Nandini (name changed) was diagnosed with acute leukaemia, a type of blood cancer, in 2023 when she was just 17 years old. Her parents were hesitant to pursue treatment because they were concerned about side effects and her future after receiving cancer therapy at a young age. However, the girl from Karnataka was determined to fight the battle bravely.
Despite facing multiple social and logistical challenges, she completed seven months of intensive therapy, returned home, and has now completed Class 12 and her therapy. Today, she is cancer-free and spreading the message of the curability of blood cancer. Now, she is busy chasing her dream of becoming an IPS officer.
Also take the case of Ananya (name changed) from rural Karnataka, who presented with a large swelling in the abdomen in 2022 when she was three years old. Tests found she has a kidney tumour called Wilms tumour, a rare type of kidney cancer that mostly affects children under the age of five.
She underwent chemotherapy for six months to shrink her tumour, later underwent surgery, and a few cycles of chemotherapy to prevent tumour recurrence. She is cancer-free, off all medications, and vaccinated appropriately for her age. Back in school, she is now in Class 2 and living just like other children in her class.
Childhood cancer is curable if detected early and treated appropriately by a multidisciplinary team. “All childhood cancers combined have a cure rate of around 70-80% in our country,” said Dr Vasudeva Bhat K, HoD of paediatric oncology at Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, who treated the two girls.
Each year, an estimated 4 lakh childhood cancer cases are reported globally. India records over 76,000. Around 17,000 children died of cancer in India in 2023, and South Asia accounts for nearly a fifth of the world’s childhood cancer deaths.
The types of cancer that occur in adults are different from the types of cancer that affect children. Adult cancers mainly originate in organs, whereas childhood cancers involve tissues such as the hematopoietic, lymphatic, central nervous system, muscles and bones.
Childhood cancer is a general term that refers to a large group of diseases. There are dozens of childhood cancer types and many more subtypes.
According to the 2023 Global Burden of Disease study published in The Lancet Oncology, India reports the high numbers of childhood cancer cases with significant gaps in diagnosis, treatment and data systems, while survival rates remain uneven despite many of these cancers being treatable.
For the vast majority of children, predicting in advance who will develop cancer is difficult. There is no routine blood test or scan that can screen healthy children for all childhood cancers. However, children who belong to families with certain inherited cancer-predisposition syndromes may need specialised genetic counselling and regular surveillance.
Most of the symptoms associated with childhood cancer are much more commonly caused by ordinary childhood illnesses. Therefore, having one of these symptoms does not mean that a child has cancer. “However, parents should seek medical attention if a symptom is persistent, unexplained, progressively worsening, or unusual for that child,” added Dr Deepak Bansal, professor, hematology-oncology, Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research (PGI), Chandigarh. The key message is persistence and progression, he said, adding that a child with an ordinary viral infection may have fever, tiredness or enlarged lymph nodes for a short period.
“Cancers can present in different ways in children based on the type of cancer, the organ involved and the extent of spread of the disease,” said Dr Ramya Uppuluri, consultant, paediatric haematology-oncology, BMT, Apollo Hospital, Chennai.
“The point to note is that any symptom which is very prolonged or very unusual or very severe, more than what would be expected for a simple routine condition or infection, needs to be investigated. For example, most children have leg pain. However, leg pain that is debilitating or that wakes up the child at night needs investigation,” she added.
Unlike many adult cancers, childhood cancers are generally not caused by smoking, alcohol, obesity or long-term lifestyle habits. “A small proportion of childhood cancers are associated with inherited genetic conditions like retinoblastoma – eye cancer,” said Dr Bansal.
“For most childhood cancers, there is currently no proven way to prevent them. Therefore, parents should not feel guilty or blame themselves if their child develops cancer,” he added.
Over the past decade, the incidence of childhood cancer has increased globally and in India. “It is predominantly due to increased awareness, early detection, and better reporting of cases,” said Dr Uppuluri. What matters, she said, is early diagnosis and early referral to a paediatric cancer centre to ensure right tests and diagnosis happen at the right time.
Common types of childhood cancers
The most common types of cancer affecting children include leukaemias, brain tumours and solid tumours such as neuroblastoma and Wilms tumour; lymphomas, bone cancer and thyroid cancer are more common during adolescence In India, the most common cancer in children is leukaemia or blood cancer, followed by brain tumours.
Retinoblastoma is a cancer of the eye that usually occurs in very young children. Parents may notice a white reflection from the pupil, particularly in photographs taken with a flash, called a “white eye” or leukocoria.
Other signs may include a new squint, a change in the appearance of the eye, redness or swelling Early diagnosis of retinoblastoma can be critical because treatment can not only save the child’s life but, in many cases, also preserve vision.
CHILDHOOD LEUKAEMIA (BLOOD CANCER)
Leukaemia is one of the most common childhood cancers.
May present with symptoms like persistent fever, pallor (paleness), unusual tiredness, bruising or bleeding, bone or joint pain, recurrent infections, or enlarged lymph nodes or liver and spleen.
These symptoms are not specific to leukaemia and are frequently seen in children with much more common illnesses.
A doctor may suspect leukaemia when several of these features occur together or when they persist.
A simple complete blood count (CBC) is often an important initial investigation, followed by further tests if necessary.
