Childhood
What parents must know
Childhood Cancer is often curable
1
What is cancer
Cancer is a group of diseases characterized by
uncontrolled cell division leading to growth of
abnormal tissue. Cancers arise from both genetic
and environmental factors that lead to abnormal
uncontrolled proliferation of cells.
This process may start in the bone marrow and is
known as Leukemia/blood cancer or may occur in
specific sites/organs like lymph nodes, bone, liver,
brain ,lungs, kidneys or eys
2
What are the common symptoms of
cancer…
Continued, unexplained weight loss
Headaches, often with early morning vomiting,
seizures, abnormal posturing
Increased swelling/distension or persistent pain
in abdomen, bones, joints, back, or legs
Lump or mass, especially in the abdomen, neck,
chest, pelvis, or armpits
Development of excessive bruising, bleeding, or
rash
Constant infections
A whitish color behind the pupil
Nausea which persists or vomiting without
nausea, jaundice, feeding difficulty
Constant tiredness or noticeable paleness or
respiratory difficulty
Eye or vision changes which occur suddenly and
persist
Recurrent or persistent fevers of unknown origin
3
What are the various types of
childhood cancers
Leukemia
Leukemia is a cancer of the bone marrow and
tissues which produce the circulating blood cells.
Leukemias are the most common childhood
cancers. Types of leukemia include:
Acute Lymphoblastic Leukemia (ALL): The
most common childhood cancer. Almost 75%
of children with leukemia have ALL, a cancer
of the lymphoid cells in the bone marrow and
the lymphoid organs of the body. They are
involved in the body’s immune system.
Acute Myelogenous Leukemia (AML): AML
(also called acute myeloid leukemia, acute
nonlymphatic leukemia or ANLL) is cancer of
the myeloid blood cells which are produced in
the bone marrow and which help fight bacterial
infections
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Cancers of the Central Nervous System
(CNS)
Brain tumors: There are many types of brain
tumors; the most common are called gliomas.
Lymphomas
Lymphoma is a tumor of the lymph tissues, which
are part of the immune system. Types of
lymphoma include:
Hodgkin
lymphoma: affects lymph nodes
nearer to the body’s surface, such as in the
neck, armpit and groin area.
Non-Hodgkin Lymphoma (NHL): affect lymph
nodes found deep within the body. There are
many types of lymphoma, include Burkitt's,
anaplastic and lymphoblastic lymphoma.
Sarcomas
Sarcomas are cancerous tumors involving the
bones and soft tissues.
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Bone cancers

Osteosarcoma: the most common type of
bone sarcoma. These tumors often are
located at the growing end of the long
bones of the extremities, close to the joints.

Ewings Sarcoma: a bone cancer that often
appears in the middle of the bone.
Commonly found in the thighs, hipbones,
upper arms and ribs.
Soft Tissue Sarcomas:

Rhabdomyosarcoma:
a
soft
tissue
sarcoma that develops in muscles. Most
often found in the head, neck, kidneys,
bladder, arms and legs.
Liver Cancers
Liver cancer is an abnormal growth (tumor) in the
liver. The most common forms of liver cancer in
children are:
Hepatoblastoma
Hepatocellular carcinoma
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Cancers of the Kidney
Wilms tumor: also called nephroblastoma
Clear Cell Sarcoma
Others
Neuroblastoma:
is a cancer of the
sympathetic nervous system which most often
originates in the adrenal glands above the
kidney.
Retinoblastoma: is a malignant tumor of the
retina (a thin membrane in the back of the eye).
Germ Cell Tumors: Germ cell tumors appear
most commonly in the testes, the ovaries,
lower end of spine the middle of the brain,
chest or abdomen.
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What you would like to know about
childhood cancers
About 40,000 children
childhood cancers/year
are
detected
Acute Leukemia (Blood cancer)
commonest of childhood malignancy
is
with
the
Leukemias and Lymphomas constitute nearly
50% of pediatric cancers followed by tumors of
central nervous system, soft tissues, kidney,
bone, eye, liver and germ cells.
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Are there any identified risk factors for
childhood cancers?
Risk factors identified for pediatric malignancies
are few as compared to adults.
