“Cancer” – just on hearing the word, strikes a deathly fear on minds. Specially, to the parents when they know their child has it. From unfounded myths to assumptions due to lack of awareness, there are several reasons why parents are scared of cancer. “They hear ‘cancer’ and parents immediately think their child is going to die,” says Dr Nandini Hazarika, Lead Consultant - Paediatric Oncology, Haematology and BMT at Madhukar Rainbow Children's Hospitals, Delhi.
“I want to state this clearly for the benefit of all the parents – cancer in children is curable with early detection and right treatment, and children can beat it to live a normal adult life,” the doctor adds. Further, a high sense of fear and fatalism, the doctor explains, can be counterproductive because it can send them into denial.
Paediatric oncologists such as Dr Nandini face an uphill battle in India, not only against the aggressive diseases affecting their young patients, but also against the lack of awareness among parents that leads to costly and entirely avoidable delays.
Childhood cancers tend to differ quite substantially from adult cancers. Children typically develop some kinds of cancers, such as leukemia (blood cancer), brain tumours, lymphoma (lymph nodes), osteosarcoma and Ewing’s sarcoma (Bone cancers), soft tissue sarcomas (muscle tissue), Wilms tumour (kidney), neuroblastoma (adrenal gland), retinoblastoma (eye), and hepatoblastoma (liver). While the exact reasons for developing cancers is not known, it is suspected that most such conditions are due to changes in the genes (called genetic mutation).
Childhood cancers are often more aggressive than adult cancers, but are also highly responsive to treatment in most cases. “Late diagnoses lead to poor outcomes. But with early diagnosis and proper treatment, we can achieve very good outcomes,” says Dr Nandini.
Dr Nandini Hazarika, Lead Consultant - Paediatric Oncology, Haematology and BMT at Madhukar Rainbow Children's Hospitals, Delhi.
However, in many cases, diagnoses are delayed because parents go into a state of denial, deciding that their child could not possibly have cancer. “Sometimes if we ask them to do a biopsy immediately, parents refuse. We have seen this happen even with educated couples,” says Dr Nandini. “Besides fear, there is also a kind of stigma attached to cancer, making people reluctant to disclose diagnoses to relatives and friends”, she adds. This further prevents awareness from spreading.
Another serious obstacle to early diagnosis is a lack of awareness among primary care physicians about the early stage symptoms of different cancers. “Since many of these symptoms also result from other causes, doctors often spend a lot of time looking for more common causes,” explains Dr Nandini.
As symptoms of cancer overlap with several other conditions, parents must not panic but be cautious and aware. Primarily, Dr Nandini explains, “parents and primary care physicians should watch out for any persistent symptoms that do not respond to routine medications.”
With leukemia, for instance, one of the common symptoms is a prolonged fever lasting more than two to three weeks and not responding to any routine medications. Unexplained black or red spots on the skin, sudden bleeding from nose, gums, or teeth can also indicate leukemia. Sudden paleness of skin, lethargy, and joint pains are other common symptoms.
A continuous, persistent headache associated with vomiting could be a sign of a brain tumour. Difficulties focusing on studies, sudden eye abnormalities such as a squint or abnormal movement of the eye, a disturbance in the gait, and sudden weakness in any part of the body could also be indicative of a brain tumour.
Swelling in the neck or armpit are an indicator of lymphoma. However, this symptom may get missed because the lymph nodes in the neck are often enlarged for children, for various reasons. Hence, doctors may often treat such conditions with antibiotics or anti-tubercular (anti-TB) drugs for a long time before considering the possibility of lymphoma.
Swellings in different parts of the body that are painless but may be growing over time may indicate bone or soft tissue cancers. Similarly, a kidney, adrenal or liver tumour may be indicated by a bloated or distended abdomen. And a retinoblastoma could be indicated by a white spot in the eye.
“Obviously, just having a fever or swelling does not immediately mean that a child has cancer,” says Dr Nandini. In other words, parents should not panic and treat every symptom as indicative of cancer. However, she adds, “Primary care physicians should be aware that they should consider the possibility of malignancy also. Parents should also be aware that if a problem or symptom is not getting resolved within a limited period of time, they should consult with an oncologist just to be safe.”
Once cancer is detected, says Dr Nandini, following the treatment protocol correctly is vital. She stresses this point because cancer treatments are often prolonged and intensive. Moreover, they are administered according to very strict protocols. “If we give the patient’s family a date for the next dose of treatment, for instance, they should not show up a day or three late,” she says.
More importantly, while children can be treated by an oncologist for adults, treatment by a paediatric oncologist at a dedicated paediatric centre like Madhukar Rainbow Hospitals is ideal. “Children are not simply small adults. Paediatric cancer treatments tend to be more intense because paediatric cancers are often more aggressive. Children also have their own specific needs that make treating them different from treating adults,” explains Dr Nandini.
In cancers being treated by chemotherapy, for instance, different systems can be impacted by the disease or by treatment-related side effects. Hence, it is important that such patients have ready access to other experts such as paediatric gastroenterologists or neurologists, as well as paediatric ICU facilities in some cases.
Further, because chemotherapy involves long-drawn courses of treatment, children require paediatric nursing care to ensure that their primary care needs are well looked after, during the treatment.
Another key area of importance for these children is dietetics. “Nutrition plays a very important role in the prevention and treatment of different cancers. Dietitians for children come with a very different perspective from dietitians for adults,” she adds.
Finally, in order to maintain mental well-being of the child and parents or caregivers through the entire process, paediatric centres also provide facilities such as counselling, support groups and art therapy.
At the end of the day, says Dr Nandini, parents should remember that a cancer diagnosis is not the end of life. But securing the best outcomes is a race against time. Paediatric cancers tend to be more aggressive, but also respond better to treatment. Children are also more resilient in terms of their tolerance to treatment-related effects. Hence, it’s important to stop fearing the C-word and build a careful and timely attitude towards cancer detection and treatment.
This article was created by TNM Brand Studio in association with Madhukar Rainbow Children’s Hospital.