PEOPLE often express surprise that children can get cancer. Cancer in childhood occurs infrequently compared to adult cancers but is very important to know about as it is one of the leading causes of death in children under 14 years of age.

In the United States, 10,000 children under 15 years will develop cancer in 2015. Locally, 50 to 60 children across the island develop cancer yearly.

WHAT IS CHILDHOOD CANCER?

Childhood cancer refers to any cancer developing in a child under 18 years of age.

The most common cancers seen in children include: Leukaemias (blood cancers); lymphomas (cancer of the immune cells); brain tumours; Wilms tumour (a type of kidney cancer) and neuroblastoma (cancer of immature nerve cells).

Other childhood cancers include: Rhabdomyosarcomas (muscle cancer); retinoblastoma (cancer of the eye); and bone cancer (including osteosarcoma and Ewing sarcoma).

WHAT CAUSES CHILDHOOD CANCER?

This is due to changes in the DNA or chromosomes of the cells (the building blocks of life).

Unlike adult cancers, there has not been any proven environmental or lifestyle associations such as a bad diet or exposure to chemicals.

Therefore, parents shouldn’t feel guilty when their child develops cancer, there is little that they could have done to prevent it.

POSSIBLE SIGNS AND SYMPTOMS OF CHILDHOOD CANCER

These include:

* An unusual lump or swelling

* Unexplained paleness and loss of energy

* Easy bruising

* An ongoing pain in one area of the body

* Limping

* Unexplained fever or illness that doesn’t go away

* Frequent headaches, often with vomiting

* Sudden eye or vision changes

* Sudden unexplained weight loss

WHAT IS THE TREATMENT OF CHILDHOOD CANCERS?

Treatments are chosen for childhood cancers based mainly on the type and stage of the cancer.

Treatment options may include chemotherapy, surgery, radiation therapy, and/or other types of treatment. Chemotherapy involves the use of chemicals (drugs) given through an IV (the drip).

In many cases, more than one of these treatments is used.

Generally, childhood cancers usually respond well to chemotherapy because they tend to be cancers that grow fast. (Most forms of chemotherapy affect cells that are growing quickly.)

Children’s bodies are also generally better able to recover from higher doses of chemotherapy than adults’ bodies.

LONG-TERM EFFECTS OF TREATMENT

Cancer treatments such as chemotherapy and radiation therapy can cause long-term side effects, so children who survive cancer need careful attention for the rest of their lives.

These can include:

* Heart or lung problems (due to certain chemotherapy drugs or radiation therapy);

* Slowed or decreased growth and development (in the bones or overall);

* Changes in sexual development and ability to have children;

* Learning problems; and

* Development of second cancers later in life.

Routine medical checks yearly and avoiding risky behaviours such as drinking and smoking will be important as the child gets older.

PSYCHOSOCIAL EFFECTS OF CHILDHOOD CANCER

No matter what age a child is, a cancer diagnosis will have a big effect on them. A child’s age, level of development and personality will determine many of their reactions. However, most children will feel a mix of being anxious, afraid, angry, or upset at some stage during their illness.

For most children with cancer, their life changes dramatically. Going through tests, doctor’s appointments and treatment will become their new routine. They will have a lot to cope with so it’s important they have people close by they can trust and feel loved by at all times.

Although children can be very strong during a serious illness, understanding a child’s specific needs, maintaining normal routines and providing boundaries, comfort and love, are very important to help support this natural resilience.

Siblings of a child with cancer have their own fears. Hospital visits, seeing their brother/sister upset, in pain or acting differently can all be very frightening to a child. They may feel they have lost the once close and fun relationship with their brother or sister. Feeling alone and lost is not uncommon.

Anger and jealousy are other emotions that may be expressed due to the amount of attention given to their ill sibling. Sadness and guilt that they caused the cancer to occur are other common feelings.

They may also pretend they are okay so as not to upset their parents more than they already are. School performance may suffer with lower marks than usual.

PARENTAL EMOTIONS

Understandably, most parents who are told their child has cancer feel completely devastated. There may be moments when people can feel numb and don’t believe what is happening. Painful emotions of anger, sadness, guilt, fear and denial are all common and normal feelings of parents who have been told their child has cancer.

