Cancer is a malignant disease that causes an improvised cell proliferation in the body, destroying the tissue from which it originated and can spread to the regional and distant tissues. As a result of the proliferation of cells in various organs, organ tumors occur. 

As with many other diseases, cancer has various types. For instance, the tumor that occurs in the retina layer of the eye is called retinoblastoma and tumors originating from the liver are called hepatoblastoma and hepatocarcinoma. The type of cancer in which blood cells proliferate is called leukemia (blood cancer).

Cancer is not contagious or a parent-transmitted disease. Although there are rare familial cancers, their number is limited.

Causes

Although the causes of many types of cancer have not been determined yet, it is known that genetic, environmental and individual factors play a role in the formation of some types of cancer. The main causes are:

• Exposition to chemicals such as, asbest powder, benzene, etc. and radiation
• Smoking and alcohol use
• Genetic causes and diseases that predispose to cancer (neurofibromatosis etc.)
• Immune system deficiency
• Exposition to sun
• Pesticides

Symptoms

Fever, fatigue, respiratory problems, cough, lumps or areas of swelling that can be felt under the skin, leg pain, headache, vomiting, sudden imbalance while walking, strabismus, hematuria may be symptoms of cancer.

Cancer Prevention

We should not forget that we have to take precautions to prevent cancer rather than fear of cancer.

• Do not consume hormone-manipulated foods. 
• Stop smoking, be careful not to be in a smoking environment.
• Consume plenty of fresh healthy fruits and vegetables of the season.
• If you are 50 or older, reduce your red meat consumption but do not be a vegeterian, consume red meat at least 4 days a week. Other days, eat fish, chicken, pasta, peas, lentils and salads.
• Do not prefer frozen foods.
• Try to exercise many days of week.
• Investigate the cancer risk in your family and get regular cancer screenings if necessary. 
• Get Hepatitis B vaccine, pay attention to avoid viral diseases.
• Avoid pesticides.
• If you drink alcohol please do it moderately, avoid excessive drug consumption and sun exposure.
• Be sure to have a doctor check-up once a year.
• Measure your vitamin D level, if it is deficient, take vitamin D under doctor’s control. Excessive D vitamin intake may cause renal deficiency.
• Pay attention to signs of cancer. Lumps and glands on the breast or anywhere on the body, extreme paleness or fatigue, persistent bone pain, joint pain , extreme loss of appetite, weight loss, persistent cough or trouble in breathing, hoarse voice, changes in bowel or bladder habits, constipation, diarrhea or bleeding, hematuria, difficulty in  swallowing, indigestion, distended abdomen, skin changes such as jaundice, darkening or redness of the skin.

Malnutrition 

Some of the preventable cancers have also been associated with diet. For instance, unbalanced diets, especially excessive consumption of red meat are associated with colon cancer in the elderly. However, for children red meat is a very important food as a source of protein and iron and cannot be excluded from the diet; therefore, in addition to red meat, eating fish and green vegetables should be emphasized. Consuming foods with fibres reduces colon cancer in the elderly. Taking vitamins naturally, from fresh vegetables and fruits instead of vitamin supplements is much better for our bodies. For this reason, it would be correct to focus on natural herbs and fruits as much as possible in our nutriotion habits.

Smoking 

The most frequent and absolutely preventable cause of cancer is smoking. Smoking, which is responsible for 90% of lung cancers, is blamed also as a cause in one third of cancers of the mouth, pharynx, larynx, liver, colon, kidney, urinary tract, prostate and female tract. Children who are passively exposed to smoking, as result of their parents’ smoking habit, are also at risk.

Alcohol

 It is certain that the cancer risk increases in alcoholics. Head-neck, pharynx, larynx, esophagus, stomach, liver and pancreas cancers increase in parallel with alcohol consumption. Laryngeal cancer rate in both alcohol and cigarette consumers is 100 times higher than the normal non-drinking, non-smoking population.

Stress 

It is believed that stress causes cancer. In fact, stress increases consumption of alcohol, cigarettes and food in many people. It may be possible to avoid stress to a certain extent by adopting a healthy lifestyle. Keeping strong family and friend relationships and support is also one way to deal with stress.

