April 21, 2022
Introduction to Pediatric Cancers
Childhood cancers are unique type of cancers, the etiology of which is uncertain however majority of these cancers are curable. The estimated cases in India is around 70,000 per year out of which roughly only 10,000 reach the hospitals due to lack of awareness of its curability or inability to reach a cancer care center.
The cure rates have improved from 4% survival in 1960’s to >80% survival in the present age. The rapid and impressive progress in the field in recent decades requires the specialty to be practiced in a milieu in which teaching and research are actively conducted. Outcome of childhood cancers is one of the most impressive among all cancers put together provided these cancers are treated early, diagnosed properly and treated appropriately by trained Pediatric oncologists.
What are the types of Pediatric cancers?
Pediatric cancers are different spectrum as compared to adult cancers. They are classified into 2 types mainly- Hematolymphoid cancers and Solid tumors. Hematolymphoid refer to cancers of blood and lymphatic systems example: Leukemia and Lymphomas. Solid tumors arise from organs example: Kidney- Nephroblastoma (Wilms tumor) or Brain (Medulloblastoma). Leukemias are the most commonly seen cancer in childhood followed by brain tumors.
What are the symptoms expected?
Symptoms depend upon the type of cancer. Usually blood cancers present with fever of prolonged duration, bony pains and bleeding manifestations. Brain tumors manifests with neurological symptoms like headache, vomiting and gait disturbances. Solid tumors again present based on organ involved example: Wilms’ tumor can present as mass in abdomen or blood in urine whereas bone tumors can present with swelling over a bone for a long duration along with pain.
How are the tumors diagnosed?
Blood cancers can be diagnosed on peripheral blood or bone marrow samples. Solid tumors require blood tests as well as diagnostic biopsies. Brain tumors are mainly diagnosed based on age, location of tumor and on CT/MRI scans. Many of the tumors also require investigations to see if disease is spread to other sites for which a PET CT scan maybe required.
What are the available treatment modalities?
Cancers like leukemia and lymphomas are generally managed with chemotherapy alone. Radiation therapy is needed in very few cases of blood cancers. Brain tumors and solid tumors require multi-disciplinary management with chemotherapy, radiation therapy, surgical expertise and palliative care. The timing of each modality is crucial and impacts the outcome from the disease.
What are the expected outcomes?
Majority of the pediatric malignancies are extremely responsive to chemotherapy and radiation. The expected outcomes differ from type of malignancy and certain malignancy like Leukemia and Lymphoma have more than 80% cure rates. The outcomes of solid tumors and brain tumors depend on whether the tumor is only at one site or has spread. For certain solid tumors like Wilms’ tumor of kidney which has not spread, the expected outcomes are as high as 90% even if Stage IV.
Pediatric Oncology in Kasturba Medical College and Kasturba Hospital, Manipal
The expertise to treat pediatric cancers has started from November 2019 in Kasturba Medical College and Kasturba Hospital, Manipal. Pediatric Hematology and Oncology ward has a 24 bedded ward with state-of-the-art induction rooms with HEPA filters to prevent infections. The ward is ideal for all childhood cancer treatment including stem cell transplantation. The ward also features a day care unit for outpatient based blood transfusion and chemotherapy. The chemotherapy is prepared under laminar flow with strict asepsis. The division also has dedicated pediatric nutritionist and pediatric nurses trained in oncological aspects. The unit is managed by doctors trained in well reputed institutions from India.
The division works with NGO’s like Indian Cancer Society, Yuvraj Singh Foundation, CanKids, Leukemia Crusaders, Access Life assistance Foundation and Cuddles foundation which are dedicated towards supporting children with cancer by providing monetary support, human resources and nutritional supplementation.
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