CHILDHOOD CANCER

INTRODUTION

Cancer in childhood is uncommon. Out of 10,000 normal children, one will develop cancer
during their childhood. The initial diagnosis can be frightening and stressful for child and
his/her parents. These emotions are not out of place and quite understandable but they are
also compounded by lack of information as well as some misconceptions. In most cases, there
is no specific reason or cause for the child to have developed cancer as it is no one’s fault, so
parents should not feel ashamed or guilty. The good news is that all childhood cancers are
treatable and most are curable.

The cancers can affect any part of the body- the most common affected are bones, blood, and
muscles. The familiar cancers include: blood cancers (leukemia), cancers of the lymphatic
system, (lymphomas), cancer of the brain and spinal cord, muscle and bone cancers
(sarcomas) and other cancers seen in the very young children (embryonal cancers). As of
today, more than 80% of children with cancer get cured, depending upon the type of cancer
they are suffering from. Like for some cancers acute lymphoblastic leukemia and Wilms
tumour, there is 90% cure rate, while that for Hodgkin disease and germ cell tumours, it is
almost 95%.

Children are not adults; their needs are different and need to be treated by someone who is
trained to look after them. Paediatric oncologists are responsible for treating all malignant
conditions among children like leukemia, bone cancers, Wilms tumor, brain and spinal cord
tumors among several others. With timely, appropriate and complete treatment, majority of
children with cancer get cured and can lead their lives peacefully.

Information and support are important to feel sure about the treatment. The more you know
about cancer, the less confused or unprepared you will feel. Regular parent support group
meetings should be attended, which will be an opportunity for parents of children with cancer
to meet other parents whose children are either being treated or have completed treatment.

MOST COMMON TYPES OF CHILDHOOD CANCER

 Primary Cancer and Secondary Cancer - The “Primary Cancer” is where the
cancer started. In case some cells break away from the primary cancer site and settle in
another part of the body, this cancer is then called as “Secondary Cancer” or metastases.

1
 The cancer cells can spread locally by entering the bloodstream or lymphatic system.
However, secondary cancers are made up of same type of cells as primary cancer.

 Leukemia - Found in the blood and bone marrow, this cancer accounts for one
third of all childhood cancers. The common cancers found in children are: Acute
Lymphocytic Leukemia (ALL) and Acute Myeloid Leukemia (AML). These cancers can
cause fatigue, weight loss, bleeding, joint pain and high fever. As acute leukamias have a
tendency to grow quickly, they need immediate medical intervention (chemotherapy).

 Brain and Spinal Cord Tumors - The second most common cancers in children
are brain and central nervous system tumors that account for a quarter of all childhood
cancers. They commonly occur in lower parts of brain like cerebellum or brain stem.
Most common symptoms seen are dizziness, double vision, severe headaches, vomiting,
and difficulty in walking or holding things.

 Lymphomas - They start in lymph nodes and lymph tissues and can also affect
bone marrow as well as other organs. The most common symptoms are swollen lymph
nodes under neck and armpit, excessive weight loss, and fatigue. 2 types of lymphoma
that can occur both in children and adults are:

o Hodgkin Lymphoma

o Non-Hodgkin Lymphoma

 Wilms tumor - This tumor accounts for 5% of childhood cancers and is commonly
found in children aging 3-4 years. It usually starts in one or both kidneys, causing
swelling or lump in the abdomen with symptoms like loss of appetite, nausea and fever.

 Neuroblastoma - This cancer develops in infants and young children. Accounting

for about 6% of childhood cancers, neuroblastomas can begin anywhere but starts in the
abdomen, and may also cause severe bone pain and fever.

 Bone Cancers - About 3% of childhood cancers are bone cancers that occur in
older children and teenagers (though they can develop at any age). Most common types
of bone cancers are:

o Osteosarcoma, which occurs in the areas where the development of bone

is quick i.e. long bones in arms or legs. The pain usually becomes severe at night or
while doing activity, causing swelling around bone.

2
o Ewing Sarcoma is most commonly found in young teenagers. It usually
begins in the hip bones, ribs or shoulder bladders or leg bones.

Types of Childhood Leukemia

Almost all cases of childhood leukemia are acute, which means they develop rapidly. A tiny
number are chronic and develop slowly.

