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CHILDREN CANCER                                                         educate, support & empower


1.      INTRODUCTION
Definition of children cancer

    Children developed different types of cancer compared to adults
    Children cancer grows more rapidly than adult cancer
    It has common disease process like other types of cancer
    Uncontrolled and abnormal size and shape cells spread very fast
    Cancer cells will continue to grow and divide out of control
    Cells cannot die unlike normal cells
    When cancer cells grow, they demand more of the body’s nutrition
    Cancer will take children strength, destroy organ and bone, and weakens the body’s
     defenses against other illnesses

Cancer in children

    Children’s cancers are rare
    Leukemia, lymphoma and brain cancers usually occur in children
    Bone cancer (osteosarcoma) will occur as they grow
    For each type of cancer, it occurs in different place

Place to get the treatment

    If cancer disease is detected, parents or caregivers should take them to get treatment
    The treatment for the children with cancer is at the hospitals that have children oncology
     specialists
    In Malaysia, cancer treatment for children can be sought at:

            -   Pediatrics Institute, Hospital Kuala Lumpur
            -   University Malaya Medical Centre, Petaling Jaya
            -   Universiti Kebangsaan Malaysia (UKM) Medical Center (UKMMC), Cheras
            -   Hospital Universiti Sains Malaysia, Kubang Kerian (HUSM)
            -   Hospital Umum Sarawak, Kuching
            -   Hospital Pulau Pinang, Georgetown
            -   Hospital Likas, Kota Kinabalu, Sabah
            -   Hospital Sultan Ismail, Johor Bahru
Risk factor and symptom

-Risk Factors

   The factors that cause cancer in children are usually not similar as factors that cause cancer in
    adults, such as smoking or exposure to environmental toxins.
   The known risk factors include:
    i) Inherited conditions
         There maybe increased risks of childhood cancer in children who have genetic factor
         such as Down syndrome, but the cases are rare
    ii) Problems with development in the womb
         Some cancers occur when the baby is still inside their mother. As a baby growing in the
         womb, many parts of the body develops. There is possibility that the cells that should
         have turned into mature cells to form a part of the body still remain as very immature
         cells. However, the immature cells do not cause any problems and will mature by
         themselves at the age of 3 or 4. If they don’t, the immature cells will begin to grow out of
         control and develop into cancerous tumor.
    iii) Previous cancer treatments
         Children who have had chemotherapy or radiation treatment for their previous cancer
         treatment have an increased risk to get second growth of tumor.
    iv) Exposures to infections
         Epstein-Barr virus (EBV) which a common infection in young children causes no
         symptoms. However, teenagers and young adults can have glandular fever when they are
         affected by the virus. It has possibility to develop cancers like Hodgkin’s disease and
         Burkitts’s lymphoma.

   Sometimes, the doctor may be able to detect early symptoms of cancer in regular checkups
       such as fever, anemia or bruises. However these symptoms also related with other
       conditions which is not a cancer. Because of this, the doctors rarely suspect children
       illness when cancer symptoms first appear.

-Symptoms
Parents should look for degree of symptoms, period of the symptoms lasting and the condition of
the children whether they getting worse or not in early detection in their children. Examples of
symptoms that might indicate children cancer are:
 Vomiting for more than 7 days and getting worse when the children wake up in the morning,
    wakes your children up at night or related with headache
 Bone pain or muscle pain
 A continuously cough
 Having very decreased activity
 Loss of appetite
 Easy bleeding, bruising or a red pinpoint rash
 Rapid visual changes
 Enlarged liver or spleen
 Weight loss


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2.      SCREENING AND DIAGNOSIS

    Blood test- Complete blood counts (CBC). This test is used to measure the number of white
     blood cells, hemoglobin and platelets. Blood smear is carried out to show the presence of
     abnormal cells where it maybe leukemia disease.

    Bone marrow aspiration (take a small amount of bone marrow) and bone marrow biopsy-
     Bone marrow biopsy is tested under the microscope to confirm whether it is leukemia or not.

