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Common types of childhood cancer explained
Abrilliant beacon of hope and expertise in pediatric oncology, Dr. Adedayo Joseph, consultant clinical radiation oncologist and Research Programme Director at the NSIA-LUTH Cancer Centre (NLCC), acknowledges childhood cancer’s distinct challenges and complexities. Childhood cancer, unlike other forms of the disease, affects children and adolescents up to the age of 19. Beyond her clinical duties, Dr. Joseph, with a special interest in cancers that affect children and women, advocates tirelessly for increased resources, better infrastructure, and heightened awareness in Nigeria. Dedicated to innovative solutions, she stands as a steadfast ally for young cancer patients and their families, illuminating a path toward improved care and brighter futures. She spoke with Associate Editor ADEKUNLE YUSUF
The most prevalent childhood cancer, acute lymphoblastic leukemia (ALL), often termed blood cancer, predominantly affects white blood cells. In Nigeria, Wilms tumor, a type of Nephroblastoma, is common. Medical terminology insight reveals that “nephrons” filter urine in the kidney, while “blast” signifies immature cells. When nephron cells proliferate abnormally as blastomas, they impair organ function and disrupt normal cells, leading to tumors. Other childhood cancers include sarcomas (soft tissue or bone), neuroblastomas (nerve cells), and hepatic blastomas (liver cells). Unlike adult cancers linked to lifestyle factors, pediatric cancers often originate from prenatal events and lack screening measures. Unlike adults, where screening detects common cancers like prostate, cervical, colon, and breast cancers, early detection in children relies on recognising symptoms promptly and seeking specialised treatment. This approach significantly improves survival rates, as pediatric cancers stem from immature cells, differing fundamentally from adult cancers. Therefore, timely intervention by qualified experts remains pivotal in achieving favorable outcomes for childhood cancers.
In cancer treatment, the mantra “early detection saves lives” holds particularly true. The analogy of cancer growth likened to a mathematical progression underscores the urgency of catching it in its nascent stages. By the time a tumor becomes visible on imaging scans, it has often burgeoned to over a billion cells or more, signifying a substantial proliferation. However, prompt intervention, such as surgical excision, can often suffice at this juncture. Yet, as cancer advances, its management grows increasingly intricate. When tumors metastasize to lymph nodes or adjacent organs, the therapeutic approach necessitates a more comprehensive strategy. What might have previously entailed the removal of a portion of an organ now demands the excision of entire structures, often accompanied by meticulous dissection of surrounding vasculature. Even so, the risk of leaving behind residual cancer cells looms large, potentially leading to recurrence and further metastasis.
The progression from localised disease to widespread metastasis fundamentally alters the treatment landscape. At this juncture, surgery alone is often inadequate, prompting the adoption of systemic therapies. These interventions, typically administered intravenously or orally, traverse the bloodstream to reach cancer cells scattered throughout the body. While effective, they also pose a conundrum: the collateral damage inflicted on healthy tissues by these potent agents, resulting in a spectrum of adverse effects ranging from mild to severe.
In cases of extensive metastasis, the sheer burden of disease renders curative attempts unfeasible. Instead, the focus shifts towards palliation and long-term disease control. Such an approach acknowledges the limitations of current therapies while striving to optimise quality of life for patients battling advanced cancer. Transitioning from the clinical to the socio-economic realm, the Nigerian context underscores the multifactorial barriers to timely cancer diagnosis and treatment. Despite a propensity to seek healthcare for their children, adults often prioritise their familial and occupational responsibilities over attending to their own health concerns. Moreover, the pervasive issue of misdiagnosis, particularly prevalent in resource-limited settings, exacerbates delays in accessing appropriate care. In essence, the narrative of cancer care converges on the pivotal role of early detection. Whether in the intricate theatre of treatment modalities or within the socioeconomic fabric of healthcare access, the imperative remains unchanged: to detect and intervene before cancer’s inexorable march renders its eradication an elusive pursuit.
The second problem we have is cost of treatment because we don’t have insurance coverage for many Nigerians. Every time someone goes to the hospital with their child who is not well, they have to pay out of pocket for CT scan, blood test, etc. Because of that high cost of treatment and the general financial strain in society, people are afraid to go and look for healthcare in conventional places. Therefore, many times they seek healthcare from what they consider to be more affordable and accessible to them but those places do not have the expertise to find that this is a cancer and it is time for the child to see a pediatric oncologist. For those reasons, those of us who are working in the teaching hospitals and know how to treat it, don’t tend to see these children until they come with stage four disease that can no longer be cured, no matter how much money there is available to spend, and no matter what part of the world they would take the child to for treatment and that is the importance of early detection. If we were able to discover them and create a system that provides access to them when things are still early, we will begin to change our survival rates in Nigeria.