ALL
Wilm’s tumor
Ionizing radiation, birth
weight>4 kg
Genetic conditions-Down
syndrome,LCH
Chemotherapy - alkylating
agents
Genetic-Down syndrome,
familial monosomy
Ionizing radiation
Genetic conditions
Family history-monozygotic
twins
Immune deficiency
Infections-EBV
Congenital anomalies
Hepatoblastoma
Hemihypertrophy
Retinoblastoma
No known nonhereditary risk
factors
Ionizing radiation,
chemotherapy ,genetic factors
AML
Brain cancer
Hodgkin’s disease
NHL
Osteosarcoma
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Did this happen because of something I
did or passed on to my child? What are
the chances that my other children will
develop cancer?
Not all cancers run in families. Hereditary
component of some pediatric malignancies
Hereditary component
Adrenocortical tumors
50-60%
Optic glioma
45%
Retinoblastoma
40%
Pheochomocytoma
25%
Wilm’s tumor
3-5%
CNS neoplasms
<1-3%
Leukemia
2.5-5%
Does cancer spread to any other family
member in any way?
Cancer does not spread in any way. Touching
/eating with a child with cancer does not cause
cancer. This child cannot harm any one.
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How is cancer diagnosed
Doctors use many tests to diagnose cancer and
find out if it has metastasized (spread). Some tests
may also determine which treatments may be the
most effective. For most types of cancer, a blood
/bone marrow examination, biopsy or surgery to
remove as much of the tumor as possible is the
only way to make a definitive diagnosis of cancer.
If a biopsy is not possible, the doctor may suggest
other tests (mostly blood tests) that will help
make a diagnosis. Imaging tests (ultrasound, CT
scan, MRI, PET scan and others) may be used to
diagnose a cancer, know the extent of spread and
find out whether the cancer has metastasized.
Your child’s doctor may consider these factors
when choosing a diagnostic test:
Age and medical condition
Type of cancer suspected
Severity of symptoms
Previous test results
11
What are the various means to treat
childhood cancers
Treatment modalities
The mainstay of treatment for most childhood
cancers is chemotherapy, radiotherapy ,surgery
and combinations of any or all of these .Bone
marrow transplant is sometimes done when
indicated.
Chemotherapy is the term used for
medications used for treatment of cancer. The
may
be
given
orally,
intravenously,
intramuscular, subcutaneous or intrathecally.
Radiotherapy /Radiation therapy is the term
used when radiation is used to treat cancer .
Radiation therapy uses high-energy radiation
to shrink tumors and kill cancer cells. About
half of all cancer patients receive some type of
radiation therapy sometime during the course
of their treatment.
The treatment for all cancers is different. You
must discuss with your treating doctor whether
your child will undergo chemotherapy alone or
will also require radiotherapy and surgery
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Summary of treatments for selected childhood cancers
Cancer
Treatment
Acute lymphoblastic
leukemia
The main treatment is chemotherapy, in
combination with steroids. Chemotherapy is
administered in three phases: induction,
consolidation and maintenance. Donor stem
cell or bone marrow transplantation is
considered for relapsed patients or those with
resistant ALL. Radiotherapy is sometimes
given to prevent or treat leukemia cells in the
brain or as part of a stem cell transplant.
Acute myeloid
leukemia
The main treatment is chemotherapy, which is
administered in two phases: induction and
consolidation. Donor stem cell or bone
marrow transplantation is considered for
relapsed patients or those with resistant AML.
Hodgkin lymphoma
The main treatment is chemotherapy alone or
with radiotherapy.
Non-Hodgkin
lymphoma
There are many types of NHL and the
treatment depends on the type but the main
treatments are chemotherapy, radiotherapy
and biological therapies. Stem cell or bone
marrow transplantation is considered for
relapsed patients. Radiotherapy is sometimes
given.
Brain and CNS
tumors
The main treatment for most brain and CNS
tumors is surgery (if feasible). If the entire
tumor cannot be removed, chemotherapy
and/or
radiotherapy
may
be
given.
Radiotherapy is usually avoided in children
under three years old due to the risk of
damaging a still immature brain.
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oma
Neuroblastoma
Localized tumors may be removed by surgery
alone. Later stage or poor prognosis tumors
are generally treated with chemotherapy (and
sometimes radiotherapy) either before or after
surgery. Stem cell transplantation may be
considered. A new monoclonal antibody
treatment for high risk neuroblastoma is
currently being tested in clinical trials.
Retinoblastoma
Smaller tumors have treatment just to the eye
itself with laser therapy, freezing therapy
(cryotherapy) or heat therapy (thermotherapy)
to destroy the tumour. Larger tumours may be
treated with chemotherapy, radiotherapy or
surgery to remove the eye (enucleation). A
combination of treatments may be necessary.
