It was a huge shock the day when Suhana got diagnosed with Cancer. She was only three years old and
everyone was excited to celebrate her elder sister, Ronika's, 10" birthday together. Her mother told that
Suhana had been quite unwell, but thought it was because of viral infection. She took her to the Doctor
expecting some common medicine, but after blood tests, doctor recommended few more tests and then,
this devastating news came into their life. The moment she heard the word "Leukemia" the only thing
she could understand that her baby had cancer. She could not breathe. That moment changed their life.
After a long and painful cancer treatment, Suhana has now overcome it. Her whole family thanks medical
community and all the research and development in Cancer treatment. Suhana is now five years old, and
visit a doctor twice a year for follow-up. She has a bit of cognitive issues but is doing amazingly well.
Her class teacher told her mother that no one can be sad in a room with Suhana because of her intectious
smile.
Globally, cancer kills 90,000 children below 15 years every year. In India the incidence of pediatric
cancer is increasing and is an emerging epidemic. Exact reason for this increasing prevalence is not yet
certain, but the ethnic or environmental differences due to geographical variation can be attributable.
Among all types of pediatric cancers, leukemia is the most frequent one. Further, certain conditions
such as T-cell diseases, adverse cytogenetics and hypodiploidy can exaggerate the condition and result
in poor outcome.
In spite of good prognosis, only 20% of cancers in lower income countries are cured,
due to lack of early and accurate diagnosis, lack of access to treatment, treatment abandonment, death
from toxicity and recurrent relapse. The most common cancer in children between the age of o to 14 is
leukemia, followed by lymphoma and central nervous system tumor. The 5 year survival rate of all childhood
cancers combined in India is only 37 - 40%. There is an urgent need for early detection, prompt treatment
and regular follow-up to change this scenario.
What is the most deadly childhood cancer?
In children, cancer is categorized based on location and extent of spread. Biologically pediatri cancers differ
from those in adults. Other ways in which childhood cancers differ from adult cancers is the distinctive array
of cancer types that occur in youngsters. While blood cancers are most common in childhood group, adults
have a higher incidence of certain cancers such as breast cancer, ovarian cancer, prostate cancer and lung cancer.
While the word cancer may evoke fear and worry in the mind of the parents and loved ones, early
diagnosis and treatment can increase the survival rate by a great degree.
What causes childhood cancer?
Broadly the causes can be categorized into environmental, microbial and genetic factors. However, unlike
cancer in adults, majority of childhood cancers do not have a known cause and are not linked to Lifestyle or
environmental risk factors.
Some environmental factors which may increase the risk of cancer include exposure to ionizing radiations,
certain drugs, metals, hydrocarbons or pesticide. Children exposed to parental smoking were around 1.5 times
more likely to suffer from malignancy. Microbial risk factors arise due to exposure to viruses such as Epstein
Bar virus, HIV, Hepatitis B Virus. Several genetic factors are involved in the development of cancer,
for instance, patients with Down's syndrome are 20 times more likely to suffer from leukemia. Other genetic
factors associated with higher risk of developing cancer include immune deficiencies, genetic syndromes
like neurofibromatosis, familial adenomatous polyposis, glycogen storage diseases and inherited gene mutations.
However, only a few childhood cancers are inherited from parents.
How do you know if your child has cancer?
The early signs and symptoms of cancer are often nonspecific and overlap with symptoms of other diseases,
which make them slightly difficult to spot. The common signs and symptoms can be summarized as a
mnemonic CHILD CANCER
Continued unexplained weight loss
Headaches associated with early morning nausea
Increased swelling and pain in joints and bones
Lumps, especially in the abdomen, neck, chest, pelvis or armpits
Development of excessive bruising
Constant infections
A whitish color behind the pupil of eyes
Nausea with or without vomiting
Constant tiredness
Eye or vision changes
Recurrent or persistent fevers
In addition to these, other symptoms can be observed which are specific to each cancer type.
