Childhood cancer

Childhood cancer

Childhood cancer

Key facts

1-Each year, approximately 400 000 children and adolescents of 0-19 years old are diagnosed with cancer.

2-In 2018, the study estimated that 200,166 new children, age 0-14 years, were diagnosed and registered with cancer globally, of whom 28,712 (14.3%) were from India

3-The most common types of childhood cancers include leukemias, brain cancers, lymphomas and solid tumours, such as neuroblastoma and Wilms tumours.

4- In high-income countries, where comprehensive services are generally accessible, quite 80% of youngsters with cancer are cured. In low- and middle-income countries (LMICs), an estimated 15-45% are cured.

5-Childhood cancer cannot generally be prevented or identified through screening.

6-Most childhood cancers can be cured with generic medicines and other forms of treatment, including surgery and radiotherapy. Treatment of childhood cancer are often cost-effective altogether income settings.

7-Avoidable deaths from childhood cancers in LMICs result from lack of diagnosis, misdiagnosis or delayed diagnosis, obstacles to accessing care, abandonment of treatment, death from toxicity, and higher rates of relapse.

 

The problem

 

Cancer may be a leading explanation for death for youngsters and adolescents, particularly in high-income countries. The likelihood of surviving a diagnosis of childhood cancer depends on the country during which the kid lives: in high-income countries, more than 80% of children with cancer are cured, but in many LMICs only 15-45% are cured .


The reasons for lower survival rates in LMICs include: delay in diagnosis and advanced disease, an inability to get an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and avoidable relapse. Improving access to childhood cancer care, including to essential medicines and technologies, is very cost effective, feasible and may improve survival altogether settings. 

 

What causes cancer in children?

 

It begins with genetic change in single cells, that then grow into a mass (or tumour), invades other parts of the body and causes harm and death if left untreated. Unlike cancer in adults, the overwhelming majority of childhood cancers don't have a known cause. Many studies have sought to spot the causes of childhood cancer, but only a few cancers in children are caused by environmental exposure or lifestyle factors. Cancer prevention efforts in children should specialise in behaviours which will prevent the kid from developing preventable cancer as an adult.
Some chronic infections, like HIV, Epstein-Barr virus and malaria, are risk factors for childhood cancer. They are particularly relevant in LMICs. Other infections can increase a child’s risk of developing cancer as an adult, so it's important to be vaccinated (against hepatitis B to assist prevent cancer of the liver and against human papillomavirus to assist prevent cervical cancer) and to other pursue other methods like early detection and treatment of chronic infections which will cause cancer.
Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors.

 

Improving outcomes of childhood cancer

 

Because it's generally impossible to stop cancer in children, the foremost effective strategy to scale back the burden of cancer in children and improve outcomes is to specialise in a prompt, correct diagnosis followed by effective, evidence-based therapy with tailored supportive care.

Early diagnosis

When identified early, cancer is more likely to reply to effective treatment and end in a greater probability of survival, less suffering, and sometimes less costly and fewer intensive treatment. Significant improvements are often made within the lives of youngsters with cancer by detecting cancer early and avoiding delays in care. A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy.
Early diagnosis consists of 3 components :
• awareness of symptoms by families and primary care providers;
• accurate and timely clinical evaluation, diagnosis, and staging (determining the extent to which a cancer has spread); and
• access to prompt treatment.
Early diagnosis has relevancy altogether settings and improves survival for several cancers. Programmes to promote early and correct diagnosis have been successfully implemented in countries of all income levels, often through the collaborative efforts of governments, civil society and nongovernmental organizations, with vital roles played by parent groups. Childhood cancer is related to a variety of warning symptoms which will be detected by families and by trained primary health-care providers.
Screening is generally not helpful for childhood cancers. In some select cases, it are often considered in high-risk populations. For example, some eye cancers in children can be caused by a mutation that is inherited, so if that mutation or disease is identified in the family of a child with retinoblastoma, genetic counselling are often offered and siblings monitored with regular eye examinations early in life. Genetic causes of childhood cancers are relevant in just a couple of youngsters with cancer. There is no high-quality evidence to support population-based screening programmes in children.

Treatment

A correct diagnosis is important to prescribe appropriate therapy for the sort and extent of the disease. Standard therapies include chemotherapy, surgery and/or radiotherapy. Children also need special attention to their continued physical and cognitive growth and nutritional status, which needs a fanatical , multi-disciplinary team.
However, cure is possible for more than 80% of children with cancer when childhood cancer services are accessible. Pharmacological treatment, for instance , includes inexpensive generic medications included on the WHO List of Essential Medicines for youngsters (27 cytotoxic agents, 5 targeted therapies and 4 hormone treatments for childhood cancer). Children who complete treatment require ongoing care to watch for cancer recurrence and to manage any possible long-term impact of treatment.

Palliative care

Palliative care relieves symptoms caused by cancer and improves the standard of lifetime of patients and their families. Not all children with cancer can be cured, but relief of suffering is possible for everyone.
Palliative care programmes are often delivered through community and home-based care, providing pain relief and psychosocial support to patients and their families.



by:-


Dr Sunil Kumar

(MBBS, MD oncology)