Childhood Cancer

Childhood cancers are of different types compared to those that appear in adults, these cancer types appear in children and adolescents below the age of 15 years. Regardless, it is still one of the leading causes of death, even in high-income countries. Although around 80% of children with cancer have a chance to get cured in these nations, in nations with mid-level and low-level income the possibility of cure can vary between 15% to 45% [1].

India lies in the Low and Middle-level income countries group and as such, it is one of the countries to which childhood cancer is a burden due to disparity in healthcare accessibility, lack of skilled personnel, higher abandonment of treatment, and few other factors. Although much progress has been made over the past few decades, there are still numerous barriers that lie before the country is able to effectively reduce mortality caused due to childhood cancer. Presently, cancer is the 9th leading cause of death of children aged 5 to 14 years in India [2]. Lacking quality data about the cancer incidence rate for childhood cancer across the different states of India is one of the causes of poor cancer care management for childhood cancer. This data is mainly obtained from Population-Based Cancer Registries (PBCRS) and Hospital-Based Cancer Registries (HBCRS). As per this registry, the urban incidence rate is much higher compared to the rural incidence rate, which in some cases are non-existent. Similarly, the male to female ratio for childhood cancer in India is 1.56 suggesting gender discrimination against girl child that is a prevalent phenomenon in the greater part of Southeast Asian countries results in delayed healthcare treatment[3]. 

General Barriers for Effective Childhood Cancer Treatment

To improve the treatment of Childhood cancers it is necessary to understand the general barriers that prevent effective diagnosis and care in India, a few of which are as follows:

Barriers for Diagnosis

Childhood Cancers of most types can be effectively controlled or cured if the patient receives treatment at an early stage.  Some of the Barriers are

1. Lacking awareness about early signs and symptoms
2. Inaccessibility and insufficiency of essential healthcare facilities in India.
3. Depending on traditional or alternative treatment and expecting.

Deferred Diagnosis

Grassroot personnel lack expertise in detecting early signs of childhood cancer and often miss or misdiagnose it as tuberculosis. Absence of diagnostic facilities in lesser urban areas with addition to lack of skilled technicians especially for MRI facilities and immunophenotyping, lower the chances of detecting cancer at an earlier stage.

Barriers for Cure

Deny or Abandon Treatment

Fear, faith, financial difficulties, disappointing care, are few of the main reasons for patients denying or abandoning treatment for cancer. This is especially the case when patient is asked to undergo aggressive intervention such as amputation or enucleation. There are also patients that deny or are unable to undergo multiple painful surgical procedures such as those that include bone marrow treatment and intrathecal injection.

Types of Childhood Cancer

Childhood cancers are very different when compared to cancers in adults; since in adults the origin of cancer is related to the organs whereas, the origin of cancer in children is related the body’s tissues such as muscle, bone, lymphatic system, central nervous system, etc. Early diagnosis can be effectively administered only when one has sufficient awareness regarding the different types of childhood cancer. A few of which are as follows:

Blood Cancers

Blood cancer is caused due to abnormal cell activity in the production of blood cells.

• Leukemia

This disease produces a massive amount of white blood cells that creates a deficiency production of other necessary types of blood cells such as red blood cells and platelets. Acute Lymphoblastic Leukemia (ALL) is the leading type of blood cancer in children, in which the bone marrow produces too many undeveloped lymphocytes.

• Lymphoma

This cancer grows in the lymphatic system and are of two types: Hodgkin lymphoma and Non-Hodgkin lymphoma (NHL). While there are often cases of patents with Hodgkin lymphoma getting cure rates for those with Non- Hodgkin lymphoma are based on the subtype of their Lymphoma.

Tumour In Brain Caused by Cancer

Tumour in brain during childhood is formed due to abnormal cell growth in the tissues of brain and/or spinal cord. This tumour can be benign or cancerous in nature, benign tumours do not recur once removed whereas, cancerous tumour has a chance to recur after surgery.

Bone Cancer

This is one of the rarer categories of cancer. There are many types of bone cancer but bone cancers commonly found in children and adolescents such as, Ewing sarcoma and Osteosarcoma.

Neuroblastoma

Cancer of immature nerve cells is called Neuroblastoma and most often detected in young children. It usually develops in adrenal glands but then start to spread to the neck, abdomen, spine and chest.

Wilms’ Tumour

This cancer grows in the kidney of children usually of age two and four. These are different from adults’ cancer and has high chance of getting cured of detected and diagnosed early.

Rhabdomyosarcoma

This cancer develops in the muscles that are anchored to the bones and help the body in movement, however, this cancer can develop in more than a single part of the body. It is a soft tissue cancer often observed in children.

Retinoblastoma

It is a rare type of cancer that grows in the eye or more precisely the retina. It affects one or both eyes and is mostly observed in children aged less than five. Once detected cancer can be successfully cured.

Treatment

The right diagnosis is essential to decide the appropriate treatment plan for any given type of cancer and stop the extent to which it has spread. Following are few of the common cancer treatments available:

• Chemotherapy
• Surgery
• Radiation Therapy
• Immunotherapy
• Stem cell transplant

Palliative Care

Palliative Care doesn’t destroy cancer cells, but relieves symptoms of cancer. It is used to improve the patient’s quality of life when cure is deemed impossible. Although most childhood cancers can be cured based on circumstances, when it isn’t possible to cure, palliative care relives them of suffering. For childhood cancers palliative care is a fundamental requirement throughout their treatment period whether or not they have a curative intent. Palliation can be a part of curative treatment also, where there is a need to reduce symptoms such as pain, vomiting, fatigue etc.