What are the Types of Cancer that Develop in Children?
1. Leukemia- It accounts for a large number of childhood cancers. It is a cancer of bone marrow. Acute
lymphocytic leukemia starts in the bone marrow. Most often, the leukemia cells invade the blood and
can sometimes spread to other parts of the body, including the lymph nodes, liver, spleen, central
nervous system (brain and spinal cord), and testicles in males. In chronic lymphocytic leukemia, the
cells can mature partly but not completely. The classic signs of leukemia in children include anemia,
thrombocytopenia, fever, recurrent infections, bone or joint pain. blood tests should be done to
get a complete blood count, which should be further confirmed by bone marrow biopsy.
2. Lymphoma-
Lymphoma affects the lymphoid tissues and is divided into two major types: NonHodgkin's
lymphoma and Hodgkin lymphoma, of which the former occurs more commonly.
Common signs and symptoms include severe headaches in the morning that improve through the course
of the day, blurred vision, dizziness, seizures, behavioral and personality changes. In children younger
than 2 years of age, irritability, poor feeding, vomiting are also symptoms. The most common sign is the
presence of a painless lymphadenopathy (lymph node swelling), especially in the supraclavicular area,
which are usually firm and rubbery. Diagnosis is done by complete blood count test, biopsy, lumbar
puncture, X- ray scans and/or CT scan. These are treated with chemotherapy, monoclonal antibodies
and stem cell transplant.
3.Central Nervous System Cancer-
CNS cancers mostly involve cerebellum, brain stem, followed by frontal, parietal and occipital lobes. CNS
cancers are further classified into gliomas- Glioblastoma, Astrocytoma and Ependymoma, and Primitive
Neuroectodermal Tumor (PNET).
Signs and symptoms of CNS cancers differ based on the child's age. In infants, there may be virtually no
sign ofincrease in the size of the skull to accommodate the growing tumor. By the age of 2, the child
may show discomfort by rolling the head and being fussy. Detection is done by CT scan or MRI, but
definitive diagnosis requires biopsy. These tumors are treated with surgery (if operable), chemotherapy
and radiation.
4. Neuroblastoma-
Neuroblastoma starts in early forms of nerve cells found in a developing embryo or fetus. About 6% of
childhood cancers are neuroblastomas. This type of cancer develops in infants and young children. It is
rare in children older than 10. The tumor can start anywhere, but it usually starts in the belly (abdomen)
where it is noticed as swelling. It can also cause other symptoms, like bone pain and fever.
5. Wilms Tumor.
Wilms tumor (also called nephroblastoma) starts in one, or rarely, both Kidneys. It is most often found in
children about 3 to 4 years old, and is uncommon in older children and adults. It can show up as a swelling
or lump in the belly (abdomen). Sometimes the child might have other symptoms, like fever, pain, nausea,
or poor appetite. Wilms tumor accounts for about 5% of childhood cancers.
Palliative Care in Pediatric Cancer
Palliative care is a patient care approach that improves the quality of life of the patient and family
facing lifethreatening, life-limiting or chronic illness by treatment of pain and other problems including
spiritual and psychological struggles. Since children deal with significant physical and psychosocial
suffering while dealing with cancer, the importance of palliative care is emphasized even in resource
limited healthcare settings.
It is mostly based on symptom assessment and intervention, an awareness about patient perspective
regarding preferences. Symptoms are more than just markers to identify a disease, they are painful
experiences for children, and efforts have to be made by the healthcare staff to help them through
this. Anxiety, fear of being alone, loss of independence are psychological symptoms and are often
untreated in favor of physical symptoms. Pain is commonly reported in children dealing with cancer,
which is particularly distressing for the family as well. Palliative care has to be integrated as a standard
of care to help both the patient and their family.
Conclusion
Finally, it should be kept in mind that as children are Surprisingly resilient and strong in many cases,
they are reported to respond better to cancer treatments as compared to adults. So, our role as adults
is to be aware of the signs and be supportive.
