Mediscene -When the dreaded disease hits a child

By Ayesha Inoon

Three-year-old Saman (name changed), an active young toddler, was the light and joy of his home. When he came down with a fever, his parents were worried, but put it down to just another infection. However, the fever kept recurring and after some time they noticed a swelling in his abdomen. He also started coughing up blood. His frantic parents rushed him to the Lady Ridgeway Hospital, where doctors referred him to the National Cancer Institute at Maharagama. Saman was diagnosed with liver cancer and treatment began immediately. "We have been living here for the past four months," says Saman’s grandmother, who stays with him in the hospital. "Saman and I have got used to it by now. The doctors say he will get better-but that it will take time."

Every parent knows the agony of having their child suffer an illness, and when that illness is cancer, it strikes fear and dread into our hearts. However, thanks to medical advances, more children today are undergoing successful treatment and returning to normal life. At present it is estimated that up to 70% of all children with cancer can be cured.

Childhood cancer is relatively rare, making up 3-4% of all cancers, says Dr. Damayanthi Pieris, Consultant Clinical Oncologist at the National Cancer Institute at Maharagama.

All kinds of cancer, including childhood cancer, have a common disease process - cells grow out of control and develop into abnormal sizes and shapes, she explains. Cancer cells can destroy their neighbour cells and ultimately spread to other organs and tissues. As cancer cells grow, they demand more and more of the body's nutrition, weakening a child's defences against other illnesses. Childhood cancer is not a single disease entity, but rather a spectrum of different malignancies.

It varies by the type of histology, the site of disease, origin, race, sex and age. The most common types of cancer in children, says Dr. Pieris, are leukaemia, lymphoma and brain cancer. Leukaemia is more common in the one-nine age group, lymphomas in children over nine years and brain tumours from one year onwards. Environmental factors do not play a role in childhood cancer, unlike smoking or alcohol- use in adults. Rarely, in cancers such as Wilm's tumour - a cancer which affects the kidneys - the cause may be genetic, but in most cases the cause for childhood cancer is not known.

Cancer can be difficult to diagnose in a child, she says, because so many of the symptoms, such as fever, are common to other diseases. Any illness such as fever, headache or unexplained pain, that has been persisting for a long period of time, for instance 3-4 weeks, should be carefully investigated, she adds.

The treatment of cancer in children can include chemotherapy (the use of medical drugs to kill cancer cells), radiation (the use of radiant energy to kill cancer cells), and surgery (to remove cancerous cells or tumours). The type of treatment needed depends on the type and severity of cancer and the child's age.

In children, says Dr. Pieris, radiation is the most rarely used form of treatment because it has a long term effect on their growth. If used at all, it is in highly reduced dosages. The most successful method of treatment at present is believed to be a combination of chemotherapy and surgery.

Chemotherapy courses are usually devised in such a way as to minimize side effects, she says.
Most side effects are usually reversible, such as nausea, vomiting, hair loss, fatigue, anaemia, abnormal bleeding, and increased risk of infection.

Some drugs may cause damage to the heart or pancreas, which is extremely rare. In many situations however, treating infections or these rare side effects of drugs can be very difficult and may cost the life of the child due to their deficient immune systems, she adds.