What every parent should know about cancer.

Early Warning Signs of Cancer in Children 1. A child who is very pale and is bleeding. 2. A child with persistent fever, may be losing weight and who cannot participate in normal activity because of his or her symptoms. 3. Bone pain. Persistent pain in any bone. Bone pain usually moves around, persists despite temporary relief from pain killers and may wake a child from sleep at night. Backache not related to physical injury is not normal in children. 4. A child with persistently swollen, firm lymph glands, not responding to conventional antibiotics or which are growing very quickly. 5. A lump or mass anywhere, particularly on the limbs or in the abdomen. 6. Loss of brain function which controls any part of the body, for example, a child who suddenly becomes weak on one side of their body or who has walked or stood previously and then is unable to do so. Also confusion, fits or coma. 7. Eye changes: sudden loss of vision, sudden appearance of a squint or loss of the light reflex of the eye.

Common Childhood Cancers 1. Leukaemia: leukaemia is a cancer of white blood cells. Under normal circumstances white blood cells fight infections. There are produced in the bone marrow. Leukaemia cells or blasts are abnormal and cannot perform their normal functions. 2. Lymphoma: Lymphoma refers to cancer of the lymph glands. Lymph glands occur all over the body and can be felt in the neck, armpits or groin. 3. Nephroblastoma: cancer of the kidney. 4. Retinoblastoma: cancer of the eye (retina) 5. Neuroblastoma: cancer of specialised nerve cells. 6. Rhabdomyosarcoma: cancer of muscle tissue. 7. Osteosarcoma and Ewing’s sarcoma: cancer of 8. Hepatoblastoma: cancer of the liver. Important Facts! Cancer is rare in children. If you encounter any of the early warning signs you should go to your local clinic and/or consult your doctor as soon as possible. Delays in diagnosis can lead to cancer spreading and children requiring stronger treatment which may have more side effects. ALL children with cancer should preferably be treated by a children’s cancer specialist – a paediatric oncologist.

Leukaemia What is Leukaemia? Leukaemia is a cancer of white blood cells. Normally white blood cells are produced in the bone marrow and fight infections. When white cells become cancerous they are called blasts and can be seen in the blood under a microscope. Common Symptoms 1. A pale child who bleeds, may have high fevers and recurrent infections. Common. 2. Bone pain. Common. 3. Persistent tiredness or excessive sleepiness. Common. 4. Swollen lymph glands. Common. 5. Persistent backache (with no history of injury). Less common. 6. Swollen joints (arthritis) or swollen testicles in boys. Less common. 7. Swollen gums which cover the teeth or swelling around the eyes. Less common. Tests and diagnosis Leukaemia can be suspected if blasts are seen on a blood count. Definitive diagnosis is made on a bone marrow biopsy. Treatment Chemotherapy (anti-cancer drugs given into a vein via a drip, by injection or as tablets): 2 years for girls and 3 years for boys. Some children require radiotherapy as well. Fewer than 5 % of children will need a bone marrow transplant.

Muscle Tumours What is the common Muscle Tumours? The most common tumour arising from muscle in all areas of the body is rhabdomyosarcoma. It can occur anywhere in the body and can spread to other organs, most commonly the lungs, liver and bone marrow. Common Symptoms 1. A lump or swelling at the site of the tumour. Common. 2. Pain associated with the swelling. Common. Tests and diagnosis Imaging is done with X Rays, Ultrasound, CT Scan or MRI. A biopsy is required to make the diagnosis. This is usually performed by a paediatric surgeon.. A bone marrow biopsy needs to be performed to make sure the tumour has not spread to the bone marrow. Treatment Chemotherapy (anti-cancer drugs given into a vein via a drip). Patients ideally need to have the tumour removed by a paediatric surgeon. This usually happens following several cycles of chemotherapy. These children, also require radiotherapy in place of or in addition to surgery.

Neuroblastoma What is a neuroblastoma? Neuroblastoma is a tumour that arises from the nerve cells next to the spinal cord or the adrenal glands on top of the kidneys. They may occur almost anywhere in the body and can spread to the bones, the bone marrow. and other organs like the liver. Common Symptoms 1. A lump or swelling at the site of the tumour. Common. 2. Pain associated with the swelling. Often bone pain Common. 3. Weakness and inability to walk. Common. 4. Pallor. Common Tests and diagnosis Imaging is done with X-rays., Ultrasound, CT Scan or MRI. A biopsy is required to make the diagnosis.This is usually performed by a paediatric surgeon. A bone marrow biopsy is required to ensure that the tumour has not spread. Specialised urine tests are sent to confirm the diagnosis. Special scans called MIBG scans and bone scans are also Needed to stage the disease. Treatment Chemotherapy (anti-cancer drugs given into a vein via a drip): Patients ideally need to have the tumour cut out by the surgeons. This usually happens following several cycles of chemotherapy. Certain children, will also require radiotherapy. Some children may require a bone marrow transplant.

