Paediatric Oncology

Paediatric Oncology

What is Paediatric Oncology?

Paediatric Oncology is the branch of medicine that deals with cancers in babies, children and teenagers. As with adult cancers, there are many different types of paediatric cancers, requiring different courses of treatments.

Children’s growth, development, dynamic nutritional status and immature organ function requires dose precision and monitoring for acute and long term organ specific side effects. Hence the need of trained paediatric specialists in this field.

What types of cancers are common in kids?

Common cancers in adults are different from common cancers in children. Some of these are:

● Leukaemia

● Brain and nervous system cancers

● Hodgkin and Non-Hodgkin Lymphoma

● Rhabdomyosarcoma

● Retinoblastoma

● Bone cancers

● Neuroblastoma

● Nephroblastoma/Wilmstumor

● Germ cell tumours

What is the most deadly childhood cancer?

Both Brain Cancer and Leukaemia have the highest mortality rates among all Paediatric Cancers. While the recent years have seen many advancements in the treatment of Leukaemia, brain cancer treatments are still challenging in most cases. Bone cancers are also known to have high mortality rates.

How common is childhood cancer?

About 3-5% of all cancer patients in India are children. Moreover, about 50,000 children are diagnosed every year with cancer, according to the Indian Cancer Society. That said, these cancers can be curable if detected early and treated under experienced specialists. Post-effective treatment, affected children can go on to lead normal lives and perform all activities as their peers.

TYPES

Leukaemia

Leukaemia is a type of a blood cancer that causes an abnormal growth of white blood cells in the body. This growth may lead reduced healthy red and white cells, causing the following symptoms:

● Bone and joint pain

● Fatigue/ Dizziness

● Weakness

● Bleeding

● Fever

● Weight loss

● Frequent infections

● Loss of appetite

The most common types of Leukaemia occurring in children are Acute lymphoblastic leukaemia and Acute myeloid leukaemia.

Brain and Spinal Cord Tumours

The term brain and spinal cord tumours refers to the growth abnormal cells in the brain or spinal cord. The most common of these in children are Medulloblastomas, forming in cerebellum and Gliomas, forming in the supportive tissue of the brain. There are currently no known risk factors for brain and spinal tumours except radiation exposure.

Neuroblastoma

Neuroblastoma is one of the most common solid tumor affecting babies and develops in their nerve tissues. It is known to metastasise quickly, making early detection crucial for successful treatment. Like other paediatric cancers, the causes and risk factors of Neuroblastoma aren’t clear. However, in some rare cases, it is sound to be hereditary. The treatment may involve a combination of Surgery, Chemotherapy, Radiation therapy, autologous Bone marrow transplantation and Immunotherapy.

Wilms’ Tumour

Wilms’ Tumour is rare cancer developing in the kidneys. There are two main types of Wilms’ Tumours – Favorable histology and Anaplastic histology. abdominal pain, swelling, or discomfort. Common symptoms associated with the disease are:

● Abdominal Lump/Swelling

● Nausea

● Constipation

● Loss of appetite

● Fever

● Fatigue

● Blood in the urine

● High blood pressure

Its treatment includes surgery (radical nephrectomy) and Chemo and Radiation Therapy.

Lymphoma

Lymphomas develop in the lymph system of children and is known to metastasize to other parts of the body quickly. The most symptoms associated with the disease are fever, fatigue and swollen lymph nodes. The two types of cancers affecting children are Hodgkin lymphoma: blood cancer that develops when lymphocytes grow abnormally, and Non-Hodgkin lymphoma.

Rhabdomyosarcoma

Rhabdomyosarcoma refers to the growth of cancerous cells in a child’s muscle tissue. There are four main types of Rhabdomysarcomas:

• Embryonal: Occurring commonly in the head and neck region or the genitals
• Alveolar: Occurring commonly in the arms or legs, chest, abdomen or genitals
• Spindle cell/sclerosing: Occurring commonly in the spermatic cord area and head & neck.
• Pleomorphic: Growing in multiple shapes and sizes

Retinoblastoma

Retinoblastoma affects the retina and mostly affects children under the age of two. The most common symptom of the disease is a cloudy white pupil, an enlarged pupil, crossed pupils poor vision or redness or swelling of the eye in advanced stages. The two forms of retinoblastoma are sporadic and heritable, and when the cancer affects both eyes, it is known as bilateral retinoblastoma.

