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Paediatric Oncology

India accounts for 20% of childhood cancer cases around the world, annually. Approximately, the incidence of childhood cancer in India is 1 in 10,000.

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Overview

India accounts for 20% of childhood cancer cases around the world, annually. As per the World Health Organisation, India reports around 75,000 cancer cases in the age group of 0-19. In India, cancer is the 9th common cause of death among children aged between 5 to 14 years and according to a paper published by the Indian Paediatrics Journal, the proportion of childhood cancers relative to all cancers reported by Indian cancer registries vary from 0.8% to 5.8% in boys, whereas it is 0.5% to 3.4% in girls. Approximately, the incidence of childhood cancer in India is 1 in 10,000. Reports suggest that cancer in general, especially in children is under diagnosed and under reported.

Owing to the committed paediatric oncologists, onco-surgeons and researchers, treating childhood cancers no longer paints a grim picture anymore. In the last few decades, extensive research and medical advancements made inroads into the field of paediatric oncology – the study of childhood cancers. With more and more medical inventions and therapeutic discoveries that are being unveiled, young cancer patients are now able to experience positive clinical outcomes in the majority. Overall, globally about 80-85% of childhood cancers can be cured completely.

Paediatric oncology is the study of childhood cancers, diagnosis and treatment. Doctors trained in this highly advanced medical field deal with cancers and tumours affecting infants, children, teenagers or adolescents, between the age group of 0-19 years. These paediatric oncology experts diagnose the type of cancer and treat the child while ensuring their safety and comfort at every stage.

Types of Childhood Cancers

Cancer in children is rare but not unusual, and it differs biologically from the cancers diagnosed in adults. The most common types of cancers diagnosed in children include:

1. Leukaemia

Leukaemia is the cancer of the blood and bone marrow that interferes and restricts the body’s ability to fight infections. It is the most common type of childhood cancer comprising about 1/3rd of all childhood cancers. Often referred to as blood cancer, there are many types of leukaemia, including acute lymphoblastic leukaemia, acute myeloid leukaemia and chronic myeloid leukaemia.

Acute lymphoblastic leukaemia is the most common type of leukaemia in children, while acute myeloid leukaemia is the second most common. Chronic leukaemias are rare among children. Leukaemia is unfortunately more common in children. It is a disease of children and young adults and develops when the DNA of the single cell in the bone marrow mutates. Genetic disorders like neurofibromatosis, Klinefelter Syndrome, Down syndrome can trigger leukaemia among kids and teenagers.

2. Lymphoma

Lymphoma is defined as the cancer of the lymphatic system that includes the lymph nodes, spleen, bone marrow and thymus gland. Broadly, there are two main types of lymphoma in children, namely Non-Hodgkin’s Lymphoma and Hodgkin’s Lymphoma.

Hodgkin’s lymphoma can happen at any age but is mostly diagnosed in children and adolescents. Though what causes this type of cancer is still unknown, children with a weakened immune system are prone to this condition. There is no evidence to prove the genetic connection in lymphoma. With early diagnosis and advanced treatment options, the survival rates for Hodgkin’s lymphoma stand at 90%.

Non-Hodgkin’s lymphoma is of various types – generally, they are more aggressive and have varied manifestations. They can present at any age but are more common in children and adolescents. With early diagnosis and appropriate treatment, most children are expected to do well.

3. CNS Tumour

Tumours of the Central Nervous System or simply CNS tumours happen when healthy cells in the brain or spinal cord mutate and grow enormously, forming into a mass or tumour. CNS tumours can either be benign or malignant. The most common CNS tumours diagnosed among the younger age group are:

  • Medulloblastoma
  • Gliomas- Low grade and high grade
  • Astrocytoma
  • Oligodendroglioma
  • Ependymoma
  • Germ Cell Tumour

Most brain tumours require a multidisciplinary team approach, wherein treatment planning is made by a team comprising of neurosurgeons (who specialise in operating on children with brain tumours), radiation oncologists and paediatric oncologists. With the MDT approach, the majority of brain tumours can be treated with positive clinical outcomes.

4. Neuroblastoma

Neuroblastoma is a rare type of cancer that develops in nerve tissues, making them grow out of control. It affects kids under the age of 5 and especially below two years of age.