Types of childhood leukemia include:

 Acute lymphoblastic leukemia (ALL), also called acute lymphocytic leukemia. ALL

accounts for 3 out of every 4 cases of childhood leukemia.
 Acute myelogenous leukemia (AML). AML is the next most common type of childhood
leukemia.
 Hybrid or mixed lineage leukemia. This is a rare leukemia with features of both ALL and
AML.
 Chronic myelogenous leukemia (CML). CML is rare in children.
 Chronic lymphocytic leukemia (CLL). CLL is very rare in children.
 Juvenile myelomonocytic leukemia (JMML). This is a rare type that is neither chronic
nor acute and happens most often in children under age 4.

Symptoms of Childhood Leukemia

Symptoms of leukemia often prompt a visit to the doctor. This is a good thing, because it
means the disease may be found earlier than it otherwise would. Early diagnosis can lead to
more successful treatment.
Many signs and symptoms of childhood leukemia happen when leukemia cells crowd out
normal cells.
Common symptoms include:

 Fatigue or pale skin
 Infections and fever
 Easy bleeding or bruising
 Extreme fatigue or weakness
 Shortness of breath
 Coughing

Other symptoms may include:

 Bone or joint pain

 Swelling in the abdomen, face, arms, underarms, sides of neck, or groin

3
  Swelling above the collarbone
 Loss of appetite or weight loss
 Headaches, seizures, balance problems, or abnormal vision
 Vomiting
 Rashes
 Gum problems

Diagnosing Childhood Leukemia

To diagnose childhood leukemia, the doctor will take a thorough medical history and do
a physical exam. Tests are used to diagnose childhood leukemia as well as classify its type.

Initial tests may include:

 Blood tests to measure the number of blood cells and see how they appear
 Bone marrow aspiration and biopsy, usually taken from the pelvic bone, to confirm a
diagnosis of leukemia
 Lumbar puncture, or spinal tap, to check for spread of leukemia cells in the fluid that
bathes the brain and spinal cord

A pathologist examines cells from the blood tests under a microscope. This specialist also
checks bone marrow samples for the number of blood-forming cells and fat cells.

Other tests may be done to help determine which type of leukemia your child may have.
These tests also help the doctors know how likely the leukemia is to respond to treatment.

Certain tests may be repeated later to see how your child responds to treatment.

Treatments for Childhood Leukemia

Have an honest talk with your child's doctor and other members of the cancer care team about
the best options for your child. Treatment depends mainly upon the type of leukemia as well
as other things.

The survival rates for most types of childhood leukemia have gone up over time. And
treatment at special centers for children and teens has the advantages of specialized care.

4
 Childhood cancers tend to respond to treatment better than adult cancers do, and children's
bodies often tolerate treatment better.

SYMPTOMS OF CHILDHOOD CANCER

The cancers in children are hard to recognize as the symptoms are common/similar to
childhood illnesses or injures. However, if the below mentioned symptoms persist, it requires
immediate intervention:

 An unusual lump or swelling

 Unexplained paleness and loss of energy

 Easy bruising or bleeding

 An ongoing pain in one area of the body including bones, joints, back

 Limping

 Unexplained fever or illness that doesn’t go away

 Frequent headaches, often with vomiting

 Change or deterioration in walk, balance or speech

 Sudden eye or vision changes including white spot in the eye, new squint, new
blindness, bulging eyeball

 Sudden unexplained weight loss

DIAGNOSIS OF CHILDHOOD CANCER

Paediatric oncologists diagnose a child’s cancer by doing tests to identify the specific type of
cancer. This is called as “Confirmatory Testing”. Thereafter, a series of tests are done to
determine the burden of cancer and where is it located. This is called as “Staging”. For this,
several investigations are done like:

 Blood and Urine Tests

 Imaging with ultrasound, MRI, CT scan, PET CT scan

 Bone Marrow examination and lumbar puncture

5
 Biopsy

To Stage “Solid tumors”, the doctor examines the size of tumor and affected lymph nodes as
well as where it has spread.