Bone Cancer

As the name suggests, bone cancer is a type of cancer that affects one’s bones.

Osteosarcoma is the most bone cancer occurring in children and is most common in people between the ages of 10 and 20. It starts in the bones and can further metastasize to other parts of the body

Ewing sarcoma usually starts in bones, but can also begin in soft tissues like tendons, ligaments, cartilage, or muscles.

Signs & symptoms of childhood cancer

Paediatric Cancers can be hard for parents and guardians to detect for multiple reasons: parents may mistake common cancer symptoms for common illnesses, children may fail to communicate changes in their health or they could be asymptomatic.

Here are some common symptoms to look for:

● Unexplained weight loss

● Fatigue/Weakness

● Headaches

● Nausea

● Bones/ Joint pain

 ● Unexplained lumps on the body

● Unexplained and recurring bruising

● Changes in eyes like white spots or problems with vision/ squinting

● Recurring or persistent fevers

What are the child’s first symptoms of leukaemia?

Leukemia is the most common cancer in children and accounts for a large percentage of all childhood cancers. It starts in the patient’s bone marrow and spreads to the blood and further to the organs. Hence, early detection can be the key to successful treatment.

Here are common symptoms associated with Leukaemia in children:

● Bone and joint pain

● Fatigue/ Dizziness

● Weakness

● Bleeding

● Fever

● Weight loss

● Frequent infections

● Loss of appetite

What are the signs of lymphoma in a child?

There are two main types of lymphoma: Hodgkin lymphoma and Non-Hodgkin lymphoma. The common signs and symptoms associated with them are:

● Swollen Lymph nodes/ swollen neck

● Fever or chills

● Unexplained weight loss

● Night sweats

● Itching

● Fatigue

● Breathing problems or cough.

Please note that Lymphoma can cause various signs and symptoms, depending on where it is in the body. If you notice any of the above symptoms, consult a specialist at the earliest.

Where does lymphoma usually start?

Lymphoma starts in lymphocytes, a type of white blood cell. Affecting lymph nodes and tissues, it can further spread to the bone marrow and surrounding organs. While the exact cause of lymphoma is unknown, there are many risk factors associated with the disease.

Various causes of childhood cancer

When it comes to adults, we have a fair understanding of causes for certain cancers. And lifestyle factors such as smoking, obesity, an unhealthy diet, etc. can be attributed as risk factors. However, in children the cause of these diseases isn’t clear.

While it may be important for parents to know what caused their child to suffer from these difficult diseases, the brightest minds in medicine are still working to give them a conclusive answer.

Various risk factors / what increases risk of childhood cancer?

There are multiple mutations that eventually lead to cancer in an individual. Some of these gene mutations can be acquired, while some can be genetic – this is rare. Exposure to radiation or prior chemotherapy can be responsible for these mutations in some cases. Other factors that are known to increase the risk are medical conditions, problems with development in the womb and exposure to infections. Children affected by certain medical conditions like Down’s Syndrome are also at a higher risk to develop cancers like Leukaemia.

Genetic and non-genetic risk factors for childhood cancer

As previously mentioned, while some gene mutations that result in cancer are acquired, others are genetic.

The genetic factors are:

● congenital abnormalities

● Low maternal weight

● Birth weight

Non-genetic risk factors include:

● Maternal alcohol consumption / smoking

● Exposure to radiation

● Prior chemotherapy

● Parental diet

● Maternal medication

● Pollution exposure

How is childhood cancer diagnosed?

There are multiple tests and assessments that can help diagnose childhood cancers. Depending on the suspected cancer and the symptoms. A doctor may perform:

● Physical examination

● Ultrasound

● CT

● MRI

● Biopsy

● Blood tests

● Bone marrow aspiration

● PET Scan

● Lumbar puncture

How do you diagnose leukaemia in children?

When diagnosing the disease, a doctor may look for physical signs that may indicate Leukaemia. If a child is suspected to have Leukaemia, it being a blood cancer, your doctor might require you to take a blood test for an abnormal white cell count or order a bone marrow biopsy. Specialised bone marrow tests are required (immunophenotyping and cytogenetics , MRD) for knowing the subtype and prognosis.