Childhood cancer may be rare, but it still continues to be the leading cause of childhood mortality in many countries. Since the symptoms of childhood cancer are often nonspecific and hard to detect, delays in diagnosis and treatment are common. India, unlike many developed nations, has a 94% survival rate for children with early-stage cancers like Hodgkin Lymphoma disease. Unfortunately, there’s hardly any awareness about childhood cancers – a condition that affects millions of children.
Most people don’t even know that adult cancers are vastly different from childhood cancers. Children’s bodies respond to cancerous cells and cancer treatments very differently. Most cancer research available today is based on adults. Thankfully, recent advancements in medical research have helped cancer care teams understand childhood cancer better. As childhood cancers were rare many co-operative research groups have worked together which has resulted in major improvements in the treatment. Thankfully, the chance of recovery for childhood cancer patients is currently very high and in fact far better than that observed in adults for the majority of childhood cancers.
Here’s the full, detailed guide on cancer in children – the types, symptoms, where it occurs, and how it’s treated.
In This Article
- What is Cancer?
- Where do Childhood Cancers Occur?
- Types of Childhood Cancer
- Causes of Cancer in Children
- Symptoms of Childhood Cancer
- Diagnosis of Cancers in Children
- Treatment of Cancers in Children
- Late and Long-Term Effects of Cancer Treatment
- Differences Between Adult Cancer and Child Cancer
- How Does Cancer Affect the Children and the Family?
- How Can Parents Reveal to the Child About Their Cancer?
- Helping the Child Cope With Childhood Cancer
- FAQ’s
What is Cancer?
Cancer is a cellular level disease. Every inch of our body is made of basic building blocks called “cells.” These cells can be categorized into – bone cells, skin cells, blood cells, etc. based on the tissue they are present in. Our bodies naturally grow and replace cells. The new cells replace the old cells. That’s why many skin injuries heal themselves. Skin cells naturally grow and replace dead or damaged cells and a similar process occurs after surgery to heal the wound. Cell multiplication is an orderly process and is strictly controlled by several genes. However, this process can go wrong, and cell production/replacement mechanisms can become abnormal in some people.
Anomalous cells typically keep dividing to make more anomalous cells out of control due malfunctioning of critical genes. They can even gather to form swellings or tumours. Malignant tumours are the ones that become cancerous and spread to other regions of the body (benign tumours don’t). Since we’re made of cells, any region of the body can be the starting point of anomalous cancer cells.
Where do Childhood Cancers Occur?
Childhood cancers usually occur in different regions of the body compared to adults. Adult cancers are likely to impact the lungs, pancreas, colon, breasts, and prostate. These cancers almost never occur in children. Common childhood cancers such as Leukaemia, brain tumours, lymphomas, etc., also occur in adults. But childhood cancer treatment is vastly different to adult cancer treatment.
The type of cancer a patient is diagnosed with depends on the original type of cell from which their cancer starts (skin, brain, blood, etc.). This is determined by analysing the properties of the cancer cells. The types of cancers with known origin points (organs from which they arose originally) are called primary cancers. When the origin points of cancer can’t be detected by doctors, the condition is called “cancer of unknown primary.” Most childhood cancers are blood cancers (Leukaemia, Lymphoma, etc.) Other types of cancers like the brain or spinal cord tumours or Neuroblastoma are rarer, but they do happen.
Types of Childhood Cancer
Cancers that affect kids can be of many different types. Here we list the types of cancers that children get.
1. Leukaemia
This cancer affects the bone marrow, the chief blood-producing tissue in the body. Bone marrow can be found inside various bones. It produces platelets, red blood cells (RBCs), and white blood cells (WBCs). Children suffering from leukaemia experience abnormal cell developments in their bone marrow. These abnormal cells are called “leukemic.” Leukemic cells are underdeveloped, multiply very fast but fail to mature into functional adult cells. . They crowd the narrow spaces inside and around the bone marrow, preventing the healthy production of RBCs, WBCs, and platelets.
Children typically suffer from two main types of Leukaemia.
A) Acute Lymphocytic Leukaemia (ALL)
ALL is the most common form of childhood leukaemia. Leukemic WBCs (Lymphoblasts) overtake the production of healthy blood cells in children’s bone marrow. ALL in children is typically detected between the ages of 3-5 but can occur any time during childhood.
Acute Myeloid Leukaemia (AML) is a much rarer form of childhood leukaemia. This condition causes the under-production of healthy blood cells. Instead of healthy RBCs, WBCs, and platelets, the patient’s bone marrow produces myeloid cells, a different type of cancerous early white cells.
