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Paediatric (Ped) Oncology
Overview
Cancer in childhood is uncommon. Out of 10,000 normal children, one will develop cancer during their childhood. The initial diagnosis can be frightening and stressful for child and his/her parents. These emotions are not out of place and quite understandable but they are also compounded by lack of information as well as some misconceptions. In most cases, there is no specific reason or cause for the child to have developed cancer as it is no one’s fault, so parents should not feel ashamed or guilty. The good news is that all childhood cancers are treatable and most are curable.
The cancers can affect any part of the body- the most common affected are blood, brain, bones and muscles. The familiar cancers include: blood cancers (leukemia), cancers of the lymphatic system, (lymphomas), cancer of the brain and spinal cord, muscle and bone cancers (sarcomas) and other cancers seen in the very young children (embryonal cancers). As of today, more than 80% of children with cancer get cured, depending upon the type of cancer they are suffering from. Like for some cancers acute lymphoblastic leukemia and Wilms tumour, there is 90% cure rate, while that for Hodgkin disease, it is almost 95% provided the disease is detected early and treated appropriately.
Children are not adults; their needs are different and need to be treated by someone who is trained to look after them. Paediatric oncologists are responsible for treating all malignant conditions among children like leukemia, bone cancers, wilms tumor, neuroblastoma, brain and spinal cord tumors among several others. With timely, appropriate and complete treatment, majority of children with cancer get cured and can lead their lives peacefully.
Information and support are important to feel sure about the treatment. The more you know about cancer, the less confused or unprepared you will feel. Regular parent support group meetings should be attended, which will be an opportunity for parents of children with cancer to meet other parents whose children are either being treated or have completed treatment.
- Leukemia - Is a medical term for blood cancer. The cancer cells arise from bone marrow (which the factory for producing all blood cells). This is the most common type of cancer in children and accounts for one third of all childhood cancers. The common leukemias found in children are: Acute Lymphocytic Leukemia (ALL) and Acute Myeloid Leukemia (AML). These cancers can cause pallor, fever, fatigue, weight loss, bleeding, joint pains. As acute leukamias have a tendency to grow quickly, they need immediate medical intervention (initial stabilisation and chemotherapy).
- Brain and Spinal Cord Tumors - The second most common cancers in children are brain and central nervous system tumors that account for a quarter of all childhood cancers. They commonly occur in lower parts of brain like cerebellum or brain stem. Most common symptoms seen are severe or persistent headaches, abnormal balance or head position, abnormal movements, difficulty in walking or holding things, double vision, dizziness, early morning vomitings, excessive drinking or urination.
- Lymphomas - They start in lymph nodes and lymph tissues and can also affect bone marrow as well as other organs. The most common symptoms are swollen lymph nodes under neck and armpit, excessive weight loss, and fatigue. Two types of lymphoma that can occur both in children and adults are:
- Hodgkin Lymphoma
- Non-Hodgkin Lymphoma
- Wilms tumor - This tumor accounts for 5% of childhood cancers and is commonly found in children aging 3-4 years. It usually starts in one or both kidneys, causing swelling or lump in the abdomen with or without blood in urine.
- Neuroblastoma - This cancer develops in infants and young children. Accounting for about 6% of childhood cancers, neuroblastomas can begin anywhere and may also cause severe bone pain and fever if it has spread.
- Bone Cancers - About 3% of childhood cancers are bone cancers that occur in older children and teenagers (though they can develop at any age). Most common types of bone cancers are:
- Osteosarcoma, which occurs in the areas where the development of bone is quick i.e. long bones in arms or legs. The pain usually becomes severe at night or while doing activity, causing swelling around bone.
- Ewing Sarcoma is most commonly found in young teenagers. It usually begins in the hip bones, ribs or shoulder bladders or leg bones. This can also occur in any soft tissue of the body.
