<p>The most rewarding days for me are the ones when I get to inform parents that their child is finally free from cancer. The demanding treatments they endured for years are over at last. On the other hand, the most difficult days are the ones when I have to deliver the heart-wrenching news to parents that their child has been diagnosed with cancer.
</p><p>Many can't believe it: “Do children get cancer?" As a paediatric oncologist – a doctor who treats children with cancer – I am often asked this question. Sadly, the answer is yes. Far too many, in fact.
</p><p><strong>Why do children get cancer?</strong></p><p><strong></strong>There are no definitive answers, but it is heart-breaking to see how many parents blame themselves. We try to reassure them as best as we can, providing information about the diagnosis, the treatment, and the care. Other than ionizing radiation, which can cause leukemias, there are very few known causes of cancers in children and no proven environmental factors. It is crucial that parents understand this and focus instead on the mental and emotional health of their child as they make their way through the treatment journey.</p><p>Every year, around 8,000 to 10,000 children in Pakistan are diagnosed with cancer. The two most common types of cancers are leukemia (blood cancer) and brain tumours. There is a silver lining though: most children have a significantly better chance of recovering from cancer than adults. However, the journey to recovery can be difficult and filled with many trials and tribulations. How difficult it is, depends on the type of cancer and the stage at which it is diagnosed.
</p><p><strong>The types and stages of cancer</strong></p><p>There are as many different types of cancer as there are parts of the human body, ranging from cancers of the bones and muscle, known as sarcomas, to those of the kidneys, known as Wilms tumour; to those affecting lymph nodes, known as lymphomas, to those affecting the eyes, called retinoblastoma.</p><p>“What stage is the cancer?" is an important question. This is determined by finding out how advanced the disease might be or how far it may have spread in the child's body.</p><p>Appropriate staging is the cornerstone of an accurate and ultimately successful treatment plan, as outcomes may be different when the cancer is widespread (metastasized) or limited to a certain part of the body. Staging is an intensive process during which the patient must undergo numerous scans, tests, and biopsies.
</p><p><strong>The treatment for childhood cancers</strong></p><p>Once the stage and mode of treatment have been established, most children are fitted with a cannula - a thin tube inserted into a vein to administer medications and fluids safely, efficiently, and quickly. Treatment is usually in-patient, with children often being admitted to the hospital for weeks or months at a time. During their stay at the hospital, patients end up forming new bonds with the nurses, doctors, and other patients who share not only their pain but also the joy of 'getting better'.</p><p>Far too often, we see patients with advanced cancers because they were either not diagnosed in time or did not receive the right treatment.</p><p>There are three fundamental methods of treating cancer: chemotherapy, surgery, and radiation therapy. The choice of method or combination of methods depends on the type of cancer and how far it has spread at the time of diagnosis (the stage). For example, most leukemias can be treated with chemotherapy alone, while others might also require radiation therapy. Some tumours require surgery and chemotherapy, while others can be treated with chemotherapy and radiation alone.</p><p>All these treatments take a huge toll on the body, especially a child's body, so patients must be closely monitored during and after treatment. It is not unusual for children to be repeatedly admitted to the hospital to treat or manage the side effects of cancer treatment. Cancer, as we repeatedly explain to parents, is an aggressive disease and will only respond to strong treatment. Painful as the side effects are, unfortunately, there is no other option.</p><p>This can be hard for parents to accept, and some may look for alternative cancer treatments. Known as 'treatment abandonment', this occurs when families choose, either due to a lack of trust in modern medicine or frustration with the impact of aggressive treatments on their child, to forgo medical treatment despite being in the right place and having the right diagnosis. This is a double tragedy because, to date, there are no alternative cures for cancer other than those offered by modern medicine.
</p><p><strong>The post-treatment journey</strong></p><p>What happens once the cancer treatment is successfully completed? The child must continue to see their doctor for at least 5 years after. During this part of the journey, the “survivorship journey", doctors must keep an eye on any long-term complications that may arise from the treatment or signs that the cancer is coming back. Because occasionally, it does. Universally, children endure cancer treatment better than adults and often find themselves completely cured of their cancer. The paediatric oncology community is fortunate to have had the responsibility of taking care of these children and helping families in the most difficult time of their lives, providing them hope with the promise of a cure.</p><p>Which brings me to the best part of my day: telling my patients they are cured and watching them go back to living their lives.
</p><p><em>Dr. Sadaf Altaf (Consultant) Paediatric Haematologist and Oncologist, Department of Oncology, The Aga Khan University Hospital</em></p>