Cancer is defined as an abnormal growth of cells in the body and these abnormal cells invade into surrounding normal structures causing damage to them and can also spread to other parts of the body. Apart from cancer involving blood and lymph nodes (leukemia and lymphoma), solid organs can also get afflicted by cancer in children. They can arise anywhere in the body but commonly involve brain, kidney, liver and eyes. The cancers in children are different from adult cancers and the treatment protocols also vary.
In India, roughly 70,000-80,000 childhood cancer cases are diagnosed every year. The exact reason for cancer in children is unknown. However, about 5% can be because of genetic predisposition (i.e history of cancer in the family) or because of defects in the genes associated with particular cancer. Certain drugs taken by the mother during pregnancy can also predispose.
The symptoms vary as per the organ/system involved. However, to be aware of common symptoms is important and should prompt parents to consult a doctor. As an example, kidney tumours can cause blood in the urine or liver tumours can cause jaundice and brain tumours can cause neurological symptoms.
Consult a doctor if you feel:
1. Lump anywhere in the body especially the abdomen, head, neck, testes, extremities. The lump may be painless and gradually increasing in size.
2. Unexplained fever with loss of weight and appetite
3. Pallor, easy bruising or bleeding, body aches, easy fracture of bones with trivial injury
4. White spot in the eye or recently noticed squint, loss of vision or protruding eyes, rapid movement of eyes
5. Unusual behaviour or movements
6. Blood in urine or stools
Common childhood cancers are Leukemia, lymphomas, brain tumours, Neuroblastoma, Wilm’s tumour, Rhabdomyosarcoma, Hepatoblastoma and Retinoblastoma.
Clinical examination by a doctor is most important and solid organ tumours can be easily diagnosed:
Blood and urine tests
Radiological investigations as ultrasound, CT scan, MRI scan
Specialised radionucleotide scans as PET scan, MIBG scan or DOTA scan may be needed in selected patients
Bone marrow aspiration and biopsy
Biopsy from cancer. A small piece from the cancer is taken by a needle or small surgery to determine the type of cancer, its virulence and spread. It helps to plan and start the treatment
The type of cancer, tumour load and staging help in deciding the treatment plan. This helps in reducing the treatment burden for cancers which are less malignant. This is called risk stratification.
1. Surgery: It plays a very important role in cancer diagnosis and local treatment. Surgery plays an important in local treatment of solid tumours. The plan for surgery depends on the site and organ involved. It may be the only therapy needed for small tumours.
2. Chemotherapy: These are the drugs given to stop cancer cells from multiplying, destroying abnormal cells and preventing the cancer cells to spread in the body. Chemotherapy also helps in shrinking the tumour and thus make removing of very large tumours feasible if they are chemosensitive. The drugs are very strong and are used in various combinations. They are given for varying durations. The common side effects of chemotherapy include nausea, vomiting, loss of appetite, loss of hair, and bone marrow suppression. Certain drugs may affect the heart or kidneys.
3. Radiation: High energy beams of energy are used to kill cancer cells and are delivered through a machine. The treatment is painless but the child needs to be still when this treatment is being given. So the child may need sedation to make him sleep on the table for 10-30 min and treatment may take a few weeks.
4. Bone marrow transplant: This modality is being used these days more frequently to achieve a cure from cancer. Here the stem cell transplants replace the diseased or damaged bone marrow cells with healthy and new mature cells
5. Advanced treatments as liver transplant or kidney transplant may be necessary.
The operation depends on the site of cancer and the organ involved. The surgical procedure can be
2) Tumour removal
3) Chemoport or Hickman catheter placement for long term venous access so that child is not pricked frequently
4) Bypassing any obstructions caused by the tumour
5) Any complications which can be managed by surgery
The outcome of childhood cancer depends on the type, stage and spread of cancer. It also depends on the effectiveness of surgical removal and response to chemotherapy and radiation. In tumours which are in early stage, a cure rate of 90% can be achieved whereas a 70% survival in high-grade tumours is frequently seen. Overall the outlook for childhood cancer is good and many of these cancers are curable with minimal long term side effects.
Consultant - Pediatric Surgery
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