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  • Dhvani Pandey

Cancer in Children


In September of 2012, the former president of the United States, Barack Obama, issued a presidential proclamation recognizing September as National Childhood Cancer Awareness Month. Today, we use this opportunity to spread awareness and lend assistance to all those affected by this tragic disease, especially those still living their childhood days.


The internationally recognised symbol for childhood cancer is the gold ribbon. The gold ribbon represents all types of cancer affecting children and adolescents: it is the universal symbol to create awareness about childhood cancer and mobilize increased attention. Gold being a precious metal, and children being treasured by all, is used to celebrate and praise the tremendous strength and courage shown by the young champions.


Cancer is a leading cause of death for children and adolescents.The likelihood of surviving a diagnosis of childhood cancer depends on the country in which the child lives: in high-income countries, more than 80% of children with cancer are cured, but in many LMICs less than 30% are cured.


The reasons for lower survival rates in LMICs include: delay in diagnosis, an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and avoidable relapse. Improving access to childhood cancer care, including to essential medicines and technologies, is highly cost effective, feasible and can improve survival in all settings


Causes


The causes of childhood cancer are still widely unknown in the medical realm. They are neither found nor understood well due to their rarity and presence in several various forms. This makes childhood cancer a very difficult disease to research but there are some assumptions on what can cause it, mainly gene mutations.


Gene Mutations

In recent years, scientists have begun to understand how certain changes in the DNA inside our cells can cause them to become cancer cells. DNA is the chemical that makes up our genes, which control nearly everything our cells do. We usually look like our parents because they are the source of our DNA. But DNA affects more than just how we look. It also influences our risks for developing certain diseases, including some kinds of cancer. Cancers can be caused by DNA changes that keep oncogenes turned on, or that turn off tumor suppressor genes.


  1. Inherited - Some children inherit DNA changes from a parent that increase their risk of certain types of cancer. These changes are present in every cell of the child’s body, and they can often be tested for in the DNA of blood cells or other body cells. Some of these DNA changes are linked only with an increased risk of cancer, while others can cause syndromes that also include other health or developmental problems.

  2. Acquired - Most childhood cancers are not caused by inherited DNA changes. They are the result of DNA changes that happen early in the child’s life, sometimes even before birth. Every time a cell divides into 2 new cells, it must copy its DNA. This process isn’t perfect, and errors sometimes occur, especially when the cells are growing quickly. This kind of gene mutation can happen at any time in life and is called an acquired mutation. Acquired mutations are only in the person’s cancer cells and will not be passed on to their children.


Types


The types of cancers that occur most often in children are different from those seen in adults.


The most common cancers of children are:

  • Leukemia

  • Brain and spinal cord tumors

  • Neuroblastoma

  • Wilms tumor

  • Lymphoma (including both Hodgkin and non-Hodgkin)

  • Rhabdomyosarcoma

  • Retinoblastoma

  • Bone cancer (including osteosarcoma and Ewing sarcoma)


Other types of cancers are rare in children, but they do happen sometimes. In very rare cases, children may even develop cancers that are much more common in adults.


Improving the Outcomes


Because it is generally not possible to prevent cancer in children, the most effective strategy to reduce the burden of cancer in children and improve outcomes is to focus on a prompt, correct diagnosis followed by effective, evidence-based therapy with tailored supportive care


  • Early diagnosis

When identified early, cancer is more likely to respond to effective treatment and result in a greater probability of survival, less suffering, and often less expensive and less intensive treatment. Significant improvements can be made in the lives of children with cancer by detecting cancer early and avoiding delays in care


  • Treatment

A correct diagnosis is essential to prescribe appropriate therapy for the type and extent of the disease. Standard therapies include chemotherapy, surgery and/or radiotherapy. Children also need special attention to their continued physical and cognitive growth and nutritional status, which requires a dedicated, multi-disciplinary team. Access to effective diagnosis, essential medicines, pathology, blood products, radiation therapy, technology and psychosocial and supportive care are variable and inequitable around the world. However, cure is possible for more than 80% of children with cancer when childhood cancer services are accessible.


  • Palliative care

Palliative care relieves symptoms caused by cancer and improves the quality of life of patients and their families. Not all children with cancer can be cured, but relief of suffering is possible for everyone. Pediatric palliative care is considered a core component of comprehensive care, starting when the illness is diagnosed and continuing throughout treatment and care, regardless of whether or not a child receives treatment with curative intent


WHO Response


In December 2021, WHO and St Jude Children’s Research Hospital launched the Global Platform for Access to Childhood Cancer Medicines, the first of its kind, to provide an uninterrupted supply of quality-assured childhood cancer medicines with end-to-end support from selecting to dispensing medicines according to best possible care standards.


WHO and the International Agency for Research on Cancer (IARC) collaborate with the International Atomic Energy Agency (IAEA) and other UN organizations and partners, to:


  • increase political commitment for childhood cancer control;

  • support governments to develop high-quality cancer centers and regional satellites to ensure early and accurate diagnosis and effective treatment;

  • develop standards and tools to guide the planning and implementation of interventions for early diagnosis, treatment and palliative and survivorship care,

  • improve access to essential medicines and technologies; and

  • support governments to safeguard families of children with cancer from financial harm and social isolation as a result of cancer care.


The Global Initiative for Childhood Cancer is part of the response to the World Health Assembly resolution Cancer Prevention and Control through an Integrated Approach (WHA 70.12), focused on the reduction of premature mortality from NCDs and the achievement of universal health coverage.


 

Sources:

http://www.acco.org/

http://www.who.int/

http://www.cancer.gov/

http://www.cclg.org.uk/

http://www.paho.org/

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