To Stage “Lymphoma”, the doctor examines the lymph nodes, bone marrow, liver, spleen,
lung and the res t of the body. Also, few special tests like genetic testing of tumors are also
done to assess the capability of cancer.

It is most important to get the correct diagnosis so that right treatment can be given to the
child. Though not all tests are done on children and what is conducted depends on the type of
cancer suspected. For most of these tests, the child is sedated so that he/she may not move or
feel any pain. The results may take 3-5 days to come back so this is explained to the parents.

TREATING CHILDHOOD CANCER

Once the diagnosis is confirmed, the oncologists provide detailed counseling to parents.
Treatments are available for all childhood cancers, and most children can be cured. The team
should ensures that all children are comfortable and free of pain as the treatment of childhood
cancer is long and tough. The main types of treatment options available are:

 Surgery - The tumor is removed by an operation

 Chemotherapy - The medical drugs are given to stop the growth of cancer cells.

 These are given by:

o Intravenous ( IV) (drip) : injection into a vein

o Oral (PO or O) : as syrups, tablets or capsules

o Intramuscular ( IM) : injection into muscle

o Subcutaneous ( SC) : injection just under the skin

o Intrathecal ( IT) : by lumbar puncture

The chemotherapy drugs travel through the bloodstream. As the drugs are carried in the
blood, they destroy cancer cells in the body. Therefore, chemotherapy is useful for treating
cancers that are generalized, e.g. blood cancers or those cancers that have spread to other
parts of the body. Though the chemotherapy drugs destroy the cancer cells completely but
they also affect the healthy cells. As a result, chemotherapy is given as a series of treatments

6
 in cycles/phases to allow the healthy cells to recover. The chemotherapy drugs can cause side
effects as all children may react to it differently.

 Radiotherapy – Radiation is an invisible treatment that requires the use of high

energy rays to destroy the cancer cells in one particular area of the body. This treatment
is given in daily sessions at the hospital and takes about 10-15 minutes. However, the
overall length of treatment depends on the type of tumor and may extend from 2-6
weeks. High doses of radiation are applied to stop the cancer cells from growing, which
can kill some healthy cells, causing fatigue, skin changes and loss of appetite.

 Bone Marrow Transplantation- It is a medical procedure done to replace the

damaged bone marrow with healthy bone marrow cells. It is useful in certain types of
cancer or when the cancer comes back.

POSSIBLE SIDE EFFECTS OF TREATMENT

As the treatment is quite strong, there may be some side effects. It is important to remember
that your child may have only some of these side effects. The oncologists can help the child
through some of these treatments and counsel parents that these are a part of treatment, which
is ultimately going to cure the child. Below are few side effects:

 Tiredness/Lethargy

 Aches and pains - These may happen all over the body including the jaw and the
legs. They can be managed with paracetamol if needed

 Loss of appetite - There may be several reasons that a child may not eat as normal.
This could be because of disrupted routine, anxiety, nausea/vomiting or sores/ulcers in
the mouth. Your doctor will continuously monitor this and advice appropriately along
with input from a dietitian.

 Nausea and vomiting - They may begin immediately after chemotherapy and the
effects may last for a variable period of time. Medications are given to decrease the
feeling of nausea and vomiting after chemotherapy.

 Diarrhea - It is quite possible that this symptom develops immediately after

chemotherapy because of two reasons: Drugs may affect the intestines and due to
unhygienic food consumed (fruit juices and coconut water from roadside vendors).

7
 Sores and ulcers in the mouth and throat - These effects start few days after
chemotherapy, hence it is required that the child must have a good oral hygiene. It is
important to inform the doctor immediately if the child develops sores or ulcers in the
mouth.

 Constipation - This symptom usually appears because of other drugs prescribed

with chemotherapy. Please inform the doctor if the child experiences constipation, as it
may seem unimportant but constipation can have significant repercussions on the
treatment.

 Hair loss - The child can have partial or complete hair loss during treatment.
However, there is no proven effective measure to prevent this side effect. Most children
will regain their hair within 4-6 months of completion of chemotherapy.

 Low white blood cell counts (leukopenia) with or without infection - This
complication usually begins 6-7 days after chemotherapy and last for few days. Low
WBC counts may or may not be associated with infection. The first sign of infection is
usually fever (≥ 100°F), although some patients can develop severe infection without
fever.

