Childhood cancer in Africa is now clearly an important disease condition. With most health system resources being directed to combating infectious diseases including HIV/AIDS, TB, malaria and other conditions such as malnutrition, it is expected that these conditions will be brought under control and that cancer will be an increasingly important cause of child morbidity and mortality. Using unpublished data from the Child Health Department of the Korle Bu Teaching hospital, excluding the deaths occurring in the first 48 hours after admission in the emergency room, child cancer cases account for the highest percentage (17%) of deaths on the longer stay wards at KBTH.

What causes Childhood cancers ?

Very little is known about the cause of most childhood cancers. Many types have the highest incidence at an early age suggesting causative factors operate before birth.

  • Environmental factors – radiation is established as a cause
  • Drugs, chemicals
  • Infections – viruses for example E-B virus (interaction with malaria in Burkitt lymphoma), Hepatitis B virus, HIV.
  • Genetic factors – Less than 5% of childhood cancers can be attributed directly to genetic factors, for example, there is a hereditary form of eye cancer.

How can it be diagnosed ?

Physical examination by a health worker, blood tests, Ultrasound scans, Xrays, CT or MRI scans, bone scans, a sample of the tumour to a laboratory by fine needle aspirate or biopsy, other investigations e.g bone marrow sample, fluid from the spine (CSF) may be sent to the laboratory.

What are the early symptoms/signs ?

The following symptoms are useful for public awareness about early presentation of childhood cancer

  • S – seek help for persistent symptoms
  • I – eye signs, white spot, squint, blindness, bulging eye
  • L – lumps in abdomen, head, neck, glands
  • U – unexplained fever, weight loss, bleeding, pallor, fatigue
  • A – aches in bones, back, fractures
  • N – neurological change in balance, gait, behaviour, headache

The presentation of cancer in children frequently mimics those of common childhood conditions.

How can it be treated ?

Chemotherapy is the mainstay of treatment for most childhood cancers. Surgery is required at times. Radiotherapy may be necessary but is avoided in very young children if possible. Supportive care is important to treat infections, administer blood and blood product transfusions and provide optimal pain and all other untoward symptom control.

What are the Challenges ?

  • The general lack of awareness about childhood cancer
  • Adverse socio-cultural beliefs and practices
  • Limited access to services leading to late presentation.
  • There are few health workers trained in paediatric cancer management.
  • Inadequate diagnostic services.
  • Lack of NHIS cover for childhood cancer
  • Unaffordable costs of chemotherapeutic agents, irregular supplies, uncertain quality of generics.
  • Very high rates of treatment abandonment.
  • Inadequate supportive and palliative care.

What is the way forward ?

  • To address this issue of childhood cancer before we are overtaken by it as a nation, it is of the utmost importance to:
    • Raise public awareness of the early signs and symptoms,
    • Invest in capacity building of health workers for early detection and referral,
    • Set up treatment centres in all regions with the capacity to provide rapid diagnosis and treatment including adequate supportive care and palliative care
    • Develop appropriate national treatment protocols bearing in mind the limited resources.
    • Ensure that childhood cancer care, at least the most curable cancers, is fully included in NHIS.
    • Ensure chemotherapeutic agents are of assured quality
    • Establish a cancer registry to determine the burden of childhood cancers and obtain data for epidemiological studies.
    • Bring NGOs and support groups in this area together to collaborate.
    • Ensure that the National Cancer Strategy is rolled out.

Conclusion:

There is a general lack of awareness about childhood cancer in Ghana as a whole and it has to compete with other pressing health care needs for limited resources.
Despite this, one has to bear in mind the fact that it is our moral duty to ensure children affected worldwide by all disease conditions, including cancer should have access to acceptable standards of care.
The most important message to remember is that childhood cancer can be cured provided the known effective treatments are made available, affordable and are utilised appropriately.
Families should look forward to a long productive life for affected children and should be given a more optimistic outcome.

LET US ACT NOW FOR CHILDREN WITH CANCER!!!