Paediatric cancer on the rise

By Carol Aloysius

Childhood cancers are treatable and some are curable, and once cured they can lead a normal life, says Dr Lakshman Obeysekera of National Cancer Institute, Maharagama, in an interview with Sunday Observer.

Question: Cancer in children is on the rise. Why?

Answer: According to the cancer register published in 2005 by the Ministry Of Health the number of children affected were as follows: males between the age group of 1-14 was 187, Females - 179 patients. Out of those 50 percent of them were leukemic patients. Other patients had cancers in brain, bone, ovary, testis, thyroid and muscle.

The number of cases are rising due to several reasons.

The availability of modern medical diagnostic facilities in most of the major hospitals and the easy access to the medical facilities, plus availability of specialist doctors in this field in rural hospitals. Hence the number of cases reported are more. Another important reason is that parents are more aware about the diseases compared to a few decades ago.

Q. Are there any other factors that have contributed to this rise in paediatric cancer?

A. Yes, familial cancers due to genetic mutations, over exposure to environment factors like heavy metal containing chemicals and inadvertent use of pesticide and other toxic chemicals for agriculture could also have led to cancers of brain and leukemia.

Q. What age group is most at risk? Newborn children? Between 1-5 yrs? or pre-teens?

A. Any age group can be affected. But the most susceptible age group is between 2 and 10 years.

Q. What kind of cancer is commonest among each group?

A. The commonest cancer is leukemia. The peak age is 4 years of age. Among all pediatric cancer patients, over 50 percent are in this category.

The commonest age group is between 3 and 9 years. Unfortunately we cannot say the exact reason for this presentation. However statistics-wise we are similar to other countries.

Q. I understand this disease is curable if medication is given at the right time.

A. Yes, according to the studies, it is found that multi drug chemotherapy gives a good outcome in leukemia patients; not only that, there are a few more cancers like renal tumors, eye tumors, bone cancers, germ cell tumors that are also curable. Early intervention and proper side effect management is important in the treatment of childhood cancers. Highly specialised units are needed to treat them.

Q. What is the percentage of children having other forms of cancer in Sri Lanka?

A. Other cancers like retinoblastoma (eye cancers), nephroblastoma (kidney cancer),neuroblastoma(nerve tumours) also occur during early years of life. Bone tumors and muscle tumours are also common in the age group of 4 -12 years of age.

Q. What about brain tumors that occur in the same age group? How are they detected?

A. Presentation of brain tumors varies from child to child. Headaches or blurring of vision or double vision are one form of presentation. Gait changes or imbalance in walking, is another. Sudden behavioural changes in a child, and a noticeable decline in his/her learning ability for no known reason, could be an early sign of a brain tumor.

Q. How is it detected?

A. Depends on the symptoms of presentation, the doctor will request a few essential investigations.These will help him arrive at a diagnosis. The most important test is the biopsy.

Q. What is a biopsy?

A. A biopsy means, we take a piece of tissue from the affected organ and examine it under a microscope and give a report on the cells.

Radiological investigations are also used for this purpose especially when some parts of the brain are not amenable to biopsy and we have to rely only on CT scan findings. According to the latest diagnostic tools molecular and genetic markers play a major role in confirmation of the disease.

Q. Even without a family history is it possible for a non medical person like a parent to detect specific forms of cancer in a child?

A. Without family history of cancer, parents can identify “cats eye”, a feature of retinoblastoma. Then between the ages of 7 to 14, if the child complains of pain around the knee joint or an unexplained swelling, this is a significant symptom of a bone tumors.

We often see parents of these children carrying them and taking them from one place to another for alternative medicine. This is the wrong thing to do.

By the time they come to an oncologist it is already very late. So it is very important to get surgical opinion from a child specialist if your child complains of knee joint pain or a swelling, as soon as he complains of it.

Q. Once detected, is it treatable? Manageable? Curable?

A. Certain cancers are curable. For example in the case of leukemia in childhood, curability is over 80 percent. However, to achieve this figure, the patient should get the ideal treatment and the timely side effect management. Sometimes we see children die not due to cancer itself but due to the toxicity of treatment and side effects like infections and low blood counts.

