A warm welcome to the Cancer Brief, a column brought to you by Zimpapers (1980) Ltd in conjunction with Island Hospice.
This is in recognition of the fact that cancer has become a cause for concern not just in Zimbabwe but across the world. Cancer deaths are fast rising – leading many people to watch what they eat and adopt healthier lifestyles as they try to prevent not just cancer but other non-communicable diseases – which have to do with lifestyle patterns.
It is our hope as Zimpapers that through this column readers will be educated, questions will be asked, experienced shared and stories of hope amplified. We hope through this column policy-makers will be lobbied while service providers will also be spoken to.
Because September was Children’s Cancer Awareness Month, the first piece on the Cancer Brief will focus on childhood cancers.
Island Hospice interviewed specialist consultant haematologist, Dr Tendai Chris Maboreke, MB, BS (Ibadan), MRCP (UK), DipRCPath (UK), FRCPath (UK), MBA (UK) from Lancet Laboratories and below is the full interview.
Q: What are the early signs and symptoms of childhood cancer?
A: The early signs and symptoms of childhood cancer depends on the part of the body the cancer is located. But sometimes symptoms are non-specific, not indicative of the organ affected. Maybe I should just group the cancers into two: solid tumours where is there is a lump and the second group is the blood cancers and these present differently.
Q: For solid cancers, is there is a specific set of signs and symptoms?
A: For solid cancers I can give an example for the most common one being Wilms Tumour, tumour of the kidney, which usually presents with a lump in the tummy which the mother or parent can feel when washing the baby or a distended belly type of swelling. For all the solid tumours the lump can be anywhere in the body, any lump anywhere on the body should be suspected to be cancer.
The second most common cancer in children is Kaposi Sarcoma, presenting as multiple lumps on the skin, resulting in skin changes. Another common cancer is retinoblastoma, that is cancer or tumour affecting the eye, usually starting off as a white spot in the eye, progression of this cancer can lead to visual impairment, at advanced stages the eye protrudes as the cancer causes swelling and the eye is pushed out.
Lymphomas which are the fourth most common type of cancers in children and usually present with lumps in the neck, armpits and groin sometimes in the liver and spleen which can lead to an enlarged tummy. Then another type is the brain tumour, the symptoms referable to the head, headaches, sometimes vomiting, personality changes, occasional fits that may point to the cancer in the brain.
Q: So if a child is not able to articulate themselves, how easy is it to note a change in personality?
A: Well, you note that there will be other manifestations in younger children, the head may actually grow bigger because of the head of a younger child is still more pliable, a growing tumour will be noticeable. In brain cancers the child may not develop normally, the milestones may not occur at the time you expect them to such as delayed walking, delaying sitting and all sorts of things.
Then for the blood cancers, the leukaemia, they usually present with signs and symptoms of infection which doesn’t go away or which keeps coming back, reducing the immunity and infection usually showing as a high temperature or hot body. It can also present as the signs and symptoms of anaemia which include difficulty in breathing, listlessness, lethargy, loss of colour especially in the hands the usual pinkness goes away.
Blood cancers may present as bruising and bleeding from anywhere, bruising occurs due to low blood count and bleeding may be a result of a low platelet count.
Q: So does the bleeding stop?
A: The bleeding only stops when you treat the cancer when you transfuse platelets.
Q: So it can be confused with haemophilia?
A: Yes, that is why you need to do some investigations for suspected cancer for any child who comes in with symptoms similar to the above.
Q: Do you know what the prevalence of paediatric cancer is?
A: Professor Chitsike did a study of all cancers registered with the Cancer Registry of Zimbabwe. Out of all the cancers registered, about 3,8 percent were paediatric cancers. If I am to talk in terms of numbers, the total cancers registered where 46 786 out of which 1 766 were childhood cancers over a period of 10 years.
So it means about 177 childhood cancers were registered each year during that period, that is those that ended up in hospital, obviously there are some who died before they got to hospital so that an under-estimate. Some may not have sought professional medical attention and do not end up at a clinic or hospital.
Some are referred to Parirenyatwa as it has the only paediatric cancer unit in Zimbabwe, but don’t make it for various reasons.
Q: You mentioned that some people would not use the conventional route of seeking help from a medical hospital, what do you think constitutes the lack of health-seeking behaviour especially when it comes to children?
A: Whenever there is an illness in a family, they will try to take one of three options to seek care. These options are traditional healers, faith healers while others choose to go to the clinic or hospital. For those who don’t seek hospital or clinic treatment this constitutes reasons for late delay in seeking treatment.
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