More and more children survive cancer

In South Africa 1500 new cases of cancer amongst children are diagnosed every year. Owing to earlier methods of detection, improved medication and more effective treatment methods, many more children’s lives are saved than was the case thirty years ago.

In 1969 no children with leukemia survived. In 1998, 55 percent of the children treated at the Tygerberg Hospital’s Paediatric Oncology Unit since 1983 were still alive, said Professor Peter Hesseling, Head of the department Paediatrics and Child Health of the faculty of Health at the University of Stellenbosch.

One out of every 75 000 children develop cancer every year. In South Africa, 15 000 new cases of children with cancer are diagnosed every year.

Limited chances of survival in Africa
More than 75 percent of children in the world who develop cancer, die unnecessarily from the disease, because they do not have access to modern therapies, according to Professor Hesseling. With very few exceptions, African countries or other developing countries do not have state hospitals that have modern facilities or medications for the effective treatment of cancer.

Types of cancer prevalent amongst children
The most prevalent cancers amongst paediatric patients in South Africa is leukaemia (24 percent), brain tumours ( 21 percent), lymphomas (16 percent), cancer of the kidney – also known as Wilm’s tumour (10 percent) and cancer of the sympathic nervous system, known as neuroblastoma. Leukaemia attacks the bone marrow where the blood stem cells are produced as well as the white blood cells, and lymphomas affect the lymphatic system.

The cancers are treated by means of specific combinations of surgery, radiotherapy and chemotherapy.

The greatest progress has been made in the field of early detection of cancer. This can be ascribed to two factors : the ability to identify specific genetic changes, that are connected to leukaemia and other types of cancer, as well as better and more efficient chemotherapy drugs. Owing to improved chemotherapy drugs, less radiotherapy is necessary these days. Furthermore, radiotherapy can be done more accurately, thereby reducing the chances of damaging healthy cells, said Dr Felicity van der Riet from the Paediatric Oncology Unit at Tygerberg Hospital.

Longterm survival
A longterm follow-up study looking at children who were treated for cancer at Tygerberg Hospital in the last 20 years, showed that the survival rate of these patients was the highest in Africa, and compared well to the best survival rates in Western Europe and other Western countries, confirmed Professor Glyn Wessels, head of the Paediatric Oncology Unit.

The greatest strides as far as treatment is concerned were made in the last decade in the treatment of leukaemia, Burkitt lymphomas and all other types of lymphomas. The survival rate for leukaemia has increased from 60 to over 80 percent just in the last ten years.

The survival rate for astrocytoma (brain tumour) is 64 percent, B-cell- lymphoma 80 percent, cancer of the kidney (Wilm’s tumour) 70 percent, neuroblastoma 52 percent and cancer of the liver 33 percent.

The follow-up study also revealed that most children who survive cancer make normal progress at school. More than 80 percent of the children who survived, are now, as in any other control group, working adults. Most of them are healthy.

Only in the cases where patients had brain cancer, where the cancer itself, surgery or radiotherapy could have damaged brain cells, some of the survivors are handicapped or severely handicapped.

Side effects
Studies have revealed that radiotherapy of the brain can influence bone density and that children who have undergone this treatment, are more prone to bone fractures. This risk seems to change as children get older and puberty sets in and it is yet to de determined whether the effects of this radiotherapy are in any way longterm.

Some chemotherapy drugs have more side effects than others. Some of them cause infertility in men who were treated with cancer drugs when they were children. High doses of other chemotherapy drugs can have a toxic effect on the liver, the heart, the kidneys or the bone marrow. Large studies done overseas, where extensive research is done in the field of side effects and effectiveness of new chemotherapy drugs, enable units such as those at the Red Cross Children’s Hospital and the Tygerberg Hospital to adjust their treatment protocols immediately in order to use new drugs in the best combinations with the least side effects.

The Red Cross Children’s Hospital and the Tygerberg Hospital can, at this point, still afford the best and latest chemotherapy drugs, thereby ensuring the highest possible survival rate for children who have cancer. Should these budgets be cut, however, children with advanced cancer, who currently respond well to treatment, or children with a lower chance of recovery, could not be helped, doctors warned.

Symptoms Typical symptoms that should alert parents if their children complain of these, include the following:

• A persistent fever, the origin of which remains a mystery
• Pain in the bones, without the child having any sign of injury
• A lump, such as gland in the neck, under the arms, in the groin, or a larger mass in the abdomen that does not disappear
• Blood in the urine or the stools
• Sudden weight loss
•  
• Headaches in the mornings that cause nausea and vomiting
• A slight spotted rash consisting of small blood specks on the child’s body
• Many bruises

Parents should definitely take these symptoms seriously. Exhaustion, contrary to what one would expect, is not a symptom of cancer in children.

Contact details. For more information on children and cancer and cancer treatment for children, contact the Tygerberg Hospital’s Paediatric Oncology Unit at (021) 938 5995 or the Red Cross Children’s Hospital at 658 5111.

- (Mari Hudson, Health24)

Read more:
What is leukaemia?
Lymphoma
Brain Tumour
Cancer and genetics