STACY* recalls how floored she was when she heard that her daughter’s symptoms were caused by cancer. She knew her four-year-old had not been too well lately, but cancer?

There had been some vomiting episodes over the past few weeks, but her child had always been a picky eater. She had some fever at night, but didn’t all children get that?

She had become concerned though when she noted that her clothes weren’t fitting as well, and her daughter was sleeping more than usual. She was also complaining of pain in her legs which made it hard to sleep at night.

What in the world was a neuroblastoma? How would she tell her family? She contemplated all of this as tears rolled down her cheeks.

Awareness

This story reflects the reality faced by families affected by childhood cancer and this month — Childhood Cancer Awareness Month — is an opportune time to share experiences while seeking to assure the best possible health outcomes for children and families so affected.

“Your child has cancer” are some of the most terrifying words a family can hear. Cancer never only affects the child; it also impacts families, communities and health care providers who strive valiantly to take away a child’s suffering.

Cancer in children is relatively rare, with approximately 300,000 children aged 0 to 19 years old diagnosed globally each year. In the United States, 15,780 children between birth and 19 years will be diagnosed with cancer yearly. In Jamaica, approximately 74 children will be diagnosed with cancer yearly.

However, while cancer in children occurs infrequently, it is the leading cause of non-accidental death for children and adolescents around the world. Because of major treatment advances in recent decades, in resource-replete settings 84 per cent of children with cancer now survive five years or more. Overall, this is a huge increase since the mid-1970s when the five-year survival rate was about 58 per cent.

In resource-limited settings, cure rates have lagged behind. Survival rates from childhood cancer in low- and middle-income countries range from five to 60 per cent, in part due to variability in health system capacity, political attention, and commitment within and between countries.

Causes

The majority of childhood cancers are caused by DNA changes occurring early in a child’s life. Errors during DNA replication contribute to the development of acquired mutations.

Unlike many cancers of adults, lifestyle-related risk factors (such as smoking and diet) do not play much of a role in a child’s risk of getting cancer. Parents should not feel guilty if their child develops cancer, as it is extremely unlikely that much could have been done to prevent it.

With few modifiable risk factors for childhood cancer, early detection, therefore, becomes important in optimising the outcome by children presenting before cancers become advanced. This allows for more treatment options and their chance of survival is significantly improved.

How can we ensure that children present to hospital at an early stage? It becomes imperative that health care workers who are the first point of contact for children — paediatricians, emergency room physicians, nurses and doctors in primary health care, as well as general practitioners — be aware of the signs and symptoms of childhood cancer and refer immediately.

Delays also occur when parents are unaware of the signs and symptoms of childhood cancer, so education is also needed for them.

Some signs

The most common cancers occurring in children are leukaemias, brain cancers, lymphomas, and solid tumours.

Leukemia accounts for 32 per cent of cancer in children under 15 years, and 13 per cent in children between 15 and 19 years of age. It is also generally the most curable. Children with Down’s syndrome are at increased risk. It is caused by an uncontrolled increase in the white blood cells of the bone marrow.

Symptoms are non-specific and include fever; easy bruising or bleeding; bone or joint pain; painless lumps in the neck, underarm, stomach, or groin; weakness, feeling tired; looking pale as well as loss of appetite.

Diagnosis is made by doing a bone marrow aspirate, and treatment is mainly by chemotherapy. Other treatment options, including a bone marrow transplant, are available overseas if chemotherapy does not work.

Brain tumours are more frequent in early childhood — five to 10 years — and then decrease after puberty. Symptoms may vary depending on the location of the tumour within the head.

The most frequent symptom is a headache, which may seem generalised and intermittent but increases in intensity and frequency over time. There may also be nausea, vomiting and hearing problems. The headache awakens a child at night and is more intense in the morning. It may improve during the daytime with sitting or standing. Sometimes the vomiting may be very forceful and not necessarily occur with nausea.

Other symptoms may occur, such as confused mental status, changes in personality, or sudden changes in mood or behaviour — which also leads to a decrease in school performance. Seizures may occur. Children may also have disturbances in their vision — seeing doubles, having abnormal eye movement, or just not seeing as well as before. An infant may be more irritable than usual, not feel to eat, experience vomiting, weight loss or much slower weight gain. There may be a noticeable increase in the size of the child’s head or the head may appear to be bulging. The anterior fontanelle, which is the soft spot in the head in infants, may bulge or feel tense.

Lymphomas are the third-most common of childhood cancers after leukaemias and tumours of the central nervous system. Symptoms may be very non-specific, such as fatigue and loss of appetite, and there may be compression or the effect of the cancer pressing on the normal tissues. For example, tumours located within the chest may be accompanied by difficulty breathing.

Being alert to the signs and symptoms of childhood cancer can save lives.

For more information on childhood cancers, visit: www.cancer.gov/types/childhood-cancers or www.aboutkidshealth.ca 

Dr Michelle Reece-Mills is paediatrician/paediatric haematologist/oncologist at the University Hospital of the West Indies.