Cancers are malignant (malicious) growths or tumors caused by abnormal and uncontrolled cell division which may spread to other parts of the body through the lymphatic system or the blood stream. An arbitrarily adopted standard of the ages used if they are childhood cancers, are 0–14 years inclusive, that is, up to 14 years 11.9 months of age(1). Pediatric oncology is the branch of medicine concerned with the diagnosis and treatment of cancer in children.

Cancer isn’t fair at any age, but perhaps no cancer is more emotionally devastating than those that occur in children. Worldwide, it is estimated that childhood cancer has an incidence of more than 175,000 per year, and a mortality rate of approximately 96,000 per year, and the second only to accidents as a cause of death in children, according to the World Health Organisation. In low resource settings, on the other hand, mortality is approximately 80 per cent, or even 90 per cent in the world’s poorest countries. This high mortality is explained by low human resources, lack of infrastructures, poverty and mostly by ignorance.

Causes of childhood cancers

The types of cancers that develop in children are different from those that develop in adults. Lifestyle or environmental risk factors don’t play a role in children. Instead, it’s usually the result of DNA changes in cells that take place very early in life. Thus they can appear at an early age.

In a small percentage of childhood cancers, familial or genetic factors are thought to predispose the child to cancer. An even smaller percentage of childhood cancer has an identified environmental link(5). Identified familial and genetic factors occupy 5-15%, known Environmental exposures & exogenous factors <5-10% and Unknown causes 75-90%. The most common cancers in children are (childhood) leukemia (34%), brain tumors (23%), and lymphomas (12%), but in Rwanda, nephroblastoma is the most prevalent.

How childhood cancers present

Since most of the symptoms of cancer can also be attributed to benign conditions, the diagnosis of cancer can be a long process. Parents must trust and work as a team with health professionals, using their knowledge of their child and health professional’s knowledge of medicine. There are different types of childhood cancers, some progress rapidly and others lowly.  Here are warning signs of childhood cancers: Continued unexplained weight loss; headaches, often with early morning vomiting; increased swelling or persistent pain in bones, joints, back, or legs; lump or mass, especially in the abdomen, neck, chest, pelvis, or armpits; development of excessive bruising, bleeding, or rash; and constant infections.

Others signs include; a whitish color behind the pupil; nausea which persists or vomiting without nausea; constant tiredness or noticeable paleness and recurrent or persistent fevers of unknown origin.

Pediatric cancers arising from blood, kidney, brain and eyes are going undiagnosed until late stages even though they present so early. We need to understand the character and presentations of childhood cancers. As with all cancers, relieving the pain, symptoms, and distress of cancer experienced by children (palliative care), and their families is as important as treating the disease itself. Survivors face big challenges because two-thirds of children with pediatric cancers suffer long term effects from treatment, including loss of hearing and sight, heart disease, secondary cancers, learning disabilities and more.

The writer is a fifth year medical student at University of Rwanda