No kidding

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 country

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 - kentmeireisphotography

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 cancer.

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.

A: Mainly because of proper detection of the disease and more awareness among parents and carers due to our educational programmes.

A: Because their bodies and immune systems are still developing. So exposure to any toxic substances can increase their risk to cancer.

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 related problems.

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.

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 cancer.

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 alcoholic cirrhosis.

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 liver?

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 children?

• The most common cause of fatty liver disease is obesity. Besides obesity, nutritional causes of fatty liver disease are: starvation and protein malnutrition.

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 environmental factors

(Courtesy Canadian Liver Foundation)

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 school.

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.

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.

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.

A: It is able to detect even tiny tumours in the bone joints and brain more easily than the Ultra Scan machine.

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 prognosis.