For the past three years, we have been seeing around 100 children with cancer every year. Out of which, 232 cases (54%) were diagnosed to have blood cancers, 52 children (12%) were diagnosed to have abdominal malignancy (Neuroblastoma, Wilms’ tumour, or Hepatoblastoma), 43 children (10%) with Lymphomas, 35 patients with a brain tumour (12%), 33(7%) with bony cancers, and the remaining 5% belong to another rare type of cancers. The incidence pattern of childhood cancers here is different as half of them are diagnosed with acute Leukaemia whereas the data from the western world shows acute leukaemia contributes to 30% of the total numbers. The survival of children with acute lymphoblastic leukaemia is one the best in India which has an event-free survival of 85% at 3 years. All these cases mentioned belonged to the age group of 1 to 18 years and come from the regions of Mangalore and neighboring districts.
Common Cancer Symptoms in Children and Young People:
Symptoms of childhood cancer can be the same as for many childhood illnesses making identifying cancer in children is difficult. Whereas in common childhood illnesses due to infections children generally recover quite fast and if a child simply does not get better as quickly as they should then we need to investigate further. Some general common symptoms are:
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Looking pale, tired, and exhausted all of the time.
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Having repeated infections or persistent infections (such as ear, throat, or chest) that don't go away or keep coming back
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Unexplained or excessive bleeding in urine, stool, or when being sick
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Bruising easily or a rash of small red spots on the skin (called 'petechiae')
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Persistent and unexplained sweating or fever especially at night
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Pains and weakness that don't go away, especially in the bones, joints, back, or legs, and maybe worse at night
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Feeling a lump, swelling, or unusual firmness anywhere on the body, especially in the abdomen, neck, chest, pelvis, or armpits
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Losing a significant and unexplained amount of weight.
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Change in behaviour such as persistent crying and screaming in young children, sleeping a lot, being off food.
Stages of Cancer and Treatments
The stage of cancer means the size of the tumour and whether or not it has spread beyond where it started in the body. Knowing the extent of cancer helps us to decide on the best treatment for the child. Staging applies to nearly all cancers apart from leukemia. Generally, cancer is divided into four stages:
• Stage 1 – The cancer is small and only in one place in the body.
• Stage 2 or 3 – Cancer has spread into parts of the body close to where it started.
• Stage 4 – The cancer is large or may have spread to other parts of the body.
If cancer has spread to distant parts of the body, it’s known as secondary or metastatic cancer. The treatment depends on the type of cancer the patient has. There are many different treatments available for different types of cancer. The most common are:
• Surgery - which aims to remove the tumour during an operation.
• Chemotherapy - which uses anti-cancer (cytotoxic) drugs to destroy cancer cells.
• Radiotherapy - which uses radiation to destroy cancer cells.
• Stem cell and bone marrow transplants - which involve having high doses of chemotherapy drugs followed by an infusion of blood stem cells.
• Immunotherapy - which involves having specific drugs that target particular cancer cells.
• Targeted therapy - which involves special drugs that target protein.
Importance of Early Diagnosis
When it comes to childhood cancers, early diagnosis is a challenge as the signs and symptoms vary from each patient. Due to this reason, many childhood cancer cases are presented in the advanced stages. But, some of the early signs can be sudden weight loss, regular vomiting, unexplained pains in joints, bones, legs, etc., and regular infections. Hence, it becomes imperative that parents need to keep an eye out for these symptoms for early diagnosis which is very crucial in treating cancer. The chances of survival are very high if the patient is diagnosed early and is provided with timely treatment.
Consultant - Pediatric Hemato Oncology
