Cancer in Children

Cancer developes 100 times less in children than in adults. In other words, the 2-4 percent of all cancer cases are seen in children.

Every year, cancer is developed in 120 to 1 million children. Childhood cancer is mostly seen in the first five ages or in the ages of 10-15.

Distribution of childhood cancer

Leukemia 30%
Lymphoma 20%
Nervous system neoplasms 15-20%
Neuroblastoma 7-8%
Wilms’ tumor 6-7%
Rhabdomyosarcoma 5-6%
Bone tumor 4-5%
Germ cell tumors 3-4%
Retinoblastoma 2-3%
Liver Tumors 1%

30 percent of all cancer cases in Turkey and all around the world is leukemia. Of the other 70 percent, the second one in Turkey is Hodgkin’s and non-Hodgkin lymphoma. Then, nervous system tumors, neuroblastoma, Wilms’ tumor, soft tissue sarcomas (rhabdomyosarcoma) are seen respectively. Bone, skin, eye and liver cancers are not seen in children often.

Percentages of Recovery

One of the characteristics of childhood cancer is that it develops and grows very fast. They grow and become apparent in several weeks. Because of this high-speed, they are sensitive to drug therapy (chemotherapy) and radiotherapy. Hence, two out of three with childhood cancer recovers. In childhood cancer, surgery, drug therapy and radiotherapy are generally used together. Mostly, if two years have passed after finishing up with the treatment and the cancer has not reoccurred, this means that the patient is completely healed.

The 75-80% of childhood leukemia is being recovered nowadays, while this ratio was only 5 percentage in the 1960s. 90 percent of Hodgkin disease and 75 percent of non-Hodgkin lymphoma is being recovered. 60 percent of Osteosarcoma which is bone tumor and Ewing sarcoma is being recovered if they are diagnosed early and 90 percent of kidney tumor Wilms is being recovered.

Percentages of Recovery in Childhood Cancer

LALL(*)  80-90 %  (standard risk)
70-80 % (middle risk)
40-50 % (high risk)
AML(**)  35-55 %
Hodgkin  90 %
Non-Hodgkin Lymphoma  80 %
Retinoblastoma 90 %
Neuroblastoma  50 %
Wilms’ tumor  90 %
Osteosarcoma  70 %
Rabdomyosarcoma 70 %
Ewing Sarcoma  65 %

(*) Acute Myebloblastic Leukemia is being treated with chemotherapy. Bone marrow transplantation is used in 10 percent of them.

(**) 50 percent of Acute Myeloblastic Leukemia is cured with chemotherapy, in the other 50 percent, bone marrow transplantation is used with chemotherapy.

Causes and Protection

Like in adults, structural and environmental factors are important in childhood cancer. Genetic predisposition, congenital diseases, congenital anomalies, genetic defects, immune system defects are main structural causes. As environmental causes, physics (radiation) chemistry (drugs, industrial agricultural products), viruses and nourishment factors are important.

Because consanguineous marriage is one of the reasons of childhood cancer, one principal way of protection is to avoid consanguineous marriages.

Having a strong immune system from birth is crucial for a child to not get cancer, as well as other diseases. The main ones are proper diet, cleanliness and children vaccines.

Early Diagnosis

As it is for adults, the early diagnosis is also important for children. When a gland, anemia, abdominal distension or any widening in a tissue is noticed in a child, we should consult a doctor at once and the reason of it should be investigated.

If there are any symptoms such as heavy-breathing, dot-blot bleedings or bruises, exhaustion, tiredness, ache of bone; or if a spleen or liver gland widens, leukemia should be the first to be thought of. In this case, a blood test and if necessary for certain diagnosis, bone marrow test should be done.

In the case of the lymphatic gland widening; where symptoms like fever, night sweating, exhaustion, weight-loss or itching are seen, Hodgkin sickness must be thought of. Diagnosis is made by a biopsy of the lymphatic gland.

If there are symptoms such as a painless stomach bulk, little swelling under the skin (nodule), cough or fever, heavy-breathing, bulging eyes side by side or both and dark circles around eyes in little children, a tumor called neuroblastoma, caused by the sympathetic nervous system or the adrenal gland, is thought of. Diagnosis is made by a biopsy, bone marrow test or vanillylmandelic acid in urine (VMA) test.

Symptoms such as painless stomach bulk or rarely stomach ache and stomach bulk, blood in urine, iris’ non-existence should make you think of a kidney tumor (Wilms tumor) in little children. Diagnosis is made by using MR or BT and biopsy.

Symptoms such as bulk around liver, hepatitis, nausea, vomiting, weight-loss should make you think of a liver tumor. In this case, alfa-fetoprotein (ALP) in blood increasing will be noticed. Diagnosis is made by a biopsy.

 

Treatment

Surgical

Cancer in children is generally treated by taking the tumor out of the organ it is in, surgically. But if the tumor is too big to be taken out or has spread (metastasis), a section of it will be taken out surgically by a biopsy. Following this biopsy chemotherapy will be done to try and reduce the metastasis. When the tumor or metastasis has shrunk, the rest of the tumor will be taken out surgically.

Chemotherapy

Chemotherapy is done regularly by giving the pills orally or via veins. Sometimes it can be given through the spinal cord or brain-spinal fluid; this is called intrathecal treatment.

Spans of chemotherapy can depend on the schemes of the treatments. From 2-3 to 7-8 days in flux, pills should be taken as a bloc. Span of chemotherapy can change between 6 months and 2 years.

Pills given for chemotherapy can have side-effects but these effects are temporary and can be prevented successfully with some medication. During chemotherapy, children are generally very tired and exhausted; vomiting and bone aches can be seen. Chemotherapy’s most noticeable effect is hair loss. Children should be told that their shed hair will grow back.

Hygiene is very important during this period due to the increasing risk of infection, which is a side effect of chemotherapy. Generally, it will be better for the child to be kept away from school. But if the chemotherapy treatment is not too tough, it will not be a problem for the child to go to school.

 

Radiotherapy

Radiotherapy is the treatment that is done by applying ray to the main area that has the tumor. Radiotherapy is rarely applied to the children. Especially during the growth periods of children, radiotherapy is not the first choice as a treatment since it can cause mutations.

As long as it is suitable with class hours, there is no problem for the child to go to school during the radiotherapy treatment.

Generally, the 2-3 years after the treatment are important since there is a high risk of recurrence. The earlier the recurrence is diagnosed, the better it will be for the treatment. During this period, the doctor should be seen, blood and scanning tests should also be renewed monthly or at 2-3 months intervals.

Furthermore, after the risk of recurrence is overcome, late side effects that can occur due to the treatment such as thyroid insufficiency, shortness, irregular menstruation, problems for heart muscles, kidneys, hearing or psychological disorders should be fought or treated, so they need to be closely and carefully watched for.

Environmental Factors

Environmental factors’ negative effects on human health are well-known. Reinforcement of environmental factors is good for both today’s children’s and future’s adults’ healthy lives. One of the best solutions is making individuals aware of the importance of their environment.

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