Paedratic haematology and oncology
Cancer in children is relatively rare, with only 325 new cases diagnosed in Belgium each year. One quarter of all childhood cancer cases in our country are treated at the Paediatric Haematology and Oncology Department in the Cliniques Universitaires Saint-Luc Cancer Centre. This level of activity makes it the leading reference institution in French-speaking Belgium.
Blood cancer, or leukaemia, accounts for some 30% of childhood cancer cases. It is followed by cancers of the central nervous system (brain tumours) and lymphatic ganglion cancers, or lymphomas.
Some types of cancer are found only in children. These are embryonic tumours or blastomas. Cells in embryos have great powers of multiplication, as there are few of them and their ultimate task is to build an adult body.
Once the body is complete, the cells stop multiplying, but in blastomas, the growth continues. There are therefore nephroblastomas, which develop from embryo kidney cells, hepatoblastomas, which develop from embryo liver cells, and retinoblastomas, which develop from embryo cells in the retina. Retinoblastomas are rare and every case observed in our country is treated at the Cancer Centre, which is a Europe-wide reference centre for this condition.
Finally, sarcomas, such as bone cancers, are commoner in teenagers. These tumours are treated through joint work with specialists in surgery and radiotherapy, who also deal with adult tumours.
Each young patient’s case is discussed in multidisciplinary meetings, in which every specialist doctor involved in the diagnosis and treatment of paediatric tumours participates. The specialists meet together and decide on the best treatment for each individual patient, on the basis of diagnosis, standards of care, and recent scientific discoveries.
Symptoms of cancer develop rapidly, that is, in a few weeks, in children. In leukaemia, blood cells cease to function normally. Changes in red cells cause pallor and tiredness, changes in white cells cause repeated infections, changes in platelets cause frequent bleeding, which is difficult to control. In addition, cancer cells invade the bones, causing “migratory” pain, so called because its location constantly changes.
Les symptômes traduisent l’altération de l’organe dans lequel la tumeur se développe : sang dans les urines lorsque le rein est atteint, jaunisse lorsqu’il s’agit du foie, fractures en cas d’atteinte des os …La place occupée par la tumeur peut la rendre visible ou palpable : gonflement dans le cou, palpation d’une masse dans le ventre…La compression provoquée par cette masse peut à son tour générer des symptômes, tels les maux de tête ou les nausées survenant en cas de tumeur au cerveau.
The symptoms show changes in the organ in which the tumour is developing: blood in urine when the kidneys are affected, jaundice if the liver is affected, fractures if bones are affected. The location of the tumour can make it visible or palpable, by producing swelling in the neck or stomach, etc. Compression caused by the mass can in turn generate symptoms, such as headaches or nausea in the case of a brain tumour
The rapid development of cancer in children requires immediate referral to a reference centre, which will have the necessary experience of this condition and access to the most up-to-date diagnosis and treatment techniques.
There are few contributory factors to cancer in children. Some genetic problems can sometimes play a part. Research currently being conducted within our institution is aimed specifically at better identifying the genetic factors that favour the onset of retinoblastoma.
Highly efficient imaging techniques, such as the PET Scan, now allow tumours to be better defined. So-called functional imaging, for example, marks cells that multiply rapidly in various areas of the body. The boundaries of a tumour can now be pinpointed with great accuracy, thus ensuring complete removal during an operation.
Chemotherapy, used in most types of paediatric cancer, is now becoming more effective and less toxic, and can bring about a complete cure in most cases. Large-scale studies are ongoing at international level to improve the results of chemotherapy still further. Patients in the Cancer Centre’s paediatric haematology and oncology group are included in controlled studies that deal with the newest drugs, and have access to modern treatments without having to travel abroad. Regular contact with other world experts, which is a prerequisite of the studies, guarantees good quality care.
In some indications, depending on the type or severity of the tumour in question, a bone marrow transplant can be envisaged. The paediatric haematology and oncology group is very experienced in this field, having been a pioneer in the technique of transplantation for various blood diseases. Transplants are carried out in a dedicated children’s department and overseen by paediatric haematologists and oncologists. There is no need for transfer to an adult department or to another institution.
Side effects associated with chemotherapy are now better controlled. Effective drugs can combat nausea and vomiting, and reduce the risk of infection. Laser treatment, which aims to prevent or treat irritations of the mucous membrane such as mouth ulcers, has improved, reducing pain and speeding up the formation of scar tissue.
Finally, progress in treatment is also linked to refinement of reconstructive surgery and to the possibility of more targeted administration of radiotherapy, that is, destruction of cancer cells and preservation of healthy tissue.
Despite progress in treatment, the discovery of cancer in a child is often difficult to accept. The care must therefore relate not only to the medical aspects but offer both social and psychological support to children and their families. A school based in the hospital allows children to continue with their education during their stay in hospital. Thanks to a number of different associations, the paediatric haematology and oncology group now offers various programmes and organises holiday camps and other functions.