GUWAHATI, Jan 17 - Childhood cancer has a high fatality incidence in developing countries, including India. In the North-east, which has a high prevalence of several types of cancers, the Aizawl district of Mizoram has the highest childhood cancer incidence of 107 (in boys) per 10,00,000 population. Imphal West of Manipur records the maximum incidence in girls (69 per 10,00,000 population).
In Assam’s Kamrup (Metro) district, the incidence in boys is 62 per 10,00,000, and in girls 45 per 10,00,000.
Approximately 200 childhood cancer patients are treated at the Dr B Borooah Cancer Institute (BBCI) every year.
“Incidence of childhood cancer is defined as the number of new cases detected in the age group of 0-14 years per 10,00,000 population per year, in a defined geographic location. Incidence of childhood cancer in India, as per Population Based Cancer Registry of ICMR, is highest in Chennai for both boys and girls (boys – 159 per 10,00,000 and girls – 112 per 10,00,000),” BBCI Director Dr AC Kataki told The Assam Tribune.
Dr Kataki said that the proportion of childhood cancer relative to cancers in old-age group varied between 0.5-5.8 per cent. In boys, the relative proportion is lowest in East Khasi Hills (0.8 pc) and highest in Delhi (5.8 pc). In girls, it varied from 0.5 pc in East Khasi Hills to 3.4 pc in Ahmedabad Rural.
Dr Kataki said that lack of awareness and access to timely treatment results in a high fatality rate of childhood cancer in developing countries.
“Childhood cancer mortality is as high as 80 per cent in countries like India, whereas the incidence is around 20 per cent in developed countries. Worldwide, it is estimated that childhood cancer has an incidence of over 1,75,000 per year and a mortality rate of approximately 96,000 per year,” he said.
The most common cancers in the children are leukemia (34 pc), brain tumours (23 pc) and lymphomas (12 pc). Other less common childhood cancers are Wilms tumour (5 pc, kidney), Rhabdomyosarcoma (3 pc, many sites), Retinoblastoma (3 pc, eye), Osteosarcoma (3 pc, bone cancer), Ewing sarcoma (1 pc, many sites), Germ cell tumour (many sites), Hepatoblastoma and Hepatocellular carcinoma (liver cancer).
“Cancers in childhood constitute one of the most important groups of tumours, not only because of the age of occurrence, but because of different causative factors from those commonly seen in adult cancers. Childhood cancer is defined as cancers in the age group of 0-14 and in some centres cancers up to the age of 19 are also included as childhood cancer,” Dr Kataki said.
Warning signals of childhood cancer are – (1) continued, unexplained weight loss, (2) headaches, often with early morning vomiting, (3) increased swelling or persistent pain in bones, joints, back, or legs, (4) lump or mass, especially in the abdomen, neck, chest, pelvis or armpits, (5) development of excessive bruising, bleeding or rash, (6) constant infections, (7) whitish colour behind the pupil of the eye, (8) nausea that persists or vomiting without nausea, (9) constant tiredness or noticeable paleness, (10) eye or vision changes, which occur suddenly and persist, and (11) recurrent or persistent fevers of unknown origin.
Causes of childhood cancer vary from familial and genetic factors to environmental exposure and exogenous factors, while in a majority of the cases individual causes remain unknown.
“Familial and genetic factors are identified in 5-15 pc of childhood cancer. In <5-10 pc of cases, there are known environmental exposure and exogenous factors, such as exposure to tobacco, X-ray and certain medications during pregnancy. For the remaining 75-90 per cent of cases, the individual causes are not known,” Dr Kataki added.
“The high fatality incidence of childhood cancer in developing countries warrants that the public, doctors and parents are educated on the warning signals. Management of childhood cancer is a complex issue which needs the support of doctors, family members, teachers, friends and well-wishers,” Dr Kataki said, adding that education and psychological aspect of children were equally important.