Leukaemia is a cancer of the blood and bone marrow. It accounts for about 30% of all childhood cancers in the world. ALL is more common than AML. Both these conditions have similar symptoms (joint pain, pale skin, weight loss, etc.) but different treatments. For instance, AML develops very rapidly. Giving the patient chemotherapy as soon as AML is detected is vital. Chronic Lymphocytic Leukaemia, another type of Leukaemia, affects mostly adults.
[Read : Leukaemia in Children]
B) Lymphoma
This is another form of blood cancer, and it starts from more mature white cells. It originates in the body’s WBCs (scientific name – lymphocytes). Lymphoma can affect the WBCs in the child’s spleen, lymph nodes, or thymus glands. Patients’ “lymph systems” become overburdened with the cancerous cells, leading to severe damages to the networks that carry/produce WBCs.
There are two main types of Lymphoma that impact children.
a) Hodgkin Lymphoma
Approximately 3% of children in the world with cancers suffer from Hodgkin Lymphoma. Typically, children between the ages of 5-14 get this disease. Thankfully, the majority of the children with this cancer do very well. Children and adults with Hodgkin’s lymphoma experience similar symptoms and require similar treatment.
b) Non-Hodgkin Lymphoma
Approximately 5% of children in the world with cancers suffer from non-Hodgkin Lymphoma. Children as young as three are at risk of getting this cancer. Unlike Hodgkin Lymphoma, the treatment for non-Hodgkin Lymphoma is different in children and adults. This form of cancer is also known for growing rapidly. Thankfully, children who receive intense treatment respond well compared to adults suffering from non-Hodgkin lymphoma.
2. Brain Tumours
Brain tumours are also common causes of childhood cancers and account for almost 25% of all childhood cancers. In most cases involving brain tumours in children, the tumours start in the lower regions of the brain. For instance, their brain stems may experience abnormal, cancerous tumour growth. These tumours initially cause dizziness, vomiting, severe headaches, double vision, new-onset squint, new-onset difficulty in walking or balance and sudden behavioural changes. Outcomes depend on the type, location within the brain etc.
3. Spinal Cord Tumours
Spinal cord tumours also affect children. They are not as common as brain tumours, and also affect adults.
The symptoms of spinal cord tumours include –
- Blurred vision
- Dizziness
- Trouble walking
- Difficulty handling objects,
- Loss of bladder and bowel control
Treatment for spinal cord tumours is different for adults and children.
4. Neuroblastoma
Neuroblastoma is a form of primitive nerve cancer. Nerve cells inside developing embryos or foetuses may develop cancerous nerve cells. This condition is relatively rare in children above the age of 8-10. It mainly affects infants and children under the age of six. Neuroblastoma tumours typically originate in the child’s abdomen. They manifest as an odd swelling.
Some symptoms of Neuroblastoma include
- Severe bone pain
- Constant fever
- Dizziness
- Nausea
- Vomiting, Irritability
- Weight loss
5. Wilms Tumour(Nephroblastoma)
This condition typically affects children aged 3-4. It originates in their kidney/s. This condition doesn’t affect adults or older children. Nephroblastoma manifests itself as lumps in the child’s belly.
Some common symptoms of Nephroblastoma include
- Blood in the urine
- Loss of appetite
- Nausea
- Fever
- Stomach pain
6. Rhabdomyosarcoma
This form of cancer affects the child’s skeletal muscle cells and soft tissues. These are the cells that enable us to move our body parts. Rhabdomyosarcoma can originate on any muscle cell – from the neck to the pelvis. Some symptoms of this cancer include – swelling in certain regions of the body, bone pain, loss of movement, etc.
7. Retinoblastoma
This form of cancer affects the child’s eyes. Retinoblastoma is relatively rare. It mainly impacts children aged 3-6. The risks of children older than 6 developing Retinoblastomas is rare. Doctors typically spot symptoms of Retinoblastoma during routine physical check-ups. If they notice abnormalities in the child’s pupil, they recommend further diagnosis. Children with Retinoblastoma have pupils that turn white or pink.
8. Bone Cancers
Primary bone cancers can develop at any age. But they mostly impact older children. Ewing sarcoma, a rarer version of primary bone cancer, affects teenagers. It can originate in the teen’s leg bones, shoulder blades, hip bones, or ribs. Symptoms of Ewing sarcoma include – severe bone pain, bone swelling, and loss of movement.