Inactivity and Obesity

It has been shown in statistical studies in the USA that exercise prevents colon cancer. The exercise involved here is not a heavy exercise but exercises such as brisk walking, gymnastics, swimming or climbing stairs. It should be done 2-3 times a week for at least 20 minutes and should be continued as a lifestyle.

Carcinogenic Additives

Research on the carcinogenic effects of additives is ongoing and some additives have been proven to have carcinogenic effects. Avoiding additives as much as possible and consuming natural foods is highly recommended. It is also recommended to read packaging carefully before purchasing any food item for a healthy lifestyle.

Cancer in children is 100 times less common than in adults. In other words, only 2-4% of all cancers are diagnosed in children. 120 out of 1 million children a year develop cancer.  Childhood cancers most frequently occur in the first 5 years and 10-15 years of age.

Distribution of Childhood Cancers

Leukemia 30%

Lymphoma 20%

Central Nervous System Neoplasms 10-15%

Neuroblastoma 7-8%

Wilms’ Tumor 6-7%

Rhabdomyosarcoma 5-6%

Bone Tumors 4-5%

Germ Cell Tumors 3-4%

Retinoblastoma 2-3%

Liver Neoplasms 1%

Leukemia constitutes 30% percent of childhood cancers in Turkey and all around the world. Among the remaining 70%, lymph node cancers (Hodgkin’s and non-Hodgkin’s lymphoma) rank second in our country. They are followed by respectively nervous system tumors, neuroblastoma, Wilms tumor, and soft tissue sarcomas (rhabdomyosarcoma). Bone, skin, eyes, and liver tumors are rarer in children.

Recovery Rates

One of the characteristics of childhood cancers is that they proliferate and grow very rapidly. In a few weeks, they grow and become apparent. As they grow rapidly, they are also sensitive to drug therapy (chemotherapy) and radiation therapy (radiotherapy). Therefore, two-thirds of childhood cancers are completely cured. In childhood cancers, surgery, radiotherapy, and drug treatments are usually used in combination. Usually, when 2-3 years have passed after the end of treatment without ant tumor recurrence, we consume that the patient has completely recovered.

While in 1960, 5% of childhood leukemia could be cured, today 75-80% of childhood leukemia can be treated successfully. Hodgkin’s disease, which is a malignant disease of the lymph nodes, is 90% and non-Hodgkin lymphoma disease is 75% cured. Bone tumors osteosarcoma and Ewing sarcoma can be cured by 60% if diagnosed early, and Wilms tumor of the kidney is cured  by 90%.

Recovery Rates for Childhood Cancers

ALL (*) 80-90% (standard risk)

70-80% (moderate risk)

40-50% (high risk)

AML (**) 60-70% (APML>95%)

Hodgkin 90%

Non-Hodgkin Lymphoma 80%

Retinoblastoma 90%

Neuroblastoma 50%

Wilms tumor 90%

Osteosarcoma 70%

Rhabdomyosarcoma 70%

Ewing Sarcoma 65%

Medulloblastoma 70-80%

(*) Acute lymphoblastic leukemias (ALL) are treated with chemotherapy. Bone marrow transplantation (BMT) is applied to 10%.

(**) 50% of acute myeloblastic leukemias are treated with chemotherapy, the other 50% are treated with bone marrow transplantation (BMT) in addition to chemotherapy. APML acute promyelocytic leukemia.

Causes and Prevention 

It is known that structural and environmental factors play a role in childhood cancers as well as in adult cancers. Familial predisposition, congenital diseases, congenital anomalies, gene disorders, immune system disorders are the main structural causes.  Environmental reasons include; physical (radiation), chemical (medicine, industrial agricultural products), viruses, and nutrition. Since consanguineous marriages are an important factor in childhood cancers, one of the main ways of protection is to prevent consanguineous marriages.

In terms of cancer and many other diseases, the necessary precaution for the child is to have a strong immune system beginning from birth and all childhood vaccinations should not be neglected.

Early Diagnosis

Early diagnosis is very significant in children, as in adults.

