I remember Charles (name changed) very well. He was my patient when I was training to become a paediatrician. Patients with cancer usually stayed on the ward for a long time and we usually grew fond of them. Charles had retinoblastoma (cancer of the eye). He came to the hospital with advanced disease and we sadly, lost him.
During my training, there were times when caregivers or parents who were told that their wards had cancer protested and said their children could never get cancer. It usually took repeatedly counseling to get them to accept the diagnosis and agree to treatment. Their reaction was quite understandable. Cancer is a hard pill to swallow. But as unpleasant as it sounds, the harsh truth is that, children can get cancer too. Fortunately, 75 to 85% of childhood cancers are curable when detected early and treatment, commenced early.
Cancer is abnormal multiplication of cells in the body. The cells in the body are programmed to be able to regulate their multiplication and growth. They are also programmed to repair unwanted changes in the DNA and get rid of cells with such changes that cannot be repaired. A cell can lose its ability to do this due to mutations in that cell or as a result of an existing genetic condition that makes the cell susceptible to errors during multiplication. And when cell multiplication and growth get out of control, cancer can occur.
So though the direct cause of cancer largely remains unknown, there are certain risk factors that can increase a child’s chance of getting cancer.
These risks include infection by viruses like HIV and Ebstein Barr virus as well as exposure to ionising radiation and pesticides. Majority of patients however don’t have any identifiable risk factor.
Globally, if 500 children were followed for 15 years, 1 of them will get cancer. From this data, it can be estimated that in Ghana, about 1200 children get cancer every year. However, just about a third of this figure report to the two childhood cancer centres in the country. A very worrying statistic. Technically, cancer can occur in any part of the body in children but the four commonest ones seen in Ghana are lymphoma, leukemia, retinoblastoma and kidney cancers.
Signs and symptoms seen in a cancer patient depend on the type of cancer.
Kidney cancers (nephroblastoma) usually present with enlargement of or a mass in the abdomen, bloody urine and hypertension.
Eye cancer (retinoblastoma) can present with a white spot in the pupil, a new squint, impaired vision, blindness and protrusion of the eye.
Cancer of the blood (leukaemia) usually presents with persistent or recurrent fever, weight loss, abnormal bleeding, anemia and bone pain.
Brain cancer can occur in children too and may present with persistent headaches, nausea, vomiting, problems with walking and balance, speech and visual impairment.
Lymphoma can present as a painless swelling of the lymph nodes or as a swelling of the jaw or testes.
A type of cancer which is usually seen in toddlers is neuroblastoma. This has a variety of symptoms and they include persistent diarrhoea, fever, hypertension, bleeding tendencies, bulging eyeball and darkening around the eyes.
Bone cancer is usually seen in adolescents. Liver cancer can occur too, though uncommon.
The diagnosis of cancer is made after thorough questioning (history taking), careful examination of the patient and a variety of lab tests.
The duration of treatment depends on the type of cancer and how advanced the disease is. Regular follow up is necessary for patients even after achieving cure. Sometimes, relapse occurs. A lot of cured children are however able to continue their education and engage in regular activities.
Contrary to what some people believe, cancer is not infectious. Children with cancer and their families should be shown love and given financial support.
In this month of September, as we create awareness on childhood cancers, let us remember that early detection and early treatment help to achieve complete cure. Let us remember that cancer is not infectious. Let us remember that children with cancer should be shown love and are not to be stigmatised. Let us remember to say a prayer for them and their families.
Written by Dr Gloria Amponsah-Kodua,
a paediatrician and executive director ( healthy kids foundation )