The simple ways to detect signs of cancer in children

By Stevie Emilia

JAKARTA (JP): Nunuk A. Prabowo is unable to say how she felt upon learning that her five-month-old daughter, Frida, tested positive for leukemia four years ago.

"We weren't ready for the reality. We wanted to scream in disbelief ... I broke down many times when I saw Frida lying helpless in (the hospital's) isolation room with a drip attached to her head," Nunuk said.

It never crossed her mind that her third child could have such a serious disease. At first, she thought that Frida had simply caught a sore throat from her sick sibling.

But after the infant came down with a high fever every six or seven hours, even after taking her medicine, Nunuk sensed that something was wrong. "She refused breast milk. She would sleep most of the time," Nunuk said.

After several tests, including a bone marrow biopsy at Cipto Mangunkusumo General Hospital, a hematologist confirmed that Frida had leukemia.

Frida was then taken to Amsterdam for treatment, where, for at least four months, the infant went through a high dosage therapy to stop the cancer from spreading to her brain. The side effect, it turned out, was torturous: The skin on Frida's bottom peeled off, and seemed like it was scorched. Anytime she was cleaned up, she would scream in pain.

After completing the therapy, Frida's treatment was continued at St. Carolus hospital in Central Jakarta for about a year. "Now Frida is four years and four months old. She's healthy, beautiful ... I never stop praying that my daughter will continue to be well," Nunuk said.

Nunuk shared her experience with participants of a seminar about recognizing the signs of cancer in children.

The seminar was jointly organized by the Indonesian Childhood Cancer Foundation, the Indonesian Oncologists Association, the University of Indonesia's School of Medicine and Cipto Mangunkusumo General Hospital. It was held last Saturday at Klub Rasuna in South Jakarta.

According to psychologist Ninuk Widyantoro, most parents feel shocked, panicked, stressed and angry when they learn that one of their children has cancer.

"Such feelings are understandable, natural and human. Allow the feelings to linger for a while, cry if necessary, but don't let them go uncontrolled. The sick children need treatment. Feeling sad will not solve the problem," Ninuk said.

She suggested that parents seek as much information as they can, including the necessary steps that should be taken, types of treatment and their side effects and where to go for consultations.

She advised that when collecting information the parents should be accompanied by a friend who will take notes, help find doctors, psychologists or somebody who has had a similar experience. The companion is necessary in case the parents are too distressed to think clearly.

In facing the bitter truth, members of the family, especially husbands and wives, should keep their spirits high and discuss the matter openly. They should not allow the sick child to see their distress.

"It's also important to tell the child about their disease, using language they can easily understand," Ninuk said.

Symptoms

According to hematologist and oncologist Djajadiman Gatot of the University of Indonesia's School of Medicine, it is difficult to spot cancer in children at an earlier stage because generally children do not have any specific complaints.

"The cause of cancer in children is not known. But according to studies and research, cancer happens due to a combination of genetic and ecogenetic (environmental) factors," he said.

Cancer, he added, could be cured, although in some cases treatment might have to sacrifice certain organs, such as the eyes and kidneys.

"There's no exact figure on the number of children with cancer in Indonesia. But it has been predicted that the number will not be too different from the overall figure, which is about 2 percent to 4 percent of the number of people with cancer," said Djajadiman.

Last year, it was estimated there were about 17.5 million people with cancer. That number is predicted to increase to 30 million in 2015.

He said there were some cancers which commonly affected children, but that the most common were leukemia, brain tumors, retinoblastoma, malignant lymphoma, Wilms tumors, rabdomiosarcoma, and osteosarcoma.

"Leukemia is the most common of all. It represents about 25 percent to 30 percent of overall cancers in children. It mostly occurs in children between the ages of three and six, with boys outnumbering girls," Djajadiman said.

Brain tumors

Among the symptoms of leukemia that parents should be aware of are unclear fevers, abnormal bleeding and hard or swollen stomachs.

Brain tumors, be they metastastic or not, are thought to damage the central nervous system. Symptoms include headaches, problems with speech and balance, blurred sight, changes in behavior and declining alertness.

Retinoblastoma -- a malignant tumor of the retina that develops during childhood -- is the most visible eye cancer found in children between six months to two years old. Both girls and boys have the same risk of developing this disease. Symptoms include a white spot at the center part of the eye, which shines when there is light.

Malignant lymphoma, or a tumor of lymphoid tissue, occurs mostly in children between five to seven years of age, with boys being at highest risk, three to one. Symptoms include swelling of the lymphoid tissue in neck, armpits or thigh areas, without signs of infection. If the swelling is inside the intestine, symptoms include stomachaches, constipation and fever.

Neuroblastoma, a malignant tumor formed in embryonic ganglion cells, occurs mostly in newly born babies up to four-year-old children. Boys are more likely to get it than girls. Symptoms depend on the tumor's location but usually the early symptoms are hard to notice. If it is in the backbone, it may put pressure on the spine and cause paralysis.

Wilms tumor, a malignant tumor of the kidney, primarily affects three-and-a-half-year-old children. Boys and girls have the same risk of developing this cancer. Symptoms include bleeding when urinating and an uncomfortable feeling in the stomach.

Ostoesarcoma is a sarcoma of the bone. It is the most common bone cancer in children with high occurrence in those between 10 and 20 years of age. Its symptoms include progressive swelling along with pain and fever.

"If parents see those symptoms in their children, consult a doctor right away to find out whether it is cancer or not. Sometimes, there's also a need to perform certain tests to confirm the diagnosis," Djajadiman said.

Cancer treatments for children are about the same as those for adults -- a combination of operations, radiotherapy and chemotherapy, he added.

"Treating children with cancer will not only prolong their lives, but more importantly put the disease into remission. But again, it all depends on the type of cancer, the stage of the disease when diagnosed and the treatment.

"If, after undergoing thorough medical treatment, children live for at least five more years, then the possibility of the cancer going into remission is higher," he said.