• When you notice an enlarged lymph node, anemia, abdominal distension, abnormal lump in any tissue in a child, immediately consult a doctor and make the necessary investigations.
• If the patient has symptoms such as pallor, spot bleeding or bruises on the skin, weakness, fatigue, bone pain; If the spleen, liver, and lymph nodes are enlarged, leukemia should come to mind first. In this case, a blood test and a bone marrow test are performed immediately, if necessary, for a definitive diagnosis.
• If lymph nodes growth is accompanied by symptoms such as fever, night sweats, weakness, weight loss, and itching, Hodgkin’s disease should be considered. The diagnosis is made by biopsy from the lymph node.
• In young children, if there are symptoms such as a painless abdominal mass, small swelling (nodule) under the skin, cough or fever, pallor, single or double-sided protrusiveness of the eyes and bruising around the eyes, bone pain, a tumor caused by the adrenal gland or sympathetic nervous system called neuroblastoma comes to mind. The diagnosis is made by biopsy or bone marrow examination, vanillylmandelic acid in urine (VMA test).
• Symptoms such as a painless abdominal mass or, rarely, abdominal pain and swelling, blood in the urine, the absence of the iris , ( the colored layer of the eye), should suggest a kidney tumor (Wilms tumor) in a young child. Diagnosis is made by imaging methods (MRI or CT) and biopsy.
• Symptoms such as swelling in the liver area, jaundice, nausea, vomiting, weight loss should bring to mind a liver tumor. In this case, a substance called alpha-fetoprotein (ALP) in the blood will be detected as increased. The diagnosis is made by biopsy.

Treatment

Surgery

Surgical methods in childhood cancers are usually used for removing the tumor if the tumor is confined to the organ where it originated. However, if the tumor is too large to be removed or if it has spread to other tissues (metastasis), then a tru-cut biopsy of the tumor is performed, and the tumor and/or metastases are tried to be destroyed by chemotherapy first. After the tumor shrinks and metastases disappear, the tumor residue is surgically removed.

Chemotherapy

Chemotherapy is executed by giving chemotherapy drugs by mouth orby injection through vessels at regular  intervals. Sometimes drugs can also be administered into the spinal cord or into the cerebrospinal fluid; this is called Intrathecal Therapy.

Duration of chemotherapy varies according to the treatment schedules applied. In periods ranging from 2-3 days to 7-8 days, there is combined use of drugs in blocks. The duration of chemotherapy usually ranges from 6 months to 2 years.

Drugs used in chemotherapy have some side effects, but these effects are temporary and can be successfully prevented with some medications. During chemotherapy, the child becomes quite sluggish,  nausea, vomiting, bone pain may be observed. The most obvious external side effect of chemotherapy is hair loss. Children should be informed that their hair will begin to grow as soon as their treatment is finished.

Hygiene becomes very important during this period because the risk of infection increases as an effect of chemotherapy. Therefore, usually it is useful for school-age children to stay away from school for a while. But if chemotherapy is a mild treatment that does not drop  the child’s blood cell levels and immunity  too much, there is no harm for him or  her to go to school.

Radiotherapy

Radiotherapy is a form of treatment applied in the form of direct radiation to the area where the tumor is located. Radiotherapy is used as little as possible in children, it is not the first choice of treatment, except for compulsory cases, because it may lead to developmental disorders especially in growing bodies. If the school hours are adjusted, there is no harm in the child going to school during the radiotherapy period.

Follow-Up After Treatment

Generally, 2-3 years after stopping treatment there is  a risky period for recurrence in the majority of tumors.To detect a recurrence early can increase the chances of success in the treatment. During this period, it is necessary to visit the doctor at monthly or 2-3 months intervals and to repeat blood and imaging tests.

In addition, after the risk of recurrence has passed, follow up may be required to follow up the late effects of treatment like thyroid gland insufficiency, short stature, menstrual irregularities, heart muscle, kidneys and hearing problems, or psychological disorders that can occur.

Environmental Factors

The negative effects of environmental conditions on human health are a known fact. Improving environmental factors is directly related to a healthier life for both today’s children and future adults. The primary solution is to raise the awareness of individuals about the importance of the environment. It must be the goal of our society for a better future.