FOR HANNAH

FOR HANNAH – ABOUT CANCER IN CHILDHOOD
This week, my sister’s granddaughter celebrated her 3rd birthday in the hospital. The hospital sent some clowns to perform and gave her a birthday cake, but they also gave her parents the news that she has cancer. She is still being tested to determine the extent and type of her cancer and the treatment that will be used. Whatever it is, it will be a difficult year for Hannah and her parents and her whole family. Hannah’s family will become very familiar with the hospital environment and may start to feel strange away from it. They will spend time being depressed, then hopeful, then depressed again and not necessarily in unison.  Because they live in Canada, they will not have the burden of the medical bills that people from some countries would have but Hannah’s parents will have to spend much time away from work which will add to the stress. The rest of life goes on and the other bills still come in but cancer takes priority over all. Cancer is no longer the death sentence that it once was, though it is still a very difficult disease to get through. It is difficult to see your child so ill and to authorize treatments that will make them sick while making them better. Small children are not able to look at the outcome as a reason for the discomfort. Family and friends need to gather around and offer as much support, both physical and spiritual, as they can because it is needed.

Statistics on childhood cancer are hard to find for places outside the United States and Canada but it is said to vary little by region and to be about 1 to 2 children per 100,000 that will get cancer. Only 1 percent of all cancers are in children. Nonetheless, it is the 2nd greatest cause of death, after accidents, during childhood. There has been a steady increase in the survival rate and, now, over 80% of children diagnosed with any form of childhood cancer survive for more than 5 years. Most grow up to lead relatively normal lives. Childhood cancer is defined as cancer diagnosed before 15 years of age but over half of childhood cancers are diagnosed before 5 years of age.  Lymphoma is rare before 3 years of age but Wilm’s tumors are rare after 6. In children under 1 year of age, neuroblastoma is the most common type of cancer, though it is far less common in older children.

Childhood cancer and adult cancer are very different. Firstly, most types of adult cancer have a hard tumor, such as breast cancer, lung cancer or pancreatic cancer, but by far most childhood cancers do not.  The most common type of childhood cancer is leukemia, a cancer of the white blood cells, followed by lymphoma (which affects both children and adults), a cancer of the lymph system. The third most common type of childhood cancer is of the brain and nervous system and which does start with a tumor. Wilm’s tumors, which is a type of kidney cancer, is also seen in children and not in adults. Bone cancers are also more common in children and are seen more often in older children.

Another difference in childhood cancers is the causes. While they are not clearly understood, they are thought to be genetic, in the form of a mutation which is thought not to be inherited but to occur after conception. Environment plays a much smaller role in childhood cancers than it plays in adult cancers.  This is not to say that children are not affected by exposure to know carcinogens, such as dioxin and passive smoke, they are and you see increased incidence of cancers at all ages when there has been exposure. This is to say that most childhood cancers develop in the absence of such exposure.  Children with certain genetic disorders, such as Down Syndrome, Neurofibromatosis or Von Hipple syndrome, are at greater risk of developing cancer in childhood than is the general population. As a result, there seem to be few preventative measures that can be taken. Eating a high fiber, low junk food diet and avoiding known chemical carcinogens is useful for everyone, children included, but may not prevent childhood cancers.

Childhood cancers progress much faster than most adult forms. Symptoms of childhood cancers are very similar to symptoms of other childhood diseases and ones first thought does not go to cancer. For this reason, many cancers are not diagnosed immediately. In Hannah’s case, her main symptom was that her tummy started to swell. Her mother was first told that it was just her posture. When mom insisted that it was something else, she was told constipation (though there did not seem to be a problem in that area). After three weeks of persistent concern, the doctor did a sonogram and immediately sent her to the children’s oncology ward. The truth is that most times a swollen tummy is related to constipation.

Finally, Children are not adults. They are still growing themselves. Their systems respond differently to many things including cancer treatment. On the one hand, Children are more sensitive to Chemotherapy and Radiation therapy so do not need as much as adults do to have an effect. On the other hand, children are more sensitive to Chemotherapy and Radiation (yes, that is what I said above), so there are more “late effects”. In other words, children who have been treated for cancer may suffer other problems later in life, including being more susceptible to other cancers as adults. A child who has had cancer will need to follow their health closely all of their life but the chances are good that they will have a rest of their life.

for more information, the following articles were used to write this piece:
1. http://www.dorak.info/epi/ccepi.html  Childhood Cancer Epidemiology
2. http://www.cmaj.ca/content/180/4/422.full  Canadian Cancer Statistics, Cancer in Children
3. http://www.cancer.org/Cancer/CancerinChildren/DetailedGuide/cancer-in-children-childhood-cancer  American Cancer Society, Learn About Cancer
4. http://www.cancer.net/patient/Coping/Age-Specific+Information/Cancer+in+Children American Society of Clinical Oncology, Cancer in Children
5. http://www.nlm.nih.gov/medlineplus/cancerinchildren.html  Medline Plus, Cancer Information
6. http://seer.cancer.gov/publications/childhood/infant.pdf  Cancer Among Infants, a study.