Childhood cancer: from care to cure by cancer specialist Dr Sameer Kaul

The successful treatment of childhood cancer is one of the true success stories of our times. It is not that long ago that it was extremely distressing to work with children fighting cancer because they invariably died. It is therefore not surprising that the word “cancer” evokes more negative feelings than any other word in English literature. However recent advances over the past 20 years or so have changed the scenario dramatically. With early diagnosis and appropriate treatment, not only can most of these children be cured, they can also hope to live normal lives. The results of treatment for children are far superior to those of adults. The success achieved in the management of childhood cancer is often called the “medical miracle” of our times.

Childhood cancer is rare in comparison to cancer in adulthood. Only 1 child in 600 is likely to develop cancer before the age of 15. Again the pattern of childhood cancers is very different from that in adults. Blood cancers and cancers of the lymph glands are the commonest cancers in childhood followed by brain tumors. With optimal treatment upto 70% can be cured. For certain cancers (e.g. Hodgkins’ disease and Wilm’s Tumor the results can be as good as 80-90%). Unfortunately this is not the scenario in our country even when treatment is entirely affordable. The reasons are many but primarily include delay in diagnosis, inability to afford treatment and sub-optimal treatment being given even for families where costs may not necessarily be an issue. It is important to remember that the cost of treatment for some of the eminently curable childhood cancers is not very high and may be affordable for a significant proportion of patients. Also a number of organisations both nationally and internationally are putting in major efforts to help children fighting cancer. It may be a long time before we can offer appropriate treatment to all children fighting cancer. However, we have to make a start at encouraging early diagnosis, prompt referral to the specialist, and improving the quality of treatment being delivered.

Adult cancers in a large number of cases are life-style related (e.g. smoking, chewing tobacco/supari, alcohol etc.). Efforts can there be made to reduce the incidence of cancer by increasing public awareness about adult cancer and prevent it from happening. On the other hand the exact reasons why some children develop cancer are still unclear. In a very small proportion there may be a familial predisposition but by and large there is very little that can be done to prevent childhood cancer. Efforts therefore have to be directed at encouraging early diagnosis and developing facilities that provide appropriate treatment. It is an undeniable fact that that there is a huge hesitation even amongst paediatricians to entertain the diagnosis of cancer in children even when there are obvious pointers in that direction. The “caution signs” that must alert one to the possible diagnosis of cancer are:

• Persistent fever for no obvious reason

• Loss of appetite, weight loss

• Swelling in the neck, underarms, above the thighs

• Distension of the abdomen (stomach)

• Persistent headache associated with vomiting

• Severe anemia or bleeding from any site

• Bone pain

Presence of any of these may not necessarily mean cancer but should alert one to the possibility. The intensity of treatment and the overall chances of cure both depend on the stage of the disease. The earlier the diagnosis, better the results.

Children who survive cancer have their entire life to live. All efforts need to be made to decrease the chances of any disabling long-term side effects from the treatments. All modern treatment protocols take this into account. It is also important to bear in mind what a small child burdened with the diagnosis of cancer must go through. The whole experience can be highly traumatic for them. Efforts therefore need to be made to minimise this trauma as far as possible. However hiding the diagnosis from them is not the answer. Often families do this to protect the children. It is a fact, though, that when the truth is hidden from children, what they tend to think and believe is far worse than the truth. The correct approach therefore is to be honest with them but positive. It amazes all parents how well children cope with the truth and hardship. Their courage in adversity gives tremendous strength to the parents to cope.

In summary, a large proportion of childhood cancers are curable. Even when they are not curable a lot can be done to prolong their life and also ensure that they do not suffer any distressing symptoms. The media also has to play its role. Popular hindi movies and television serials continue to treat cancer as a death sentence. This is far from the truth especially for children. There is a glaring need to change this attitude. Where treatment is feasible there is no reason for us to have results inferior to anywhere in the world. As doctors working with these children we believe that “if we care enough, we will cure enough”. There are plenty of survivors even in our midst to tell the tale that this battle can be won.