Childhood cancers are rare cancers as compared to cancers in adults. Their biology is also very different to adult cancers in that they originate from more primitive cell types. As a result of that, these cancers respond better to chemotherapy than adult cancers. These cancers occur commonly due to genetic changes in the child or in the presence of genetic syndromes. Other causes such as radiation, infection with EBV (Epstein Barr Virus) or parental factors such as smoking, drugs and alcohol.
There are various childhood cancers, and some are discussed in this section. Lymphomas and Leukaemias are discussed in their own sections. They are
Children with cancers are managed by Paediatric Oncologists or a Haematologist. Surgeries are carried out usually by Paediatric surgeons although some cancers like bone tumours and brain tumours are treated by orthopaedic surgeons and neurosurgeons respectively. Radiotherapy is provided by Radiation Oncologists. Some larger cancer centres may have dedicated Paediatric Radiation Oncologists.Treatment of childhood cancers involve a multi-disciplinary and multi departmental approach including Oncologists, Paediatricians, Parents, Pathologists, Radiologists, Counsellors, Endocrinologists, Nurses and others. The response rates to cancers and children being cured of their cancer is high and so extreme care is required to make sure the child is able to grow up and function with as little toxicity and side effects as possible.
As childhood cancers are rare, treatment protocols and plan may not be as standardised as with adult cancers. Patients may be offered a clinical trial as part of the treatment plan as the option for treating that particular cancer may not be defined yet. Treatments, particularly chemotherapy, can be intensive and ideally should be done under close supervision by a cancer unit that deals with these cancers.
During treatment, the child is likely to experience side effects of the treatment being given. Knowing about what side effects to expect and what to do about them will go a long way in reducing the anxiety and difficulty in managing these side effects. If in doubt, having a telephone number to contact the doctor or other healthcare professional will help in managing the situation.
Nutrition is quite an important part of the treatment process. Intake of sufficient amount of carbohydrates, proteins, fat, vitamins, minerals and fluids will ensure the child is physically as fit as possible to tolerate the treatment. The treatment itself will make the child lose their appetite and taste and may not be able to eat as much as they did before the treatment. Modifying the diet into smaller and more frequent meals, providing those meals that the child always likes, addition of nutritional supplements etc will help.
Coming to know the diagnosis of cancer in a child can be a very difficult process to go through for the parents, siblings, relatives or friends. The first reaction after hearing such a diagnosis will be a sense of shock and disbelief. A situation such as that will be easier to cope by speaking to close relatives and friends, speaking to the doctor again and in detail to understand exactly what has been said. A sense of denial where it is difficult to believe what is happening is common after the initial shock. Asking the doctor a lot of questions or trying and getting a second opinion is quite common and not a bad thing to do to make sure the diagnosis is understood and this can give some reassurance to the parent or family. Having a sense of fear and anxiety about what will happen next, how the treatment is going to progress, how the child is going to cope with the treatment, will the child have pain and discomfort are all common questions and fears that the parent and family may experience at that point. A lot of times, children are better than adults at being able to tolerate anti-cancer treatments such as chemotherapy. Seeing the child go thorough the treatment and with them being able to tolerate it can take off some of the anxiety that the family have.
Just as a diagnosis of cancer and the process with it is shocking and difficult for the parent, it also has a significant impact on the child itself. Depending on the age of the child, he or she may be able to understand the situation or not. For them to be able to cope with the situation better, the surroundings and the environment around them should be as normal as possible. For example, the child can be explained to about what is happening with them and this is commonly done in western countries. This helps them understand the situation and makes coping with the situation better for them. By knowing what is happening, the child can be more cooperative with the treatment process. If the child is not aware of what is happening, he or she may imagine the situation to be more serious that it actually is. By telling them what is happening and gaining their trust will aid in them expressing their feelings and thoughts. Also, encouraging the child to express their feelings, allowing them to play with their friends, encouraging them to be independent, ask questions about their condition all help in this situation. Too much attention on the child from extended family or friends and not allowing the child to do anything on their own even if they can could be counter productive in ensuring a quick recovery of the child after the treatment is completed. As the treatment process may make children miss school often, providing alternate means of education, home tutoring etc in association with the school will help the child to keep up with learning and go back into education easily after completion of treatment.
Children who have been treated for cancer should be under follow up for many years, until they reach adulthood or longer to look for any ill effects of treatment they may develop as a result of their treatment. These ill effects vary depending on the type of cancer and the treatments used. Some of the things to be monitored are listed below.
For patients treated for brain tumours with certain types of chemotherapy, surgery and radiotherapy, the function of the brain can be affected. When selecting such treatment, the doctor and parent have to weigh the benefit of the treatment against the risk. Children under 2 years are usually not given radiotherapy as the side effects may outweigh the benefits. The dose of radiotherapy given along with the chemotherapy used can have an effect on how much function of the brain is affected. The side effects can include reduced memory and concentration, reduced performance in school and reduced function of the pituitary gland which can be managed with medications.
Other Effects of treatment in a Child
Treatment of cancer in a child can have an effect on other systems in the body. The growth of the child in terms of height and weight is monitored after the treatment is complete. Height of a patient can be affected by chemotherapy or radiotherapy to areas of the brain such as the spine or the brain. Close follow up helps assess the growth of the child.
Care is taken when radiotherapy is given to the area of the abdomen or pelvis to minimise the dose of radiation to the testes in the male or the ovaries in the female. A higher dose of radiation to these organs can affect the capacity of the child to be fertile in the future. Care is taken by the treating doctor to make sure that these organs are spared as much as possible at treatment.
Looking after the eyes, ears and teeth, kidneys and other organs to the effects of chemotherapy and radiotherapy is done again over time.