80 per cent of childhood cancers are reversible, UAE paediatric oncologists say

UAE oncology specialists say the campaign for awareness and education of parents has been ongoing and the situation has not escalated. Dr Abdul Hafeez Siddiqui, paediatric haematology oncologist at the American Hospital told Gulf News: “Community awareness on regular screening, early detection and treatment of child hood cancers has been ongoing. It is with this education in UAE about paediatric cancers, plus insurance coverage for all types of childhood cancers, that the prevalence of paediatric malignancies has not risen and has remained steady. But more needs to be done to reduce its prevalence.”

Top five paediatric cancers in the UAE

MoHaP statistics on paediatric malignancies list the top five cancer types. These are:

Leukaemia: Affecting 41.2 per cent children.

Brain and Central Nervous System Tumours: 12.7 per cent.

Non-Hodgkin’s Lymphoma: 12.7 per cent.

Kidney and Renal/pelvis cancers: 6.1 per cent.

Hodgkin’s Lymphoma: 6.1 per cent.

Knowing the basics

First, let us understand a few basic facts about cancer. Dr Zainul Abideen, Head of the Department of Haemato Oncology at the Burjeel Medical City and Medical Director of Hope Child Cancer Care Foundation explained the fundamentals on how cancers occur and why children are susceptible to certain kinds of cancers.

What is cancer and different types of childhood cancers?

Our body is made up of millions of tiny building blocks called cells. Cancer is a disease of these cells, leading to abnormal growth. Normally, cells divide in an orderly and controlled fashion. This division of cells takes place in a child’s body, too, as cells copy, divide and grow. New cells replace older cells and help them grow. However, for reasons unknown, this process sometimes goes awry. Instead of normal cells, abnormal cells or malignant cells are produced.

When this happens, body has a mechanism to destroy these cells. However, in some situations, this system is vitiated and the abnormal cells continue to divide and accumulate in the body and begin to grow at faster rate than normal cells. This abnormal growth of these abnormal cells (malignant cells) is called cancer.

How do tumours form?

Abnormal growth of cells in the body forming a lump is called a tumour. There are two types of tumours. They are cancerous (malignant) and non-cancerous (benign). In a malignant tumour, the cancer cells have the ability to spread beyond the original area of the body. Benign or non-cancerous tumours are contained and do not spread.

Common kinds of cancers in children:

Cancers in children can occur in different parts of the body such as the kidney or the brain.

The commonest cancer in children is that which develops in the blood cells, producing cells in the bone marrow, which is called blood cancer or Leukaemia.

Lymphoma is a type of cancer that develops from lymphoid, which is part of the defence system of the body.

Sarcoma is a type of cancer seen in children that affects bones and muscles.

Wilms’ tumour is a type of kidney cancer commonly seen in children.

Neuroblastoma is a type of cancer that arises from the adrenal system of the body, usually seen in children.

Hepatoblastoma is a type of liver cancer seen in children

Retinoblastoma is a type of cancer that develops inside the eye.

How do cancerous cells metastasise?

Sometimes cancer cells from the original (primary) site may spread to other parts of the body. When the cancer cells reach a new area, they may go on dividing and growing at the new site. This process is called metastasis. These new sites can be bone, bone marrow, liver, lungs and brain. These growing cancer cells in the new site can affect the function of the new site. For example, if it spreads to the brain, it can affect functioning of the brain; or if it spreads to the liver, it can affect liver function. Each type of cancer is capable of spreading to a particular part of the body. The result of the cancer treatment is good if we can diagnose cancer before it spreads to other parts of the body. Sometimes, this is not possible because the original cancer remains hidden without any symptom — until it spreads to the other body parts. If the cancer has already spread to other parts of the body at the time of detection, then treatments are available, but these may be more prolonged.

What are the symptoms and signs of cancers in children?

Most of the symptoms and signs of cancers in children are similar to very common diseases in children. These can be persistent fever, bleeding from the skin, pallor, persistent headache, vomiting and swelling of the glands in the neck, generalised distention of the abdomen, swelling and persistent pain at the joints. All these could be due to common diseases. Therefore, parents should not get worried when children get these symptoms initially. Only if these are persistent should parents discuss with the doctor the need for further investigations.

How are cancers in children different from cancers in adults?

Cancers in children respond differently to treatment. Cure rates for most of the cancers in children are much higher than that of adult cancers. Although children are younger compared to adults, their bodies are more resilient and are able to withstand the side-effects of cancer treatments much better than adults. By using available treatments, most cancers in children can be cured.

What are the causes of cancers in children?

The exact causes of cancers in children and young people are still unknown. It is also important to understand that it is very unlikely that anything you or your child has done in the past has triggered cancer. According Dr Siddiqui, poor diet lacking in nutrition, passive smoking, obesity and lack of physical exercise, over-exposure to the laptop and television screens can be triggers. In children above 14, smoking is a high-risk factor. Genetic history of cancers in the family can also put them at risk.