Nephroblastoma
The main treatment is surgery, which usually
involves removing all of the kidney (called a
nephrectomy, though partial nephrectomies
are performed if there are tumours in both
kidneys). Chemotherapy and radiotherapy may
be given before or after surgery.
Osteosarcoma
The main treatment is surgery to remove the
bone tumour and some surrounding tissue,
although sometimes a whole limb may need to
be removed (amputation). Chemotherapy may
be given before or after surgery. Radiotherapy
is sometimes given.
Rhabdomyosarcoma
The main treatment is surgery. Chemotherapy
and radiotherapy may be given before or after
surgery.
High-dose chemotherapy or total body irradiation is often
accompanied by stem cell or bone marrow transplantation.
Other new therapies, such as immunotherapy are being
developed.
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We realize many of you have come from
distant places. Where will you stay. where
will you arrange finances from. How will you
look after the rest of your family? : these
thoughts bother you. How do you handle
this?
Have faith in God
Be positive
You are not alone
If you have decided to
take treatment and are short of finances;
Discuss with your doctor and social worker
who will guide and help you with arranging
funds for treatment and also accommodation
It is better that once the treatment for your
child has started and he is settled one
parent/guardian may stay with child for
treatment and the other may go home to work
and look after rest of family.
You may have to arrange for blood if the
doctor as asked you .
15
How are we expected to look after our
child if we decide to take treatment here.
Besides the chemotherapy, radiotherapy
or surgery is there any thing else that
must be taken care of?
You must understand the disease of your child
properly from your doctor
Always listen carefully to what your doctor has
to say regarding treatment
and care
Arrange for stay, finances for
chemotherapy and place to
stay
The child must be protected
from infection. Your doctor
will give you instructions regarding care and p
(4 C’s) Clean hands , Clean water, Clean food
and Clean environment are most important
Infection precautions:
Remind kids to wash their hands
before eating, after using the
bathroom,
and
after
touching
animals.
16
Friends or family members with contagious
illnesses (such as a cold, the flu, or chickenpox)
should refrain from visiting.
Try to avoid crowds and children who have
received certain vaccines, such as
chickenpox or oral polio — these are
live-virus vaccines and can spread
disease to kids with low blood cell
counts.
Certain vaccines are not to be given to your child
and siblings, please understand from your doctor
and ask your doctor to write clear instructions for
you
regarding the dos and don’ts about
vaccination
And to prevent food-borne infection, your child
shouldn't eat raw fish, seafood, meat, raw
unwashed
vegetables/fruits, uncooked eggs.
Home made clean and nutritious food is best for
him.
Your doctor may give some
medications to be taken on a
regular basis, please give
those to your child
If your child develops fever
particularly when the (white blood cell count is
low), cough, vomiting, loose motions, bleeding
from any site, breathing difficulty etc always
consult your doctor immediately. You may
sometimes not realize the severity of illness and
sometimes the condition of the child worsens very
fast; therefore you must always consult your
17
treating doctor. A senior resident is always posted
in the Pediatric casualty and may be consulted .
What are the side effects of cancer
treatment
Cancer treatment with chemotherapy and
radiotherapy is associated with side effects which
are often handled if one knows about them .
Chemotherapy side effects are different for
each child. The type of anticancer drug used, the
dosage, and a child's general health affect the risk
of developing unpleasant side effects. Most side
effects are temporary — as the body's normal cells
recover, the side effects gradually go away.
Common acute side effects of chemotherapy
include allergic reactions,
fatigue, pain ,
discomfort, nausea, vomiting, decreased appetite,
change of taste, ulcers in throat, mouth and
gums, jaundice
Lowering of blood counts ( red blood cells,white
blood cells/platelets) leading to anemia, infections
and bleeding is often seen and needs immediate
attention.If fever is also present,you should
immediately consult your doctor.
Some chemotherapy drugs can irritate or damage
the bladder or kidneys . Urinary disturbances and
decreased urine output are sometimes seen. The
doctor may ask for a blood or urine sample before
beginning and during chemotherapy to evaluate
kidney function.
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Giving your child plenty of fluids to drink will
ensure good urine flow and help prevent problems
in the urinary tract.
Increased weight gain, coagulation disturbances,
cardiac dysfunction, renal and hepatic impairment,
seizures, drowsiness, altered sensorium ,
electrolyte abnormalities etc may occur.
