Why has there been an increase in childhood cancer in Singapore over the years?
About 100 children are diagnosed with cancer every year, in Singapore. This number has steadily increased over the years despite rapid advances in medical science.
According to Today, the rate of leukaemia among children in Singapore has doubled in boys, from 3.5 to 7.1 per 100,000 each year, from 1982 to 2012. In girls, the increase in rate over the 30-year period is about 80 %.
Common childhood cancer in Singapore
According to the KK Hospital website, in Singapore, common types of childhood cancer cases are:
- Leukaemia 35%
- Brain tumour 20%
- Lymphoma 10%
- Eye tumour 7%
- Kidney tumour 6%
- Adrenal tumour 5%
- Bone tumour 5%
- Germ cell tumour 5%
Symptoms of childhood cancer
According to Dr Soh Shui Yen, senior consultant of Haematology/ oncology Service, Department of Paediatric Subspecialties at KKH, possible symptoms of leukaemia in children include:
- Pallor (unhealthy pale appearance)
- Persistent or recurrent fever
- Bleeding or bruising
- Swollen lymph nodes
- Bone pain
Possible symptoms of brain tumours in children are:
- Persistent or worsening headaches, headaches and/or vomiting that get worse in the mornings
- Unsteadiness when walking
- Enlarging head in a young infant
- Blurring of vision
Why is childhood cancer in Singapore on the rise?
The exact causes of childhood cancer are unknown, as unlike adults, children are unaffected by lifestyle factors like excessive drinking and smoking, and diseases like diabetes and obesity. Current research in the area, hence focusses on how environmental factors combined with genetic factors can cause cancer.
Here are some theories for possible causes of childhood cancer:
- "Over-cleanliness?": One theory is the 'delayed infection' hypothesis, which suggests that we might actually be overdoing our hygiene bit, and delaying our kids' exposure to infections. In fact some studies blame cancer on the fundamental failure of a person's immune system.
Associate Professor Allen Yeoh, senior consultant at the Division of Paediatric Haematology-Oncology at National University Cancer Institute, Singapore and National University Hospital (NUH), has been quoted as saying, "Personally, I feel it is due to a combination of factors — delayed exposure to bacteria and viruses due to our hygienic environment delays our children’s immune system maturation, subtle genetic differences that are overcome by sub-fertility treatment and advanced age of the time of conception.”
- According to Assoc Prof Yeoh, children conceived via in vitro fertilisation (IVF) have a 30 % increased risk of developing cancers.
- Exposure to excessive amounts of ionising radiation, like in X-rays and medical devices, is also known to increase cancer risk.
Dr Soh has been quoted as saying, “In general, pregnant women should avoid exposure to X-rays. Similarly, unnecessary exposure of young children to excessive ionising radiation should be avoided.”
Children respond better to cancer treatment
On the bright side, children seem to respond better to cancer treatment than adults, in the absence of other 'adult' complications like diabetes and heart disease. Apparently, about 7 in 10 children with cancer are long-term survivors.
According to Assoc Prof Yeoh, childhood cancer is genetically “less complex” than adult cancers. For example, childhood leukaemia harbours one to 10 mutations, compared to hundreds in adult cancer. Also children tolerate, and are more compliant to chemotherapy. “Like a new car, a child’s body is pristine — they don’t have diabetes, high blood pressure or heart disease which complicate adults,” he says.
A chief challenge of childhood cancer is managing the side effects of the treatment. It is heartbreaking to see little souls suffering from hair loss, nausea and pounding headaches. Treatments like intensive chemotherapy can also cause damage to organs like the heart, skin and brain, which may result in long-term complications that may lead to a relapse, later on in life.
Advances in treatment for childhood cancer in Singapore
Thankfully, rapid advances in medical technology have enabled young patients in Singapore to undergo treatment with lesser side effects, and to increase their chances of survival.
Apparently, Singapore children with Acute Lymphoblastic Leukaemia (ALL), (which makes up 80 % of all childhood leukaemia), are now treated using a personalised treatment protocol developed by doctors from Singapore and Malaysia.
Assoc Prof Yeoh informs that, recently, NUH researchers discovered the genetic basis to why one in 80 children in Singapore, with ALL, are sensitive to one type of chemotherapy. This enabled doctors to identify these children before they received their first dose of that chemotherapy.
Advances in stem cell transplant methods, such as the haploidentical transplant, have also saved lives. We recently reported on little Javier, whose leg was saved, thanks to a haploidentical transplant. This novel transplant method requires the donor to be only a 50% - not 100% - match. This means that even the parents of the child can be suitable donors.
Earlier, in the absence of the new method, the chance of a parent being a match for his child was low. So doctors had to rely on siblings, where there was a 1-in-4 chance of a match. When that failed, they would have to search for unrelated matching donors in the public bank.
Many children and adults have already benefitted from this new transplant method in Singapore.
Helping children with cancer
A child who has cancer will have to undergo physical discomforts, both from the cancer and its treatment. The child will experience fear, pain, and even anger. A lot of support is needed to help the child go through this difficult time.
If you know a child who is a cancer patient, you can help by:
- Cheering the child up: Send the child letters, photos, cards, gifts and emails. Make him feel wanted. Visit the child in hospital or at home, but make sure that you are healthy, as the cancer patient is susceptible to infections.
- Avoiding food items as gifts: A child undergoing cancer treatment needs to be careful about his diet, and risks contamination from non-organic food sources.
- Helping the child keep up with schoolwork: So that the child can cope better when he returns to school.
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