LEUKAEMIA
In leukaemia, one of the types of white cells, for some reason multiplies and divides at an abnormal rate, crowding the bone marrow, and spreading into the blood, lymph glands and all parts of the body.
The child may develop infections as the normal white cells are not produced in sufficient quantities to provide a healthy immunity. Platelets (which are important in the clotting mechanism) decrease, and red cell numbers fall, so the child may appear at the doctors surgery with signs of bruising and symptoms of anaemia.
Blood tests usually show decreased normal cells and some abnormal cells. A test called a bone marrow aspiration confirms the diagnosis.
Special laboratory tests will identify exactly which type of leukaemia is present, and a spinal tap or lumbar puncture will be done to see whether the leukaemic cells are present in the cerebrospinal fluid.
Treatment
The main treatment for Leukaemia is chemotherapy, and the regimen depends upon the type of leukaemia identified.
In some children with 'high risk' disease, radiotherapy to the head may be needed to prevent or treat disease reaching the brain.
Some children receiving treatment for ALL do not go into remission, and other children may go into remission then relapse. Some children with certain types of AML, or who are considered at high risk of relapse may be considered suitable to receive a bone marrow transplant.
Bone Marrow Transplantation
Bone marrow is found inside the bones, particularly the pelvic bones, and is responsible for producing red cells, white cells and platelets. One of the side effects of chemotherapy and radiotherapy is suppression of the marrow, therefore chemotherapy is programmed carefully in cycles to allow the marrow to recover from the toxic effects of the drugs. Transplants can allow much higher doses of drugs to be given, because the transplanted cells (which may be the patient's own cells or from a donor) are infused back after the treatment. This is often called 'rescue' as the new marrow is 'rescuing' the patient from the effects of the high dose treatment.
Bone marrow transplants take place in a specially designed unit, where the patient is kept in isolation to ensure there is reduced risk of infection during the phase when the body is susceptible.
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BRAIN TUMOURS
A brain tumour may be malignant or benign. The most common brain tumour found in children is Medulloblastoma.
These tumours occur mainly between the ages of 5-10 years, but can occur from infancy. A child or infant may go to the Doctors surgery when a parent notices different behaviour from normal. In an infant, there may be bulging noticed in the fontanelle or soft spot, caused by pressure and blockage of the normal circulation of fluid within the brain.
Older children may be noticeably clumsy, or have double vision and knock things over or may fall. There may be difficulty in swallowing, slurred speech, vomiting, headaches or even convulsions.
A scan (CT or MRI) is usually done with an examination of the cerebro-spinal fluid. Treatment follows very soon after diagnosis, and may be surgery, radiotherapy or chemotherapy sometimes in combination.
Any treatment or interference with the brain carries a risk of residual damage, and this can be in the form of inhibiting the intellectual and physical development of a child. Specialist care after treatment by occupational and play therapists, speech therapists and physiotherapists will be of assistance.
Child Cancer Foundation Scholarships are also available.
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NEUROBLASTOMA
The name is derived from Neuro = nerve, blastoma = collection of tumour cells. A Neuroblastoma arises from specific nerve cells which run in a chain-like formation behind the spinal cord, from the abdomen, through the chest to the skull. Most neuroblastomas are found in the abdomen or chest, more rarely in the neck or brain.
The symptoms of Neuroblastoma depend upon the site, and once diagnosed, a child will be treated according to the most current treatment protocol. This may include surgery to remove the tumour, either before or after a course of chemotherapy, combined where appropriate with radiotherapy.
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WILMS TUMOUR
This is sometimes called nephroblastoma, and is a tumour of the kidney. It is quite different from the type of cancer found in the kidney of adults. The tumour is usually found in children under 5 years of age and mostly confined to one kidney.
Once diagnosed, the kidney may be removed by surgery, followed by chemotherapy. Sometimes chemotherapy is given first to shrink the tumour, followed by surgery. Radiotherapy may be applied to the tumour bed and abdomen in more advanced stages of Wilms tumour and the lungs.
Wilms Tumour is usually very successfully treated with great advances having been made in drug therapies and protocols.
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LYMPHOMA
Lymphomas are tumours which start in the lymphatic system. There are two types of lymphoma: Hodgkin's and Non Hodgkin's Lymphoma. The treatment is different for each type.
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HODGKIN'S DISEASE
This is rare in children under three years of age, and is more commonly found in older children or young adults. The first sign of the disease is usually a painless swelling of one or more glands, which persists.
Depending upon the stage of the disease, treatment is usually radiotherapy, chemotherapy or sometimes both. Many years ago the outlook for those with Hodgkin's Disease was poor. With new treatment regimens, 90% of children who develop this disease are cured.
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RHABDOMYOSARCOMA
This group of tumours affects soft tissue of the body, muscle, fibrous or other tissue, and can affect various parts of the body. Most commonly diagnosed in the under 7 age group, and found in the head and neck, bladder and reproductive organs, or less commonly in the muscle of the abdomen and chest walls. Once diagnosed, treatment is started with chemotherapy to shrink the tumour and make it easier to remove surgically. Radiotherapy is often used as part of the treatment plan.
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RETINOBLASTOMA
As the name implies, this is a malignant growth of cells of the retina of the eye. The tumour tends to develop in the first year of life, and in two thirds of children is confined to one eye. Treatment depends upon the number, size and site of the tumours, and over 90% of children respond to treatment although there may be partial sight loss. Newer developments have seen chemotherapy being given to children with bilateral (both eyes) disease.
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BONE TUMOURS
Osteosarcoma - Osteogenic Sarcoma
Osteo = Bone
These tumours are usually found in older children and teenagers, and can arise anywhere in the body, but most commonly in the leg. Treatment depends upon the site of the tumour and its spread. Chemotherapy may shrink the tumour and deal with any secondary tumours, followed by surgical removal, which in some instances is an amputation. Further chemotherapy follows surgery. Radiotherapy may also be given, with further chemotherapy. Approximately 50% of children are cured, and able to lead a normal active life, sometimes with the benefit of a prosthesis.
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EWINGS SARCOMA
This cancer can start anywhere within the body but most commonly in the bones of the pelvis, upper arm or thigh. Unlike osteogenic sarcoma, Ewings Sarcoma can also develop in soft tissue. Chemotherapy is an important front line treatment, followed where possible by surgery. Where access surgically is impossible, radiotherapy and chemotherapy are given.
Sixty percent of children with Ewing's Sarcoma (which is localised - not widespread) at diagnosis, are cured, and although the treatment may reduce bone growth and affect muscles and tendons, many children are able to lead normal lives with little disability.
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