According to Dr Abideen, maternal exposure to paint fumes, exposure to extremely low-frequency magnetic fields, ionising radiation exposure, delayed exposure to common childhood infections, lack of breast-feeding are strong risk factors for childhood cancers. However, there is no clear evidence or study to support this. In general, the risk of developing a Lymphoma is more in children with weak immune systems.

Diagnosis and tests

If cancer is suspected, specialists ought to conduct further investigations to identify the type of cancer a child has. These are called diagnostic tests. They also need to conduct tests to understand whether a child’s cancer has spread to the other parts of the body. This is called staging investigations.

Here are some of the most common tests that are used during cancer diagnosis and treatment. Depending upon the type of cancer suspected, a doctor will decide on which of these tests to conduct and at what stage.

• Blood tests

• Bone marrow tests

• Lumbar puncture

• Biopsy

• CT (Computerised Tomography)

• MRI (magnetic resonance imaging) scan

• Ultrasound scan

• Bone scan

• MIBG scan

Blood tests:

These are usually conducted before, during and after treatment. Some of the reasons for blood tests include:

Detecting cancer

Checking for infection

Monitoring impact of treatment

Monitoring the side-effects of treatment

To make sure organs such as liver or kidneys are still working properly

Matching your child’s blood with a donor’s blood group if your child needs blood transfusion and for monitoring your child’s blood count (the number of red and white blood cells and platelets in blood).

What is a bone marrow test?

When conventional chemo and radiotherapy is ineffective in leukaemia or the there is a relapse of cancer, then oncologists advise a bone marrow test.

Bone marrow test involves looking for bone marrow samples under a microscope to see for the presence of any cancer cell in the blood or any cancer from other parts of the body that may have spread to the bone marrow.

Lumbar puncture

This test is used to examine the fluid around the spinal cord (called the Cerebro Spinal Fluid or CSF) to see if the CSF contains cancer cells. In lumbar puncture, a needle is inserted between the bones in the lower spine and a few drops of CSF is taken to examine under a microscope.

This procedure is also used to provide cancer medication (chemotherapy) in certain cancers like leukaemia. It is called intrathecal chemotherapy administration (IT).

Biopsy

A biopsy means removing a small bit from the cancer-suspecting part of the body, either with a specially designed needle (needle biopsy) or by a small operation (open biopsy). The sample is then examined under a microscopy to determine what type of cancer it is.

What are the existing treatments of childhood cancers?

Dr Siddiqui elaborated on the new treatments available for cancer. “Apart from the conventional chemo and radiotherapy and surgical options, with modern advancements, we have immunotherapy that is usually a strong medication bound to a protein that specifically targets the cancer cells to minimise damage to the healthy cells of the body. This treatment has proved very effective in Chronic Myeloid Leukaemia (CML) in children.

“Then we have the Chimeric Antigen Receptor (CAR) T cell therapy where medication is able to make the body’s T-cells strong enough to destroy tumours. This therapy has proved to be very effective in brain tumours and worked even in cases where there have been relapses.”

Dr Abideen added: “Treatment protocols will depend on the type of cancers, stage of the caners and general health of your child. Treatment of your child’s cancer may include just one of these treatments or a combination. Before your child’s treatment plan is put into action, you should try to understand what exactly is going to happen and the benefits, risks and potential side-effects of the treatments offered by the doctor.”

Insurance cover

Dr Siddiqui and Dr Abideen both maintained that in the UAE, most insurances offer full cover for childhood cancers. “In some cases where there is an insurance cap, we have found several charities such as Red Crescent and Al Rahma playing very proactive roles in extending financial support to families who do not have a comprehensive insurance cover,” said Dr Abideen.

Dr Abideen cited the case of four-year old Leukaemia patient Farzana, a Bangladeshi expatriate and Abu Dhabi resident. Her father had only the basic insurance cover for the child. He chose to keep her in Abu Dhabi for her Leukaemia treatment as he was aware of the lack of facilities in his own country. Dr Abideen continued: “She was diagnosed in 2017 and her treatment continued until 2019. Her treatment was covered under the basic insurance plan completely and then the father sent back the entire family to Bangladesh. Farzana is doing well now and her mother often sends me a message of gratitude, saying she is so happy that Farzana has completed her treatment in the UAE. In many other cases, we have contacted the Red Crescent and other charities and they have helped many underprivileged children, providing financial support for the complete treatment.”

Both the oncologists felt that the UAE’s proactive approach, modern treatment methods and insurance cover were very effective. However, they reiterated that parents needed to be more vigilant and aware of the possibility of cancer and take a child for screening. The oncologists also called upon schools to sensitise other children when a child returned to class after treatment. “In many cases, if a child had chemotherapy, he or she might be left with no hair or steroids may have added bulk to his or her frame. Teachers need to sensitise other children towards accepting that child, making get-well cards and making sure the already sensitive child is not a victim of bullying or ridicule. We need to be more inclusive and accept these children in school,” said Dr Siddiqui.

Eight signs your child may be having cancer:

• Fatigue

• Unexplained weight loss

• Bruises due to haemorrhaging from the skin

• Paleness or anaemia

• Stomach distension

• Vomiting, headache and blurry vision

•Fever

•Persistent leg pain