 Extravasation - Please inform the doctor if there is a small leakage of

chemotherapeutic drug that can cause swelling, pain and ulceration.

 Anemia - It is a symptom that refers to low hemoglobin levels and occurs after
several cycles of chemotherapy. There are several other factors that contribute to
development of anemia like bleeding, pre-existing malnutrition, heavy or prolonged
menses, poor food intake etc. The doctor may decide to give the child blood transfusions
to treat this condition or provide iron supplements and other vitamins.

RECOMMENDED CANCER DIET

 Beverages :

o Boiled and cooled water

o Fresh Fruit juice made at home

o Canned or packaged juices

 Vegetables :

8
 o Peeled carrots and cucumbers can be eaten after washing

o Boiled vegetables

o Vegetables like tomatoes should be washed and boiled for some time

 Cereals :

o Toasted bread and wheat bread

o Homemade cake and biscuits

o Cereals like ragi, jowar, wheat, rice and oats

 Fruits :

o Skinned fresh fruits like banana, pomegranate, papaya, oranges, water

melons and musk melons

o Smooth thin skinned fruits like chikoo should be peeled and washed well

o Milk and Milk Products

o Boiled milk

o Fresh homemade ice cream, curds and paneer

Please follow instructions for hygiene and diet regularly. Incase you have any doubts please
clarify them with your doctor before you get discharged.

Cancer in childhood is uncommon. Out of 10,000 normal children, one will develop cancer
during their childhood. The initial diagnosis can be frightening and stressful for child and
his/her parents. These emotions are not out of place and quite understandable but they are
also compounded by lack of information as well as some misconceptions. In most cases, there
is no specific reason or cause for the child to have developed cancer as it is no one’s fault, so
parents should not feel ashamed or guilty. The good news is that all childhood cancers are
treatable and most are curable.

The cancers can affect any part of the body- the most common affected are bones, blood, and
muscles. The familiar cancers include: blood cancers (leukemia), cancers of the lymphatic
system, (lymphomas), cancer of the brain and spinal cord, muscle and bone cancers
(sarcomas) and other cancers seen in the very young children (embryonal cancers). As of
today, more than 80% of children with cancer get cured, depending upon the type of cancer
they are suffering from. Like for some cancers acute lymphoblastic leukemia and Wilms

9
 tumour, there is 90% cure rate, while that for Hodgkin disease and germ cell tumours, it is
almost 95%.

Children are not adults; their needs are different and need to be treated by someone who is
trained to look after them. Paediatric oncologists are responsible for treating all malignant
conditions among children like leukemia, bone cancers, Wilms tumor, brain and spinal cord
tumors among several others. With timely, appropriate and complete treatment, majority of
children with cancer get cured and can lead their lives peacefully.

Information and support are important to feel sure about the treatment. The more you know
about cancer, the less confused or unprepared you will feel. Regular parent support group
meetings should be attended, which will be an opportunity for parents of children with cancer
to meet other parents whose children are either being treated or have completed treatment.

MOST COMMON TYPES OF CHILDHOOD CANCER

 Primary Cancer and Secondary Cancer - The “Primary Cancer” is where the
cancer started. In case some cells break away from the primary cancer site and settle in
another part of the body, this cancer is then called as “Secondary Cancer” or metastases.
The cancer cells can spread locally by entering the bloodstream or lymphatic system.
However, secondary cancers are made up of same type of cells as primary cancer.

 Leukemia - Found in the blood and bone marrow, this cancer accounts for one
third of all childhood cancers. The common cancers found in children are: Acute
Lymphocytic Leukemia (ALL) and Acute Myeloid Leukemia (AML). These cancers can
cause fatigue, weight loss, bleeding, joint pain and high fever. As acute leukamias have a
tendency to grow quickly, they need immediate medical intervention (chemotherapy).

 Brain and Spinal Cord Tumors - The second most common cancers in children
are brain and central nervous system tumors that account for a quarter of all childhood
cancers. They commonly occur in lower parts of brain like cerebellum or brain stem.
Most common symptoms seen are dizziness, double vision, severe headaches, vomiting,
and difficulty in walking or holding things.