    Lumber spinal- The doctor normally removes some fluids that surround the brain and spinal
     cord to detect cancer cells. The doctor uses thin and long needle to remove this fluid. This
     fluid is then examined under the microscope.

    Tissue biopsy- Small pieces of tissue are taken from the organ that is suspected to have
     cancer cells. The tissues will be examine in the laboratory to ensure either it is harmful or
     not.

    Ultrasound- Ultrasound is used to get body description by using sound waves. The
     description of tumor is different from the normal tissue.

    CT scan (computerized tomography scan) or CAT scan- This test shows three
     dimensional picture of organ. The information produced is complete and can show the
     location, size and types of tumor.

    MRI (magnetic resonance imaging) - MRI will produce the picture of internal body and
     can detect bone tumors. MRI use magnetic powers that link to the computer and provide
     clear pictures of tumors located near the bone.

3.      CANCER TREATMENT

    Chemotherapy- The use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
    Radiotherapy- The use of high radiation to kill the cancer cells.
    Surgery- To remove abnormal tissues or tumors in the body.

(The types of treatment depend on cancer types and child’s age)




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4.      SIDE EFFECT OF THE TREATMENT
Chemotherapy

It is dependent upon the children’s age. The goal of treatment is to kill cancer cells but sometime
it can destroy healthy cells. The side effects of chemotherapy may include anyone of these:

    Anemia; low red blood cell count
    Low white blood cell count (it can give risk for infection)
    Temperature above 38°C
    Fatigue or shorts of breath
    Bruises or small red spots on the skin, bleeding gums, blood in urine or stools.
    Hair loss or thinning hair

Radiotherapy

    Tiredness: This happen when too many healthy blood cells are destroyed, so less oxygen is
     carried around body.
    Loss of appetite: Sometime after treatment, patients may also have difficulty of swallowing.
    Effect on skin: The area of skin exposed to the radiotherapy can become sore and red.

5.      TYPES OF CANCER IN CHILDREN
Common types of childhood cancer in Malaysia
 Leukemia- cancer of the blood
 Lymphoma- cancer of the lymph gland
 Brain tumor- cancer of the brain

Other types of childhood cancer
 Osteosarcoma- cancer of the bone. For further information please visit www.kidshealth.org
   or www.cancerbackup.org.uk
 Neuroblastoma- cancer of sympathetic nervous system (autonomic nervous system= can not
   be controlled by the mind). For further information please visit www.cancer.gov or
   www.cancerbackup.org.uk
 Wilms’ Tumor- cancer of kidney. For further information please visit www.cancer.gov or
   www.mayoclinic.com




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Leukemia

-Introduction
 The term leukemia refer to cancer of white blood cells
 Large number of white blood cells are produced in the bone marrow
 This abnormal and immature cells cannot do normal function of white blood cells
 Then, the ability to fight infection decreases
 Leukemia can be divided into acute (rapidly developing) and chronic (slowly developing)
 Usually, children have acute leukemia
 Acute leukemia is also divided into acute lymphocytic leukemia (ALL) and acute
    myelogenous leukemia (AML).
 Leukemia may cause bone and joint pain, weakness, bleeding, fever and weight loss.

-Diagnosis of leukemia
 Physical examination- The doctor examines abdomen to see if there is an enlarged liver or
   spleen because they can become enlarged with some cancers in children.
 After this exam, blood test will be done.
 Then, bone marrow aspiration (take a small amount of bone marrow) and bone marrow
   biopsy will be taken.
 A lymph node biopsy, in which lymph nodes are removed and examined under a microscope
   to look for abnormal cells.
 Lastly, doctor carries out lumber spinal test to confirm leukemia disease.

-Treatment of leukemia
 Leukemia does not have any tumor that doctors can surgically remove.
 The doctor will use chemotherapy. The dosage and combination will depend on the
   children’s condition.
 Then, radiotherapy may be recommended. This treatment uses high radiation to keep cancer
   cells from growing.

