Paediatric cancers can be cured with early detection
and proper treatment says Dr Deepal Perera:
Cancer, one of the most dreaded diseases in the world is surging with
a vengeance, claiming the lives of both young and old alike. Grim
statistics reveal it to be one of the leading causes of death in the
world. Health Ministry statistics reveal 10,000 to 15,000 new cancer
patients being diagnosed each year in Sri Lanka, with breast and
cervical cancer high among women and lip, oral cavity, pharynx, trachea,
bronchus, lungs and oesophagus cancer high among moment. It is
responsible for nine per cent of Non-Communicable Disease deaths in the
This picture is part of a series’ ‘Kids with cancer’ at The
Children’s Hospital in Denver, photographed for a program
called Flashes of Hope a non-profit organization dedicated
to creating powerful portraits of children fighting cancer
In the US, 1 in 285 children die before their 20th birthday due to
cancer. Globally the picture is no less daunting, with the World Health
Organisation saying there are over 250,000 children currently diagnosed
with the disease. This in spite of the fact that malignancies in
childhood are now considered relatively rare and prognosis has improved
in the past decades as a result of more accurate diagnosis and improved
treatment strategies. Overall, says the WHO, fewer children less than 15
years, especially in the industrialised world, will die of childhood
Here, Dr Deepal Perera, Senior Consultant Paediatrician in charge of
the Intensive Care Paediatric Unit, Institute of Cancer, Maharagama
Teaching Hospital, talks about the increasing incidents of cancer among
children, who is susceptible, what ratchets up the risk level and the
importance of early detection.
Q: What in your estimate is the rise in cancer among children
both here and in the world?
A: Worldwide we see a rise of about one percent annually from
paediatric patients to those 25 years of age.
Q: What has brought about this increase?
A: Mainly because of proper detection of the disease and more
awareness among parents and carers due to our educational programmes.
Q: Why is this segment more susceptible than others?
A: Because their bodies and immune systems are still
developing. So exposure to any toxic substances can increase their risk
Q: What kind of chemicals are you referring to? What kind of
cancers can be caused by them?
A: Raw rubber, smoke, industrial waste... Children exposed to
rubber face the ricks of getting cancer, as rubber is a contributory
factor in bladder cancer. Exposure to smoke can cause lung cancer.
Cigarette and nitrate exposure can result in early lung cancer.
The most recent study has found that Aflatoxins found in mushrooms in
other countries (not Sri Lanka) can cause testicular cancer. Children
with Down syndrome are also likely to develop leukaemia due to blood
Q: What role do genetics play? If a close relative of a child
has cancer, will he be more at risk? What is the risk level of a child
whose brother or sister has leukaemia?
A: Genetics, mutation, translocation and amplification within
the foetus are attributed to 15% of cancers. Around 40% of retinal
cancers are also connected to genetics. Marriage between first cousins
has also been identified as a cause.
Dr Deepal Perera
Q: What role does diet play? Do the food children eat today
cause or lead to cancer?
A: Instant food and junk food, which most children consume
today, lead to cancer risks in early life. They can lead to several non
communicable diseases such as obesity, which in turn causes diabetes,
fatty liver and non alcoholic cirrhosis.
Q: You mentioned fatty liver and non alcoholic cirrhosis. Can
you elaborate on these two diseases and tell us about their impact on a
child's health. Are they reversible?
A: Fatty liver is caused by obesity (being overweight). The
excess fat gets deposited in the liver cells and results in an enlarged
liver (fatty liver). This can lead to non alcoholic cirrhosis and liver
Q: Is this condition reversible?
A: Fatty liver is reversible. But not liver cancer. That is
why parents must try to prevent this condition from developing as it
leads to a serious death related disease like liver cancer and non
Q: How are these conditions detected? What is the technology
that cancer units in state hospitals including the Cancer Institute at
Maharagama where you work use to detect cancer?
|What is a fatty
A fatty liver is the result of the excess
fat in liver cells. Fatty tissue slowly builds up in the
liver when a person’s diet exceeds the amount of fat his or
her body can handle. A person has a fatty liver when fat
makes up at least 5% of the liver 1. Simple fatty liver can
be a completely benign condition and usually does not lead
to liver damage. However, once there is a build-up of simple
fat, the liver becomes vulnerable to further injury, which
may result in inflammation and scarring of the liver.
What causes fatty liver disease in
• The most common cause of fatty liver
disease is obesity. Besides obesity, nutritional causes of
fatty liver disease are: starvation and protein
Other causes include:
• genetic factors, drugs and chemicals
such as alcohol, corticosteroids, tetracycline and carbon
tetrachloride., diabetes mellitus, hyperlipidemia (elevated
lipids in the blood), insulin resistance.
The disease progression usually takes
decades, and depends of a combination of genetic and
(Courtesy Canadian Liver Foundation)
A: We use the Ultra scan. This will reveal any abnormality in
Q. How can fatty liver and non alcoholic cirrhosis be
A: We never give medication to children with these conditions.
What we recommend to parents is to put their children on an exercise
regimen and change their diets. A healthy diet that is low in fat and
sugar and high in fibre will help to reverse the fatty liver. Parents
should encourage children to exercise more and watch less TV and other
sit down games that discourage active games when they return home from
Q: We are now living in an increasingly chemical world where
we are exposed to chemicals in our homes, food, water, and industrial
waste. Has this exposure contributed further to the rise in cancer
especially in children?
A: As I mentioned, all children living in polluted
environments where chemicals are released into the air, run a risk of
developing some form of cancer early, due to their lowered immunity
since their bodies are still developing.
Q: Recent studies in the US have shown that chemical exposure
in the womb can lead to cancer in children. One study in 2005 showed an
average of 200 industrial chemicals in the umbilical cord of infants
born in the US, of which 180 were said to cause cancer. What is the
likelihood of babies being exposed to these risks in Sri Lanka?
A: We have not yet studied the effects of industrial chemicals
in the umbilical cord and the womb.
Q: Will early detection prevent cancer in children?
A: Most paediatric cancers can be cured with early detection
if there is multidisciplinary management and proper protocols (treatment
schedules.) Unfortunately these schedules are not adhered to as many
parents take their children for alternative treatment such as indigenous
medicine before bringing the child to us directly. This delay can be a
serious setback to the child as it prevents early detection.
Q: Are there gaps in this area you would like to bridge?
A: All our hospitals have trained personnel and facilities to
prevent cancer in children. But we need the full co-operation of parents
and carers of these children. They need to come to us early.
Q: Do you have enough drugs, machines and other equipment to
detect and treat your patients?
A: At present we have adequate stocks of drugs. If the Medical
Supplies Division has a shortage of a certain drug, we always manage to
get it down through various NGO's who help children with cancer. What we
really need urgently is an MRI scanning machine .At present we have only
the Ultra Scan machine, to detect cancer in its early stages.
Q: Why is an MRI machine better for early detection?
A: It is able to detect even tiny tumours in the bone joints
and brain more easily than the Ultra Scan machine.
Q: Is the treatment free for all children with paediatric
A: Yes. Every child with cancer is treated free at the State
Q: Do you have a message for parents of children with cancer?
A: My message to them is that most paediatric cancers can be
cured with early detection and proper treatment. Unfortunately what we
are seeing at our Institute at Maharagama is that many of the patients
come to us when it is too late to be treated or prevented. Some parents
stop getting treatment to seek alternative therapy. This disrupts the
treatment schedule, which must be strictly adhered to for the sake of
the patient's complete recovery. This is one of the biggest problems
that oncologists face. Delay in treatment will result in a poor