It grows in the immature nerve tissues called neuroblasts, mostly in the adrenal glands, located on top of the kidneys. It comprises about 7% of all childhood cancers. It can vary from being localised, self-limiting and extremely curable to extensively metastatic at the time of presentation. Tumours that are metastatic at presentation require a multimodal approach, which involves chemotherapy, surgery, radiotherapy and autologous BMT. Immunotherapy and differentiation therapy may also be considered for high-risk tumours.

5. Bone Tumours

Bone tumours constitute about 3-4 % of all cancer cases in children. The common malignant paediatric bone tumours are osteosarcoma and Ewing’s sarcoma. Like in all types of cancers, early diagnosis plays a crucial role in treating osteosarcoma and Ewing’s sarcoma as well. Both these tumours require treatment support from the MDT team comprising orthopaedic onco-surgeons, paediatric oncologists and radiation oncologists. Most patients with appropriate management can have limb salvage surgeries, and chemotherapy will be given as per standard protocols. The right treatment plan prevents cancer from spreading to other regions, thus improving the survival rate significantly.

6. Retinoblastoma

Retinoblastoma is a type of eye cancer, and it is diagnosed in children under the age of 5. Early diagnosis is the key as 9 out of 10 children can be treated with a positive outcome. It can affect one or both eyes, and one of the main symptoms to watch out for is the white reflection in the pupil of the eye. Squint, poor vision and persistent redness in the eyes are other common symptoms. If retinoblastoma is diagnosed in the early stages, specialists can treat the disease successfully and save the vision as well. In advanced stages, sometimes salvage of vision and eye may not be feasible. Treatment planning will require MDT approach involving paediatric ophthalmologists, paediatric oncologists and radiation oncologists.

7. Hepatic Tumours

Tumours of the liver are the third most common cause of intra-abdominal tumours in children. Paediatric hepatic tumours can either be benign or malignant, and most children present with abdominal distension, abdominal mass or sometimes with jaundice. Hepatoblastoma and hepatocellular carcinoma are the common types of hepatic tumours. Hepatic tumours also need an MDT approach, wherein hepatic surgeons and paediatric oncologists come together to devise appropriate treatment plans for paediatric patients. In children, hepatoblastoma is more common than hepatocellular carcinoma and has better prognosis.

8. Soft Tissue Sarcoma

Paediatric soft tissue sarcoma is defined as the formation of cancer cells in the soft tissues of the body. It often presents with soft, painless lump or inflammation in the soft tissues of the body and the most common type is rhabdomyosarcoma. The cause of soft tissue sarcomas is unknown, and it is mostly seen in boys than in girls. They can arise anywhere in the body. Early diagnosis and accurate staging are essential for appropriate treatment planning. Most localised tumours are treated with the MDT approach, and cure rates are excellent.

9. Wilms Tumour

Also called nephroblastoma, Wilms tumour is a commonly seen childhood cancer that starts in the kidneys. Around 9 of 10 kidney-related tumours are nephroblastoma, and it happens when cells grow out of control in these vital organs. In the majority of cases, they affect only one kidney but rarely can involve both kidneys. Other types of kidney cancers in children include mesoblastic nephroma, clear cell sarcoma of kidney or CCSK, malignant rhabdoid tumour of the kidney, renal cell carcinoma, etc. Palpable abdominal mass, swelling and pain are the common symptoms. The doctors usually recommend chemotherapy, surgery and radiation therapy for the successful management of Wilms tumours. Again MDT approach is preferable and most children are expected to do well.

Treatment for Paediatric Cancers

The treatment options while caring for paediatric patients depend upon various factors, including the age, type of cancer, stage of the disease, immunity of the child, underlying reasons like genetic inheritance etc.

Some cancers are treated with chemotherapy alone (like the majority of leukaemias – ALL and AML, and many types of lymphomas). For some cancers like brain tumours, surgery is often recommended, which is later followed by radiation and chemotherapy. Some children, like those with neuroblastoma, may need immunotherapy.

Bone marrow or Hematopoietic stem cell transplantation may be required both in leukaemias/lymphomas or many solid tumours. BMT is also a curative option for many non-oncological benign haematological problems, namely thalassaemia, aplastic anaemia and many immunodeficiency syndromes.

Regular check-ups with the doctors, intake of nutritional food and receiving emotional support from the parents, family, school, friends and loved ones will help the child to recover faster and aid in leading a normal life.

