Childhood Cancer: Treatment process and challenges

Consultant Paediatric Haemato-Oncologist, University of Benin Teaching Hospital, (UBTH), Dr. Magdalene Odunvbun.

 By Bernadette Idalu

"She lost the battle barely six months after it was said to have occurred. It was said to have been a mosquito bite, straight, at the centre of the forehead of the neonate. She fought a good fight and even attempted to scratch the site, they say, in her infantile innocence to ease her discomfort even as her mother applied healing balm to sooth the discomfort. In about a month, a monstrous growth was said to have steadily etched itself into her forehead. The amount spent in the treatment process did not effect desired cure. Medical practitioners later said it was cancer."
(From an anonymous source)

Aside incidents of flooding, war and drought which cause famine and associated outbreak of diseases, which systemically reduce man to a mundane state of existence, the issue of sickness and death are reoccurring decimals staring man, stark, in the face.

It is no news hearing people praying (kabashing) for long life and prosperity in or out of places of worship. Prayers for good health are never in short supply even during birthday celebrations. Ironically, the last dose of medication taken by such persons to keep in good form could be that sip on "Agbo Jedi" and other aperitifs brewed locally and sold for a fee to wade off sicknesses. This has become a way of life since the attendant cost of seeking professional medical care is now on the very high side. Not everyone has the luxury of being covered by the health insurance.

Yes. The pain of the respondent in the introductory paragraph is palpable. It begs for answers. Hence the question- Are Cancers, "Spiritual Arrows," projected by evil or jealous detractors into the lives of good people just to torment, maim or kill them for possessing shiny stars/good destinies as claimed by some firebrand people with religious inclination? or they are simple health issues which require diligent attention and prompt medical intervention even when such sufferers groans and mouth out a plea for help in popular Nigerian pidgin parlance, "Make una help me o...dis sickness dey carrey me go where I nor no o."

No doubt, we all have different views to share and pointers to keep fit. However, at this stage, there is need to hear from a medical professional to get the right perspective on the causes and treatment processes for childhood cancers.

Consultant Paediatric Haemato-Oncologist, University of Benin Teaching Hospital, (UBTH), Dr. Magdalene Odunvbun says causes of Cancers are generally not known, but, there are some things which have been known to be associated with the increase or occurrence of cancer, such as radiation as evident in the bomb blast by America on Japan during the Hiroshima war, which subsequently led to a high increase of cancers. This she says, is suggestive of the fact that, the exposure to such radiation was likely a cause for increased occurrence.

She states that exposure to certain kinds of drugs have also been said to cause cancers especially drugs used to make pesticides; exposure to benzene which is found in all kinds of things including plastics are also thought to contribute to cancers. Cancer is also thought to be genetic. If a mother has breast cancer the chances that her daughters would also have it is very high.

In our own environment here, a lot of cancer patients tend to come from environments where there are oil spillage and exploration in Delta state. In our cancer ward, in UBTH, most of our patients come from Delta State. It is easy to infer that exposure to oil spillage is contributing to the presence of  cancer in our environment. But, largely, the cause of cancer remains unknown but inference has been made from exposure to certain things.

Clarifying on the issue of a mosquito bite which turned malignant, the medical personnel while debunking the claim, avowed, "That is not true. It just might be one of those cancers that presents as lymph nodes."  We also have people who scratch pimples on their face. Don't forget that the blood supply to your skin is closely connected to the brain.

She advises people not to scratch their pimples for when such is exposed to infection, it drains directly into the brain and can cause serious harm such as cerebral abscesses and they die.

The face, she asserts, is closely connected to the brain, hence the need to minimize on things that could lead to infection that drains straight to the brain. This is different from draining off puss from other parts of your skin. Carrying out surgery for an abscess in the brain is expensive and the chances of mortality is also very high. Mosquito bite she insisted, does not cause cancer.

Speaking on Cancers, Dr. Odunvbun informed that all organs are predisposed to developing cancers. In children, the commonest type of cancer we used to have, long ago, was the "Bucket Lymphoma," where there is a huge jaw tumor. That tumour can also present in the abdomen. But, in the last two or three years, it is no longer as common as it used to be. What we now see is the cancer in the eye of our children which is called the "Retinoblastoma." It presents like what looks like a cataract in the child's eye. It begins to progress till it becomes a fungating eye mass that protrudes from the child's eye.

At the time it is like a cataract, if the parents are aware of this and present it early in the hospital, it is easier to treat. Even when a child is born in developing countries and a child is born with "Embryonic Cancer," which means even as an embryo that child is already predisposed to such kind of cancer, retinoblastoma is one of such Cancers.

At birth, if you have a camera that has a red reflex and you snap that child's eye looking at you, if you do not see that red light reflect coming out of the middle of the eye then there is likely a tumour obstructing the retina. In a developed country once such is noticed, you immediately explore that child's eye as that cancer is small and very easily treatable. They don't need to go through surgery, or chemotherapy. They only do a Laser therapy to burn off the tumour.  That way the child's face is preserved and the vision is preserved.

Throwing light on the complexity of the Nigerian situation, she put forward, "Here, we don't really pick it in newborns because we don't really screen for it. Even when parents later see what looks like a cataract in the child's eye it doesn't mean anything to them until the child starts bumping into objects as he is no longer seeing with that eye. But if it involves just an eye such a child will take a long time to present with symptoms as he would not bump into objects as the good eye retains some form of vision."

She maintained, If a child bumps into objects, not able to see far, hence, goes closer to the board or television to see clearly, it is necessary to screen that child's eye. It is one of the earliest warning signs.

