On a busy Saturday morning, a group of volunteers from Rwanda Children’s Cancer Relief (RCCR) join residents in Rwinyange village in Rwimbogo cell in Kigali for ‘Umuganda’ (community work). After a vigorous cleaning activity, a public discussion on non-communicable diseases follows.

Several residents with their children sit listening in for about two hours to messages about early screening, looking out for signs, as well as possible strategies to prevent childhood cancers.

"Ahead of the annual event to mark the Childhood Cancers Awareness Month that starts September, such activities intensify and include; outreach campaigns to schools, churches, markets, hospitals and health centres. In addition, social media awareness campaigns, radio and television talk shows to raise public awareness on the burden of childhood cancers increase,” explains, Janvier Kabogo, the acting executive director of RCCR.

The belief is that once the general public understands the root cause for the cancers that affect children, victims could have access to better treatment and support, regardless of their places of residence or socio-economic background. But reaching out to every member of the community may not necessarily be a simple task.

Kabogo, who is a pharmacist by profession, points out that they take advantage of such community gatherings to boost public knowledge, but maintains there is still a long way to go in fighting childhood cancers globally.

What is cancer?

The World Health Organisation defines cancer as a generic term for a large group of diseases that can affect any part of the body. Subsequently, words such as malignant tumors and neoplasms can be used when referring to cancer. 

One significant feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs, a process known as metastasizing. These metastases are the major cause of death from cancer.

Cancer is among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer-related deaths. 

240,000 under the age of 19 in sub-Saharan Africa have cancer

A report by the International Agency for Research on Cancer (IARC) released this year indicates that the global occurrence of childhood cancers is higher than previously thought. 

In more than 100 cancer registries from 68 countries between 2001 and 2010, there were approximately 300,000 cases of cancer diagnosed in children and teens under the age of 19 every year. Of these, 80 per cent were from sub-Saharan Africa. Around the world, 80,000 succumb to childhood cancer annually.

"Overlooking childhood cancers is the reason why survival rates are still low. This is basically because most of the cancers when detected at late stages cannot be treated successfully,” says Kabogo.

Until this day, of the three known treatment options (chemotherapy, surgery and radiotherapy) for cancer, one (radiotherapy) is not yet adopted in Rwanda. Cancer patients can, however, access treatment from Butaro Cancer Center but those in need of radiotherapy need to travel abroad where treatment costs close to $10,000.

Other charges would include costs for transport.

Out of ten children, childhood cancer occurs in one although such statistics are considered misleading because they look at people admitted in hospitals. The commonest is nephroblastoma (Wilms’ tumor) or cancer of the kidneys that affects children aged between 3 and 4 and becomes much less common after age 5.

However, Dr Rajab Mugabo, a specialist in ear, nose and throat diseases at King Faisal Hospital, explains that even then, cancers can affect any part including the head and neck region in children.

"On one particular part of the body, we could have different cancers, for example, on the tongue or throat since each part of the body has different cells. This means that even on the tongue we can have two different types of tumours,” says Dr Mugabo.

He also says a huge section of the public remains confused about the cancers and can rarely differentiate between the types.

"People need to understand that cancers that come from different areas of the body have to be treated differently,” adds Mugabo.

In the head and neck regions, cancers can be operated thorough surgery, while others need a combination of two or all the three approaches.

Dr Mugabo further emphasises that late diagnosis of cancers affects the other processes of management because medical professionals cannot properly stage the diseases.

"Successful cancer management requires staging the disease. When it is advanced, treatment is a challenge since different stages have to be approached differently. In an operation, you have to ensure that the whole cancer will be removed otherwise the patient would suffer pain of the surgery and the cancer remains. This is the reason behind the misconception which people have that when you operate a cancer it gets worse,” explains Mugabo.

Currently, a national cancer unit ensures that the public remains informed of all the possible signs and symptoms of cancers in both adults and children.

Dr Marc Hegenimana, the senior cancer officer at the Rwanda Biomedical Centre, explains that signs and symptoms always manifest for all forms of cancers. 

"When you get cancerous symptoms, it is important to visit a health centre. After diagnosis, it can be determined whether it is a suspected cancer. Those centres that cannot screen the disease get ample time to make referrals to bigger hospitals,” explains Dr Hagenimana.

Research shows that while adult cancers are caused by predisposing factors such as alcoholism but rarely result from genetics, majority of childhood cancers are hereditary meaning they are passed on from the parents to the child. These could also result from mutations within the DNA.

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EXPERTS’ VIEWS ON HOW TO PREVENT CHILDHOOD CANCER

Joseph Uwiragiye, a nutritionistSome cancers in children are said to be associated with poor lifestyles. Parents should ensure that their children maintain a well balance diet as well as involving them in physical activities. Early cancer screening should be done to get timely medication if the cancer is in its early stages.

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Eugene Habimana, a medic at University Teaching Hospital (CHUK)To maintain a good immune system in children, parents should make sure their children get adequate sleep. This also helps in repairing the damaged cells, which may keep cancer at bay.

Edna Umutoniwase, a nurseSmoking around children should be avoided as it is also linked to causing cancer in children. For pregnant women, they should stay away from alcohol, eat healthy and make sure they take a prenatal vitamin to help cover any nutritional gaps in their diets.

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Christian Bahati, a pediatricianLeukemia is common in children and it’s a cancer of the blood cells that begins in the born marrow. To avoid this, one feeds the child on healthy foods. For instance, including vegetables and fruits in your child’s diet is ideal. This makes their bodies strong and less likely to develop diseases like cancer.

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Patrick Mudahemuka, a medical studentChildren should be protected from excessive exposure to the sun. This is because of the ultraviolet rays which are harmful to the skin and increase the risk of suffering from skin cancer. However, consulting a doctor in case of any suspicious condition in your child is important.