Parents play a huge role in how a child copes. A calm, loving, present, and reassuring parent can help the child to cope with the treatment.

There is no right or wrong way to feel. Most parents find their emotions go up and down over the course of a child’s treatment. Some days they may feel they are coping and other days may feel completely lost or out of control.

Whilst no-one can fully prepare a parent to cope with their child having cancer we hope the following tips will help.

* Get all the information you can about childhood cancer, treatment and care.

* Ask your doctors where to get information on the Internet – this is crucial as some websites can be misleading.

* Do not try to be “brave” and cope alone. Doctors, nurses and all staff at the hospital want to help you. Talk to them, let them know how you feel and ask for help.

* Relieve yourself of the burden of home duties (cooking, washing, cleaning, shopping) and caring for your other children by asking family members and friends to fill in. They will want to help but may need guidance as to what to do.

* Take care of yourself. Most parents find this the hardest thing to do, as they focus completely on their sick child’s needs. But it is important to take time out for you and not feel guilty for doing this. You cannot be expected to care for your child if you are not looking after yourself.

* Try to talk about your feelings with those you trust. Most people say that when they share their sadness, anger or fear it helps. If you feel you may need some professional counselling ask your doctor at the hospital for a referral.

* Set up a group email or blog for people who want to know how things are going, or delegate a close friend or family member to give information to the rest of your friendship and family groups. It can be overwhelming to try to inform everyone all the time about what is happening for your child. Be sensitive about the information posted in public about your child. They may not want their information out for everyone to see.

* Take time out to spend with your partner, family and friends. Having a child with cancer can put a lot of strain on your close relationships. It is important to maintain communication both through talking and physical intimacy where possible.

TALKING TO CHILDREN ABOUT THEIR CANCER

It is only natural to want to protect a child and their siblings from a cancer diagnosis. However, for most children, the regular hospital visits and tests, missing school and other activities will alert them to the fact that something is very wrong. Most children can pick up on their parents’ emotions. How they react to upsetting news often depends on how the parents are coping with it.

It is best to be open and honest with young people about a cancer diagnosis. Reliable, age-appropriate information can help them understand and cope with changes.

If possible, both parents should talk to their child. This way they can support each other. It is important not to give too much information all at once. Throughout the conversation, get feedback to ensure that the child understands what is being said. Keep things consistent and honest. It is important not to promise a child anything that you cannot be sure of.

Letting children know how adults are feeling will allow them to express their own feelings more easily. Reassure children that whatever they are feeling is normal and that they will be supported throughout.

RECOGNISING WHEN YOUR CHILD NEEDS EXTRA HELP

As stated before, most children with cancer and their siblings will go through a range of emotions. While they usually manage to find a way to cope, there may be times when your child needs extra support. Parents need to be able to recognise the signs if their child has a more serious problem and needs to talk to a health professional.

A child usually needs extra help and support if they:

* Feel sad all the time and cry a lot;

* Cannot be comforted or reassured;

* Show less interest in their school work, hobbies and friendships;

* Cannot concentrate;

* Have severe mood swings;

* Feel irritable, upset and angry often;

* Talk about hurting themselves or thinking of suicide;

* Have weight loss/gain/appetite changes not related to the cancer and its treatment;

* Suffer low energy/fatigue not related to the cancer and its treatment;

* Have trouble sleeping that goes on for more than a week or two.

While this is a turbulent period for the entire family, sticking with and completing treatment offers the best chance for a good outcome. When abandonment (leaving treatment early) occurs, the disease is likely to recur and is harder to treat.

SUPPORT THE FIGHT AGAINST CHILDHOOD CANCER

Local organisations involved in cancer care include:

Angels of Love, a non-profit charity assisting children with critical illnesses;

Leukaemia Care – providing financial support for newly diagnosed children with leukaemia; and parents can also get assistance from the CHASE Fund and the Ministry of Health compassionate fund.

Dr Michelle Reece-Mills is a paediatric oncologist at the University Hospital of the West Indies.