The Tribune

By CARA HUNT

Tribune Features Writer

cbrennen@tribunemedia.net

DESPITE being rare, childhood cancer is the leading cause of death from disease among children and adolescents from birth to age 19, according to statistics.

Between 2020 and 2022, Princess Margaret Hospital (PMH) recorded 20 paediatric cancer cases in its cancer registry, representing 2.3 per cent of all cases recorded.

September is Childhood Cancer Awareness Month, and during the Cancer Society of The Bahamas’ monthly general meeting, guest speaker Dr Shervette Stevens, a paediatric haematologist and oncologist, raised awareness of childhood cancer, focusing on its symptoms and the various ways to treat and support children diagnosed with the disease.

According to Dr Stevens, childhood cancers can be divided into three main groups: leukaemias and lymphomas, brain and spinal cord tumours, and solid tumours.

Leukaemias and lymphomas, two types of blood cancer, affect the production and function of blood cells. Leukaemia, which starts in the bone marrow, is the most common type of childhood cancer. Lymphoma is the third most prevalent childhood cancer and starts in infection-fighting white blood cells (lymphocytes) in the lymphatic system.

The main types of leukaemia are acute lymphoblastic leukaemia, the most common childhood cancer diagnosis, and acute myeloid leukaemia. The most common childhood lymphomas are Hodgkin lymphoma and non-Hodgkin lymphoma.

Brain and spinal cord tumours, the second most prevalent type of childhood cancer, form when cells in a child’s central nervous system grow abnormally and divide rapidly, forming a mass of tissue.

While leukaemia is more common, brain and spinal cord tumours are the leading cause of cancer-related deaths among children worldwide.

The most common brain and spinal cord tumours in children are gliomas, embryonal tumours, ependymomas, and glioneuronal and neuronal tumours.

As abnormal cells divide in a child’s organs, soft tissue and bones, they can form masses called solid tumours.

Accounting for 30 per cent of all childhood cancers, solid tumours can develop throughout a child’s body, with the most common being neuroblastoma, Ewing sarcoma and Wilms tumour.

Childhood cancer symptoms are similar to those of common childhood illnesses, Dr Stevens said. However, if symptoms persist or worsen, she strongly recommends contacting a doctor for further evaluation.

According to Dr Stevens, some of the most prevalent symptoms of childhood cancer are unexplained weight loss or loss of appetite; persistent pain in the bones, joints, back or legs; lumps or swelling in the abdomen, neck, chest, pelvis or armpits; extreme fatigue or noticeable paleness; frequent bruising, bleeding or a rash of small red spots; recurring fevers that last longer than a week or have no clear cause; frequent headaches, often accompanied by early-morning vomiting; and sudden vision changes or a whitish colour behind the pupil.

Since childhood cancer is rare and has many types, it is difficult for researchers to study and understand its causes, though they have identified factors that may increase a child’s risk.

Certain medical conditions, such as Down’s syndrome, can increase the risk of specific cancers, such as leukaemia. About eight to ten per cent of childhood cancers are linked to inherited or other germline genetic variants, such as changes in the RB1 gene linked to retinoblastoma.

Chronic infections such as Epstein-Barr virus (EBV), HIV and malaria are linked to specific childhood lymphomas and other malignancies.

Exposure to radiation from an industrial accident, radiotherapy or frequent medical imaging can also increase the risk of cancer. Children treated with certain chemotherapy drugs or radiation for a first cancer have a higher risk of developing a second cancer later.

Since early symptoms of childhood cancer are similar to those of common childhood illnesses, specific medical tests are required to make a diagnosis.

These include blood tests to check for abnormal blood cell counts and imaging scans, such as X-rays, CT scans or MRIs, to view internal organs and locate tumours.

A biopsy involves removing a small tissue or fluid sample to confirm the presence of cancer cells under a microscope, while bone marrow aspiration tests marrow from inside the bone, often for blood cancers such as leukaemia.

A lumbar puncture, or spinal tap, checks the fluid around the brain and spine for cancer cells, while genetic tests check for mutations associated with specific childhood cancers.

Dr Stevens explained that when considering a treatment plan for childhood cancer, doctors take into account the child’s age, overall health and the specific type of cancer.

Treatment is often successful in countries where it is accessible and typically combines several options, including chemotherapy, surgery, radiation therapy, stem cell transplants, immunotherapy and targeted therapy.

Chemotherapy, the most common treatment for childhood cancer, uses medicines given through a vein, by mouth or via injection to destroy fast-growing cancer cells.

Surgery removes solid tumours or abnormal tissue. When possible, surgeons use minimally invasive methods to help children recover faster, while radiation therapy uses high-energy rays to shrink or destroy tumours.

Stem cell transplants replace damaged bone marrow with healthy stem cells after high-dose chemotherapy. This treatment is often used for blood cancers such as leukaemia or lymphoma.

Immunotherapy boosts a child’s immune system to fight cancer, while targeted therapy attacks specific cancer cell genes or proteins.

In addition to treatment, Dr Stevens said children with cancer need specialised care that supports physical growth and development, cognitive and educational development, and nutritional health and well-being.

Another important aspect of childhood cancer care is psychosocial support, which, she noted, includes financial guidance for parents, school and social reintegration programmes, family and sibling support, and age-appropriate therapy.