HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

Be­fore COVID-19 sur­faced, there was an­oth­er med­ical con­di­tion that all health care pro­fes­sion­als dis­liked di­ag­nos­ing – that is “CAN­CER”; which is al­so non-dis­crim­i­na­to­ry, can oc­cur at all ages and can af­fect any part of the body. Pa­tients all around the world equat­ed a di­ag­no­sis of Can­cer to that of, one step clos­er to heav­en’s gates and dread­ed this di­ag­no­sis. It be­comes even more up­set­ting when it is a child.

Sep­tem­ber marks Child­hood Can­cer Aware­ness Month

The PROB­LEM:

• Can­cer is the lead­ing cause of death for chil­dren and ado­les­cents around the world and ap­prox­i­mate­ly 300,000 chil­dren aged 0 to 19 years old are di­ag­nosed with can­cer each year.

• In high-in­come coun­tries more than 80% of chil­dren with can­cer are cured, but in many low- and mid­dle-in­come coun­tries (LMICs) on­ly about 20% are cured.

• Avoid­able deaths from child­hood can­cers in LMICs re­sult from lack of di­ag­no­sis, mis­di­ag­no­sis or de­layed di­ag­no­sis, ob­sta­cles to ac­cess­ing care, aban­don­ment of treat­ment and high­er rates of re­lapse.

Ac­cord­ing to pub­lished re­ports by World Health Or­ga­ni­za­tion, “Un­like can­cer in adults, most child­hood can­cers do not have a known cause. It be­gins with ge­net­ic changes in a sin­gle cell that then grows out of con­trol. If left un­treat­ed, can­cer gen­er­al­ly ex­pands, in­vades oth­er parts of the body and caus­es death.” Many stud­ies have sought to iden­ti­fy the caus­es of child­hood can­cer, but very few can­cers in chil­dren are caused by en­vi­ron­men­tal or lifestyle fac­tors.

Ear­ly di­ag­no­sis is KEY

The most ef­fec­tive strat­e­gy to re­duce the bur­den of can­cer in chil­dren is to fo­cus on a prompt, cor­rect di­ag­no­sis fol­lowed by ef­fec­tive ther­a­py. When iden­ti­fied ear­ly, a cor­rect di­ag­no­sis is es­sen­tial to treat­ing chil­dren with can­cer be­cause each can­cer re­quires a spe­cif­ic treat­ment reg­i­men that may in­clude surgery, ra­dio­ther­a­py, and chemother­a­py.

Ear­ly di­ag­no­sis con­sists of three com­po­nents:

• Med­ical Lit­er­a­cy and aware­ness of warn­ing signs by fam­i­lies

• Clin­i­cal eval­u­a­tion, di­ag­no­sis and stag­ing (de­ter­min­ing the ex­tent to which a can­cer has spread)

• Ac­cess to on­go­ing treat­ment

Cop­ing with Child­hood Can­cer

For any fam­i­ly, be­ing in­formed that their child is di­ag­nosed with can­cer is dev­as­tat­ing. Ad­just­ing to this di­ag­no­sis and find­ing ways to stay strong is chal­leng­ing for every sin­gle per­son in that fam­i­ly. In Trinidad and To­ba­go, one such fam­i­ly, the Josephs, turned their lost bat­tle with Child­hood Can­cer in­to a bene­dic­tion for oth­er fam­i­lies cop­ing with a sim­i­lar tragedy. Health Plus in­ter­viewed the founders of The Just Be­cause Foun­da­tion (JBF) as they com­mem­o­rate their 13th An­niver­sary.

JBF is a non-prof­it or­gan­i­sa­tion found­ed by Chevaughn and Noel Joseph in ho­n­our of their son Jabez ‘JB’ Joseph. JB was di­ag­nosed with a rare form of child­hood can­cer, Alve­o­lar Rhab­domyosar­co­ma (can­cer of the mus­cle) at the age of 3 ½ and suc­cumbed to his ill­ness at the age of 5 ½ in March 2007. The Foun­da­tion was launched on 2nd Au­gust 2007, which would have been JB’s 6th birth­day and is ded­i­cat­ed to im­prov­ing the qual­i­ty of life for chil­dren with can­cer and their fam­i­lies in Trinidad and To­ba­go and around the Caribbean. JBF con­tin­ues with its mis­sion of cre­at­ing greater aware­ness of the warn­ing signs of Child­hood Can­cer.

Chevaughn said “It’s cru­cial that any­one who is a par­ent, guardian or care­giv­er to a child is aware of the signs of child­hood can­cer. It can very eas­i­ly be masked as oth­er typ­i­cal child­hood ill­ness­es or in­juries and there­fore can eas­i­ly be missed.”

Here are some of the most preva­lent types of child­hood can­cer in Trinidad and To­ba­go and some of the key signs and symp­toms.