Paediatric Oncology at HCG

At HCG, our multidisciplinary team of doctors, who are extensively trained at world-class institutes, bring in all the more abilities while treating children affected by cancer. The expert team at HCG provides hands-on treatment, reviews the progress of each patient regularly and offers patient-centric and compassionate care, along with providing immense support to parents and families to wade through the cancer crisis with grit, determination and enormous amounts of positivity.

Our doctors of world-class excellence and well-trained paramedical staff are available round-the-clock. The treatment plan is charted not just for longevity but also towards providing a better quality of life.

Frequently Asked Questions

1. What does a paediatric oncologist do?

Paediatric oncologists are extensively trained medical specialists, who are skilled in the diagnosis and management of children with cancer like leukaemias, lymphomas, bone tumours, tumours of the brain & spinal cord, kidney tumours, sarcomas and other cancers among children.

2. What are the common symptoms of childhood cancers?

Cancer in children often presents with the following symptoms:

  • Unexplained prolonged fever or frequent fever
  • Sudden emergence of lump or swelling anywhere in the body
  • Easy bruising that takes a longer period to heal
  • Persistent fatigue
  • Pale skin
  • Severe pain often located at one place in the body, bone pains, night pain
  • Unexplained weight loss
  • Headaches associated with vomiting, especially early morning
  • Limping
  • Sudden changes in the vision
3. When are childhood cancers often diagnosed?

Childhood cancers are often diagnosed between the ages of 0 and 19. Leukaemia is common between the ages 2 and 14 with a peak being between 2-5 years, while neuroblastoma that forms in the nerve tissues, adrenal glands and also in the abdomen, neck and chest can occur even at infancy and commonest below 2 years of age and generally most children present before 5 years of age. Bone tumours are generally diagnosed in the adolescent age group.

4. How are childhood cancers diagnosed?

High index of suspicion is essential in diagnosis children with cancer. The doctor would run a few tests based on the signs and symptoms experienced by the child or reported by the family members. Some of the commonly recommended tests include extensive blood work, bone marrow aspiration, biopsy, lumbar puncture, PET-CT, MRI, ultrasound and other types of scans. Tissue diagnosis may need a biopsy from these tumours in most solid tumours. These tests help the specialist in zeroing in on the final diagnosis, staging and hence deciding on the specific type of treatment plan for ensuring a positive outcome.

5. Can my child play and be around others?

Cancer is not contagious, and your child can play, be around others, and attend school as long as it doesn’t make him or her tired very easily. However, the risk of infection from others is higher in these kids while undergoing treatment as their immunity level is very low. Children undergoing cancer treatment would require a lot of emotional support from family and friends. Ensure standing by them during tough times; fill in hope and confidence to fight it back.

6. Can cancer survivors live a normal life after their treatment?

Yes. Children who have successfully fought back cancer go ahead and lead normal lives. Thanks to the revolutionary medical advancements, more than 80% of childhood cancer survivors live for more than 5 years post treatment, and most of them would be normal long term survivors. It is possible for these kids to grow and continue to live a happy and near-normal life.

7. What side effects can my child expect during treatment?

The common side effects of cancer treatment in children include vomiting, nausea, loss of appetite, fatigue, sore throat and mouth, hair loss, lower blood cell count, fever, diarrhoea or constipation etc. However, most of these changes will subside after the completion of treatment.

8. What are the long-term side effects of childhood cancer?

The long-term side effects include problems with the heart, kidneys or endocrine effects like growth and thyroid functions. Most of these could be tackled by modifications of treatment protocols and close follow up and surveillance to detect these problems early. Some children and adolescents may also have issues related to anxiety and depression, which could be managed by counselling with psycho-oncologists.

9. What should parents know about long-term follow-up care for childhood cancers?

Parents need to be mindful of periodic doctor visits, the importance of preventive care and ensure a long-term comprehensive follow-up and nutritional support for the child to grow up healthy and lead a normal life. Long term follow-ups aim at detecting any relapse or recurrence of cancer and also make sure that long term side effects can be prevented or picked up early and managed.

10. Can paediatric cancers be prevented?

Since the majority of childhood cancers do not have a known cause, unfortunately, it is difficult to prevent childhood cancers. In rare cases, genetic or environmental factors also play a role in childhood cancer development. However good nutrition, vaccination, healthy lifestyle, regular follow up with the paediatrician and whenever there is suspicion of cancer, reaching out to the specialists and getting appropriate treatment are very important.

The first time is the best time and with appropriate treatment by the specialists in dedicated paediatric oncology units, most of these children are expected to be treated successfully and live to their potential.

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