Osteosarcoma is another type of primary bone cancer that mostly affects teens. It grows in areas of the body, experiencing rapid bone growth. For example, the arm bones of young children grow rapidly. Children with Osteosarcoma will experience severe pain in their arm bones. This pain worsens at night and also causes lumps in the affected areas.
[Read : Blood Cancer in Children]
Causes of Cancer in Children
The exact causes of most cancers in children are not known. However, scientists have noted that certain genetic-level changes may lead to the irrepressible growth of cancerous cells in children’s bodies.
Some common suspected causes of childhood cancers include
- Inherited gene mutations
- Acquired gene mutations
- Combination of inherited and acquired gene mutations
- Inherited immune system conditions (e.g., Schwachman-Diamond syndrome)
- Immune System Suppression due to other intensive treatment (e.g., organ transplants)
- Having Siblings or parents with Leukemia
- Having parents with smoking/alcohol addictions
- Excessive exposure to UV rays, radiation, or cancer-causing chemicals.
Symptoms of Childhood Cancer
Since childhood cancers are very rare, doctors don’t recommend early screening tests. That’s why parents need to look for certain symptoms of childhood cancer. Parents with a history of cancers in the family should be extra careful and go for regular medical check-ups.
They must look for the following early signs of cancer.
1. Leukaemia (ALL and AML)
Fatigue, prolonged fevers especially more than 2 weeks with no identified cause, recurrent infections, anorexia, anaemia, and gingival bleeding.
2. Brain and Spinal Cord Tumours
Persistent early morning headaches, nausea, vomiting, new-onset squint, behavioural changes, difficulty in walking, seizures, and developmental delays.
3. Lymphoma (Hodgkin and Non-Hodgkin)
Fevers, Night sweats, abnormal weight loss, nausea, vomiting, and abdominal pains.
4. Neuroblastoma
Anorexia, bone pain, back pain, irritability, and abdominal pains.
5. Ewing Sarcoma and Osteosarcoma
Localized bone pain, pathological fractures, prolonged fevers, fatigue, weight loss, etc.
6. Retinoblastoma
Squinting, vision loss, white colour in the central circle of the eye (pupils), fevers, etc.
Diagnosis of Cancers in Children
The diagnosis of childhood cancers varies based on several factors. They include – the child’s age, the type of cancer suspected, the symptoms, the severity of the symptoms, and pre-existing medical conditions. The cancer care team will review the child’s medical history and order imaging, urine, or blood tests. If abnormal tumours are found inside the child’s body, the doctor may conduct biopsies.
Treatment of Cancers in Children
Childhood cancers based on the type of cancer will be dealt with differently. They’re categorized on the basis of the immediate health risks faced by the child.
In general, childhood cancers are treated far more aggressively than they would be in an adult. As children’s organs are young and healthy, they tolerate aggressive treatment well which translates into improved outcomes compared to their adult counterparts. These treatments generally may last from 6 months up to 3 years based on the diagnosis. Based on the diagnosis and the stage of the disease it may involve only surgery or chemotherapy or any combination of surgery, chemotherapy and radiotherapy.
Late and Long-Term Effects of Cancer Treatment
Some youngsters who’ve beaten cancer may experience the following long-term effects in their bodies
- Impaired fertility
- Increased risk of developing other cancers
- Heart problems
- kidney problems
- Lung problems due to chemotherapy
- Hormone deficiencies
- Pain and swelling in certain body parts
- Developmental issues
Differences Between Adult Cancer and Child Cancer
The effects of all types of cancer vary depending on the age of the patient. That’s why adult treatment plans for cancer are vastly different to paediatric cancer treatment plans. Parents with children who suffer from cancer must know that most cancer research and treatments are focused on adults. When they look for information, they should focus on children-specific information. They must find a specialist team of paediatric oncologists to better understand their children’s condition.
Here are the main ways in which adult treatment plans for cancer differ from paediatric cancer treatment plans
1. The Biological Impact of the Cancer
Most adults who get cancer get it due to external, environmental reasons. For instance, exposure to certain chemicals due to smoking is a leading cause of adult cancers. Most children don’t get cancer due to external factors. Instead, childhood cancers develop in fundamental cells like bone cells or blood cells due to genetics-related causes and arise from primitive embryonic cells. That’s why childhood cancers are also harder to detect. The symptoms of childhood cancer often manifest themselves as symptoms of other common childhood diseases.