Acute Lym­phoblas­tic Leukaemia (ALL)

ALL, the most com­mon type of child­hood can­cer, is can­cer of the blood that starts in the bone mar­row and spreads to the blood­stream. (The bone mar­row is the spongy in­ter­nal part of bones where new blood is made).

Leukaemia de­vel­ops be­cause of a mu­ta­tion in a white blood cell that caus­es it to mul­ti­ply un­con­trol­lably. These mu­tat­ed white blood cells, called “blasts” take over the bone mar­row and crowd out nor­mal blood cells. One blast soon gen­er­ates bil­lions of oth­er blasts, with a to­tal of about a tril­lion leukaemia cells typ­i­cal­ly present in the body at the time of di­ag­no­sis.

Signs and Symp­toms:

• Fa­tigue and pale­ness

• Fever

• Bruis­ing or bleed­ing - known as throm­bo­cy­tope­nia

• Bone pain, some­times as­so­ci­at­ed with swelling of the joints

• Weight loss or loss of ap­petite

• En­larged lymph nodes

Hodgkin’s Lym­phoma (Hodgkin’s dis­ease)

Hodgkin’s Lym­phoma is a can­cer that af­fects your lym­phat­ic sys­tem which is a part of your im­mune sys­tem that helps to fight in­fec­tion and dis­ease. This sys­tem in­cludes the lymph nodes, ton­sils, bone mar­row, spleen, and thy­mus.

It has been re­port­ed in in­fants and young chil­dren, but it is con­sid­ered rare be­fore the age of five. Most cas­es are in teenagers and young adults.

Signs and Symp­toms:

The most com­mon symp­tom of Hodgkin lym­phoma is swelling of the lymph nodes.

Lymph nodes are found in the neck or above the col­lar­bone, as well as un­der the arms or in the groin. They are usu­al­ly pain­less, firm, rub­bery, and mov­able in the sur­round­ing tis­sue.

Brain Tu­mours and Cen­tral Ner­vous Sys­tem Tu­mours

Brain tu­mours in chil­dren oc­cur in the cen­tral ner­vous sys­tem (CNS) and spinal cord. To­geth­er, these im­por­tant or­gans con­trol func­tions such as breath­ing, heart rate, move­ment, think­ing and learn­ing.

Signs and Symp­toms:

Typ­i­cal symp­toms of CNS tu­mours are di­rect­ly re­lat­ed to the lo­ca­tion of the tu­mour.

• Headaches (fre­quent, re­cur­rent)

• Vom­it­ing - es­pe­cial­ly in the morn­ing

• Eye move­ment prob­lems and/or vi­sion changes

• Un­steady gait or wors­en­ing bal­ance

• Weak­ness in the arms or legs

• Bulging fontanel (soft spot on an in­fant’s head) or in­creased head size

• Tilt­ing of the head or neck to one side

• Seizures/Dizzi­ness/Loss of Con­scious­ness

• Dif­fi­cul­ty with speech, swal­low­ing or drool­ing

• Ir­ri­tabil­i­ty or oth­er be­hav­iour­al changes

• Hear­ing loss

Wilms Tu­mor and Neu­rob­las­toma

Wilms tu­mor is the most com­mon form of kid­ney can­cer in chil­dren.

Neu­rob­las­toma most of­ten orig­i­nates in the adren­al glands, which are lo­cat­ed on top of each kid­ney. How­ev­er, tu­mours can be­gin any­where in the body such as the chest, neck and pelvis.

Signs and Symp­toms:

• A lump or mass or pain in the ab­domen

• Blood in the urine (Wilm’s Tu­mour)

• Fever

• Di­ar­rhoea

• Nau­sea and vom­it­ing

• Weight loss

• Anaemia, fa­tigue

• Short­ness of breath

• El­e­vat­ed blood pres­sure

• Weak­ness or paral­y­sis if the tu­mour is near the spinal cord (Neu­rob­las­toma)

The NEXT STEPS

We be­lieve, equipped with this knowl­edge, the next step is seek­ing ear­ly med­ical in­ter­ven­tion. The same way it is rec­om­mend­ed that women have their an­nu­al pap smears and mam­mo­grams done and men their PSA’s; please en­sure that your chil­dren have an an­nu­al phys­i­cal ex­am done. Keep in mind, Chevaughn’s moth­er­ly ad­vice to the gen­er­al pub­lic, “Please be vig­i­lant, ear­ly de­tec­tion can def­i­nite­ly save lives.”

Look out for HEALTH PLUS every Tues­day for more in­for­ma­tive and health­ful ar­ti­cles. If you have any ques­tions or con­cerns re­gard­ing this top­ic, please email Guardian­Health­Plus2020@gmail.com