Sometimes the chemotherapy may leak out of the
vein into adjoining skin and cause skin irritation,
swelling ,ulceration, necrosis and pain. You
should apply ice locally and should immediately
consult your doctor.
Radiation therapy
can cause both early and
late side effects. Acute side effects occur during
treatment, and chronic side effects occur months
or even years after treatment ends. The side
effects that develop depend on the area of the
body being treated, the dose given per day, the
total dose given, the patient’s general medical
condition, and other treatments given at the same
time.
Acute radiation side effects are caused by damage
to rapidly dividing normal cells in the area being
treated. These effects include skin irritation or
damage at regions exposed to the radiation
beams. Examples include damage to the salivary
glands or hair loss when the head or neck area is
treated, or urinary problems when the lower
abdomen is treated.
Fatigue is a common side effect of radiation
therapy regardless of which part of the body is
19
treated. Nausea with or without vomiting is
common when the abdomen is treated and occurs
sometimes when the brain is treated. Medications
are available to help prevent or treat nausea and
vomiting .
Other side effects include skin damage/changes
(red, sensitive,swelling or texture change.)The
skin may be more sensitive to sun exposure for
months after treatment. There may also be some
permanent changes to the color and elasticity of
the skin.
Hair Loss,Sore Mouth and Tooth Decay,
Gastrointestinal Problems (such as loss
appetite, diarrhea, nausea, and vomiting)
of
Thrombocytopenia and low white cell counts are
other side effects of radiation therapy
Late side effects of radiation therapy may or may
not occur. Depending on the area of the body
treated, late side effects can include
Fibrosis (the replacement of normal tissue with
scar tissue, leading to restricted movement of the
affected area).
Damage to the bowels, causing diarrhea and
bleeding
Memory loss
Infertility (inability to have a child).
Rarely, a second cancer caused by radiation
exposure.
20
When suggesting radiation therapy as part of a patient’s
cancer treatment, the radiation oncologist will carefully
weigh the known risks of treatment against the potential
benefits for each patient including relief of symptoms,
shrinking a tumor, or potential cure.
How is cancer therapy given ..
Sometimes a child may need to be admitted for a
few days for chemotherapy. If the child is well then
injections are given mostly on a day care basis .
Oral medications are taken at home.
Radiotherapy
department.
is
given
in
the
Radiotherapy
Long-Term Side Effects
Chemotherapy can cause long-term side effects
(sometimes called late effects), depending on the
type and dose of chemotherapy and whether it was
combined with radiation. These effects may involve
any organ, including the heart, lungs, brain,
kidneys, liver, thyroid gland, and reproductive
organs. Some types of chemotherapy drugs may
also increase the risk of cancer later in life.
Receiving chemo during childhood also may place
some kids at risk for delayed growth and cognitive
development, depending on the child's age, the
type of drug used, the dosage, and whether
chemotherapy was used in addition to radiation
therapy.
21
You should pay attention to your
child’s nutrition
Nutrition is an important part of the health of all
children. It is especially important for
children getting cancer treatment.
Cancer and its treatments may affect
a child's appetite, tolerance to foods,
and their body's ability to use
nutrients. Eating the right kinds of
foods before, during, and after
treatment can help a child feel better
and stay stronger. Children who get good nutrition
while they are being treated for cancer:
Tolerate treatment and treatment side effects better
Are better able to stay on schedule for treatment
Heal and recover faster
Have less risk of infection during treatment
Have better strength and energy
Keep up their weight and their body's store of nutrients
Are better able to keep up normal growth and
development
Feel better and have a better quality of life -- they are less
irritable, sleep better, and work better with the health care
team
Each child with cancer has their own nutrition needs. If
your child has cancer, talk with your doctor about your
child's diet.
Sometimes your child does not eat in spite of best of your
efforts and your doctor is concerned. The doctor may
sometimes advice you to start tube feeding which is a
means of providing nutrition to your child via a tube that
is inserted into your stomach via the nose.
22
Working with Cancer patients & their
families
You as parents must know about the following
The disease is discussed in detail; the prognosis ,
duration of treatment, side effects of chemotherapy
The financial issues are discussed. If the family is
unable to take treatment because of financial
constraints then finances are arranged through
NGOs or government organizations
The requirement of blood donation is discussed with
the family
Places available for their stay in Delhi should be told
to you
Importance of hygiene and nutritional care has been
discussed
Chemotherapy protocols should be discussed with
the parents
Any risk factor of disease if present should have
been discussed
Children should wear face masks when moving to
crowded places. If the parents also suffer from upper
respiratory infection they should try to stay away
from the child /wear face masks
The parents should be told of the alarming
symptoms and they should be advised to bring the
child to the casualty in any eventuality.