Q. What happens if the cancer is not curable?

A. If the cancer is not curable, patients are given palliative care or best supportive care. Other than leukemia, cancers like germ cell tumors, renal tumors, early retinoblastoma are also curable.

Q. I understand that certain forms of cancer in children like leukemia, is curable if medication is given at the right time.

A. Yes, according to studies it is found that multi drug chemotherapy gives a good outcome in leukemia patients. Other cancers like renal tumors, eye tumors, bone cancers, germ cell tumors are also curable.

Early intervention and proper side effect management is important in the treatment of childhood cancers. Highly specialised units are needed to treat them.

Q. What kind of treatment options are available today for peadiatric cancer globally? Any new breakthrough? Are they available in Sri Lanka as well?

A. Basically we use a multidisciplinary approach - drugs, surgery, chemotherapy and radiotherapy - which play a major role in treating cancer. Target therapy ,Cryotherapy, Laser therapy Immunotherapy, Genetic counselling, psychotherapy and rehabilitation also help in the management of childhood cancers.

Q. If controlled at an early stage in children, what is their chance of survival?

A. Acute lymphoblastic leukemia ranges from 70-85 percent with a 5 year survival rate. In other words, we can consider them as cured. There is another category of acute myeloid leukemia in childhood for which the 5 years survival rate is 65 percent.

In brain tumors there are two types high grade and low grade.There is a five year survival rate for 90 percent among the low grade one.

This drops to 10 percent in the other group. In Renal tumors among children called as “Wilm’s tumor” the curability is over 95 percent with the latest chemotherapy protocols. Other important tumors in childhood are bone cancers(osteosarcoma and ewings sarcoma) and the eye cancer (retinoblastoma). Survival rate in eye cancer is between 80-100 percent with proper treatment.

Q. What treatment options are available for children with cancer in Sri Lanka?

A. In Sri Lanka except for bone marrow transplant all the other treatments are carried out in hospitals with cancer treatment facilities.

Q. What are the state hospitals that have these facilities?

A. Maharagama Cancer Hospital, Kandy General Hospital , Galle Teaching Hospital, Jaffna Teaching Hospital, Badulla General Hospital, Anuradhapura Teaching Hospital Ratnapura General Hospital and Kurunegala Teaching Hospital.

Q. What are the health facilities that parents with kids who have cancer can take them in Sri Lanka? Are there special wards in these hospitals or are they kept in general wards alongside adult patients?

A. In Sri Lanka paediatric cancers are being treated by trained staff specialised in this field.

Maharagama and Galle hospitals have a separate ward for children with cancer. During the treatment mother or guardian has to stay round the clock with the baby.

The best way of keeping the baby would be to have a separate bed for mother in the same vicinity like at home. However in practice it is impossible to provide all the facilities.

Q. What are the common myths with regard to paediatric cancer in particular and cancer in general?

A. The general public think that only the adults get cancer and that once you are diagnosed with cancer you carry an undated death certificate. This is not so, especially in the case of childhood cancer. Childhood cancers are treatable and some are curable and once cured they can live a normal life.

Q. As one who works in the Maharagama Hospital among children, what do young children with cancer need mostly? Counselling? Playmates? Medications? Reading material?

A. They need care by their parents, in a friendly environment during the course of treatment. Social support like playmates, teaching, singing sessions, and other recreational activities will help them get out of their stress during the hospital stay

Q. Your suggestions as to how present facilities and services given to children with cancer can be improved? Also any contact numbers if outsiders wish to help?

A. Social support is mandatory in cancer care, not only for children but also for adults. So if anyone wants to help there is a donations procedure in the Cancer Hospital under the guidance of the Hospital Director. You can also contact National Cancer Institute Maharagama at any time to get information by telephoning 0112 850252.

Scientists warn of possible early sign of Alzheimer's

Sleep loss can be an early warning sign of Alzheimer's, new research suggests.

The findings, from a study of apparently healthy volunteers, point the way to new methods of detecting and monitoring the disease, say scientists.

Evidence indicates that the link between sleep and Alzheimer's runs in two directions.

