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Overview

Paediatric (childhood) cancers are different from adult cancers as there are no clear causative factors as to why a child gets cancer. The most common childhood cancers are leukaemia, lymphoma and brain cancer.

Cancer in children is certainly distressing but here is a reason to smile-paediatric cancers tend to respond better to treatment, compared to adults. Children can usually be cured for life. It is essential to be patient and trust your doctor.

Warning signs

  • Unexplained weight loss
  • Headaches, often with early morning vomiting
  • Pain/swelling in bones, joints, back or legs
  • Lump or mass in the abdomen, neck, chest, pelvis or armpits
  • Excessive bruising, bleeding or rash
  • Constant infections
  • A whitish colour behind the pupil
  • Persisting nausea
  • Constant tiredness or noticeable paleness
  • Eye or vision changes that occur suddenly and persist
  • Recurrent fevers of unknown origin

Risk factors

  • Longer life expectancy in children allows a longer time for cancer processes to manifest, increasing the risk of developing some cancer types later in life.
  • Genetic and familial factors are identified in 5-15 per cent of paediatric cancer cases.
  • Environmental exposure such as prenatal exposure to tobacco, X-rays or certain medications are identified in <5 per cent of cases.
  • For the remaining 95 per cent of cases, however, individual causes remain unknown

Progression

Different types of cancers in children spread to different organs of the child's body. Leukaemia may affect the brain and spinal cord, testicles, rarely ovaries, kidneys and other organs. Lymphoma may spread to the liver, bone marrow or spleen. Brain tumours may spread to spinal cord tissue. Rhabdomyosarcoma, when it spreads, creates new lesions in the lymph nodes, bone, bone marrow or lung.

Diagnosis

  • Primary diagnosis: Physical examination, blood tests
  • Advanced diagnosis: Biopsy, bone marrow aspiration and biopsy, lumbar puncture, ultrasound, computed tomography scan (CT or CAT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scan may be performed.

Treatment in a nutshell

Treatment options might include surgery, radiation therapy, chemotherapy, and/or other types of treatment. In many cases, more than one of these treatments is used. Treatment of paediatric cancer should always be done in a Children's Cancer Centre under the care of a Paediatric Oncologist as there is abundant evidence that the expert care in these centres leads to vastly superior outcomes. In advanced cases a Stem Cell Transplant can be life-saving.

Milestones

  • Biggest Stem Cell Transplant unit in Western India
  • Our PICU (10 beds) is a tertiary care referral centre for various PICUs across Mumbai and the surrounding region and well-equipped to deal with oncological emergencies.
  • Kokilaben Hospital performed a Stem Cell Transplant procedure on a six month old baby,the youngest to have such a procedure in India.
  • MRD (minimal residual disease) monitoring has led to changes in outcome in paediatric leukaemia.

Reported Outcome

The outcomes in paediatric cancers are, in general, much better compared to that in adults. The five-year survival rates for the more common paediatric cancers are:

Leukaemia 90 per cent
Brain and other Nervous System Tumours 71 per cent
Wilms' tumour (kidney cancer) 88 per cent
Hodgkins lymphoma 95 per cent
Non-Hodgkins lymphoma 86 per cent
Rhabdomyosarcoma 68 per cent
Neuroblastoma 74 per cent
Osteosarcoma (bone cancer) 70 per cent

Top tips

There are simple things you can do to decrease risk of child cancer.

  • Don´t smoke.
  • Breastfeed longer.
  • Get them to eat their greens and fruits.
  • Get medical checkups done with your Paediatrician regularly.
  • Reduce salt and sugar intake.
  • Don´t use in-home herbicides or pesticides.
  • Avoid antibiotics

Remarkable Case

Bone Marrow Transplant for a Six-Month-Old

Background and Diagnosis : A six-month-old baby was diagnosed with neuroblastoma, one of the common cancers seen during infancy and known to originate from the nerve cells. The baby underwent surgery and eight cycles of chemotherapy to shrink the tumour at another reputed hospital in Mumbai. However, because that hospital does not perform bone marrow transplants in children below the age of one (owing to the lack of a full-fledged paediatric department and ICU), the family approached Kokilaben Hospital.

Treatment : An autologous transplant, where the patient's own stem cells are removed to save them from getting destroyed before a high-dose chemotherapy or radiation treatment, was advised. At least 10 specialists from different fields of paediatrics, including cardiologists and intensivists, stood guard in the hospital room for hours as the stem cells were being collected from the baby. We wanted to be prepared for any eventuality. The infant's blood pressure was being monitored second by second. The team repeated the process on the second day and collected enough stem cells to proceed with the transplant. The procedure was then carried out successfully.

Outcome : According to the baby's mother, the child has been recovering well after the procedure.

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