 Lymphomas - They start in lymph nodes and lymph tissues and can also affect
bone marrow as well as other organs. The most common symptoms are swollen lymph
nodes under neck and armpit, excessive weight loss, and fatigue. 2 types of lymphoma
that can occur both in children and adults are:

10
o Hodgkin Lymphoma

o Non-Hodgkin Lymphoma

11
Symptoms of Hodgkin lymphoma

Children with Hodgkin lymphoma most often have swollen lymph nodes down one side of
their neck but other lymph nodes might be affected. They might not have any other
symptoms, but some children have ’B symptoms’. 
Other possible symptoms include difficulty shaking off infection, fatigue and anaemia (low
red blood cells, which can cause tiredness and shortness of breath).

Symptoms of Burkitt lymphoma

Children with Burkitt lymphoma often develop large lumps of lymphoma, usually in their
abdomen (tummy) or bowel. If this happens, your child might have serious abdominal
swelling, pain and vomiting, or a build-up of fluid in their abdomen. This type of lymphoma
can also cause fluid to collect in the chest. If this happens, your child might have difficulty
breathing. Burkitt lymphoma can also grow in the parts of the jaw where your child has
permanent teeth. This can cause swelling and can make the teeth wobbly or unstable. It can
also involve the bone marrow, causing tiredness, bruising or susceptibility to infection, or it
can occur in the central nervous system (brain and spinal cord), which can cause headaches. 
Symptoms of lymphoblastic lymphoma

12
 Lymphoblastic lymphoma most often causes swelling of lymph nodes inside the chest around
the heart, in an area known as the mediastinum. This can put pressure on the trachea
(windpipe). If this happens, you child might have problems such as coughing or wheezing
and shortness of breath. These symptoms may be mistaken for asthma. Sometimes the
swollen lymph nodes put pressure on the blood vessels inside the chest. In this case, your
child might have a swollen neck, redness to their face and chest, and the veins in their neck
might stand out. If fluid collects in your child’s chest, around one or both lungs, they might
feel short of breath. Some children have lumps and nodules under or in the skin or scalp.

Symptoms of diffuse large B-cell lymphoma (DLBCL)

Children with DLBCL often develop large lumps of lymphoma. These might be in internal
lymph nodes (deep inside the body, rather than easily felt from the outside) or in extranodal
sites (areas outside of the lymph nodes), such as the chest, abdomen and bones. Your child’s
symptoms depend on what part of the body is involved; for example, if their bowel is
affected, they might have abdominal pain or diarrhoea.

Symptoms of anaplastic large cell lymphoma (ALCL)

ALCL can develop anywhere in the body, either in the lymph nodes or in extranodal sites
such as the skin, liver, lung or bone. This type of lymphoma often causes pain and swelling.

 Wilms tumor - This tumor accounts for 5% of childhood cancers and is commonly
found in children aging 3-4 years. It usually starts in one or both kidneys, causing
swelling or lump in the abdomen with symptoms like loss of appetite, nausea and fever.

 Neuroblastoma - This cancer develops in infants and young children. Accounting

for about 6% of childhood cancers, neuroblastomas can begin anywhere but starts in the
abdomen, and may also cause severe bone pain and fever.

 Bone Cancers - About 3% of childhood cancers are bone cancers that occur in
older children and teenagers (though they can develop at any age). Most common types
of bone cancers are:

13
 o Osteosarcoma, which occurs in the areas where the development of bone
is quick i.e. long bones in arms or legs. The pain usually becomes severe at night or
while doing activity, causing swelling around bone.

o Ewing Sarcoma is most commonly found in young teenagers. It usually

begins in the hip bones, ribs or shoulder bladders or leg bones.

