The cell is the building block of life and cancer is a disease of the cell.
Each cell contains a set of instructions telling it to carry out a certain function within the body. Some cells are programmed to build our organs, others our bones and muscles and some are on standby to heal a wound, fight infection or replace diseased cells. There are over 200 different types of cells and so there can be over 200 different types of cancer. Whilst cells may do different things, they all divide and reproduce in similar ways.
During division and reproduction, a healthy cell will make an exact copy of itself. One cell becomes two, two become four, four become eight and so on. When our bodies are growing, cells divide more rapidly. A healthy cell reproduces a certain number of times before it dies naturally but will die prematurely if it is damaged or finds itself in the wrong place (for example, a liver cell finds itself amongst bone cells).
Sometimes the division and reproduction process goes wrong and abnormal cells are produced. These cells are unable to carry out their instructions and are called cancer cells. They continue to reproduce and group together to form solid tumours, causing problems by pressing onto surrounding organs and tissues.
The most common type of cancer in tamariki is leukaemia.
Sometimes the division and reproduction process of our cells goes wrong and abnormal cells are produced. These cells are unable to carry out their instructions and group together to form solid lumps called tumours. Tumours can be either benign (non cancerous) or malignant (cancerous).
Cells in a benign tumour cannot spread to other parts of the body but they can keep growing at the original site and press on surrounding organs and tissues. Cells in a malignant tumour are able to spread beyond the original tumour site into surrounding tissue or to other parts of the body. Malignant cells travel throughout the body in the bloodstream or the lymphatic system and begin to divide and grow to form a tumour in another area. This is called secondary metastatic cancer.
Malignant tumours are classified by stage and grade and you may have heard these words being used. The stage relates to how far the cancer has spread in the body and the grade describes the type of cells contained within the tumours.
Stage 1: the cancer is small and localised, has not spread beyond the original site
Stage 2 or 3: the cancer has spread into surrounding tissues/structures
Stage 4: the cancer has spread to other parts of the body (secondary or metastatic cancer)
The most common type of cancer in children is leukaemia. These are cancers of the bone marrow. The bone marrow is a spongy material found in the centre of some of our bones. All of our blood cells are produced in the marrow. There are three types of blood cells:
Red, white and platelet cells grow from stem cells within the bone marrow.
Leukaemia occurs when the marrow creates a large number of immature blood cells. These cells cannot perform their functions properly because they cannot grow to maturity. The word leukaemia refers to white cells as the disease usually affects their production. Acute Myeloid Leukaemia affects the early white myeloid blood cells and Acute Lymphoblastic Leukaemia affects the lymphoblasts (early lymphoid white blood cells).
The large number of immature cells inhibits the production of healthy, mature blood cells. This reduces the body's ability to fight infection. Production of red cells and platelets is lessened too and this can result in anaemia and significant bruising.
You may have noticed that your taitamaiti (child) was more tired than usual, lacking in energy, quiet and withdrawn. Perhaps they were complaining of headaches or pain or just saying to you, 'I don't feel well.'
Taking your taitamaiti to your family doctor to have these symptoms checked was the first step. A referral to the hospital to see a paediatrician, or perhaps a paediatric oncologist or a haematologist followed and now you have received news you never expected or wanted to hear: a diagnosis of cancer for your taitamaiti.
Right away the doctors are recommending tests. There can be a confusing number of these with unfamiliar names and purposes. For more information about diagnostic tests, scroll down.
Tests are needed to give an accurate diagnosis of the cancer. As we mentioned earlier, there are many different types of cancer so the specialists need to know exactly what type of cancer your taitamaiti has so they can determine the best treatment. The information gained from tests can then be shared amongst the medical team looking after your taitamaiti. The tests will also determine the stage and the grade of the cancer and provide an overall assessment of the general health of your taitamaiti.
Waiting for tests to be scheduled, completed and for the results to come back can be difficult because you want the best outcome for your taitamaiti and for treatment to start right away. It is hard to be patient but all the necessary information is needed from the tests to ensure the correct diagnosis is made and the most appropriate and effective treatment is given to your taitamaiti.
Your taitamaiti may not have all these procedures but here's an overview for your information. Some of these tests may be conducted only once or, as your taitamaiti goes through treatment, certain tests may be done more frequently to monitor the effectiveness of the treatments.
