15th February is observed as the International Childhood Cancer Day. On this day, all around the world a collaborative campaign is held to raise awareness about childhood cancer, and to express support for children with cancer.
This day fosters appreciation and a profound understanding of issues related to childhood cancer that has an impact on adolescents and children suffering with cancer, their families and society as a whole.
According to the WHO (World Health Organisation) each year, more than 150,000 children are diagnosed with cancer.
Throwing a spotlight on this issue, we interviewed Dr. L. Appaji, Pediatric Oncologist at the Kidwai Cancer Institute, Bengaluru, who has been involved in treating children with cancer for the last 33 years.
Excerpts from the interview are as below:
Neha: Looking at the statistics, a decade back childhood cancers were 2.5% of the total number of cancer cases. Now, it has added up to 5.5%. What has led to an increase of childhood cancers in India?
Dr. L. Appaji: Childhood cancers are relatively rare. They constitute to 2% of all the cancers in the western industrialized nations. In India, they constitute from 4.5% to 5.5% of the total cancers. Increase in childhood cancer, under the age of 15 years, is due to overcrowding, pollution, under-nutrition, which may decrease the immune mechanism and a high index of suspicion. An early awareness and referral to the oncology centre for confirmation of the diagnosis can help reduce this number.
Neha: In Bangalore, approximately how many children have been diagnosed with cancer?
Dr. L. Appaji: At our institute, we have registered more than 500 new cases of children with cancers for treatment.
Neha: What are the most common types of cancer in children?
Dr. L. Appaji: Common cancers in children are leukaemia (30% of total), brain tumours (20%), lymphomas (15%), neuroblastoma and wilms tumour (10%) and the remaining 25-30% are bone tumours, soft tissue sarcomas, retinoblastoma, hepatoblastoma and germ cell tumours.
Neha: Why does it occur and what are the signs and symptoms of childhood cancer?
Dr. L. Appaji: Exact causes of childhood cancers are unknown; however, the conditions associated with an increased incidence of cancers in children are predisposing genetic conditions, immunodeficiency disorders, irradiation, drugs and chemicals and cancer-producing viruses.
The symptoms in leukaemia patients are fever, pallor, bleeding, bone and joint pains, lymphadenopathy and hepatosplenomegaly. The solid tumours like brain tumour comes with headache, vomiting, and convulsions.
The symptoms of retinoblastoma cancer are white reflex in the eye, decreased vision and acquired squint. Bone and soft tissue tumour symptoms are pain and swelling. Neuroblastoma and wilms tumour symptoms are abdominal mass and pain.
Neha: Does folate deficiency have any impact on children's cancer?
Dr. L. Appaji: No definite evidence is there to say that folate deficiency can cause cancer; however, patients with folate deficiency will have more toxicity with methotrexate chemotherapy. (Methotrexate is a chemotherapy drug which is used to treat different cancers).
Neha: Do teenagers have any of these cancers?
Dr. L. Appaji: Teenagers have a high incidence of Hodgkin and non-Hodgkin lymphoma, ewing sarcoma and osteosarcoma.
Neha: Who are more at a higher risk of childhood cancers - Boys or Girls?
Dr. L. Appaji: Boys are more affected compared to girls in the ratio of 1.2:1.
Neha: At what age can a child suffer with cancer?
Dr. L. Appaji: From a newborn to older aged people, cancer can occur. In general, children under the age of 6 years will have twice the incidence compared to children aged above 6 years.
Neha: What is the stage or extent of this disease?
Dr. L. Appaji: The stage and extent of disease depends upon the type of cancer. The age of the patient, initial WBC (white blood cell) count, phenotype and molecular features are determined in leukaemia patients and are used to stratify as a standard or high risk.
Solid tumours are classified as Stage I-IV, depending upon the extent of disease at diagnosis.
Neha: If a child is diagnosed with cancer, what is the first thing that a parent should do?
Dr. L. Appaji: First thing the parents should do is to consult the family paediatrician and take referral to a tertiary care hospital providing Paediatric Oncology Services.
Neha: What are the treatments of childhood cancer?
Dr. L. Appaji: Treatment of childhood cancer includes chemotherapy, surgery, radiotherapy and supportive care during intensive phase of chemotherapy.
Chemotherapy is the main modality for leukaemia, whereas solid tumours require surgery, radiotherapy and chemotherapy.
Neha: Is childhood cancer curable? How long does it take to cure?
Dr. L. Appaji: Majority of Paediatric Cancers are curable with a protocol-based therapy. Patient with Hodgkin Lymphoma and Wilms Tumour has more than 90% survival chances. Neuroblastoma cancer above the age of one year and Acute Myeloid Leukaemia have about 30% survival chances and all other childhood cancers will have 65%-70% of survival chances.
If the child has maintained complete remission (no recurrence of the disease) 3 years post therapy, we consider it as curable. The duration of therapy varies from 9-12 weeks for germ cell tumour, 2 years for acute lymphoblastic leukaemia and other cancers require less than 2 years for therapy.
Neha: Are there any side effects of the treatments?
Dr. L. Appaji: Common side effects of chemotherapy are nausea, vomiting, alopecia, mucositis and myelosupression. These side effects are temporary and reversible.
Neha: Can the child go back to leading a normal life, considering the childhood trauma they go through at an early age?
Dr. L. Appaji: Post therapy, the child can go back to leading a normal life, attend school, can receive remaining vaccination after 6-12 months of completion of therapy.
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