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DEPARTMENT
OF PEDIATRIC ONCOLOGY
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| Dharamshila
Cancer Hospital And Research Centre (DCHRC) offers
a comprehensive service for treatment of childhood
cancers. Though childhood cancers are rare, with
a 1 in 600 chance of a child developing cancer before
the age of 15, it is an important cause of child
mortality. In the developed world more children
die due to childhood cancer than due to any other
disease. |
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cure rates for children with cancer are very good
and are constantly increasing with two-thirds of
children achieving long-term cure. This figure is
even higher for certain conditions like Wilms' tumor
and Hodgkin's disease. |
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quality of treatment is the biggest prognostic factor
in the overall outcome of these children. Their
disease spectrum is very different from that of
adults and so are their needs. Treatment of childhood
cancers needs to be highly individualized. It is
therefore important that pediatricians trained in
the management of childhood cancer manage these
patients. |
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Pediatric Oncology unit at (DCHRC) has been set
up keeping these in mind. The unit is fully geared
up for the comprehensive management of children
with blood cancer, solid tumors, brain tumors and
nonmalignant hematological conditions. |
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HISTORY |
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Pediatric Oncology first emerged as a specialty
in Europe in the early 1950's. Odile Schweisguth,
a French doctor was one of the pioneers in this
field who fought relentlessly to develop facilities
for children with cancer. She was also one of the
first doctors who forced other doctors to treat
these children with hope rather than despair. Hospital
wards looking after children in those years were
sad places as the disease was universally fatal.
Fortunately great advances in this field now mean
that up to 70% of children with cancer can be cured.
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| Childhood
cancer has been called the "modern medical miracle"
because of the remarkable progress that has been
made in curing infants, children and teenagers with
cancer. Many of the principles of therapy used in
treating adults with cancer were first tested and
developed in children. |
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Oncology as a specialty is in its infancy in India
and optimal treatment for children with these conditions
is available only at very few centers. However,
there is increasing realization that, children are
not miniature adults. The pattern of cancers in
children and the strategy of treatment is different
from that in adults. Care needs to be taken to avoid
long-term side effects such as damage to the heart
and kidneys in a growing child. |
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Oncologists in different parts of the world have
formed cooperative groups and through concerted
team efforts have evolved precise treatment protocols
to improve cure rates and reduce long-term morbidity. |
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INFRASTRUCTURE AT DCHRC |
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Dedicated Leukemia/Neutropenia wing |
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Acute leukemias are common in children and chemotherapy
in leukemia leads to severe neutropenia. In this
state, there is a high risk of infection and management
in a dedicated leukemia / neutropenia facility reduces
the risk of infection. |
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Day Care Centre |
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Many patients can be managed in the day care without
admission to the hospital ward. This avoids disruption
of the family life and is more acceptable to children.
Day care is used as much as possible. |
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Intensive care unit |
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critically ill patients |
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Blood Bank |
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Equipped with blood cell separator for single donor
platelets and stem cell therapy |
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Fully equipped Radiotherapy department |
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Fully equipped operation theatres |
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complex in the hospital is fully equipped to cater
to the needs of pediatric patients needing surgical
treatment. |
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PATIENT INFORMATION |
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Is cancer a significant problem in children? |
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Cancers in children are much less common than they
are in adults. There is a 1 in 600 chance of a child
developing cancer before the age of 15 years. However,
in western countries, cancer is the leading cause
of death in children as infectious diseases have
been controlled. |
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Why does cancer occur in children? |
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The precise reasons why some children develop cancer
are still unclear. Cancer in children occurs when
due to some reason genes that control cells in the
body undergo change causing the cells to multiply
in an uncontrolled manner. A great deal of research
is currently underway to study a number of possible
causes. The proportion of cancers occurring due
to inherited genetic defects is higher in children.
In fact, retinoblastoma is a classical example of
childhood cancer where inherited gene defect has
been identified and it has been a model of study
for genetic basis of cancer. However, majority of
cancers still have no identifiable inherited genetic
defect. |
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Is cancer infectious? |
| Cancers
are not infectious. They never spread from person
to person. Presence of a cancer patient in the family
poses no risk to other family members of acquiring
the cancer. |
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Can childhood cancer be prevented? |
| Prevention
is an important approach in countering the menace
of cancer. However, till now no preventive approaches
are available for childhood cancers. Preventive
approaches are important if environmental factors
have a strong impact on the incidence of a given
cancer. No strong environmental risk factors have
been identified in childhood cancer. |
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Parents often worry that their child has a cancer
because of something they did or did not do. This
is not the case and parents should not take any
sort of blame for their child developing cancer.
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Can cancer in children be treated successfully?
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| Although
the total number of children developing cancer has
changed little in the last 40 years, the success
of treatment has improved dramatically in the same
time. |
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specialists decide on the best way to treat your
child, various tests are carried out to confirm
the diagnosis and 'stage' the cancer. Tests may
also need to be done to assess the child's general
health as this may affect how treatment is planned.
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How can we make the treatment more acceptable
to children? |
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undergoing treatment for cancer will often require
repeated blood tests and insertion of needles to
enable chemotherapy and other drug treatment to
be given. Despite very experienced people doing
these, it may be an unpleasant experience for the
child. Many children therefore prefer to have a
special device called a central line, which can
be used to take blood samples and give chemotherapy
and blood or platelet transfusions. These can stay
in place for many months. |
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How is childhood cancer treated? |
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for adult cancers, there are three modalities for
treating childhood cancer also: surgery, radiotherapy,
or chemotherapy. A number of factors decide the
best treatment for each child. Often a combination
of these treatments is used. In fact, multimodality
management using a combination of approaches has
been responsible for the dramatic improvement in
outcome of childhood cancer that has occurred in
recent years. |
| What
are the common side effects of treatment? |
| Low
blood count: Blood cells are made in the bone
marrow (the spongy material which fills the bones).
Almost all chemotherapy causes low blood counts.
This means that the child has less ability to fight
an infection and may need blood and platelet transfusions. |
| Hair
loss: Many of the medicines used can cause the
child's hair to foil out temporarily. It always
grows again quite normally after stopping treatment. |
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Loss of appetite and weight: Chemotherapy
may make your child feel sick and may decrease his
/ her appetite. Modern anti-sickness drugs are very
effective. Your child's weight will be checked regularly.
Sometimes we may need to support the food intake.
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| Concerns
regarding long-term effects on various body organs:
The treatment protocols for children have been specifically
designed with a view to reduce long-term effects.
The vast majority of children being treated do not
have any significant damage to their organs. Most
children shall grow and develop as normal but will
need regular monitoring fill growth is completed.
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