Cancer in the child – Signs to watch for

A new study has indicated that almost half of children with cancer are undiagnosed and may die without treatment.
What is more disturbing, according to the study, is that the actual number of childhood cancer cases in the world is almost double the number recorded.

"Our model suggests that nearly one in two cancer patients is never diagnosed and is at risk of dying without treatment," said study author Zachary Ward.

He is a researcher at Harvard University Hospital. Chan School of Public Health in Boston.

The study, published in The Lancet Oncology, listed 224,000 childhood cancer diagnoses worldwide in 2015. The researchers estimated the actual number at 397,000.

The story is not different in Ghana. According to Dr. Lawrence Osei-Tutu, a pediatric oncologist at Komfo Anokye University Hospital (KATH) and Agogo Presby Hospital (APH), the cunning nature of childhood cancer was complicated by diseases that were very advanced in the past. treatment centers quite late.

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He noted that parents or caregivers generally sought other sources of complementary and alternative care, such as religious healers, and hospital when they have not seen the desired answer.

Early detection is the key to survival

Dr. Osei-Tutu said that early detection of cancer in children is essential because it could increase the survival rate.

"The earlier the stage of diagnosis, the lower the total cost of treatment, depending on the type of cancer," he added.

Dr. Lawrence Osei-Tutu states that early detection of cancer in children is essential

He said it was important for parents, caregivers and practitioners to be aware of how different cancers in the child presented themselves and how to detect early stage symptoms.

"When cancers are diagnosed early, it could lead to less intensive treatment and thus reduce the financial burden on families," he said.

Dr. Osei-Tutu recounted a case he recently met:

"In February of this year, I saw a nine-year-old girl who came to see us paralyzed from waist to leg. According to his family, they noted a painless swelling of the size of a small lemon on the left side of his neck last November. The swelling continued to increase gradually, although they were bv religiously apply a local herbal remedy recommended by herbalists.

"She was losing weight now and about a week before her visit to the hospital, she had lost her ability to stand up. non supported, until she can no longer feel her legs and be paralyzed. At that time, the swelling of the neck had more than tripled to the size of a medium size the paw and scans revealed that it had spread around the spinal cord, causing paralysis.

"Our tests revealed that she was suffering from a type of cancer called Burkitt's lymphoma and that after the initial treatment she is now able to walk with help."

What signs should I look for?

Dr. Osei-Tutu said that childhood cancers are very tricky for the parent or the unsuspecting doctor. They usually show symptoms of other common childhood diseases such as malaria, colds and sickle cell disease. At the beginning of disease many children may look good up to the cancer becomes more advanced and perhaps, spreads.

For example, he said, many cases of bone cancer in children were only diagnosed when teens underwent an x-ray for routine medical examinations or suspicion of injury while playing sports.

Brain tumors in children have remained hidden because they usually start with migraines or tension headaches. Many of these symptoms, he says, are treated as such with over-the-counter medications and painkillers until the disease progresses to cause more specific symptoms such as seizures, strabismus, vomiting. persistent, abnormal body postures and even strokes.

Although swelling is generally evident, in our traditional Ghanaian environments, many parents tend to seek treatment with various alternative and complementary local remedies, believing that these symptoms can not be treated by conventional or "hospital" treatments.

However, Dr. Osei-Tutu notes that the swelling may involve a larger body part, such as a limb or the abdomen, or a smaller part of the body, such as a lymph node. . For example, a type of kidney cancer called Wilms' tumor is frequently observed by parents as they hold or bathe their children. They usually feel an abnormally hardened mbad at a time sides (flanks) of the child's abdomen for which they are seeking help.

In infants or young children, cancer of the eye called retinoblastoma can be seen as a white patch of the usual black hole (or pupil) of the eye.

"Sometimes we only see it when the baby's eyes are examined at birth when a doctor lights them a light to check it. Many times, coincidentally, when you take a picture of the baby with the camera flash on the parents, a red reflex in the affected eye can get them to hospital seek help, "he said.

Again, he noted that at this early stage of the disease, many families consider it harmless and seek help only when the disease reaches the stage of the disease. swelling of all the eyeball with the badociated blindness.

Dr. Osei-Tutu said that fever, a very common symptom of many common infections in children, including malaria, may be the only early feature of leukemia. Other symptoms include intense bone pain that usually wakes up the child at night and can be confused with episodes of acute pain or a sickle cell crisis; Unexplained weight loss and swelling of the lymph nodes. The child may also look pale and bleed from the nose, in the urine and / or stool or in the skin (difficult to see in a child with dark skin).

Cancers in children in Ghana

Dr. Osei-Tutu said that Ghana was recording an increasing number of children under 18 years old with cancer.

Each year, 1,000 to 1,300 new cases are diagnosed in the two largest teaching hospitals. According to the World Health Organization (WHO), every year, more than 300,000 children under 19 years of age are diagnosed with cancer worldwide.

There are only two "comprehensive" centers for the treatment of childhood cancer in Ghana. The two centers treat between 500 and 600 reported cases of newly diagnosed childhood cancers per year: 100 to 150 at KATH and 300 to 350 at Korle Bu University Hospital (KBTH) about 1000 to 1300 new cases. Across the country, other hospitals, called shared care centers, treat children with cancer.

In the last five years, KATH's Childhood Cancer Unit has registered at total 585 children newly diagnosed with cancer: 121 in 2018; 111 in 2017; 113 in 2016; 106 in 2015 and 134 in 2014. This gives a reported average of 117 new cases per year to KATH.

The author of the new study, Ward, notes that accurate estimates are essential to define health care. the priorities, and plan an effective diagnosis and treatment of all children with cancer.

"Although under-diagnosis has been recognized as a problem, this model provides specific estimates that are lacking," he added.

In most regions, the number of new cancer cases in children is declining or stable. However, 92% of new cases occur in low- and middle-income countries, more than expected, the researchers said.

Unfortunately, Rifat Atun, professor of global health systems, observed, "Health systems in low- and middle-income countries are clearly not meeting the needs of children with cancer.

"Universal health coverage, one of the targets of the UN Sustainable Development Goals, must include childhood cancer as a priority to prevent unnecessary deaths," he added.

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