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.

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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.