SYMPTOMS OF CHILDHOOD CANCER

The cancers in children are hard to recognize as the symptoms are common/similar to
childhood illnesses or injures. However, if the below mentioned symptoms persist, it requires
immediate intervention:

 An unusual lump or swelling

 Unexplained paleness and loss of energy

 Easy bruising or bleeding

 An ongoing pain in one area of the body including bones, joints, back

 Limping

 Unexplained fever or illness that doesn’t go away

 Frequent headaches, often with vomiting

 Change or deterioration in walk, balance or speech

 Sudden eye or vision changes including white spot in the eye, new squint, new
blindness, bulging eyeball

 Sudden unexplained weight loss

DIAGNOSIS OF CHILDHOOD CANCER

Paediatric oncologists diagnose a child’s cancer by doing tests to identify the specific type of
cancer. This is called as “Confirmatory Testing”. Thereafter, a series of tests are done to
determine the burden of cancer and where is it located. This is called as “Staging”. For this,
several investigations are done like:

 Blood and Urine Tests

 Imaging with ultrasound, MRI, CT scan, PET CT scan

 Bone Marrow examination and lumbar puncture

14
 Biopsy

To Stage “Solid tumors”, the doctor examines the size of tumor and affected lymph nodes as
well as where it has spread.

To Stage “Lymphoma”, the doctor examines the lymph nodes, bone marrow, liver, spleen,
lung and the res t of the body. Also, few special tests like genetic testing of tumors are also
done to assess the capability of cancer.

It is most important to get the correct diagnosis so that right treatment can be given to the
child. Though not all tests are done on children and what is conducted depends on the type of
cancer suspected. For most of these tests, the child is sedated so that he/she may not move or
feel any pain. The results may take 3-5 days to come back so this is explained to the parents.

TREATING CHILDHOOD CANCER

Once the diagnosis is confirmed, the oncologists provide detailed counseling to parents.
Treatments are available for all childhood cancers, and most children can be cured. The team
should ensures that all children are comfortable and free of pain as the treatment of childhood
cancer is long and tough. The main types of treatment options available are:

 Surgery - The tumor is removed by an operation

 Chemotherapy - The medical drugs are given to stop the growth of cancer cells.
These are given by:

o Intravenous ( IV) (drip) : injection into a vein

o Oral (PO or O) : as syrups, tablets or capsules

o Intramuscular ( IM) : injection into muscle

o Subcutaneous ( SC) : injection just under the skin

o Intrathecal ( IT) : by lumbar puncture

The chemotherapy drugs travel through the bloodstream. As the drugs are carried in the
blood, they destroy cancer cells in the body. Therefore, chemotherapy is useful for treating
cancers that are generalized, e.g. blood cancers or those cancers that have spread to other
parts of the body. Though the chemotherapy drugs destroy the cancer cells completely but
they also affect the healthy cells. As a result, chemotherapy is given as a series of treatments
in cycles/phases to allow the healthy cells to recover. The chemotherapy drugs can cause side
effects as all children may react to it differently.

15
 Radiotherapy – Radiation is an invisible treatment that requires the use of high
energy rays to destroy the cancer cells in one particular area of the body. This treatment
is given in daily sessions at the hospital and takes about 10-15 minutes. However, the
overall length of treatment depends on the type of tumor and may extend from 2-6
weeks. High doses of radiation are applied to stop the cancer cells from growing, which
can kill some healthy cells, causing fatigue, skin changes and loss of appetite.

 Bone Marrow Transplantation- It is a medical procedure done to replace the

damaged bone marrow with healthy bone marrow cells. It is useful in certain types of
cancer or when the cancer comes back.

SIDE EFFECTS OF TREATMENT

As the treatment is quite strong, there may be some side effects. It is important to remember
that your child may have only some of these side effects. The oncologists can help the child
through some of these treatments and counsel parents that these are a part of treatment, which
is ultimately going to cure the child. Below are few side effects:

 Tiredness/Lethargy

 Aches and pains - These may happen all over the body including the jaw and the
legs. They can be managed with paracetamol if needed

 Loss of appetite - There may be several reasons that a child may not eat as normal.
This could be because of disrupted routine, anxiety, nausea/vomiting or sores/ulcers in
the mouth. Your doctor will continuously monitor this and advice appropriately along
with input from a dietitian.

 Nausea and vomiting - They may begin immediately after chemotherapy and the
effects may last for a variable period of time. Medications are given to decrease the
feeling of nausea and vomiting after chemotherapy.

 Diarrhea - It is quite possible that this symptom develops immediately after

chemotherapy because of two reasons: Drugs may affect the intestines and due to
unhygienic food consumed (fruit juices and coconut water from roadside vendors).