Alterations in the brain caused by the disease may disrupt sleep, and poor sleep also promotes the changes. Prof David Holtzmann, from Washington University School of Medicine in the US, said: “This link may provide us with an easily detectable sign of Alzheimer's pathology.

“As we start to treat people who have markers of early Alzheimer's, changes in sleep in response to treatments may serve as an indicator of whether the new treatments are succeeding.”

Sleep problems are common among people with full-blown Alzheimer's. The new research suggests they may also be a sign of early-developing disease and symptoms to come.

Previous animal studies conducted on mice have demonstrated a link between sleep loss and beta-amyloid plaques - lumps of protein in the brain that are a hallmark of Alzheimer's disease.

The new research involved 145 volunteers aged 45 to 75 who were showing no signs of memory loss or other dementia symptoms when enrolled.

Analysis of samples of the volunteers’ spinal fluid showed that 32 participants had molecular markers of pre-symptomatic Alzheimer's.

The volunteers kept daily sleep diaries for two weeks, noting what time they went to bed and got up, the number of naps they took during the day, and other relevant information.

Daytime activity was tracked using movement sensors worn on the wrist. Participants who had pre-clinical Alzheimer's had a “sleep efficiency” of 80.4 percent compared with an average 83.7 percent for those without Alzheimer's markers.

People with early signs of Alzheimer's spent the same amount of time in bed as non-affected volunteers, but did not sleep as long. They also napped more often.

Signs of Alzheimer's became more common with deteriorating sleep quality, according to the research published in the journal JAMA Neurology. Co-author Yo-El Ju, also from Washington University said : “When we looked specifically at the worst sleepers, those with a sleep efficiency lower than 75 percent they were more than five times as likely to have pre-clinical Alzheimer's disease than good sleepers.”

The scientists are now conducting a new study on younger participants with sleep disorders.

Dr Ju said: “We think this may help us get a better feel for the way the connection flows - does sleep loss drive Alzheimer's, does Alzheimer's lead to sleep loss, or is it a combination? That will help us determine whether we can change the course of the disease with pharmaceuticals or other treatments.”

A separate study published today lends more support to the theory that lack of sleep is linked to weight gain and obesity.Scientists found that sleeping just five hours a night for a working week and having unlimited access to food caused volunteers to gain an average of nearly two pounds.Study leader Kenneth Wright, from the University of Colorado at Boulder, US, said: “Just getting less sleep by itself is not going to lead to weight gain.

But when people get insufficient sleep, it leads them to eat more than they actually need.

PA

Lifelong exercise keeps the brain working better

Lifelong exercise can lead to improved brain function in later life, a study has shown.

People perform better in mental tests at the age of 50 if they have engaged in regular intense activity, such as playing sport, running, swimming or working out in the gym, since childhood.

More than 9,000 individuals took part in the research from the age of 11. Interviews were conducted at regular age intervals to monitor levels of exercise. Participants also undertook tests of memory, attention and learning.

Those who had exercised two to three times per month or more from the age of 11 scored higher in the tests than those who had not.

Study leader Dr Alex Dregan, from King's College London, said: “As exercise represents a key component of lifestyle interventions to prevent cognitive decline, cardiovascular disease, diabetes and cancer, public health interventions to promote lifelong exercise have the potential to reduce the personal and social burden associated with these conditions in late adult years.”

The findings are published today in the journal Psychological Medicine.

Government guidelines say that adults aged 19 to 64 should exercise for at least 150 minutes per week.“It's widely acknowledged that a healthy body equals a healthy mind,” said Dr Dregan. “ However, not everyone is willing or able to take part in the recommended 150 minutes of physical activity per week. For these people any level of physical activity may benefit their cognitive well-being in the long-term and this is something that needs to be explored further.“ Setting lower exercise targets at the beginning and gradually increasing their frequency and intensity could be a more effective method for improving levels of exercise within the wider population.”

Intense exercise appeared to provide greater benefit for the brain than regular moderate activity, said Dr Dregan.“ Clinical trials are required to further explore the benefits of exercise for cognitive well-being among older adults, whilst examining the effects of exercise with varying levels of frequency and intensity,” he said.

- PA