Paediatric Cancers (Solid and Haematological)
Paediatric cancers are malignant diseases that develop in children and adolescents, a group distinct from adult cancers in both their origin and type. They are broadly categorised into solid tumours, which form a mass, and haematological malignancies, which are cancers of the blood and bone marrow. The most common childhood cancers are haematological, primarily leukaemia, followed by solid tumours like brain tumours and lymphomas.
Key Risk Factors
Unlike adult cancers, the causes of most paediatric cancers are not well understood, and they are generally not linked to lifestyle or environmental factors.
Genetic and Congenital Factors: A small percentage of childhood cancers are caused by genetic predispositions or inherited syndromes.
Birth Weight and Parental Age: Some studies suggest a link between birth weight, parental age at conception, and an increased risk of certain paediatric cancers.
Prior Treatment: A very small number of children who have received intensive chemotherapy or radiation for a previous cancer may be at a higher risk of developing a second cancer later in life.
Epidemiology
In India, paediatric cancers contribute significantly to the overall cancer burden.
Incidence: It is estimated that over 50,000 new cases of childhood cancer occur in India every year. The country's paediatric cancer burden is substantial, and a rise in cases has been noted.
Most Common Types:Leukaemia is the most prevalent type of cancer in Indian children, accounting for about one-third of all cases. Other common cancers include lymphomas, brain tumours, and bone tumours.
Survival Rates: While the survival rate for childhood cancer in high-income countries is over 80%, it is significantly lower in low- and middle-income countries like India, where less than 30% of children are cured.
Challenges in India: Late-stage diagnosis, lack of awareness among parents and caregivers, limited access to specialised healthcare, and treatment abandonment due to financial constraints are major challenges that contribute to lower survival rates. Most paediatric oncology centres are concentrated in urban areas, resulting in a significant healthcare gap.
Typical Symptoms
The symptoms of childhood cancer are often non-specific and can be confused with common childhood illnesses, making early diagnosis challenging. ⚠️
Persistent Fever: Unexplained fever that does not go away with standard treatment.
Lumps or Swelling: An unusual lump, mass, or swelling, especially in the abdomen, neck, chest, or armpits.
Fatigue and Paleness: Persistent tiredness, weakness, or noticeable paleness, which can be signs of anaemia.
Pain: Chronic or persistent bone and joint pain that is not due to an injury and may wake the child up at night.
Easy Bruising or Bleeding: Frequent or excessive bruising, bleeding from the gums or nose, or small red/purple spots on the skin.
Neurological Changes: Headaches, often with early morning vomiting, dizziness, or sudden changes in vision or balance, which can be signs of brain tumours.
Whitish Reflection in the Eye: A white reflection in the pupil, especially noticeable in flash photographs, can be a symptom of retinoblastoma (a type of eye cancer).
Diagnosis and Treatment Approaches
Diagnosis and treatment of paediatric cancers require a specialised, multi-disciplinary approach.
Diagnosis
Physical Examination and History: A thorough physical exam and a detailed medical history are the first steps.
Blood Tests: Blood counts can reveal abnormalities in blood cells, which are key to diagnosing leukaemia.
Imaging: CT scans, MRIs, and X-rays are used to pinpoint the location and size of solid tumours.
Biopsy: A biopsy, which involves taking a tissue sample, is essential for a definitive diagnosis and to determine the type and stage of the cancer.
Bone Marrow Aspiration: A sample of bone marrow is taken to check for cancer cells, especially in cases of suspected leukaemia or neuroblastoma.
Treatment
The goal of paediatric cancer treatment is to cure the child while minimising long-term side effects.
Chemotherapy: This is the most common treatment for paediatric cancers. Drugs are used to target and destroy rapidly growing cancer cells.
Surgery: Surgical removal of the tumour is often the primary treatment for solid tumours. In India, there's a growing focus on minimally invasive techniques.
Radiation Therapy: High-energy rays are used to shrink tumours and kill cancer cells.
Stem Cell or Bone Marrow Transplant: This is a crucial treatment for certain types of leukaemia and lymphomas.
Targeted Therapy and Immunotherapy: These are newer, highly promising treatments that specifically target cancer cells or boost the body's immune system.
Supportive Care: This includes psychological support, nutritional guidance, and pain management, which are vital for a child's overall well-being during and after treatment.