Cancer on the rise among children from poor families

Feb 06, 2011

THE world celebrated World Cancer Day last Friday, and Uganda emphasised prevention and early diagnosis of cancers, especially in children. Over the years, coverage on cancer in adults has overshadowed cancer among children, yet the numbers continue to rise.

THE world celebrated World Cancer Day last Friday, and Uganda emphasised prevention and early diagnosis of cancers, especially in children. Over the years, coverage on cancer in adults has overshadowed cancer among children, yet the numbers continue to rise.
By Agnes Kyotalengerire

CHILDREN groan in pain with plaster wrapped around their swollen knees. They can hardly walk or support themselves. Others lie helplessly with swollen jaws and eyes, while their parents look on helplessly.

Such is the situation in the children’s ward at the Uganda Cancer Institute, Mulago. Dr. James Kafero, an oncologist at the Institute, says childhood cancers are among the life-threatening diseases in children.

In a month, the institute registers about 50 cases of children with cancer. A total of 25% have Burkitt lymphoma cancer and 15% are leukaemia cases. Other common cancers are Wilm’s tumour, Kaposi’s Sarcoma and bone cancer.

Burkitt’s lymphoma
Dr. Fred Okuku, an oncologist at the institute, says this cancer constitutes about half of the childhood cancers in the age bracket of three to 15, with the peek age being six.

Burkitt’s lymphoma affects the lymphatic system (tissues and organs that produce, store and carry lymphocytes, a type of white blood cells that fight infections.) The cancer is caused by the epstein barr virus.

Okuku says the cancer is aggressive and spreads to other body parts other than the lymph nodes. Although the chest and abdomen can be affected, Burkitt’s lymphoma presents with swelling of the jaw, leading to loosening and falling out of teeth.

After tooth extraction, the cancer grows faster. “Burkitt’s lymphoma is highly aggressive with a doubling rate of eight to 16 hours. By four weeks, the patient experiences unbearable pain and beyond that, the cancer get worse,” he explains.

Signs and symptoms
Okuku says 50% of the children with the cancer present with a swollen face, especially the eyes, on the side of the affected gum.

Other symptoms include bleeding from the gums and bad breath, which is a result of bacteria getting into the mouth due to swelling. It causes nasal blockage which leads to snoring.

It can also affect the central nervous system. Okuku says when the brain is affected, a child gets convulsions. If the infection is in the spine, the lower limbs get affected.

As a result, the bladder and rectum muscles are weakened, resulting in failure to control stool and urine. In girls the ovaries swell, which may necessitate removal; while in boys, the scrotum gets affected. Other organs that get affected are the facial bones, breasts, kidney and liver.

Kafero says Burkitt’s lymphoma is treated by chemotherapy, where drugs are administered. In spite of its fast-growing nature, with the current aggressive forms of chemotherapy that use drugs in high doses and the availability of measures to support individuals during intensive treatment, Burkitt’s lymphoma is curable when detected early.

Kafero says the cancer mainly affects people of low social economic status due to poor nutrition and hygiene as well as failure to treat malaria effectively, reducing resistance to the epstein barr virus. The virus is transmitted through faecal matter.

Kafero says the cancer of the white blood cells is equally deadly. “When one has leukemia, large numbers of abnormal white blood cells are produced in the bone marrow.

They crowd the bone marrow and flood the bloodstream,” says Kafero, adding that they cannot protect the body against disease because they are defective.

As leukemia progresses, the cancer interferes with the body’s production of other types of blood cells, including red blood cells and platelets. This results in anaemia, leading to general body weakness, easy bruising, bleeding in the gum and under the skin as well as bone and joint pain.

Other symptoms are night sweating, frequent fever and infections caused by white cell abnormalities. Leukaemia is classified into acute (rapidly developing) and chronic (slowly developing).

Twelve-year-old Ronald Aliganyira’s mother, Pauline Karungi, says her child’s condition started last year when Aliganyira was about to sit for his Primary Leaving Exams. It began with swelling and pain in the knee.

Later the pain and swelling shifted to the groin, accompanied by high temperature. He was operated on to remove the groin swelling. The doctors diagnosed him with Burkitt’s lymphoma. The swelling and pain moved to the scrotum and later spread to the jaw and face.

Thirteen-year-old George Olanya started treatment for leukaemia last year. The cancer first presented with high body temperature, excessive sweating, especially during the night and constant headache. He was also put on malaria treatment for about two weeks, but did not respond. His father, Christopher Adrigwe, took him to Mengo Hospital where investigations were done and it was discovered Olanya had leukaemia.

How I knew it was cancer
Juliet Namubiru, Azari SSekatawa’s mother, says her one-year-old child had on-and-off coughs, accompanied by difficulty breathing when he was six months old.

She took him to various health centres and was given syrups, but his condition did not improve. He was anaemic, lost weight and his stomach swelled. His head also grew bigger and his lymph nodes started swelling. A bone marrow test revealed he had leukaemia. He is on cancer treatment.

Cancer diagnosis, treatment
Diagnosis depends on the cancer. For leukaemia, a blood and bone marrow test is done. For other cancers, a biopsy (where tissue is taken from the affected area and the cells studied) is done. Diagnosis also largely depends on the symptoms.

Kafero says on average, one requires a minimum of sh1m to treat cancer, but the cost largely depends on the type of cancer. However, the Government supplies cancer drugs to the institute.

However sometimes the drugs run out, and patients have to buy them from elsewhere. But some organisations like the Uganda Child Cancer Fund aid children, especially those with Burkitt’s lymphoma to meet the expenses.

Treatment for some cancers may include radiation or chemotherapy, where a combination of drugs is administered. If chemotherapy wipes out a patient’s immune system, a transplant is done.

In addition to the treatment follow-up tests, magnetic resonance imaging, X-rays, scans and ultrasounds are also carried out.

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