According to the World Health Organization (WHO), approximately 400,000 children and adolescents worldwide develop cancer each year. Genetic factors, radiation exposure and certain infections such as HIV increase the likelihood of childhood cancers. So what types of cancers do children develop and how do they present?
Bone marrow and blood cancers (leukemia) are the most common. Others include lymphomas, retinoblastoma, soft tissue sarcoma, and solid tumors, such as neuroblastoma and Wilms tumors. The majority of childhood leukemias are either acute lymphoblastic leukemias (ALL) or acute myeloid leukemias (AML). Common initial symptoms include musculoskeletal pain, fatigue, anemia, easy bruising, recurrent infections etc. These symptoms may go unnoticed; therefore, it is important for doctors to take a detailed history and consider early referral to a specialist if clinically suspected or during blood tests. Retinoblastoma, a rare cancer of the retina, a layer at the back of the eye, occurs around age 2 in the majority of cases. There is an abnormal white reflection in the pupil (white pupil) usually noticed after flash shooting. If this is detected, the child should be urgently referred to an ophthalmologist. It has a high cure rate. Other signs or symptoms include strabismus or visual deterioration.
Neuroblastoma, the tumor of nerve cells, is found in children up to the age of 10. It is also a rare cancer that most commonly affects the abdomen and presents as swelling in the abdomen. Bone pain, weight loss, fever, lack of appetite and liver problems are some of the other characteristics of this tumor. If you as a GP suspect this, these patients should be referred to a specialist as soon as possible for further examination.
Wilms tumor, although rare, is the most common type of kidney tumor in children. It usually starts in one kidney but in rare cases involves both kidneys. Symptoms include a swollen abdomen, fever, decreased appetite (similar to neuroblastoma), and blood in the urine. Again, in case of clinical suspicion or radiological findings, urgent referral to a specialist is imperative.
Soft tissue sarcomas are tumors that appear in muscle, fat, or other soft tissues of the body. In children especially, they can appear as a lump or swelling in the head and neck, groin, abdomen and pelvis, and upper or lower limbs. Recovery depends on their location and how quickly they are identified and treated.
There is an urgent need to develop basic health units in Pakistan as these facilities are the first point of contact for patients with the health system.
The main forms of treatment for childhood cancer include surgery, chemotherapy and radiation therapy. Acute lymphoblastic leukemia, Wilms tumors and retinoblastoma can be successfully treated. Medicines used to treat cancers (chemotherapy) are effective but can cause side effects such as fatigue, nausea, loss of appetite, hair loss and hearing loss, anemia, recurrent infections etc. Going through chemotherapy and having side effects can be stressful. These children also find social interactions difficult.
Approximately 7,000-7,500 children (under 18) per year in Pakistan are diagnosed with cancer (ncbi.nlm.nih.org 2020). With the high incidence and prevalence of childhood cancers in low- and middle-income countries like Pakistan, proper collection of cancer data in the form of a cancer registry must be a priority.
How to ensure early detection of injuries or sinister discoveries?
What strategies can help improve patient outcomes? There is an urgent need to develop basic health units in Pakistan. These institutions are the first point of contact for patients with the healthcare system.
Physician training at these facilities should focus on taking a complete history and identifying risk factors, including family history of cancer and danger signs of cancers in the young population. Ensure urgent referral to hospital for further assessment and investigations in suspected cases. A close liaison between the doctors/hospital specialists and the GP/community family doctor should be established to monitor the patient’s progress, follow-ups, any side effects of treatment and any support required for the child or parent.
Oncology nurse practitioners, as part of the multidisciplinary team, can address many issues such as routine immunizations or nutrition for a child at home, and provide feedback to the primary physician when the child receives their leave.
Keeping a treatment record, completing it, and monitoring it regularly can improve mortality rates. Terminally ill children need palliative care that helps relieve pain and address other physical or emotional symptoms/needs.
Primary care teams can also be used for public awareness and education about childhood cancers.
Early detection is essential because cure rates in children are higher than for cancers in adults. Access to comprehensive health care can help improve survival.
The writer is a family doctor