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Cancer Info

Childhood cancers

Childhood cancers are cancers that occur in children, typically under the age of 18. They can affect various tissues and organs, including the blood, brain, bones, and soft tissues. The most common types include leukemia, brain tumors, neuroblastoma, Wilms tumor, and lymphoma.

Childhood cancers are relatively rare, accounting for about 2-3% of all cancers. In India, it is estimated that around 15,000 new cases of childhood cancers are diagnosed each year. Despite their rarity, early diagnosis and treatment are crucial for improving outcomes.

Common symptoms can include:

  • Unexplained weight loss
  • Persistent fever
  • Fatigue and weakness
  • Swelling or lumps, especially in the abdomen or neck
  • Frequent infections
  • Bone pain or limping
  • Changes in vision or headaches (for brain tumors)

Diagnosis typically involves:

  • Physical examination: Checking for lumps or signs of illness.
  • Blood tests: Including complete blood count (CBC) to assess overall health and detect abnormalities.
  • Imaging tests: Such as X-rays, ultrasound, CT scans, or MRIs to visualize tumors.

Biopsy: A sample of tissue may be taken from the tumor to confirm the diagnosis

Key blood tests may include:

  • Complete Blood Count (CBC): To check for anemia, infection, or bleeding issues.
  • Blood chemistry tests: To assess organ function and detect specific tumor markers.
  • Coagulation tests: To evaluate the blood’s ability to clot, especially in certain types of leukemia.

Staging helps assess how far the cancer has spread. Different cancers have specific staging systems. Common factors considered include:

  • Size of the tumor
  • Involvement of nearby lymph nodes
  • Presence of metastasis (spread to distant organs)

Management strategies vary based on the cancer type and stage:

  • Localized tumors: May be treated with surgery alone or followed by chemotherapy or radiation.
  • Advanced stages: Often require a combination of chemotherapy, radiation, and possibly surgery.
  • Certain leukemias: May need immediate chemotherapy, sometimes with bone marrow transplantation as a follow-up.

Surgery is often the first line of treatment for solid tumors. Its goals include:

  • Removing the tumor entirely (curative intent)
  • Reducing tumor size to make other treatments more effective (neoadjuvant approach)
  • Relieving symptoms, such as pressure on surrounding organs Surgeons aim for clear margins, meaning no cancer cells are left at the edges of the removed tissue.

Radiotherapy uses high-energy rays to kill cancer cells. It can be used:

  • After surgery to eliminate remaining cancer cells (adjuvant therapy)
  • Before surgery to shrink the tumor (neoadjuvant therapy)
  • To relieve symptoms caused by cancer, such as pain or pressure on organs Radiotherapy is carefully planned to minimize damage to surrounding healthy tissue, especially in growing children.

Chemotherapy involves using drugs to kill cancer cells or stop their growth. It is often administered in cycles, which allows the body to recover between treatments. Chemotherapy can be:

  • Curative: Aiming to completely eradicate cancer.
  • Palliative: Helping to relieve symptoms and improve quality of life if a cure isn’t possible. Combination regimens are common, tailored to the specific type of cancer.

Immunotherapy boosts the body’s immune system to fight cancer. It’s increasingly used for certain types of childhood cancers, such as neuroblastoma and leukemia. Techniques include:

  • Monoclonal antibodies: Targeting specific cancer cells.

CAR T-cell therapy: Engineering the patient’s own T-cells to attack cancer cells

There are two main types:

  • Autologous transplant: Uses the patient’s own stem cells, collected before chemotherapy.

Allogeneic transplant: Uses stem cells from a donor. This may be considered for more aggressive or relapsed cancers.

The duration typically involves 2-4 weeks in the hospital for the transplant procedure, followed by outpatient care for several months. Costs can range from ₹15 lakhs to ₹30 lakhs in India, depending on the hospital and whether it’s autologous or allogeneic

Total body radiotherapy (TBI) is part of the conditioning regimen before an allogeneic transplant. It helps destroy cancer cells and suppresses the immune system, allowing the new stem cells to engraft successfully

Survival rates vary by cancer type but have improved significantly over the years due to advancements in treatment. Overall, the 5-year survival rate for childhood cancers is now around 80%. For specific types like leukemia, survival can exceed 90% with appropriate treatment.

Rehabilitation focuses on physical, emotional, and social recovery. It may include:

  • Physical therapy to regain strength and mobility
  • Occupational therapy to assist with daily activities
  • Psychological support to address emotional challenges and stress

Educational support to help children catch up on schoolwork missed during treatment

Regular follow-up appointments are crucial and typically occur every 3-6 months for the first few years, then annually. These visits may include physical exams, blood tests, and imaging studies to monitor for recurrence and manage any late effects of treatment

Follow-up investigations may include:

  • Blood tests (CBC, specific tumor markers)
  • Imaging tests (X-rays, MRIs, CT scans) to check for new tumors or signs of recurrence

Regular assessments of growth and development, especially in younger patients

CyberKnife is a precise form of radiation therapy that can target tumors with minimal damage to surrounding healthy tissue. It is particularly useful for small, localized tumors or for patients who cannot undergo traditional surgery.

Proton therapy is a type of radiation therapy that uses protons instead of X-rays. It allows for more precise targeting of tumors, minimizing radiation exposure to surrounding healthy tissue. This is especially beneficial for children, whose developing bodies are more sensitive to radiation

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