2. The Rate of Impact
Childhood cancers are thankfully significantly less common than adult cancers. Childhood cancers account for a very small share of all cancer treatments in the world.
3. Causes
Most adult cancers are caused due to external, lifestyle-related reasons. The most common lifestyle risk factors include – poor diet, excessive tobacco or alcohol use, and inactive lifestyles. Most childhood cancers have genetic roots. This does not mean that the cancers are inherited, and the majority of the childhood cancers arise as random events due to changes in the genetic material during cell divisions. Many of these deep-lying causes are the subject of intense ongoing research.
4. Treatment
Since childhood cancers are rare, it’s often hard for parents to find apt treatment in their local communities. That’s why parents must pick cancer centres specialising in children, children’s hospitals, or university medical centres for treatment options. Adults diagnosed with cancer find it easier to access treatment options in their local communities.
5. Prognosis
The rate of children getting diagnosed with cancers has increased in the past two decades. Thankfully, survival rates have also increased. In general, the survival rate for childhood cancers is much better than cancers in adults.
How Does Cancer Affect the Children and the Family?
Going through emotions is a standard part of being a cancer patient. Childhood cancers tend to emotionally affect entire families, not just the victims. Right from diagnosis to treatment to relapse –adjusting to living with cancer is not easy for children or their families.
Families and children may experience the following emotions during diagnosis and treatment.
1. Shock
The sense of shock may prevent parents from absorbing the information provided by their cancer treatment teams. They may fail to complete basic tasks or forget basic day-to-day responsibilities.
2. Fear
For many parents, fear fades away once their children start responding well to treatment. That’s why getting over the scary cancer diagnosis part and entering a fixed treatment routine is vital.
3. Denial
Knowing that your child has cancer is a life-changing fact. Many parents use denial to cope with this unbelievable fact as they’re overwhelmed by the shocking news.
4. Other Emotions
Other emotions also arise during the diagnosis and persist for several months include – anger, anxiety, guilt, stress, and depression.
Hope is the only antidote to these emotions. Being hopeful doesn’t mean having an unrealistic picture of the future. It’s about making the best treatment decisions for the child, believing that the condition is curable. Given the current increases in survival rates for children with cancers, parents have plenty of reasons to be hopeful.
How Can Parents Reveal to the Child About Their Cancer?
Discussing the disease with the affected children is very important. Children deserve to hear about their conditions from their parents. Learning about their disease from another source may be a more painful experience.
Here are steps concerned parents can take to discuss this sensitive issue with their children.
- Practice what you want to say.
- Use simple, direct words.
- Don’t create a feeling in your child that his or her treatment should be a “family secret.”
- Learn about their understanding of cancer, hospital treatments, etc. How much information you provide about cancer depends on the age and maturity of the children.
- Comfort younger children by telling them they’re not at fault for their illness.
- Your paediatric oncologist can help you in gently breaking the news to the older child if the family feels uncomfortable.
- Teenagers and older children feel much more in control and cope better with the treatment if they are aware of what is going on with them than being kept in the dark
- Parents must exercise patience as soon as they learn about their children’s conditions.
- There are several helpful sources of information created by parents who’ve had similar experiences. Getting access to such resources or having face-to-face discussions with such parents can be immensely helpful.
Helping the Child Cope With Childhood Cancers
It’s normal for children to feel anxious/stressed when they discover they have cancer or during treatment. Doctors recommend children with cancers take part in – relaxation exercises, meditation, yoga, Tai chi, and physiotherapy. Pursuing hobbies and interests also helps balance out the stresses of treatment.
A child being affected by cancer is a tough time for the child as well as the family. Fortunately, with advances in medical science, diagnosis methods and treatment options have vastly improved. Early detection and timely treatment will provide a complete cure in most cases.
[Read : Stem Cells Uses, Importance, and Potential Medical Applications]
FAQ’s
1. What Are the Early Signs of Bone Tumours?
Worrisome symptoms of bone tumours include severe pain in the limbs, swelling, and rapid weight loss.
2. What Are My Child’s Chances of Recovering From Cancer?
In general, all childhood cancers have a high cure rate that can be more accurately predicted after the diagnostic workup is completed.
3. Will My Child Need Operations?
Depends on the treatment plan. Don’t worry – doctors inform parents about potential operations in advance. Paediatric Anaesthesiologists ensure children undergo invasive treatments safely.
Read Also: Bone Marrow Transplant For Children by Dr. Stalin Ramprakash
