Childhood cancer
Leukemia constitutes about a third of all cancer in childhood. The other most common malignancies are lymphomas and tumours of the central nervous system
Dina Farhana
Like other countries, Bangladesh is also going to observe the International Childhood Cancer Day (ICCD) today --- 15th of February 2020 --- as part of its global campaign to raise awareness and promote an increased appreciation and deeper understanding of the challenges faced by children and adolescents with cancer, the survivors and their families. ICCD reminds what our commitment and how much we have achieved till date according to World Health Organizations target of at least 60% survival rate for all children with cancer by 2030.
The statistics of childhood cancer is alarming and more than 300,000 children ages birth to 19 years are diagnosed with cancer around the world every year. In Bangladesh, the overall cancer burden including adolescent and childhood cancer is largely unknown due to the nonexistence of (population-based) cancer registries. The proportion of childhood cancers is expected to be high in Bangladesh because of the young population structure- about 47 % of the population is under 15 years old. It is expected that in Bangladesh 1300 new cases per year will be diagnosed with childhood cancer based on worldwide incidence rates.
Most common childhood cancers
Leukemia constitutes about a third of all cancer in childhood. The other most common malignancies are lymphomas and tumours of the central nervous system. There are several tumour types that occur almost exclusively in children including neuroblastoma, nephroblastoma, medulloblastoma and retinoblastoma. Cancer of the breast, lung, colon or rectum, typically occurring in adults, is extremely rare in children.
Risks for developing childhood cancer
To date only a few definite risk factors for childhood cancer have been identified. These include ionising radiation and ingestion of the hormone diethylstilbestrol during pregnancy and presence of dietary constituents like colouring agents. A number of childhood cancers are also associated with genetic factors. Some studies have suggested that viruses such as Epstein-Barr, Hepatitis B, Human Herpes and HIV may also contribute to increased risk for some childhood cancers.
Early detection of childhood cancer
Most childhood cancer initially presents with non-specific signs and symptoms, which may lead to late detection. In high-income countries, cancer has a high chance of being detected early due to their surveillance system existing. In low-resourced countries like Bangladesh, however, there are additional barriers to early detection, including poor access to health services and inadequate diagnostic facilities. Among childhood cancer 5-year survival in low income countries as low as 10% while that in developed countries like USA and UK as high as 80%.
Clinical presentations of childhood cancer
Continued weight loss, headaches, vomiting, increased swelling pain in bones, lump or mass in abdomen, neck, development of excessive bleeding, constant infections, a whitish colour of eye, nausea, constant paleness, eye or vision change, recurrent or persistent fever are all the topmost features common in most cases.
Management of childhood cancer
Pediatric Cancer Treatment cost is high.
Approximate treatment cost per child in UK-100,000. Treatment options are chemotherapy, targeted therapy, surgery, radiotherapy and bone-marrow transplantation. First Pediatric Oncology Centre in BSMMU was created in the early 1990s. In December 2008 government of Bangladesh established Pediatric Hematology and Oncology Department in eight medical college hospitals. Pediatric Onco-surgery department was established in Dhaka Medical College Hospital Chittagong Medical College Hospital in 2017.
In National Institute of Cancer Research and Hospital (NICRH) was started only solid tumour treatment from 2005. In private sector Ahsania Mission Cancer Hospital, Square Hospital, Delta Medical College Hospital and United Hospital are treating paediatric cancer patients but most of these hospitals are
driven by adult oncologist or radiation oncologists or adult hematologists.
Challenges of paediatric cancer management in Bangladesh
Late diagnosis, refusal to treat or stop treatment prematurely, economical constraint, high cost of medicines, shortage of bed in hospital, lack of reliable and modern diagnostic facilities, unavailability of pediatric Onco-surgeon and supporting health staffs and lack of support group are the major challenges that are hindering management of childhood cancer in Bangladesh.
Childhood cancer is increasing burden for our country but these are curable with simple effort. Establishment of childhood cancer institute, creating posts of pediatric oncologists as well as onco-surgeons, support group, supply of drugs with subsidies and pediatric cancer home may help to reach the goal of success in childhood cancer. While there is still a long road to travel to ensure every child has access to early diagnosis and timely care delivered by a well trained and resourced team, we can celebrate that the journey has begun at a global scale and we are all part of it.
The writer is a nutritionist