23
Are there any avenues of financial
support for cancer patients?
It is expected that the parents should arrange
finances to initiate chemotherapy for their children.
Meanwhile finances/chemotherapy
arranged from the following sources
may
be
1.
The AIIMS Hospital poor fund
2.
The National Illness Assistance
(Rashtriya Arogya Nidhi)
3.
The Prime Minister’s relief fund
4.
State Illness
Arogya Nidhi)
5.
Aiimsonian poor fund
6.
NGO’s – CANKIDS, Cancer Patient Aid
Association
7.
ESI Fund
Assistance
Fund
fund
(Rajya
The medical social worker in the department of
Pediatrics facilitates the process. you may find the
social
worker
in
the
children
OPD
from
9.00 am - 5.00 pm
The estimate of treatment is provided by the treating
doctor
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Places of stay in Delhi for cancer
patients & their families
1.
Rajgariya Dharamshala (Near AIIMS)
2.
Surekha Vishram sadan (Near AIIMS)
3.
Tirathram dharamshala (Near IIT Gate)
4.
Home away from Home (Kotla Mubarkpur)
Forms for estimates of treatment and various
dharamshalas are available with the social worker of
the department of Pediatrics
For any emergencies rush your child to
the Pediatric emergency. The child will
be attended to immediately.
Routine consultations are done in
 Pediatric Oncology clinic, Monday Room no
07 & 14 ; 9.00 am in children OPD
 Children OPD Room no. 07 Wednesday &
Saturday; 9.00am
Patients may contact us at c3sambhav@gmail.com
We will get back to you immediately
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Day Care services
Medical consultations
Intravenous fluids administration
Antibiotic therapy
Blood testing
Chemotherapy
Blood component therapy
Bone marrow examination
Cerebrospinal fluid (CSF) examination
Observation after procedures
You may be required to get a short
admission made for day care treatment
26
Cancer treatment is a team work
27
Important Room Number
S. No.
Name of Investigation
1
Immunization
Place of
investigation
Children's OPD
2
X-Ray
Children's OPD
15-A
3
Investigation reports
Children's OPD
1
5
Ultrasound
Main OPD
17
6
Blood Test
Main OPD
27
7
Urine and Stool Test
Main OPD
28
8
Radiograph
Main OPD
74
9
Bairum Meal
Main OPD,
Nuclear
Medicine
Main OPD,
nuclear
medicine
Main OPD
41
10
CT Scan
11
ECG
12
PAC
13
T-3, T-4, TSH
14
Cultures
15
Pediatric Office
16
PFT
17
EEG
Main OPD, 5th
floor
Teaching block,
2nd floor
Teaching block,
2nd floor
Teaching block,
3rd floor
Teaching block,
3rd floor
Children's OPD
Room No.
2
8
(Report hand to
hand) 32
5054
2090
Microbiology
3058
3102
12
28
18
MRI
MR department
Near CN Centre
19
Genetic Lab
4
20
PET
21
Biopsy
1st floor, Old
OT block
Main OPD,
Nuclear
medicine
1st floor
Tecahing block
22
FNAC
1st floor,
teaching block
23
Bone Marrow Biopsy
24
IRCH
8
26
Bone Marrow/Flow
Cytometry,
P/S,
Hemogram/Biochemistry
RT
1st floor,
teaching block
IRCH
1078
(Sample),1085
(Report)
1069
(Sample),1085
(Report)
1078 (Sample),
1085 (Inquiry)
8
41-
27
LFT/RFT
28
USG guided biopsy
IRCH, Ground
Floor
IRCH/ Main
OPD
Main OPD
29
CT guided
Main OPD
8
30
ECHO
CN centre
62
31
ENT
4111/4123
32
PEDS Surgery OPD
33
BCRABL
4th Floor, main
OPD
3rd floor, main
OPD
1st floor, IRCH
25
4
8 & 27
17
156
29
Childhood cancer is often curable:
IF detected in time
and
treated properly
Yes! You may become a cancer survivor
Prepared by
Division of Pediatric Oncology. Department of Pediatrics
All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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