Conquering Childhood Cancer

In Singapore, every year about 100 new cases of cancer are diagnosed in children less than 15 years of age. The most common types of cancers seen in children are given below.

Facts about childhood cancer

With advances in the understanding of cancer biology, intensive multi-agents' drug therapy and state-of-the-art therapy including haemopoietic stem cell transplant, childhood cancers are highly curable today.

For common cancers, including leukaemia, lymphoma, germ cell tumour and Wilm’s tumour, the cure rates are 80 per cent. Brain and bone cancers are moderately curable at 60 per cent.
 
Although some children may have genetic conditions that predispose them to developing tumours, the exact causes of cancer in the majority of children are unknown. It is also important to remember that cancer is not contagious. 

Signs and symptoms

Leukaemia

• Leukaemia occurs when the bone marrow produces abnormal numbers of immature white blood cells called blast cells. As so many abnormal cells are being produced, the marrow cannot make enough normal white blood cells to fight infection, or red blood cells to carry oxygen or platelets that help in clotting. As a result, the symptoms of leukaemia include recurrent fever, loss of energy and appetite, pallor and easy bruising.

Brain tumours

• The symptoms will vary depending on the location of the tumour and the age of the child. In a young baby, the head may rapidly increase in size. Older children may have headaches, vomiting and drowsiness due to increased pressure on the brain by the growing tumour. The child may develop weakness, unsteadiness when walking, clumsiness, double vision and squinting if certain parts of the brain are affected by the tumour.

• These are tumours that start in the lymph glands. The symptoms include swelling in the neck, armpit, groin, chest and abdomen, all regions where the lymph glands are located. There may also be recurrent fever, pallor and loss of weight and appetite.

Retinoblastoma

• This is a cancer of the eye and usually occurs in very young children under two years of age. They may present with squinting or a white mass seen through the lens of the eye.

Wilm’s tumour

• This is a cancer occurring in the kidney. The child usually presents with a swelling in the abdomen which may be painful. Occasionally, the child may pass blood in the urine.

Treatment options

The treatment options available will depend on the type of cancer being treated. For example, surgery is usually necessary for solid tumours, but chemotherapy is the treatment of choice for leukaemia because the cancer cells are already present in the blood, circulating throughout the body.

Surgery

• Surgery is required for most solid tumours. However, if the initial position or size of the tumour makes the operation high-risk, chemotherapy or radiotherapy may be given first to reduce the size of the tumour.

Radiation therapy

• Radiation destroys cancer cells by injuring their ability to divide. Special equipment directs rays to the tumour site for a few minutes at a time. This is done five times a week for two to six weeks depending on the type of tumour. Side effects include skin irritation and pigmentation, which are usually temporary.

Chemotherapy

• This involves the use of drugs that interfere with cell division and stop the growth of tumour cells. The drugs circulate throughout the body and can kill cancer cells far away from the original tumour site.
• This is the mainstay of leukaemia therapy. Some chemotherapy drugs are given by injection while others can be taken orally.
• Side effects include hair loss, nausea and vomiting, loss of appetite, mouth ulcers and increased risk of infection. Steps can be taken to prevent or reduce these side effects.

This is used mainly for high-risk leukaemia or relapsed leukaemia, but can be used to treat other types of cancer as well. High doses of chemotherapy with or without radiotherapy are given to kill cancer cells. However, the body’s normal blood stem cells are also destroyed by the intensive treatment. Healthy blood stemcells from the child’s own bone marrow or from a donor are then transplanted into the body to replace the destroyed normal cells.

The Children’s Cancer Programme at KK Women’s and Children’s Hospital

The Children’s Cancer Centre at KK Women’s and Children’s Hospital (KKH) offers a holistic, comprehensive range of services to treat children with cancer, and support the emotional needs of their families. Multidisciplinary teams consist of paediatric oncologists, paediatric oncology surgeons, paediatric neuro-surgeons and oncology-trained nurses.

Our inpatient ward has 20 beds with two bone marrow transplant rooms manned by a dedicated team of doctors and nurses trained in the care of children with cancer. There is also a 10-bed Day Therapy Centre for outpatient treatment and a pharmacy which dispenses oncology drugs.

We work closely with social workers from the hospital and the Children’s Cancer Foundation (CCF) to offer psychosocial support to patients and their families. The diagnosis of cancer in a child is always devastating for both the child and family. We hope to work together with our patients and their families to achieve the common goal of conquering childhood cancer.

Ref: W09