Cancer Counseling Hotline
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Dr Anselm Lee, a paediatric haematologist-oncologist at Parkway Cancer Centre, discusses what we know and do not know about why children get cancer.
With rising cancer rates worldwide, there is no shortage of information these days about the disease, especially when it involves adult cancers.
But not as much is known about cancers affecting children. While such cancers are rare, they still affect about one in every 500 persons before their 18th birthday. The most common type of childhood cancers are leukaemia, brain tumour and lymphoma.
Much of what we know about adult cancers, though, are not applicable to childhood cancers. Here are seven common myths about cancer in children:
Most, if not all, cancers are genetic in origin. But this is not the same as saying that they are inherited from one’s parents.
There are two main types of genetic changes – somatic and germline changes.
An example of somatic change is that of adults whose cells are genetically changed to cause cancer as a result of smoking or radiation exposure. Patients with lung cancer and those who develop cancers from somatic genetic changes do not inherit cancer predisposition from their parents.
Germline genetic changes, on the other hand, are the ones that can be inherited. But they are rarely found in childhood cancers. Some breast cancers, ovarian cancers and bowel cancers are related to germline mutations. The case of actress Angelina Jolie who carries the breast/ovarian cancer gene BRCA1 from her mother who died of breast cancer, is a good example even though it is not common.
The fact that cancers occur at a young age does not imply that it is inherited.
Current research shows that only about two per cent of all childhood cancers may have a familial origin or predisposition and an overwhelming majority of cancers in children occurs randomly.
There are well-known causes or risk factors that cause cancer to develop in adults. These include smoking, radiation, diet, obesity, hormonal exposure, occupational exposure, hepatitis B infection and so on.
However, most of these risk factors are not relevant in the causation of childhood cancers and do not explain why kids, so young, get the disease.
Even if a newborn child begins smoking right after birth, he or she will not get lung cancer before his or her 18th birthday. This is not to say children can pick up smoking without risking their health, but it illustrates why childhood cancers do not happen like adult cancers.
Indeed, the causes of cancers in children are still largely unknown.
With the exception of hepatoma, childhood cancers are not preventable.
More often than not, we do not even know how they come about. As such, there is no way for children or their parents to take preventive measures to prevent or reduce the chance of cancer occurrence in children.
Hepatoma (or hepatocellular carcinoma of the liver) is now extremely rare in countries where hepatitis B vaccine is universally given to young children.
A large part of treating cancer is about early detection, which comes about through screening. This has been especially useful in the early detection of breast, cervical and even colon cancers.
Screening and early detection works best in certain circumstances. For example, if the cancer is common, if there is a precancerous stage, if the cancer grows slowly or if there is a simple way to detect the cancer cells at an early stage.
Take for example, leukaemia, which is the most common cancer in children, affecting some one in 30,000 children every year. The only reliable way to diagnose or exclude leukaemia is through a bone marrow aspiration. But the cost of the procedure, the inconvenience and the pain in getting a bone marrow puncture for each of these 30,000 children just to detect one positive case is just not worth it.
General screening or early detection strategies play only a small role in preventing childhood cancers.
Sadly, this statement is true for children in countries with poor resources, poor healthcare infrastructure, or if they are not managed by properly-trained healthcare professionals.
However, in Singapore and most other developed countries, 75 per cent of the children diagnosed with cancer survive and are, in fact, expected to be long-term survivors. Thanks to the advancements in medical diagnostics and treatment, most children can survive and lead normal lives.
For example, in acute lymphoblastic leukaemia – a common form of leukaemia in Singapore – 90 per cent of patients will be cured with chemotherapy alone.
It is true that chemotherapy is known to have many side effects.
One child with cancer told me that it felt like she has a hundred ulcers in her mouth. However, she was well the next week and was even able to eat spicy food. The acute and painful side effects of chemotherapy are usually temporary.
All chemotherapy drugs are given in doses appropriate to the individual patient’s body size and these acute effects are quite predictable and manageable. While the side effects may be harsh, children can cope with them just as adults do.
Everyone involved in fighting cancer is concerned about the long-term effects of anti-cancer treatment. Organs like the kidney, heart, eyes, ears and even the brain could be damaged from the surgery, radiotherapy or chemotherapy.
However, the majority of children with cancer do not suffer any damage to their organs. Many of those who survive also have the ability to father or mother children when they become adults.
Fertility damage is more of a concern when the ovaries or testes are damaged by the cancer, surgery or radiation, or when very high-dose chemotherapy is used, or when the hormone centre inside the brain is damaged.
Overall, children who suffer from cancer can survive, if they receive the proper treatment under expert care. Not only do they survive, they also go on to lead a productive and healthy adult life.
Written by Ben Tan
|TAGS||brain cancer, history of cancer, leukaemia in children, misconceptions, rare cancer|
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