 Sores and ulcers in the mouth and throat - These effects start few days after
chemotherapy, hence it is required that the child must have a good oral hygiene. It is
important to inform the doctor immediately if the child develops sores or ulcers in the
mouth.

16
 Constipation - This symptom usually appears because of other drugs prescribed
with chemotherapy. Please inform the doctor if the child experiences constipation, as it
may seem unimportant but constipation can have significant repercussions on the
treatment.

 Hair loss - The child can have partial or complete hair loss during treatment.
However, there is no proven effective measure to prevent this side effect. Most children
will regain their hair within 4-6 months of completion of chemotherapy.

 Low white blood cell counts (leukopenia) with or without infection - This
complication usually begins 6-7 days after chemotherapy and last for few days. Low
WBC counts may or may not be associated with infection. The first sign of infection is
usually fever (≥ 100°F), although some patients can develop severe infection without
fever.

 Extravasation - Please inform the doctor if there is a small leakage of

chemotherapeutic drug that can cause swelling, pain and ulceration.

 Anemia - It is a symptom that refers to low hemoglobin levels and occurs after
several cycles of chemotherapy. There are several other factors that contribute to
development of anemia like bleeding, pre-existing malnutrition, heavy or prolonged
menses, poor food intake etc. The doctor may decide to give the child blood transfusions
to treat this condition or provide iron supplements and other vitamins.

RECOMMENDED CANCER DIET

 Beverages :

o Boiled and cooled water

o Fresh Fruit juice made at home

o Canned or packaged juices

 Vegetables :

o Peeled carrots and cucumbers can be eaten after washing

o Boiled vegetables

o Vegetables like tomatoes should be washed and boiled for some time

17
 Cereals :

o Toasted bread and wheat bread

o Homemade cake and biscuits

o Cereals like ragi, jowar, wheat, rice and oats

 Fruits :

o Skinned fresh fruits like banana, pomegranate, papaya, oranges, water

melons and musk melons

o Smooth thin skinned fruits like chikoo should be peeled and washed well

o Milk and Milk Products

o Boiled milk

o Fresh homemade ice cream, curds and paneer

Please follow instructions for hygiene and diet regularly. Incase you have any doubts please
clarify them with your doctor before you get discharged.

CONCLUSION

Most cancers in children, like those in adults, are thought to develop as a result of mutations
in genes that lead to uncontrolled cell growth and eventually cancer. In adults, these gene
mutations reflect the cumulative effects of aging and long-term exposure to cancer-causing
substances. However, identifying potential environmental causes of childhood cancer has
been difficult, partly because cancer in children is rare and partly because it is difficult to
determine what children might have been exposed to early in their development. More
information about possible causes of cancer in children is available in the fact sheet, Cancer
in Children and Adolescents.

REFERENCE

1. A. PADMAJA,TEXT BOOK OF CHILD HEALTH NURSING JAYPEE PUBLICATION,1 ST

EDITION,PAGE NO:631-641
2. WONG’S MERLIYN J. HOCKENBERRY ESSANTIALS OF PEDIATRIC NURSING ELSEVIER
PUBLICATION,2 ND EDITION PAGE NO:920-945

18
3. Caring for Dying Children: Assessing the Needs of the Pediatric Palliative Care Nurse,
PEDIATRIC NURSING/March-April 2009/Vol. 35/No. 2
4. Bowden, V. R. & Greenberg, C. S. (2011). Pediatric Nursing Procedures. Lippincott,
Williams & Wilkins.
5. Bahadur G, Hindmarsh P (January 2000). "Age definitions, childhood and adolescent
cancers in relation to reproductive issues". Human Reproduction. 15 (1):
227.  doi:10.1093/humrep/15.1.227. PMID 10611218.
6. ^ Jump up to:a b Childhood Cancers: Basic Facts & Figures from Minnesota Department
of Health. Retrieved Dec, 2012
7. ^ About childhood cancer at Childhood Cancer 2012, by Children With Cancer UK

8. ^ Jump up to:a b c
     International Childhood Cancer Day – 15 February 2013 Archived 20
November 2016 at the Wayback Machine at [Link]. Retrieved
Dec, 2012

19