Why childhood cancer is difficult to diagnose – 02/16/2023 – Equilibrium

This week, on February 15th, the International Day to Combat Childhood Cancer was celebrated, a global campaign to raise awareness of the disease that affects thousands of children around the world and, consequently, their families. Today, around 80% of children and adolescents affected by these diseases can be cured if diagnosed early.

The estimate of new cases of childhood cancer in Brazil for each year of the triennium, from 2023 to 2025, is 7,930, of which 4,230 are boys and 3,700 are girls. The Southeast region appears in the ranking as the most affected, accounting for 3,310 estimated cases, and the North with the lowest rate of diagnoses, a total of 650. Data are from the National Cancer Institute (Inca).

On Brazilian soil, as well as in developed countries, cancer already represents the leading cause of death from disease among children and adolescents aged 1 to 19 years.

Faced with this situation, Sima Ferman, head of pediatrics at Inca, emphasizes the importance of early diagnosis. “The truth is that cancer, when it is in a very advanced stage, is easier to detect and more difficult to treat. Already in the initial stage, it is more difficult to detect, because they are similar to common diseases that children have, but they are easier to treat, including with less treatment time and long-term effects”, explains the specialist.

However, specialized centers, she says, usually receive patients with large tumors, that is, diseases in advanced stages. This means that there is often a delay in diagnosis and a delay in starting treatment.

“A part depends on the parents taking the child to the doctor when he has recurrent symptoms, but the other depends on the health centers, where, initially, he is attended to in primary care, and there is suspicion of the disease”, comments Ferman .

In short: the doctor at the Basic Health Units (UBS) is responsible, at first, for suspecting the inconclusive result of an exam, for example. Therefore, when a child starts to go to a UBS or a health center with a certain frequency, and there is no definitive diagnosis, the pediatrician must invest in a rigorous investigation, and not send him back home without diagnosing the problem. , nor underestimate it.

In 2020, according to the most recent Inca Mortality Atlas, 2,289 deaths from childhood and youth disease were recorded in the country.

“It is a very big social problem. It is necessary to better train the doctors who work in the outskirts so that they can detect something suspicious and refer these children to a specialized hospital, where they will have an early diagnosis”, indicates André Brunetto, doctor oncologist and responsible for scientific research at the Instituto do Câncer Infantil (ICI) in Rio Grande do Sul.

Most of the time, symptoms are related to common childhood problems, such as pain, fever, lack of appetite, ganglia (lump) caused by some inflammation. But this is not a reason to rule out a visit to the doctor. The important thing is not to underestimate recurring complaints.

“All pediatric tumors are very difficult to diagnose, because they are diagnoses of exclusion”, recalls Brunetto.

Early diagnosis, however, does not prevent the progression of the disease, even with metastasis, as these are usually tumors that spread quickly. “But there are some diseases in which early diagnosis makes a very big difference, such as, for example, a retinoblastoma (which affects the retina, the back of the eye) or a Wilms’ tumor (a type of kidney tumor),” says Ferman.

How childhood tumors often present

• In leukemia, the child becomes more subject to infections, may become pale, have bleeding and feel pain in the bones;

• In retinoblastoma, an important sign is the so-called “cat’s eye reflex”, whitening of the pupil when exposed to light. It can also be presented through photophobia (exaggerated sensitivity to light) or strabismus (cross-eyed gaze). It usually affects children before the age of three;
• Enlargement or the appearance of a mass in the abdomen can be symptoms of Wilms tumor (which affects the kidneys) or neuroblastoma;
• Solid tumors can be manifested by the formation of mass, visible or not, and cause pain in the limbs. This symptom is frequent, for example, in osteosarcoma (a tumor in the growing bone), more common in adolescents;
• Central nervous system tumor has as symptoms headaches, vomiting, motor alterations, behavior alterations and nerve paralysis.

What are the main differences between adult cancer and childhood cancer?

Unlike cancer in adults, childhood cancer usually affects cells in the blood system and supporting tissues.

They are also of an embryonic nature, that is, they are unrelated to external factors, such as, for example, alcoholism, smoking, sedentary lifestyle, lifestyle in general or even cellular aging. Rarely does a child have genetic alterations that make them prone to having a certain type of cancer. That’s why it’s very difficult to talk about prevention.

Cancer, both in children and adults, occurs when there is a genetic alteration/mutation in a given cell, which begins to grow, develop and then proliferate. “And it no longer obeys the body’s normal commands. So, over time, it acquires independence, autonomy and an ability to spread to other parts of the body”, describes Brunetto, an oncologist at the Children’s Cancer Institute in Rio Great South.

The most common tumors in childhood and adolescence are leukemias (which affect white blood cells), those that affect the central nervous system and lymphomas (lymphatic system).

Also affecting many children and adolescents are neuroblastoma (tumor of cells of the peripheral nervous system, often located in the abdominal region), Wilms tumor (type of renal tumor), retinoblastoma (affects the retina, fundus of the eye), germ tumor (of cells that originate the ovaries and testes), osteosarcoma (bone tumor) and sarcomas (soft tissue tumors).

How is the treatment done?

Together or combined, chemotherapy, radiotherapy and surgery remain the mainstays of childhood cancer treatment. It is planned according to the diagnosis of the tumor, its biological characteristics and the presence or absence of metastasis.

Cancer treatment is carried out by a multidisciplinary team, that is, involving several specialties, such as pediatric oncologists, pediatric surgeons, radiotherapists, pathologists, radiologists, nurses, social workers, nutritionists and the like.

In addition, psychological care is fundamental, bearing in mind that the fight against any type of cancer is never easy, and recovery should not be based only on biological healing, but also on the well-being and quality of life of the child or of the teenager.

Scientific research is still scarce

Studies show that there are still not enough investments in research for childhood cancer. Brazil has been stagnant for years.

And new drugs, such as immunotherapy and the molecular target drug, which is directed exactly at the molecular alteration, with few exceptions, are not available in the Unified Health System (SUS).

“So, although children are more responsive and cure rates are higher, there is no evolution in terms of treatments. Today, we have a lot more money being invested in oncological research and new medicines for adults, whose illnesses are much more frequent, than for children”, emphasizes Brunetto, adding that the cost is the same, but that the industry, in turn, wants to earn more.

The expert, responsible for scientific research at the Instituto do Câncer Infantil, says that this is one of the roles of the entity: to raise funds from the community for investment in research.

It is no coincidence that ICI is promoting an award to honor researchers from all over Brazil with a focus on pediatric oncology. In all, R$110 thousand reais will be distributed to the winners. The “Doing Good Has a Special Taste” award is open for submissions until February 28th.

“Because this is a very underserved area. In the last ten years, worldwide, only three drugs have been developed specifically for children. Most drugs are developed for adults and we test and use them on children, but they are not designed for them. And the pediatric disease is absolutely different”, reinforces Brunetto.

This text was originally published here