Childhood cancers account for about 3% of global cancer cases, with about 75,000 new diagnoses in India each year, with the most common types being leukemia, brain cancer, lymphoma and solid tumors such as neuroblastoma and Wilms tumor. Despite their rarity, late diagnosis, often due to lack of awareness among parents and healthcare providers, often leads to neglect of symptoms and is a major barrier to successful outcome.
In high-income countries, where comprehensive services are readily available, more than 80% of children with cancer are cured. However, in low- and middle-income countries (LMICs), cure rates are less than 30%. Avoidable deaths in LMICs often result from issues such as delayed or misdiagnosis, barriers to accessing care, treatment abandonment, treatment-related toxicity, and disease relapse.
Here’s a guide to help you understand the complexities of diagnosing and managing suspected childhood cancer.
What to do when you are diagnosed with childhood cancer:
Maintain a high index of suspicion: The symptoms of childhood cancer may resemble those of common illnesses. For example, a persistent fever may be a sign of either an infection or a malignant blood disease. When common diagnoses fail to explain symptoms, consider cancer as a possible cause.
Do a thorough assessment: Always perform a comprehensive evaluation of symptoms, including unexplained weight loss, persistent fever, unexplained lumps or masses, and signs of bleeding. These symptoms demand further investigation beyond routine diagnoses such as infection or inflammation.
Get proper diagnostic tests done: When a malignant disease is suspected, appropriate diagnostic tests such as blood tests, imaging studies, and biopsy should be performed. Ensure that any biopsy or surgical intervention is planned with a multidisciplinary team to avoid compromising treatment options.
Contact specialized centers immediately: If childhood cancer is suspected, refer the patient to a specialized cancer center, where a multidisciplinary team can provide advanced diagnostic and therapeutic options. Early referral can significantly impact treatment outcomes.
Educate and engage families: Communicate openly with the child’s family about the likely diagnosis, the need for further investigation, and the importance of prompt treatment. Engaged families are better equipped to support their child during the diagnostic and treatment processes.
What not to do for managing suspected childhood cancer:
Do not start empiric treatment without proper diagnosis: Avoid starting empiric treatments, such as anti-tubercular therapy (AKT) for suspected tuberculosis or steroids for low platelet count, without confirming the diagnosis. Incorrect treatment may delay correct diagnosis and affect the effectiveness of subsequent cancer treatments.
Do not perform unplanned biopsy: Avoid unplanned biopsies of the abdomen, chest or limbs. Unplanned biopsies can lead to complications, such as disease spread or organ salvage in cases of malignant disease. Make sure the biopsy is done by specialists who are familiar with cancer management.
Don’t ignore common symptoms: Symptoms such as headaches, backaches or poor school performance in children should not be ignored as mere growing pains. These could be signs of underlying serious illnesses and should be evaluated thoroughly.
Don’t ignore regular eye tests: Regular eye exams can help detect early signs of retinoblastoma and other ocular cancers. During routine checkups, observe the child’s eyes for abnormalities such as the white reflex, which may indicate a serious condition.
Do not delay the diagnostic process: In cases where cancer is suspected, a delay in diagnosis can have serious consequences. Timely and accurate diagnosis is important for effective treatment and better prognosis.
By following these do’s and don’ts, one can improve early detection, avoid common mistakes in treatment, and ensure that children receive the best possible care. Due to the rarity of pediatric cancer there is a need to increase awareness and proactive approach to diagnosis and referral practices to improve outcomes and provide optimal care for young patients.
