Important data

• Every year, around 400 000 children and adolescents between 0-19 years old develop cancer.
• The commonest form of childhood cancers are leukemias, brain cancers, lymphomas and solid tumours, such as neuroblastoma and Wilms tumours. 
• In developed countries, where all extensive services are normally available, more than 80% of children with cancer are cured. In developing and underdeveloped countries, less than 30% are cured. 
• Childhood cancer cannot normally be prevented or diagnosed through screening examination.
• Most childhood cancers can be cured with generic medicines and other kinds of treatment, like surgery and radiotherapy. Treatment of childhood cancer can be cost-effective in all income settings. 
• Avoidable deaths from childhood cancers in low middle-income countries lead to a lack of diagnosis, misdiagnosis or delay in diagnosis, hurdles to reach available facilities, abandonment of management, death from toxicity, and reoccurrence. 
• Only 29% of underdeveloped countries stated that cancer medicines are generally available to their populations as compared to 96% of developed countries. 
• Childhood cancer data systems are required to update and continuous improvements in the quality of management, and to inform policy procedures.

Types of Cancer that Develop in Children

The most common cancers of children are:

• Leukemia

• Brain and spinal cord tumors

• Neuroblastoma

• Wilms tumor

• Lymphoma (including both Hodgkin and non-Hodgkin)

• Rhabdomyosarcoma

• Retinoblastoma

• Bone cancer (including osteosarcoma and Ewing sarcoma)

Another type of cancer is uncommon in children. 

Complications

Cancer is a dominant reason for the death of children and adolescents. The chances of surviving and diagnosis of childhood cancer depend on the country where the child lives: in developed countries, more than 80% of children with cancer are prevented, but in many underdeveloped and developing countries, less than 30% are cured.

The reasons for more death rates in developing and underdeveloped countries include: delay in diagnosis, lack of correct or appropriate diagnosis, unavailable treatment, abandonment of treatment, death from toxicity (side effects), and avoidable reoccurrence. Improvement in childhood cancer management, including required medicines and technologies, is highly cost-effective, feasible and can improve survival in all aspects.

Causative factor of cancer in children

Cancer occurs in people of all age groups and can involve any part of the body. It starts with a genetic change in single cells, that then increases into a mass (or tumour), that invades other organs of the body and results in harm and death if remains untreated. Opposite to cancer in adults, the vast probability of childhood cancers does not have a known reason. 

Many research has been identified the reason for childhood cancer, but very less cancers in children are caused by environmental or lifestyle reasons. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.

Few chronic infections, like HIV, Epstein-Barr virus and malaria, are possible factors for childhood cancer. They are particularly common in underdeveloped countries. Other infections can increase a child’s probability of developing cancer as an adult, so it is required to be vaccinated (against hepatitis B to prevent liver cancer and against human papillomavirus to prevent cervical cancer) and other procedures such as early diagnosis and management of chronic infections that can result into cancer.

Current data indicates that around 10% of all children with cancer have a predisposition because of genetic factors. Further study is required to identify factors impacting cancer development in children.

Improving outcomes of childhood cancer

Because it is normally not possible to prevent cancer in children, the most effective procedure to decrease the burden of cancer in children and improve results is to focus on a prompt, appropriate diagnosis followed by effective, evidence-based therapy with supportive care.

Initial diagnosis

When it is diagnosed initially, cancer is more likely to respond to effective treatment and result in a greater possibility of survival. Significant improvements can be made in the lives of children with cancer by diagnosing cancer initially and avoiding delays in care. An appropriate diagnosis is important to manage children with cancer because every cancer needs a specific management regimen that may include surgery, radiotherapy, and chemotherapy.

Early diagnosis consists of 3 parts:

• knowledge of symptoms by families and primary caregivers
• appropriate clinical evaluation, diagnosis, and staging (determining the extent to which cancer has spread); and
• availability to prompt treatment.

Initial diagnosis is related to all procedures and increases survival for many cancers. Programmes to initiate early and accurate diagnosis have been successfully implemented in countries of all income levels, often through the accumulative efforts from governments and non-governmental organizations, which can play vital roles. 

Childhood cancer is associated with a range of warning symptoms, like 

• fever

• severe

• persistent headaches

• bone pain

• weight loss

Screening examination is normally not very supportive of childhood cancers. In some select cases, it can be considered in high-risk populations. Like, 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 can be proposed and siblings monitored with regular eye check-ups. Genetic reasons for childhood cancers are relevant in only a small proportion child with cancer. There is no evidence to support population-based screening examination in children.

Treatment

An appropriate diagnosis is important to give accurate management for the type and extent of the disease. Standard procedures include chemotherapy, surgery and/or radiotherapy. After cancer treatment there should be proper physical care with mental support and good nutrition is also required.

Although, treatment is possible for more than 80% of children with cancer when childhood cancer services are available. Pharmacological management, like inexpensive generic medications included on the WHO List of Essential Medicines for Children. 

Symptomatic care

Symptomatic care relieves symptoms caused by cancer and improves the quality of life of patients and their families. Not all children with cancer can be treated, but the relief from suffering is possible for everyone. 

Palliative care programmes can be provided through community and home-based care, providing pain relief and psychosocial support to patients and their families. Adequate access to oral morphine and other pain medicines should be provided for the treatment of moderate to severe cancer pain, which affects more than 80% of cancer patients in the terminal phase.

Be thankful for this day. You are here, breathing and living life. Even if it's not the life you want or hoped for, it's life. There's always something to be thankful for.

Let’s come and grow together with “Project Global Cure” and spread awareness about Childhood Cancer because together we can and we will…