You may ask to see (and have copies made) of the results of any tests conducted. You may also request that results be sent to your GP too so they have a complete record of the diagnosis and treatment of your taitamaiti. A multi-disciplinary team of specialists will be caring for your taitamaiti in hospital so having records all in one place, with your GP, can be helpful in the future.
A small part of the tumour is removed either with a special needle inserted through the skin into the tumour (a needle biopsy) or during a small operation (an open biopsy). The sample is then tested in the laboratory to determine what type of tumour it is. It may be benign or malignant (cancerous).
If a leukaemia is suspected, a needle is inserted into the bone of the hip and a small amount of the bone marrow is removed. This test is usually done under sedation or general anaesthetic to ensure as little discomfort as possible. The bone may feel sore for a few days after the test. The sample is then examined in the laboratory and provides information about the type of cells in the bone marrow, whether any are malformed and immature and if there is an imbalance in the cells being produced.
Blood tests are carried out before, during and after treatment has finished as part of follow up consultations. The samples are sent to a laboratory for analysis and reporting. The reports are then returned to your specialist. There are many reasons for blood tests and some include:
Full Blood Count - Quantities of different types of blood cells are counted. This is important for monitoring the side effects of treatments.
Blood Chemistry - Determines how well the body's systems are functioning, such as the liver and kidneys.
Blood Cross-Match - Used to find blood from a donor that is a match for your taitamaiti in case a blood transfusion is needed.
Blood Culture - Provides evidence of infection.
Lumbar Puncture - In some cancers such as leukaemia, lymphoma (cancer of the lymphatic system), and occasionally brain tumours, cancer cells can pass into the fluid surrounding the brain and spinal cord. This fluid is known as the cerebrospinal fluid or CSF. A needle is inserted between two spinal (vertebral) bones in the lower spine and a few drops of the CSF fluid are taken. This test is usually done under a general anaesthetic.
X-rays are taken when solid cancers (tumour) are suspected in the chest, bones or abdominal area. A tumour can look different from healthy tissue under an x-ray.
The CT scanner takes a series of x-rays of the soft tissues and a computer builds up a three-dimensional picture of the inside of the body. The CT is painless but your taitamaiti may be given a sedative or anaesthetic to ensure they lie still throughout the scan.
Similar to the CT scan, the MRI builds up a series of pictures of the inside of the body using magnetic waves. Whilst the scan is painless, your taitamaiti lies within a narrow tunnel and it is very noisy. Your taitamaiti may be given a sedative or general anaesthetic to ensure they lie still and also to calm them while they have the scan. Earplugs or headphones (they can listen to their favourite music) are given too and it may be possible for you to remain in the room with your taitamaiti during the scan.
This scan uses sound waves (too high for us to hear) to build up a picture of the inside of the body. The technician will spread warm gel on the area of the body to be scanned and a small handheld device is passed over the area. Ultrasound scans are painless and are often used to examine the abdominal area and the heart.
A small amount of a radioactive substance is injected through a vein, usually in the arm, and is taken up by the bones. Areas of abnormal bone absorb more of the substance than healthy bone and so show up under the scan as hot spots.
If English is not your native language or you have a hearing difficulty, ask the Hospital to provide an interpreter or someone to assist you. It is extremely important that you fully understand all aspects of the treatment your taitamaiti will receive.
There are currently three main ways of treating cancer in your taitamaiti:
There is no one single treatment plan that fits everyone because we are all unique individuals. Your taitamaiti will receive an individualised treatment plan based upon the stage and grade of their cancer and their overall health. Your taitamaiti may receive a combination of treatments, for example chemotherapy and radiation or a Bone Marrow Transplant. Don't be afraid to ask questions about the treatment plan:
You may accompany your taitamaiti to treatment and don't hesitate to query the medication being given, checking the labels to be sure it is for your taitamaiti (whilst mistakes are rare, they can happen).
Your specialist will meet with you to discuss the treatment plan and they should:
Don't be afraid to ask questions because the only silly questions are those not asked. Make lists of questions prior to appointments and take someone with you who can write notes while you discuss your child's case with the specialist. You can de-brief later with your whānau and refer to the notes taken.