The cancers in children are hard to recognize as the symptoms are common/similar to childhood illnesses or injures. However, if the below mentioned symptoms persist, it requires immediate intervention:
- Persistent fever
- Easy bruising or bleeding
- Any lump or swelling
- Paleness and loss of energy
- An ongoing pain in one area of the body including bones, joints, back
- Limping
- Frequent persistent headaches, often with vomiting
- Change or deterioration in walk, balance or speech
- Change or deterioration in walk, balance or speech
- Sudden eye or vision changes including white spot in the eye, new squint, new blindness, bulging eyeball
- Sudden unexplained weight loss
Paediatric oncologists diagnose a child's cancer by doing a complete physical examination and certain tests to identify the specific type of cancer. This is called as "Confirmatory Testing" which may include bone marrow examination, biopsy etc depending upon the cancer suspected. Thereafter, a series of tests are done to determine the burden of cancer. This is called as "Staging". For this, several investigations are done like:
- Blood and Urine Tests
- Imaging with ultrasound, MRI, CT scan or PET CT scan – based on the disease type
- Bone Marrow examination and lumbar puncture
It is most important to get the correct diagnosis so that right treatment can be given to the child. Though not all tests are done on every child and what is performed depends on the type of cancer suspected. For most of these tests, the child is sedated so that he/she may not move or feel any pain. For sedation child need to be brought empty stomach or fasting for 4 to 6 hours and the sedation is usually given by the PICU team under full precautions. The results may take 3-5 days to come back so this is explained to the parents. The treatment is started after complete evaluation and discussion with parents in details regarding the further plan to treatment, prognosis and possible complications.
- Max Institute of Cancer Care is at the forefront of participation in multicentre clinical trials related to childhood cancer currently ongoing in India including those for acute lymphoblastic leukemia (InPOG-ALL-15-01) and Hodgkin disease (InPOG-HL-15-01). Where a clinical trial in not available, patients are treated on on contemporary North American and European protocols.
- We provide a strong backup of on-site paediatric ICU as well as other speciality services like paediatric cardiology, paediatric nephrology, paediatric neurology, paediatric endocrinology, paediatric gastro-enterology and others.
- We closely work with our paediatric ICU and anesthesia colleagues to provide sedation and immobilisation of the child (when needed) for diagnostic procedures (MRI, PET CT, bone marrow examinations, etc.) as well as for therapeutic reasons (planning and delivery of radiotherapy, intrathecal chemotherapy, etc.)
- All our patients are discussed in several multidisciplinary tumour boards every week including dedicated musculoskeletal tumour boards and brain tumour boards.
- We provide patient-centred care with dedicated staff to support the patient and families psychological and social needs.
Tumor Board Timings
Paediatric Oncology - Tuesday 3:30 pm - 4:00 pm
Central Tumour Board - Monday 8:30 - 9:30 AM
Central Tumour Board - Friday 8:30 - 9:30 AM
Paediatric Oncology - Tuesday 3:30 pm - 4:00 pm
Central Tumour Board - Monday 8:30 - 9:30 AM
Central Tumour Board - Friday 8:30 - 9:30 AM
Paediatric Oncology - Tuesday 3:30 pm - 4:00 pm
Central Tumour Board - Monday 8:30 - 9:30 AM
Central Tumour Board - Friday 8:30 - 9:30 AM
Central Tumour Board - Friday 4:00 pm - 5:00 pm
Central Tumour Board - Friday 4:00 pm - 5:00 pm
Central Tumor Board - Monday & Thursday 8:30am-9:30am
Virtual Tumour Board PAN INDIA - Wednesday 3:00 PM - 4:00 pm
Virtual Tumour Board PAN INDIA - Saturday 9:00 AM - 12:00 AM pm
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Our Medical Experts
Max Healthcare is home to 2500+ eminent doctors in the world, most of whom are pioneers in their respective fields. Additionally, they are renowned for developing innovative and revolutionary clinical procedures.
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