In Summary

Cancer mostly affects adults, but there are some kinds that children get, too. Find out more in this article.

Out of the total number of cancer cases that are reported at the Uganda Cancer Institute in Uganda, nine per cent are children below 15 years. This is a big percentage compared to one per cent in developed countries. Every year, according to the Kyadondo Cancer Registry, there are 2,100 new childhood cancer cases nationwide. However, only 600 of these cases are recorded at the cancer institute annually.

Experience
Thirty three-year-old Bwagu Salim Ssentamu, an IT personnel, is a survivor of Hodgkin’s Lymphoma, a childhood cancer. The Rotarian is married with two children. He shared his experience during the launch of the East Africa Peadiatric Haematology and Oncology fellowship training.

“I did not know I had ever suffered cancer until I had a relapse when I was 10 years. The treatment card showed I had suffered cancer when I was five years in 1988. For years I was treated at the Uganda Cancer Institute but I had a relapse in 1997 with the swelling of the lymph nodes under my armpits and lower abdomen.

“I was taken to Sir Albert Cook ward for an operation and it was confirmed that I had cancer. The doctor explained that I had a relapse of the Hodgkin’s Lymphoma because I was never consistent with my treatment,” he says.
“The cost of a bottle of Vincristine, a chemotherapy drug which I had to get after every two weeks, was Shs 500,000. I would only get this medicine when my family got money. So I would miss out taking the medicine. My family was forced to seek help from Cancer Charity Foundation in Kyebando, an organisation that financially helped me get medication until 2003.

Whenever I took the medicine, I would become very weak, get nauseated and it would be difficult to take without instruction and support from the family. However, I got courage from people at the Cancer Charity Foundation and was able to complete the entire dosage. I have since lived a cancer free life and my children too. I am very vigilant with them so that I can detect early.
Bwagu is one of the few survivors of childhood cancer but many children are dying due to misdiagnosis, delayed diagnosis, superstition, poverty yet others die because of their parents’ ignorance.

Common childhood cancers
Burkitt’s lymphoma is the commonest type of cancer among children in Uganda, according to Dr Fadhil Geriga a peadiatric oncologist at Uganda Cancer Institute. It was discovered in the 1950s by Dr Denis Burkitt and accounts for 23 per cent of all child cancer cases reported at the Mulago hospital based Uganda Cancer Institute.
Burkitt’s lymphoma, a fast-growing tumour associated with impaired immunity, affects the lymph nodes and causes swelling of the jaw or neck and can be fatal if not treated.
“It manifests as a swelling in the jaw,” Dr Geriga says, adding: “Most times it begins in the form of a simple toothache that leads to a persistent swelling which some parents associate to witchcraft.”
Hodgkins Lymphoma is another common childhood cancer that causes swelling of the lymph nodes, especially the armpit area and below the abdomen. Wilms tumour presents with keloids and swellings in the glands or neck, genitalia, and mouth. It is cancer of the kidney. Acute Leukemia is the third commonest childhood cancer, Kaposi Sarcoma, Osteosarcoma (bone cancer), brain, and eye cancers also affect children.

Causes
Unlike most adult cancers, the cause for childhood cancers is not known but some researchers have tagged Wilm’s tumour to poor development of kidneys during the foetal stages. A few are linked to low immunity, genetic predisposition yet others are HIV/Aids-related, especially Kaposis Sarcoma.

Warning signs
The warning signs to childhood cancers, according to the American Cancer Society include; Lumps or painless swellings without fever or other signs of infection, bruising or bleeding, and general bone pain, unexplained weight loss, persistent coughs, shortness of breath, and night sweats, unexplained abdominal swelling, visual loss and bruising or swelling around the eyes.
However, Dr Kambugu says the symptoms of some of the childhood cancers mimic those of many common diseases so parents must be very vigilant and see a doctor for anything that could be suspicious.
“Many childhood cancers are misdiagnosed as fevers and the time they are brought at the cancer ward, the cancer has spread to other parts of the body because the symptoms were similar to those of other illnesses such as malaria. Parents should therefore be very vigilant and report any abnormalities in their children for early diagnosis and treatment,” says Dr Kambugu.

Treatment
According to Dr Kambugu, most childhood cancers can be treated if they are detected early. He says if the child consistently takes the medication and has support from the family it is possible.
Depending on the type and level of the cancer, a child may receive surgery, radiotherapy and chemotherapy. However, Dr Kambugu says if there was early diagnosis, such a child may only require chemotherapy with Burkitt ’s lymphoma as the first ever known cancer to be cured by chemotherapy only if detected early.

Threats
Since children have not lived long enough for the signs of cancer to manifest, there is no regular screening programme for childhood cancers. Sometimes, the cancers are mistakenly treated as other illnesses so they present to cancer ward in the late stage after all options have failed.
The cost of treating a child with cancer may be hard to estimate according to Dr Kambugu because different cancer types require different drug combinations also depending on the stage at which the child is diagnosed.
There are very few paediatric oncologists in Uganda. However, there are efforts to train more paediatric oncologists at the cancer institute.

bnakibuuka@ug.nationmedia.com