Childhood cancer are not as uncommon as it may seem. There are approximately 5 lakh children are diagnosed with cancer annually worldwide, and around 10% are from India. So around 50000 new cancer cases are diagnosed in India every year. This figure might be the tip of the iceberg, as many patients remain undiagnosed in remote part of India due to lack of diagnostic facilities.
Most common cancer in children is Acute Leukemia, called as Blood Cancer in normal language. Other cancers seen in children are brain tumors, Neuroblastoma, Wilms’ Tumor (Kidney Cancer), Lymphoma, Rhabdomyosarcoma (Cancer of Muscle), Retinoblastoma (Cancer of the Eye), Hepatoblastoma (Liver Cancer), Bone and other soft tissue tumors etc.
While >80% of children with cancer in high income countries now achieve long term survival, but it is not that good outcome in India. Today, cancer is the 8th most common cause of death in children. Many factors are responsible for lower survival rates in India such as coming to hospital late when there is already advanced disease with complications, lack of right information-social support-financial constrains leading to treatment abandonment, etc. Lots of improvement is possible and achieved when the children present to the pediatric cancer specialist at right time, they get right treatment by the right team.
Traditionally, there are 3 main types of the treatment strategies to treat the cancer.
- Chemotherapy: Cancer cells are dividing more rapidly than other normal cells of the body. Those medicines who can target rapidly dividing cells and don’t allow them to divide are used to kill the cancer cells. They are called chemotherapy. Chemotherapy is the mainstay for majority of cancers. Chemotherapy medicines are given orally, in veins, in muscles or in spinal canal according to the type of the medicines.
- Surgery: The tumor has to be taken out from the body through surgery. Generally, a few cycles of chemotherapy are given before surgery to decrease the size and vascularity of the tumor, so that it can be taken out easily and with less complications.
- Radiotheray: High energy beam of radiation can be given focally to the tumor area to kill those very small sized tumors masses who cannot be seen with eye and hence are left behind after surgery. Radiotherapy reduces rate to cancer coming back. In some cancers like some brain tumors, radiaotherapy is cornerstone of the treatment.
With advancement in science, the armamentarium of cancer specialist have much more to offer for better results.
- The cancer treatment protocols have become more refined, so that we can chemotherapy with better results with fewer side effects
- In cancers, robotic surgery does better job to remove almost all tumor, with minimum blood loss and quicker recovery.
- Advanced radiotherapy modalities like gamma knife, proton beam etc can now tackle difficult to treat tumors with many vital structures around them and give better outcomes.
- Bone Marrow Transplant is a sophisticated treatment which aims to replace the patient’s bone marrow and immune system with a normal functioning marrow. We can now treat and cure many patients with relapsed or refractory cancers, for which the other conventional treatment cannot yield cure.
- Targeted medicines are now developed for many cancers. They are the medicines which target the proteins or genes which make cancer cells grow, divide and spread. As the scientist know more about DNA and proteins of cancer cells, more and more targeted therapies are being developed.
- Immunotherapy taps capabilities of the body’s immune system to fight against cancers. Immunotherapy educates the immune system to recognize and attack specific cancers. The immune system is precise so that it is possible to target the cancer cells while sparing the other healthy cells entirely.
The cancer treatment is very complicated with many intricacies. It is an evolving science with many new updates coming every day. In India, the complete plethora of cancer treatment is not available in every hospital, but fortunately situation is changing today. A multidisciplinary team, consists of a pediatric cancer specialist, pediatric cancer surgeon, pediatric intensivist, radiotherapist, trained nursing staff and nutritionist, gives a child the fighting chances against the cancer. A few hospitals such as ours have all modalities to give treatment such as Targeted therapy, Immunotherapy and Bone Marrow Transplant. With timely treatment with the most recent advances, the survival result at par with western world is achievable.