Kidney Tumours What are the common kidney tumours? Wilm’s tumours (nephroblastomas) are the commonest tumours arising from the kidneys. They usually occur in children under 5 years. They can spread to other organs, most commonly the lungs and liver. Very rarely they can occur in both kidneys Common Symptoms 1.A lump or swelling in the belly with or without constipation. Common. 2.Pain associated with the swelling. Common. 3. Blood in the urine. Rare Tests and diagnosis Imaging is done with X-rays, ultrasound, CT scan or MRI. A biopsy is required to make the diagnosis This is usually performed by a paediatric surgeon. Treatment Chemotherapy (anti-cancer drugs given into a vein via a drip). Patients ideally need to have the kidney removed by the paediatric surgeons. This can happen before chemotherapy starts or following several cycles of chemotherapy. Some children, may require radiotherapy in addition to chemotherapy and surgery.

Brain Tumours What are the common kidney tumours? Brain tumours comprise roughly one third of all cancers in children and consist of a diverse group of tumours which occur in different sites and have different origins. As a result different brain tumours behave in very different ways and require different therapies. Some brain tumours may be associated with genetic disorders which run in families like neurofibromatosis type 1. Common Symptoms 1.Persistent morning headache and vomiting. Common. 2.Weakness on one side of the body (a “stroke”). Less common. 3.Impaired vision. Less common. 4.Backache. Common in spinal tumours. 5.Inability to walk or bear weight on the legs. 6.Loss of balance, easy falling over or unsteady when walking. Tests and diagnosis Imaging is done with CT scan or MRI. Ideally a biopsy is required to make the diagnosis.This is usually performed by a (paediatric) neurosurgeon. Sometimes because of the position of the tumour a biopsy is not always possible. Treatment Most brain tumours need to be as completely removed as possible. Radiotherapy is also part of the treatment for most children over the age of three. Children under three years or those with chemotherapy sensitive tumours may/will require chemotherapy.

Lymphomas What are lymphomas? Lymphomas are malignant tumours of the lymph glands. They can spread to involve the liver, spleen, gut, bone marrow and bone. They comprise two main groups: Hodgkin’s Lymphoma and non-Hodgkin’s Lymphomas. Common Symptoms 1.Persistent, firm, swollen glands which commonly occur in the groin, armpits and the neck.. Common. 2.Rapidly progressive, swollen, tender abdomen. Common. Tests and diagnosis Imaging is done with ultrasound, CT scan or MRI. A biopsy is always required to make the diagnosis.This is usually performed by a (paediatric) surgeon. Treatment All lymphomas require chemotherapy. Surgery and radiotherapy are required only in very specific circumstances.

Hepatoblastoma What is hepatoblastoma? Hepatoblastoma is the,most common tumour of the liver usually occurring in younger children. Common Symptoms 1.A lump or swelling in the belly. Common. 2.Pain associated with the swelling. Common. Tests and diagnosis Imaging is done with ultrasound, CT or MRI scans. A biopsy is normally not required to confirm the diagnosis. Rather, the diagnosis can be made by a combination of the clinical assessment of the patient and an elevated serum alpha fetoprotein level (a simple blood test). Alpha fetoprotein is made in excessive amounts by hepatoblastomas. Treatment Chemotherapy is needed to reduce the size of the tumour so that it can be removed by a specialised surgeon. Radiotherapy is not required.

Retinoblastoma What is retinoblastoma? Retinoblastoma is a tumour arising in the eye. They usually occur in young babies and can run in families. Common Symptoms 1. White pupils.. Common. 2. Loss of vision. Common. 3. Sudden onset squint.. Common. Tests and diagnosis A biopsy is required to make the diagnosis. An examination and biopsy under anaesthetic should be performed by an ophthalmologist (eye specialist). Treatment Sometimes local therapy to the tumour by laser is all that is required to control the disease. This can only happen if it is caught early. For more advanced tumours radiotherapy and chemotherapy may be necessary. It may be necessary to examine the other children in the family if the tumour is found to run in the family.