Lymphoma

   Lymphoma is a type of cancer involving cells of the immune system, called lymphocytes.
   Lymphoma can be divided into 2 categories and depending on shapes of cancer cells
    (malignant).
   It can be Hodgkin’s Lymphoma or Hodgkin disease (HL) and non Hodgkin Lymphoma
    (NHL).
   Lymphomas may spread from one site to other parts of the body.
   The cause of lymphoma is not known.
   Probably, it is caused by mutation in certain genes.
   Children have a high risk to get non-Hodgkin Lymphoma if they have Human
    Immunodeficiency Virus (HIV) infection, exposure to radiotherapy and chemotherapy, have
    undergone organ transplant and are on drugs to suppress their immune system.




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-Diagnose of lymphoma
 Physical examination- The purpose of this exam is to check for enlarged lymph nodes and
   signs of local infection.
 Medical history- The doctor will ask about children past health, parents past health and
   other issues.
 If enlarged lymph is found, the doctor will make an observation on the node closely to see if
   it continues to grow.
 Doctor may prescribe antibiotic if the gland is believed to be infected by bacteria.
 If lymph is still enlarged, tissue biopsy will be done to test the disease.
 To take the tissue from the body, the biopsy may be done using a thin hollow needle or small
   surgical procedure.
 Then, this tissue will be sent to the laboratory for examination.
 This test is to determine the specific type of lymphoma.

To identify which area is infected by lymphoma, the following test will used:

   Blood test- including complete blood count (CBC)
   Blood chemistry- including test of liver and kidney functions
   Bone marrow aspiration/biopsy
   Lumber spinal- to check if the cancer has spread to the central nervous system (brain and
     spinal cord)
   Ultrasound
   Computed tomography (CT)
   Magnetic resonance imaging (MRI)
   Bone scan or gallium scan
   Positron emission tomography (PET)- to look the abnormal cells


These tests will determine the spread of the lymphoma within the body and to decide nature of
treatment.

-Treatment of lymphoma
 Bone marrow transplants and stem cell transplants are the newest treatment options
 During this treatment, intensive chemotherapy with or without radiotherapy will be
   administered to kill cancer cells
 After that, healthy bone marrow and stem cells will be introduced into the body
 This process hopefully will begin producing white blood cells that will help to fight
   infection.

Brain tumor

   Brain tumor is the most common solid tumor in children
   A tumor is an abnormal tissue
   There are two types of tumor either malignant or benign
   A benign tumor is not a cancer cell


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    Usually, if benign tumor is removed it does not recur
    Most of benign tumors have clear borders, that mean they do not invade surrounding tissues
    Malignant tumors are cancer cells
    It is very fast growing and it invades the surrounding tissues
    The symptoms of the malignant tumors are similar to benign tumors

-Diagnose of brain tumor
 Physical examination and medical history- The doctor will check the changes from the eye
   movement, strength or other factors. The doctor will also ask the children and their parents
   about their medical histories.
 Blood test- To indicate whether cancer cells are in the organ or tissue
 Computed tomography scan (Also called a CT or CAT scan).
 Magnetic resonance imaging (MRI)
 Positron emission tomography (PET) scan- A radioactive is injected into the bloodstream to
   detect the location of cancer in the body
 Bone scan - Pictures or x-rays taken of the bone after a dye has been injected that is absorbed
   by bone tissue. These are used to detect tumors and bone abnormalities.
 After the tumor was detected, biopsy will be used to determine either it is malignant or
   benign.

-Treatment of brain tumor
It depends on child’s age and taking into consideration the size, position and type of brain tumor.