For other kinds of cancers such as Lymphoma, the oncologist said, you see what appears as nodular masses growing in a child's neck or any place you don't expect such to be growing; the child is having malaria that cannot be explained or needing blood transfusion in at least three weeks. It means something is wrong. Even children that have sickle cell don't have to be transfused like every month.

"When we see a child in recurrent need of transfusion, appearing pale or has nodules growing all over the neck, you know that there is something wrong. That child needs to be screened. Also, when you see a child with a mass growing anywhere, such children should be taken to the hospital."

Some parents, she observed, go to hospital. "But, it is not every doctor that understands that, not everything that they are treating so innocuously are simple, such could be malignant. Doctors should know that if they see a tumour anywhere, the advice is to take a piece of that tumour and send it for a biopsy, then send the child to the appropriate facility where that child's health can be managed.

"Our biggest challenge is that when a child is presenting, they have the florid signs of the cancers and also coming, in late stages. We have the early stage also known as the "Stage 1 and 2" but when it gets to "Stage 3 and 4" cancer, it is almost terminal. The treatment is more intensive and the chances of the child even dying is much higher. That is the stage in which most of our cancer patients present."

On the prevalence of cancer in society, the health expert stated, "In UBTH alone, for last year, we saw about one hundred and forty- one (141) children with cancers of which sixty- five (65) were new cases of cancer. This year, we have not yet taken documentation of total number of cases seen but averagely, we manage one hundred and forty to one hundred and forty- five (140-145) children with cancers yearly."

The treatment process is key. She reveals that treatment of cancers is carried out in phases, depending on the kind of cancers. "Most of the treatment basis here is based on "Chemotherapy" using drugs or surgery to debulk the tumour or even remove the whole tumour before we now continue with the chemotherapy. Some of them also use "Radiotherapy." Unfortunate for us, our radiotherapy machine has been bad for almost five years. Our patients who need radiotherapy have to go to other centres where it is more difficult to access the care because the queue is very long, and they might have to travel out of the state which makes their stay more expensive as per cost implications. This care is not really available anymore.

"For Chemotherapy, the drugs are not cheap. Most of the children who have cancer in this environment are largely from the low socioeconomic group. This sickness further impoverishes that family. They cannot afford the treatment process. That is why the dropout from cancer treatment is very high because the parents can no longer afford it."

When Bucket Lymphoma used to be common, she explains that, just after the first dose of Chemotherapy treatment, you see immediate improvement. By the time they take the second treatment, most of the tumours have disappeared. Unfortunately, in this environment, when you send them home, they think it is malaria, they don't come back in a month's time or even a year. When they finally do, such a child has a massive growth. Some of the time, the tumour does not respond as it did initially. There is now a degree of resistance. There is a big challenge. They don't come back because the drugs were expensive since they merely managed to pay for the earlier treatment process.

On the treatment process, this is said to be a big challenge as the cancer treatment process is not free. The parents of the children with the cancers are from low socioeconomic groups who cannot afford payment for the treatment process. It is a huge tax managing them.

Different cancers have their own treatment process. To treat Leukemia in a boy takes three and half years. He has to be on chemotherapy for three and half years. It is in phases. For a girl, it ends in two and a half years. There are some cancers that we treat in about six months. It all depends on the kind of cancer

For Eye Cancer, most of the courses are given every three weeks for a total of six or eight cycles. That simply means repeating each cycle every three weeks. The cost for chemotherapy for this and the one taking treatment for two and half years is different. We also have expensive drugs such as the elasperiagenes which the child is put on for fourteen days.

The support system put in place to help manage any cancer is as important as the drug treatment given. When you give chemotherapy aside hitting the cancer cells it also hits other human cells in the body. A complication is the reduced cell count. Their packed cell volume referred to as "PCV" drops such that, their red blood cells count, their white blood cells count and their platelet count, drops. These three limits are very important.

Without blood we cannot function, she educates, on the value of blood. When giving chemotherapy you must be ready to transfuse this child. If the white cells are too low we have to stop the treatment totally to bring it up again. The drug we use to do this called the "Glanulecolyte Colony Stimulating Factor" (GCLF), is very expensive, with an ampule costing about seventeen thousand naira.

You may need to give that drug for the next three to seven days. You only stop giving it when the cell count goes up. Until the cell count progress before you start giving the chemotherapy. Also, the longer you delay in giving your chemotherapy it means you are not touching the cancer and it is still there. It is not just the chemotherapy, the support care matters, as the platelets is what controls our bleeding. If reduced, the chances of bleeding from different places is very high. There is even this fear that the child does not go on to start spotting or bleeding within their brain. We give platelet products when low and these are not cheap. There is no support in the treatment system for managing our cancer cases.

Comparing interventions put in place for adult and children cancer patients, the doctor avows, For the adults, in recent times, the government has put up programmes to help adult cancer cases (Breast Cancer and Prostrate Cancer) but the children are not put inside that programme. If you go to my ward right now, (Children Emergency Ward), the beds are full  and begging for space but the attention has been taken by adults. Supplementing of care is being done for the adults. Leukemia is becoming so much more common among children than we saw years ago.

Appealing for funding in the treatment process of childhood cancer as previously obtainable in the 1980s. She said, "Children don't work, they don't generate income. The government must make deliberate effort to ensure that their treatment is either free or extremely subsidized, including their bed stay." 

Pointing at some peculiar cases especially for semi literate, polygamous homes, she said when such fathers notice that a child's case has become problematic he simply says let the child go, he is not the only child he has and would have another one. But, incidentally, if he is the one that is ill, he is ready to sell his land or properties to treat himself. The children suffer. Sometimes, we as caregivers are helpless.