Most of the Childhood cancers can be cured !Cancers occurring from a newborn to adolescence are grouped as pediatric cancers. These cancers diseases are unique and lot different from the cancers in the adults . Childhood cancers, most importantly, are not associated with well known cancer causing habits such as smoking, tobacco chewing, alcohol, gutkha chewing and few dietary items, which have carcinogens in them. Further, the cancers in children tend to aggressive, rapidly growing and have propensity to spread to the neighboring tissues and distant organs. Some of these childhood cancers, have characteristic genetic changesand in few (up to 10%) run in families.
The most important thing to know about these cancers in children, that most of them respond very well to the treatment and stand a real chance of cure !
Some of the common childhood cancers:
Acute lympho blastic Leukemia (blood cancer)
Hodgkin’s lymphoma
NonHodgkin’s lymphoma
Osteosarcoma (bone cancer)
Ewing’s sarcoma (bone cancer)
Neuroblastoma
Rhabdomyosarcoma (muscle cancer)
Wilm’s tumor (Kidney cancer in children)
Germ cell tumors
Blood cancers in Children: More common and important blood cancer is Acute lymphoblastic leukemia (A.L.L). The symptoms of this cancer are bleeding from the gums (with or without brushing), nose bleed, easy bruiesebility, fatigue and weakness, repeated fever due to infections. Some children may develop small lymphnodal swellings on either side of the neck, axilla (armpits) and the groin. Parents at times find some lumps in the abdomen as consequence of the enlarged spleen and liver.
Thank to 3 decades of research and progress in cancer treatment, the possibility of cure in children with this type of blood cancer is about 90 percent in America, Europe, Japan and china. The treatment for this cancer is by chemotherapy, comprising of a mix of several types of injections and few tablets initially, few months later tablets form the major part of the treatment for nearly 2 to 2 ½ years !. During the first few months, in addition to periodic intravenous injections, children also will receive injections to the spinal cord on regular basis.
The success rates for this cancer in India from New Delhi to Chennai are not as impressive as in western countries!
Lymphoma cancers in children:
The two most important lymphoma cancers in children:Hodgkin’s lymphoma and Non –hodgkins Lymphoma. These type of cancers arise from the lymphnodes, which are normally present at several locations in the body, like in the neck on both sides, axilla (armpits), groin, deep in the abdomen and chest. Parents often notice in their child that a pain less swelling, which grows with the time, more commonly in the neck, axilla and the groin. These swellings often do not trouble the child in the beginning. Rarely, children may have fever, profuse sweating in the nights and loose weight.
All children with these two types of cancers are again can easily be cured with chemotherapy. Hodgkin’s lymphoma is treated with different chemotherapy protocol and Non-hodgkins lymphoma is treated with different chemotherapy protocol. So, there is need to arrive at a specific diagnosis before treatment is started. More than 90 percent of children with these cancers can be cured !.
In our state and country too, we have impressive success in treating Hodgkin’s disease.
The common pitfall often the child and primary care doctor get in situation, is inadequate diagnosis and routine, empirical antituberculous treatment, which obviously would fail; by this time precious few months of time is lost and cancer would have progressed to the advanced stage !. The primary care doctor should order a lymphnode biopsy in all suspicious cases, because The tuberculosis affected lymphnode and hodgkin’s affected lymphnode often look similar !
3)Bone cancers:
The two important bone cancers in children are Osteosarcoma and Ewing’s sarcoma.
These cancer can also be cured by combination of chemotherapy, radiotherapy and surgery, if diagnosed in early stage and by correct treatment. Osteosarcoma is a type of cancer, which occurs more commonly at growing ends of the long bones; these are the lower end of the thigh bone (femur) and upper end of leg bone (tibia), this means that any bone swelling just above and below the knee is a suspect and should be investigated. It is extremely important to know that the biopsy of these swellings should be done by a surgeon, who has training and knowledge on bone cancers!
Ewings sarcoma is a different type of bone cancer that arises as a swelling in the middle of the long bones.
Often, the child notices a painful swelling just around the knee, either above or below, which they attribute to fall or cricket ball that hit him and usually postpones for several weeks, before seeking medical help. By this time the cancer would have progressed to a size that limb preserving surgery couldn’t be done or spread to distant organs such as lung, precluding a curative treatment. Therefore it is vital for the parents to know and be vigilant on any bone swelling around the knee and shoulder joint and seek the medical advice at the earliest.
4) Other important childhood cancers include Neuroblastoma, Wilm’s tumor, Hepatoblastoma, Rhabdomyosarcoma and Germ cell tumors. These cancers do have excellent treatment and a very high possibility of cure, when diagnosed in early stage and undergoes right kind of treatment.
Childhood cancers in India- disappointments and need for improvement:
The cure rates in children in our country, especially in our state are not as good as in the western countries. Several published and unpublished data in our state and the country showed that we have only succeeded in treating Hodgkins’lymphoma. While the common child hood blood cancer (A.L.L) has cure rates of more than 90 percent in western countries and developed Asian countries, we have best success rate of 50 percent!. It is very disappointing. There reasons which can be corrected with little effort to inform and raise the awareness among the public, because most children by the time they seek medical advice it is already quiet advanced stage spread to distant organs such as lungs. Majority of cancers in such stage cannot be cured anywhere in the world at the moment. Success rates can be increased by diagnosing the cancers in early stage. This can be done by increasing public awareness on child hood cancers and access to health care facilities. There is also need to educate the primary care doctors by conducting seminars and CMEs.
Another important reason for disappointing results is lack of enough cancer specialists treating childhood cancers. The high success rates in developed countries are due to strict adherence to treatment protocols. As we lack this discipline, the treatment protocols are compromised in several crucial areas such as chemotherapy protocols, drug doses, timing of chemo, adhoc decision making, Incorporation of radiation, when needed, faulty surgical technique, all end up affecting the success and jeopardizing the children’s lives.
It is also a fact and often offered as an excuse, that quality supportive care facilities to treat complications that arise due to chemotherapy, particularly infections are not available across the state and across the country. Some children are lost to these complications, which otherwise can be saved. The cancer treatment needs a good blood bank, to support the chemotherapy induced complication; therefore lack of blood banks with component preparation facility is also an important factor contributing to our failure.
Cost of cancer treatment, which is usually higher than other diseases, is one of the reasons behind our poor performance. Cancer treatment has been expensive and beyond the reach of common man. However, large number of Indian pharma companies are now manufacturing and selling these drugs at a fraction of the cost of the imported medicines. Additionally the Arogyashree scheme of Govt of AP, which has included all types of childhood cancers, should make every child with cancer to get the deserved treatment, free of cost!
Lack of advanced treatment facilities such as bonemarrow transplant units, which has played an important role in the treatment of high risk blood cancers, relapsed blood cancers and lymphomas, is also one of the reasons for disappointing cure rates in childhood cancer arena.
There is an immediate need to improve the success rates in the childhood cancers in our state and in our state and across the country.
Finally, it is very tragic that child with cancer, who get cured, faces isolation and at times humiliation in our schools and the society. There is a need to eradicate this social stigma and accept these children as normal and allow them to grow as responsible citizens.
