Over the last three decades there has been tremendous improvement in the survival of childhood cancer. More than 75% children are now cured of their disease in developed countries. The survival of childhood cancer in developing countries, including Pakistan, is very dismal. One of the main reasons of such poor outcome is late diagnosis and lack of knowledge about the disease. In order to bring awareness in the Third World countries International Confederation of Childhood Cancer Parent Organisation (ICCCPO) has declared 15th February as the International Children Cancer Day. This day is celebrated on 15th February every year all over the world.
The Children Cancer Foundation is a registered charitable organisation supporting children suffering from cancer for last five years. Children Cancer Hospital, a project of Children Cancer Foundation is providing cancer treatment to every child regardless of paying ability.
The Foundation has been striving hard to bring awareness among the people that Cancer in Children is Curable. Cancer in a child still means death to many parents. When a child gets cancer not only the family has any clue about the disease, they are also misguided by wrong information. This article is written with a view to give basic information to general population regarding childhood cancer.
Cancer is a disease where body cells start multiplying in an uncontrollable fashion to form a tumour and affect other organs hazardously after mixing with the blood and altering the physiological function of normal cell. Cancer can occur at any age and may affect any organ or tissue in the body.
Children can also get cancer but fortunately it is not very common in children. Out of cancers in all age group only 3% to 5% occurs in children less then 15 years of age.
Approximately 100-120 children get cancer out of a million under 15 years of age. With this rate it is estimated that in Pakistan approximately five to six thousand children get cancer every year in Pakistan.
What causes cancer in children is not known. Viruses, chemicals, environmental factors and genetic abnormalities may predispose to some cancers in children. Most cancers, however, are not inherited and it is exceptionally rare for a second child in a family to develop a cancer.
There is no evidence that cancers are infectious and therefore there is no chance of involvement of any other person on contact basis. The child should not be isolated from siblings and friends, for this reason. Parents often worry that their child has a cancer because of something they did, or did not do. But there is never any justification for such thoughts and no guilt or blame can ever be attached to the parents of a child with cancer. The signs and symptoms of cancers depend on the type and location.
THE COMMON SIGNS AND SYMPTOMS ARE:
-- Prolonged and unexplained fever.
-- Unexplained weight loss and/or pallor.
-- Bruises and bleeding without trauma.
-- Persistent headache accompanied with nausea and vomiting.
-- White eye (Cat eye) reflex in eye.
These signs and symptoms are not necessarily always due to cancers and can be seen in other diseases also. However, if they persist, it is important to consult doctor, who may do some tests to rule out cancer.
Childhood cancers are quite different from cancers affecting adults. They tend to occur in different parts of the body, they look different under the microscope and they respond better to treatment. Leukemia (blood cancer) 35% and lymphoma (cancer of lymph glands) 20% are two most common cancers we see in Pakistan.
Other common cancers includes tumours of brain, bone (osteogenic and Ewing's sarcoma), muscle and soft tissue (rhabdomyosarcoma and soft tissue sarcoma) Kidney (Wilms), adrenal gland (neuroblastoma) liver (hepatoblastoma) and gonads (germs cell tumour).
Cancers in children are very much treatable if diagnosed early and treated properly at specialised centres. With modern treatment more than 75% children in developed countries can now be completely cured. Even in developing country, like Pakistan, we have achieve survival rate of more then 50%.
Although some late facets are seen in children treated for cancer majority live a normal healthy life. Many survivors of childhood cancer have become fathers and mothers and their children are normal.
The treatment is of childhood cancer is multi-disciplinary using chemotherapy, surgery and radiotherapy. The role of surgery in leukaemias and lymphomas in children is very limited and they are mainly treated with chemotherapy. In most solid tumours, treatment is started with chemotherapy to reduce the size of the tumour so that surgery is as safe and effective as possible.
Chemotherapy is given in form of injections or tablets, which circulate throughout the body killing malignant cells far away from the original tumour. To treat a tumour with radiotherapy, special equipment directs rays to the tumour for a few minutes at a time.
This is done 5 times a week for 2 to 6 weeks depending on the cancer and its stage. The treatments are painless and children tolerate it very easily. Most of the cancer treatments are given on regular hospital visits in day-care centres.
There is very little one can do to prevent cancer in children because environmental agents do not play a major role in childhood cancer. However there are certain known factors that can cause cancer in children like supari (betel nut) and coloring agents in food.
The children must avoid these carcinogens. Similarly vaccination against hepatitis B will prevent hepatitis and hence live cancer later in the life.
The facilities for childhood cancer treatment in our country are far from satisfactory. Although the chemotherapy drugs and tools for accurate diagnosis are available in some good centers of big cities, their numbers are far less than required. With the available facilities and resources not more than 25% children suffering with cancer get proper diagnosis and treatment in Pakistan.
One of the major problems of cancer treatment is inability of afford, as the treatment is every expensive. The cost depends very much upon the type, presenting status of the disease, the complications that may occur during the course of management and treatment center. On average, it costs about one to four lacs rupee (100-400,000) for full treatment.
To improve the outcome of childhood cancer in Pakistan lots of efforts are needed at all levels. The most important step is to create awareness about this disease and its excellent outcome. We have to discourage the nihilistic approach and join hands together to fight cancer in children.
The facilities for childhood cancer treatment should be available to every child diagnosed with this disease. As the treatment is very expensive we need help of NGO's and community to provide free treatment to those who can not afford.
(Today is International Children Cancer Day)
(The writer is Chief Executive of the Children Cancer Foundation Pakistan Trust.)
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