No longer a death sentence

What is the image that comes to our minds when we first think of cancer? Well, to my mind it is the image of middle-aged people and definitely not toddlers.

Sneha (name changed), a chirpy energetic, three-year-old, started developing bruises on her body. Her mother was not very concerned as she thought that this was normal in growing children.

However a couple of weeks later, Sneha developed fever and a chest infection. She was taken to a pediatrician, where her blood count was tested. The following day, Sneha was diagnosed with Acute Lymphoblastic Leukemia (ALL), the most common form of childhood cancer.

Gone are the days when cancer diagnosis was an inevitable death sentence. Many malignant conditions can now be treated, controlled and often cured. This is especially true with childhood cancers.

Sneha was immediately put on intensive chemotherapy sessions. Her initial days of agony, misery and hospital admission gradually gave way for hope and normalisation of routine for the family. She has now completed six months of her two-year treatment course. Almost like a miracle she was free of leukemia with a 75 per cent chance of a permanent cure.  Cancer today is no longer a tedious disease to be managed. Apart from the first week Sneha was an outpatient during the rest of her treatment.

Fortunately, cancers are rare in children compared to cancers in older people. In addition, most childhood cancers are highly responsive to treatment. With modern treatment modalities, a majority of children achieve disease control and become cancer-free when compared to adults.

Causes, types and symptoms of juvenile cancers

Children with specific genetic disorders (such as Down’s syndrome, neurofibromatosis, chromosomal breakage disorders) and those with a strong family history of multiple cancers are at a higher risk compared to other kids. Other identified causes include being subject to ionizing radiation, carcinogenic drugs and chemicals and certain rare viral infections. However, all these causes put together account for only 10 per cent of childhood cancers. Thus the vast majority of cancers occur in otherwise healthy children like Sneha, with no obvious identifiable cause.

Childhood cancers are of two broad types: those arising from the bone marrow or the lymphatic system (hematological cancers) and those originating from an organ in the body (solid organ cancers). Hematological cancers include leukemia and lymphoma. Common solid organ cancers are Wilms’ tumour (kidney), neuroblastoma (adrenal gland), sarcoma (muscle, soft tissue or bone), neuro-oncological tumours (brain), hepatoblastoma (liver), retinoblastoma (eye) and germ cell tumour (reproductive organs and other sites).

Hematological cancers present with symptoms such as paleness, tiredness, shortness of breath, bruises, bleeding from the nose, mouth or bowel, bone pain, lymph gland swellings and increased susceptibility to infections. A few children may present with recurrent fever, weight loss or night sweats.  Some kids can be apparently healthy, with an incidentally detected abnormal blood count. Solid organ cancer usually presents as a progressively enlarging mass arising from the organ of origin.

This may be in the form of a swelling of the abdomen or lump in any part of the body. Brain tumours can cause persistent vomiting, severe headaches, disturbances of vision and weakness of limbs.

Evolution of cancer treatment

In the Western world, over 70 per cent of all childhood cancers are now cured (largely due to the fact that most of the common types respond well to treatment). This is in contrast to a survival figure of approximately 15 per cent in the late 1960s.

A similar but less impressive trend is noticeable in India and the rest of the developing nations. Despite almost all the diagnostic tests, chemotherapy medications and radiation facilities available in the West being accessible, the survival curve of childhood cancers in developing countries is significantly inferior.

The cause for this wide gap is multi-factorial, including a higher incidence of deaths due to infections, poor nutritional status of children, late detection of disease, cost of treatment and lack of sufficient number of trained medical staff. The gap is slowly getting bridged and the outcome of childhood cancers in some of the tertiary treatment centres in India are now comparable to that of developed countries.

With increased awareness of symptoms and the recognition that many of these diseases are curable, the survival of our children with cancer should improve steadily.

(The writer is consultant hematologist and pediatric hemato-oncologist, Apollo Hospital, Bangalore.)