Childhood Cancer Awareness Month: Do’s & don’t for a child with suspected cancer
Here’s a guide to help navigate the complexities of diagnosing and managing suspected childhood cancer.
Childhood cancers make up just about 3% of global cancer cases, with around 75,000 new diagnoses each year in India with the most common types being leukemias, brain cancers, lymphomas, and solid tumors like neuroblastoma and Wilms tumors. Despite their rarity, late diagnoses, often caused by a lack of awareness among parents and healthcare providers, often lead to neglect of symptoms and is major deterrent to successful outcome.
In high-income countries, where comprehensive services are readily available, over 80% of children with cancer are cured. However, in low- and middle-income countries (LMICs), the cure rate is less than 30%. Avoidable deaths in LMICs often stem from issues such as delayed or incorrect diagnoses, barriers to accessing care, abandonment of treatment, treatment-related toxicity, and relapse.
Here’s a guide to help navigate the complexities of diagnosing and managing suspected childhood cancer.
Do’s for diagnosing childhood cancer:
Maintain a high index of suspicion: Childhood cancers may present with symptoms that mimic more common illnesses. For instance, persistent fever could indicate either an infection or a hematological malignancy. When common diagnoses fail to explain symptoms, consider cancer as a potential cause.
Perform a thorough evaluation: Always conduct a comprehensive assessment of symptoms, including unexplained weight loss, persistent fever, unexplained lumps or masses, and signs of bleeding. These symptoms warrant further investigation beyond routine diagnoses like infections or inflammations.
Go for appropriate diagnostic tests: When suspecting a malignancy, appropriate diagnostic tests such as blood tests, imaging studies, and biopsies should be performed. Ensure that any biopsy or surgical intervention is planned with a multidisciplinary team to avoid compromising treatment options.
Refer to specialized centres early: If childhood cancer is suspected, refer the patient to a specialized cancer centre where a multidisciplinary team can offer advanced diagnostic and therapeutic options. Early referral can significantly impact treatment outcomes.
Educate and engage with families: Communicate openly with the child’s family about the potential diagnosis, the need for further tests, and the importance of early treatment. Engaged families are better prepared to support their child through the diagnostic and treatment processes.
Don’ts for managing suspected childhood cancer:
Don’t start empirical treatments without proper diagnosis: Avoid starting empirical treatments like anti-tubercular therapy (AKT) for suspected tuberculosis or steroids for low platelet counts without confirming the diagnosis. Incorrect treatment can delay the correct diagnosis and impact the effectiveness of subsequent cancer treatments.
Don’t perform unplanned biopsies: Avoid unplanned biopsies of abdominal, chest, or extremity masses. An unplanned biopsy can lead to complications, such as disease spread or compromised limb salvage in cases of malignancy. Ensure that biopsies are performed by specialists who are familiar with cancer management.
Don’t ignore common symptoms: Symptoms such as headache, backache, or poor school performance in children should not be dismissed as mere growing pains. These could be indicative of underlying malignancies and should be evaluated thoroughly.
Don’t overlook routine eye examinations: Regular eye examinations can help detect early signs of retinoblastoma and other eye-related cancers. During routine visits, inspect the child’s eyes for abnormalities such as a white reflex, which could indicate a serious condition.
Don’t delay the diagnostic process: In cases where cancer is suspected, delays in diagnosis can have serious consequences. Timely and accurate diagnosis is crucial for effective treatment and improved prognosis.
By following these do’s and don’ts, one can improve early detection, avoid common pitfalls in treatment, and ensure that children receive the best possible care. The rarity of pediatric cancer necessitates an increased awareness and a proactive approach to diagnostic and referral practices to enhance outcomes and provide optimal care for young patients.