CHILDHOOD CANCER: KNOW THE WARNING SIGNS
FOR many years childhood cancer has remained a taboo subject in our communities, mainly because too little was or is known about it.
Many have known or come across an adult with cancer but for a child to be diagnosed with cancer is unheard of. No parent wants to hear the news that their ‘heartbeat in human form’ has fallen ill. One moment they are okay, the next, waves of emotion flood the parents.
Mixed in all this are feelings of guilt, anxiety, uncertainty, constant wondering if they could have done anything differently. The question, often unuttered, remains: “Is my child dying? How much time do I have?”
Childhood cancer is rare and involves only 1% of all cancers. It is reported that globally, about 70% of all childhood cancer cases occur in low- and middle-income countries. If diagnosed early, about 70-80% of childhood cancers are curable in developed countries. Unfortunately, most children with cancer live in developing countries with limited resources and the cure rate does not reflect the same success.
The low survival rates can be attributed to poor diagnosis coupled with too few specially trained doctors and nurses and the misbelief that child cancer is too difficult to cure. However, even in resource-poor environments at least 50% of childhood cancers can be cured.
Numerically, childhood cancer is not a significant cause of death in sub-Saharan African countries, which leaves childhood cancer less of a priority. In Africa, the most common paediatric health problems are malnutrition, and infectious diseases such as HIV and tuberculosis.
Whereas in Western countries, after accidents, cancer is the second leading cause of death in children and is a burden to the health system.
A study done by Stones et al in 2014 published the survival rates for children with cancer in South Africa at two units (Universitas and Tygerberg hospitals) to be about 52%.
The conclusion was that the children present late and with advancedstage disease, which obviously affects their outcome.
They also concluded that strategies to improve awareness of childhood cancer should be improved. Identifying early warning signs of childhood cancer is critical for parents and health-care workers to ensure early diagnosis and improved cure rates. We often refer to these as red-flag signs that should raise suspicion of the possibility of cancer as a diagnosis for the presenting patient.
Almost 85% of childhood cancers will present with the red-flag signs, namely:
1. Pallor and purpura (bruising)
2. Bone and joint pain
3. Lymphadenopathy
4. Unexplained masses on any body part
5. Unexplained neurological signs
6. Changes in the orbit or eye
7. Persistent unexplained fever and weight loss
The most common cancer in children is leukaemia (blood cancer). Brain tumours are the most common non-haematological cancers, followed by nephroblastomas (kidney cancers) and neuroblastomas (sympathetic chain cells, the adrenal glands the most common site of origin).
Once there is clinical suspicion of cancer, this should be investigated or the child referred for the relevant investigations to get to the right diagnosis. Treatment for childhood cancer includes chemotherapy, surgery or radiotherapy. These may be given separately or in combination, depending on the diagnosis.
Many models of care exist, but regardless of the outcome, children and families who receive compassionate, holistic care of symptomatology and address their non-physical needs are able to face their illness with dignity and energy.
Childhood cancer should not remain a taboo subject in South Africa and should be a topic of conversation more often so that people can be educated regarding the early warning signs.
Get the word out that a cure is possible. This month, which is known as Childhood Cancer Awareness Month, and throughout the year, we honour the children battling cancer, the families who love them, the clinicians and other caregivers treating them, the survivors of childhood cancer and the children who lost their lives to childhood cancer.