The parents I spoke to simply stared back at me. There were tears in their eyes. I had just informed them that their little boy had cancer.
For them, their precious four-year-old son Jimi (not his real name) was lively and healthy, with eyes full of wonder and a brain full of mischief. He had contracted fever the week before and their GP wasn’t overly concerned. He did notice that the boy was a bit pale and arranged a “simple” blood test. This was when their whole world changed.
Unfortunately, the blood test was abnormal, and now, they were sitting before a paediatric oncologist in a specialist hospital, telling them that their child had acute leukaemia and would need chemotherapy.
All they heard was “cancer”, and all they could think of was that their child might die.
In my experience, it doesn’t matter what type of cancer it is, or the family social background – the reaction is usually the same.
The questions are always, “How did this happen?” and “Why my child?”.
There is sometimes anger, often disbelief, but almost always, palpable anguish. It is difficult to comprehend as a parent how a child so full of life and innocence can be struck down by a disease with such sinister connotations.
Unfortunately, cancer can affect anyone at any age. However, for children with cancer, the outlook is looking more promising, thanks to medical advances and extensive research. It is no longer a death sentence.
Facts and figures
Cancer is not altogether uncommon in children, with one case occurring in every 6,500 individuals aged 18 years or younger.
It is the leading cause of death in children and adolescents in most developed countries.
In Malaysia, approximately 800 new cases are seen annually, with the commonest cancers being leukaemia (45%) and brain tumours (15%).
Some cancers are unique to children. These are the embryonal cancers such as neuroblastoma and Wilms’ tumour, where the malignant cells arise from foetal origin.
Not surprisingly, these tumours are predominantly seen in infants and toddlers.
In most instances, the underlying cause that leads to childhood cancer is unknown.
Unlike adult cancers, which usually arise from chronic inflammation and exposure to toxins such as cigarette smoke, children may develop cancer from a combination of factors.
However, as unscientific as it sounds, often the cause of childhood cancer is bad luck.
A search for genetic causes for cancer development was carried out by Zhang and colleagues from St Jude Children’s Research Hospital in the United States in 2015. In their seminal study, the researchers examined the genome of 1,100 children with various cancers.
It was discovered that less than 10% of children with cancer had an inherited genetic predisposition.
Many epidemiological studies have attempted to understand why and how children develop cancer. These include studying the effects of viral infections, environmental pollution, as well as proximity of homes to high-tension electrical power lines.
However, most of these studies remain speculative at best, and the majority of these hypotheses have been disproved.
The ability to cure childhood cancer has been one of the great success stories of modern medicine.
From an invariably fatal condition in the 1950s, the overall survival for childhood malignancies currently is above 80%, even in middle-income nations.
Treatment for acute lymphoblastic leukaemia, the most common cancer in children, has now achieved cure rates of nearly 90% in many countries, including Malaysia.
Treatment modalities for childhood cancer include cytotoxic drugs, surgery, radiotherapy and bone marrow transplantation.
However, different combinations of these modalities are used for different cancer types and stages of disease.
Childhood cancer has benefited from precision medicine and targeted therapy. The recognition of the biological heterogeneity of neoplastic cells has facilitated allocation of therapy with appropriate intensity.
Paediatric oncologists are very aware of the long-term side effects of cancer treatment. Thus, current protocols are constantly attempting to reach a balance between improving cure and reducing late effects of treatment.
As with other diseases, the successful outcome of childhood cancer therapy is influenced by early detection of the cancer.
With the exception of leukaemia, other cancers, especially solid tumours, have a generally better outcome if detected at an early stage, before it has involved a distant site such as the lungs or bones.
Some of the symptoms and signs that should raise concern in parents include pallor, weight loss, prolonged fever, lumps, abdominal swelling and persistent headache.
Facing the future
During cancer treatment, children experience separation from their siblings, miss school and often develop changes to their appearance. These factors, all of which can be very distressing, are more prominent in adolescents who require a lot of emotional support.
Thus, it is of great importance that parents and physicians engage these older children in the treatment process, as well as to help them return to normalcy upon completion of treatment.
The over-arching aim of cancer therapy in children is not only to ensure cure, but also to allow them to have normal growth and development to realise their full potential as productive, healthy adults.
Over the last decade, a new area of research has emerged due to childhood cancer survivors who are increasingly noted to develop chronic illnesses such as diabetes, hypertension and cardiovascular disease at a younger age compared to their peers.
This underlines the need to follow-up childhood cancer patients for life, as well as to continuously strive to design new therapy protocols with minimal late effects.
As a post-script, Jimi recently completed two years’ worth of chemotherapy for acute lymphoblastic leukaemia and is now back to his old mischievous self.
He had standard-risk disease, which is associated with a 92% chance of cure. His parents are looking forward to enrolling him in a kindergarten later in the year.
Dr Hany Ariffin is professor of paediatrics at University Malaya and senior consultant paediatric haematologist-oncologist. This article is courtesy of the Malaysian Association of Paediatric Surgery. For further information, e-mail firstname.lastname@example.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.