Childhood Cancer: Myths Busted

Survival after childhood cancer is good with many children achieving cure with the right treatment modality. It is important to detect the cancer early and to procure appropriate treatment from a specialised centre Can children be affected by cancer? Yes, children too can suffer from cancer. Childhood cancer, however, is different from cancer in adults. What causes cancer in children? In adults, most cancers are strongly linked to lifestyle or environmental risk factors but in children cancer is often the result of Deoxyribonucleic Acid (DNA) changes happening very early in life or even before birth. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumour suppressor genes. Some children inherit DNA changes (mutations) from a parent that increase their risk of certain types of cancer. But most childhood cancers are not caused by inherited DNA changes. They are the result of DNA changes that happen early in the child’s life, sometimes even before birth. These changes start in one cell and then pass the damage on to all the cells that come from it. What are the most common types of childhood cancers? Childhood cancers are different from those seen in adults and most of them are only seen in childhood and not later. The most common cancers of children are:

• Blood cancer
• Brain tumours
• Neuroblastoma (arising from adrenal glands)
• Wilms’ tumour (tumour arising from kidneys in children)
• Lymphomas
• Rhabdomyosarcoma (tumour arising from muscles)
• Retinoblastoma
• Bone cancer (including osteosarcoma and Ewing sarcoma)

What are the symptoms of cancer? Blood cancers arising from the bone marrow and blood, are the most common childhood cancers. They present as bone and joint pain, fatigue, weakness, pale skin, bleeding or bruising, fever, weight loss and other symptoms. Brain tumours are the second most common cancers in children presenting with headaches, nausea, vomiting, blurred or double vision, dizziness, trouble walking or handling objects and other symptoms. Neuroblastoma mostly causes a swelling in the tummy but can be commonly associated with various other symptoms. Wilms’ tumour is a cancer arising from one or both kidneys in children and presents as a swelling or lump in the belly. Rhabdomyosarcoma arises from muscles and can start anywhere in the body, including the head and neck, groin, tummy or in an arm or leg. It may cause pain, swelling or both. Retinoblastoma is a cancer of the eye and in these children the pupil often looks white or pink. Bone tumours present as a swelling over the limbs or fractures with minor injuries. Parents should ensure that their children have regular medical check-up and watch for any unusual signs or symptoms that do not go away. These include:

• An unusual lump or swelling
• Unexplained pallor and loss of energy
• Easy bruising
• An ongoing pain in one area of the body
• Limping
• Unexplained fever or illness that doesn’t go away
• Frequent headaches, often with vomiting
• Sudden eye or vision changes
• Sudden unexplained weight loss

Most of these symptoms are much more likely to be caused by something other than cancer, such as an injury or infection. How is cancer diagnosed? Most of the cancers are detected with the help of imaging tests such as Positron Emission Tomography (PET) scan or Magnetic Resonance Imaging (MRI) and the diagnosis is confirmed by taking a part of the tumour and examining it under the microscope (biopsy). A battery of investigations may be done to determine the extent of its spread and initial staging of the cancer. How is childhood cancer treated? Fortunately, childhood cancer tend to respond better to treatment. The outcomes are comparatively better than adult cancers. Treatment is chosen based on the type and stage (extent) of the cancer. Treatment options might include surgery, radiation therapy, chemotherapy, bone marrow transplant and/or other types of treatment. In many cases, more than one of these treatments may be used. Today, most children with cancer are treated at specialised children’s cancer centres. Going to a hospital that specialises in treating childhood cancer and provides all the facilities under one roof, helps ensure that a child gets the best available cancer treatment. What are the chances of survival? A lot of progress has been made in treating childhood cancers in recent decades and many of these cancers can now be cured. When discussing cancer survival statistics, doctors often use a number called the five-year survival rate. The five-year survival rate refers to the percentage of patients who live at least five years after their cancer is diagnosed. Of course, many children live much longer than five years and many are cured. The five-year survival rates for the most recent time period for the more common childhood cancers are: Blood cancers: > 85 percent Brain tumours: > 75 percent Wilms’ tumours: 90 percent Hodgkin lymphomas: 97 percent Neuroblastomas: > 80 percent Retinoblastomas: 97 percent Once treatment is finished, the healthcare team will set up a follow-up schedule.