    Surgery- This is the first step of the treatment for brain tumor. The goals are to remove the
     tumor as much as possible and to determine either it is malignant or benign.
    Radiotherapy- if there are some cancer cells that have been left behind or it cannot be
     removed because of its dangerous location, the children may be given radiotherapy.
    Chemotherapy- it may also be used if the tumor cannot be removed completely with
     surgery.
    Steroids- To treat and prevent swelling in the brain tumors


6.      PSYCHOLOGICAL AND SOCIAL EFFECTS

    Treatment can impact on the physical, emotional and psychological states of the children. It
     is very important for the family to spend time and trying to understand children’s feeling.
    The children may have to quit from school temporarily until their doctors give the go-
     ahead. Parents need to consider positive ways to engage and occupy the children. It is
     useful to inform the school of the children's conditions, maintain contact periodically and
     work with the schools to help with their re-integration after treatment.
    Some treatments may have long-term effects on children, and more information can be
     obtained from the doctor. It can also give impact on children activity.



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    Siblings of the sick child may feel neglected as attention is focused on the child with
     cancer. Involve siblings by explaining to them what is happening and discuss questions and
     concerns that they may have.
    Couples that have children with cancer maybe have experienced strain and tension of taking
     care of a sick child and not have enough time together. Stress may also take the form of
     employers not understanding the situation. It is helpful for couples to communicate their
     worries and feelings and work out solutions together.


7.       FACT from MYTH

Cancer is not contagious.

Cancer cannot be spread from one child to another like flu. Children with cancer have low
immunity and cancer cell growth more rapidly.

Childhood cancer caused is unknown

At least 95 % of the cancers in children occur spontaneously. Study shows that children cancer is
not caused by inheritance.

Most childhood cancers are curable

For example, in Acute Lymphoblastic Leukemia, which is a common form of Leukemia for
children can be cured with chemotherapy alone. A successful cure depends on receiving the
current-day standard therapy, a positive attitude and determination to overcome cancer.
Childhood cancers are not a death sentence.

Children with cancer can still have a life like a normal childhood

Children with cancer can lead like a normal childhood. They have no reason to lose all life. Most
children with cancer will return to school after treatment. In other cases, the children and their
families adapt and modify their lifestyle to achieve normalcy. This becomes much easier with
care, understanding and support from family, teachers, friends and other caregivers.




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Some tumors are not cancerous

Tumors can be benign or malignant. Malignant tumors are cancerous cells and benign tumors are
not. Malignant can invade and spread to other parts of the body. In contrast, benign tumors
invade tissues surrounding it and generally do not spread.

8.                  STATISTICS

              According to National Cancer Registry in the year 2003, leukemia comprised nearly
               half of all cases reported in both sexes in the age group of 0 – 14 years.
              Leukemia have the highest cases of both sex where 312 (50.3%) cases for male and 197
               (45.2%) for female.
              The second most common tumor in this age group for both males and females is brain
               tumor.
              Male recorded 55 (8.9%) cases and female recorded 49 (11.2%) cases for brain tumors.



                                   Cases of Leukaemia by sex
                     350
                                     312
                     300
                     250
     NO. OF CASES




                                                                   197
                     200
                                                                                         Male
                     150
                     100                                                                 Female
                      50
                       0
                                    Male                         Female
                                                    SEX




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                             Cases of brain tumor by sex
                     56           55
                     54
      NO. OF CASES




                     52
                                                           Male
                     50                            49
                                                           Female
                     48

                     46
                                Male             Female
                                         SEX


9.            RESOURCES
www.ccf.org.sg
www.kidshealth.org
www.myhealth.gov.my
www.ccf.org.sg
www.cancer.org
www.cancerresearchuk.org
www.pediatrics.about.com
http://yourtotalhealth.ivillage.com
www.clicsargent.org
www.cancerbackup.org.uk
www.ccf.org.sg
cancer.about.com
www.nhsdirect.nhs.uk
www.cancerbackup.org.uk
www.cancer.gov
www.mayoclinic.com
www.makna.org
www.ucsfhealth.org
http://cancer.stanford.edu
www.chw.org

Compilation by:
Ms Nurul Syuhada Mohd Zin


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