Increasing cancer incidence and improving childhood cancer survival

When previously healthy, active three-year-old Sadana (name changed) was diagnosed with Acute lymphocytic leukemia (ALL), family was completely shattered , listening to the problem. Because of the common belief in the public on cancer, they couldn't believe initially that it does carry more than 80 to 85 % chances of cure. She came with a history of fever and pain in joints and legs . Her initial investigations and treatment options did not reveal a definite diagnosis and treated symptomatic treatment. Later she started dropping blood counts, got diagnosed as ALL and was treated for the same. She has over three years off treatment and is leading an everyday life .

Overall cancer is increasing in incidence across the world and in India as well. Pediatric cancer accounts for 7 to 10 per cent of all cancers annually. Ten years ago, around 40,000 new cancers were diagnosed in children yearly, but now more than 55,000 new cases are getting diagnosed and adding to the existing pool.

In the last two decades, the incidence of cancer doubled, partly because of the true incidence going up and somewhat secondary to better awareness of the problem in the general public and early diagnosis as people reach out to centers where diagnosis and treatment are available. Thankfully, many childhood cancers are highly treatable, provided they are diagnosed on time and treated in an appropriate centre where facilities and expertise to manage these children are available, which includes pediatric oncologists, pediatric surgeons, critical care teams, other subspecialties like pediatric neurology, trained and competent nursing staff, dieticians, psychologists etc.

In the last three decades, common pediatric cancer like acute lymphoblastic leukemia survival rates improved from 20% to more than 80%. In children, cancers are more common in boys compared to girls. The most common childhood malignancy is acute leukemia, also called commonly as blood cancer( 30 to 35 % of total childhood cancers) followed by brain tumours, neuroblastoma, lymphoma( lymph nodes), Wilms Tumor(kidney), rhabdomyosarcoma (muscle and soft tissue) and others. Cancer symptoms depend on the type, site and stage of cancer. Common symptoms of the most common cancer, i.e acute leukemia include unexplained fever, pallor, bleeding, and bone/joint pains.

Symptoms of solid tumors mainly depend on the site, like brain tumors present with headache, vomiting, seizures, altered sensorium etc. Where tumors arising in the abdomen generally present with abdominal distention, pain and other symptoms. Initial evaluation with complete blood counts and blood smear examination will raise the suspicion of acute leukemia, which should be confirmed with a bone marrow examination. Also, doing genetic tests on this sample will help in the risk stratification of these cases. Other cancers, like solid tumors, require local imaging followed by confirmation with biopsy, and histopathology examination.

urther staging of solid tumors is done with scans like PET scan, Bone marrow examinations etc. Principles of managing these childhood cancers are the same across the countries, but chemotherapy protocol varies slightly as per the research done locally and the local requirement. Management is divided into specific treatment, which includes chemotherapy, surgery and radiotherapy where it is indicated and supportive care. In addition to chemotherapy, supportive care provided during management is very important. This includes safe use of blood products, and timely and effective management of infections with antibiotics and antifungals. Preventive measures – for infection prevention, good nutritional support, safe blood products, appropriate antibiotics and antifungal usage - play a key role in supportive care.

Other measures like pain control, psychological support, and actively engaging the family in the care of their children are very important. However, even in developing countries like ours with combined multimodal treatment in an appropriate centre, where children are handled carefully, one can achieve results at par with western countries and many children are becoming long-term survivors leading everyday life.

(The author is a

Pediatric Hematologist & Oncologist MD (Peds), DNB, MRCPCH (UK), Fellow Ped.Hemato-Oncology and BMT (UK) Rainbow Children's Hospital, Banjara Hills

Phone : +91 8882 046 046)