Misconceptions surrounding childhood cancer
There are many of them. One of it is that mother’s lifestyle could cause childhood cancer or something she did in pregnancy is what caused it. This is something that we see a lot, and it can really be heartbreaking and quite unfair and again, inaccurate in 99 per cent of cases. To the mother, it’s not something she did, it is not because she took folic acid or she didn’t take folic acid. If that were the case, then we would have a lot more cases. There are many pregnant women who would then have a child with cancer because of this or that. It is not mother’s fault, it is something that happens at the level of the cells at the point where they’re being formed and there is nothing a mother could have done to prevent it.
The second thing is that a child can survive cancer, that’s another myth. People feel that cancer is so severe and that it is just this scary condition. Even adults are dying from it, how then can a child possibly survive it? I am very happy to tell people that survival rates are far better in childhood cancers than in adult cancers. There are cancers in children, for which, we don’t even discuss survival anymore, if you are in a high resource setting. Survival is taking for granted, what they didn’t talk about is reducing side effects, making sure that they can maintain quality of life over a long time, making sure to preserve the child’s fertility. So they’ve sorted out the issue of survival. Yes, they are one or two that don’t have excellent survival rates, but in general, cancer in children actually has better survival than cancer in adults. We are able to use doses of chemotherapy in children that an adult is not able to withstand also there are techniques that work in children that adults are not even able to use.
Cancer centres in Nigeria
Another myth I would like to address is that cancer can somehow spread that, for me, is one of the most devastating ones, because you see some children who have developed hands that tell you that they are neighbours, or their friends at school have been told to avoid them, the children on the streets don’t play with them anymore and when they come around they show them away because and their parents told them to stay away from that child because they are afraid that the child will somehow infect their own child. I know it comes out of fear, and that fear comes from a place of ignorance that is why we must continue to educate. Cancer is not something that can be spread. It’s not contagious because one child has cancer does not mean that the child playing with him is now also going to get cancer. That can just be cruel to the psychology of a child who is going through it.
Gaps in childhood cancer care
I think I would start with research. We need to generate our own data, we need to even know how many children are developing cancer in Nigeria., where do they live? What are the barriers that they face that are unique to them. We need to generate our own data rather than just copying data from other places and extrapolating because our situation, context, community, resource level and all of that is different.
Most of the treatment we are doing is copied and pasted from research that has been done in mostly Caucasian populations. We are assuming that it will work the same way in our in our population and produce the same results, but evidence from other types of cancer is beginning to show that that is not the case. So, we need to do our own local research to understand the specifics of our own kind of cancers, and how to treat them that are relevant to us and relevant to our resource capability. There is no point to copying a guideline for proton therapy that is not available in Africa and bringing it here to follow. We have to also develop treatment guidelines that are relevant and feasible in our context.
Also, talking about barriers to access, a child who has cancer should be able to get treatment. I’m not saying they should be treated free, because of course it does cost something and that’s that funding must come from somewhere but I think that a unity of private industry, healthcare industry, government and policymakers can devise solutions that will make sure that children are able to access care. A child who has cancer should not die when they didn’t have to die simply because the parents couldn’t afford treatment. Another problem that can be addressed is knowledge because there is a general knowledge plight in all industries not excluding healthcare but change is not isolated to healthcare.
Doctors and nurses are leaving the country not just because of the healthcare system, because of other challenges in other systems. I think as these things get better, we will retain our talent more. We are right now training talent and exporting those talents to other countries, and that is not good for our healthcare system or economy. We have to come up with innovative ways, not enough to just ban doctors from leaving the country. I don’t have to leave the country, but I might decide not to practise medicine anymore. That doesn’t help anybody. So they have to be innovative and realistic solutions to retaining the talent that we have in the country. These are some of the hanging issues that can be addressed, but there are multiple things. We need more healthcare facilities, experts, raining programmes and more referral systems that are tailored to children. We need more attention in general to pediatric cancer as there is needs to be strategic solution creation specific to cancer in children, not taking solutions that were designed for adult conditions and just sort of expanding them and thinking we can include children here. It doesn’t work that way. They have to be designed from the ground with children in mind for them to become relevant to those to that population.
Credit (The Nation )