Childhood Cancer

Cancer is the leading cause of death in children after congenital abnormalities and road traffic accidents. In Singapore approximately 100 children are diagnosed with cancer each year.

Common Types of Child Cancer

Acute lymphoblastic leukaemia (ALL) is the most common cancer in children. It occurs in about 60 per cent of all childhood cancers. This is followed by brain tumours which occurs in approximately 20 percent of cases.

Other Cancers Seen In Children Are:

Survival in standard risk leukaemia is close to 85 per cent, with almost 95 per cent of patients going into remission. Stage I and II Wilms' tumour has close to a 100 per cent survival rate. However, the prognosis for brain stem gliomas continues to be dismal. Most children rarely survive beyond six months from diagnosis. Only 30 per cent of Stage IV patients with neuroblastoma will survive.

Multidisciplinary Support in Cancer Treatment

The behaviour of childhood cancer and its response to treatment is different from that of adult cancers. Multidisciplinary support is critical in the management of childhood cancer. The team looking after a child with cancer comprises the paediatric oncologist, surgeon, radiotherapist, nurse, medical social worker, physiotherapist, pharmacist and play therapist, to name a few. Everyone in this team is focused on the unique requirements of a child with cancer and the family.

The mainstay of treatment in a child with cancer is maximum cure with minimal morbidity. Paying close attention to potential problems that can cause late effects is paramount in childhood cancer treatment.

The favourable outcomes obtained in the treatment of a child with cancer have resulted from the progress made in several areas. These include the following:

A team of dedicated paediatric orientated professionals, including surgeons, neurosurgeons, orthopaedic surgeons, oncologists, radiotherapists and specialist nurses.

Improved radio imaging modalities such as the three dimensional computed tomography (3D CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans.

New and improved treatment regimes that are carefully selected so that the most appropriate treatment is given with the least morbidity.

Intensive and improved antibiotic regimes to treat infection aggressively.

Better supportive care in terms of blood and platelet products.

The development of colony stimulating factors, which are synthetic versions of natural substances that help bone marrow make new white blood cells, red blood cells and platelets. Colony stimulating factors such as GCSF, stimulate the bone marrow to produce white blood cells, hence reducing periods of profound neutropenia (a blood disorder) and thus the risk of infection.

New and improved antiemetics, drugs that reduce or prevent nausea and vomiting which enable treatment to be more acceptable.

Central venous access devices like the portacath, a plastic or metal container placed surgically under the skin. Such devices reduce anxiety and pain from the frequent venous access required for treatment and blood sampling.

Play therapy and emotional support to help the child and the family live as normal a lifestyle as possible during treatment. The Children's Cancer Foundation and the Assisi Hospice day care and palliative facility provide services specially designed for the critical support for children with cancer and their family.

The Molecular Biology of Childhood Cancer

The molecular analysis of the biology of paediatric cancers continues to be the mainstay of research in the treatment of childhood cancer. Only with improved understanding of the underlying behaviour of the cancer can oncologists accurately select the most precise therapy thus allowing for the most appropriate treatment with minimal side effects. This practice is clearly exemplified in patients with neuroblastoma where treatment is selected both by the stage of the tumour as well as the biological characteristics of the tumour.

Source : Parkway Medicine

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