Brain and other solid tumours account
for almost 60 per cent of all childhood
cancers, but such tumours are usually
diagnosed late because they are rare,
diverse and often under-recognised.
About 150 children are
newly diagnosed with
cancer in Singapore
every year. Cancer is
the second leading cause of death
in children here and in other
developed countries.
“In children, the types of
cancer and their incidences are
very different from the cancers
in adults,” said Dr Amos Loh,
Senior Consultant, Department of
Paediatric Surgery, KK Women’s
and Children’s Hospital (KKH).
The types of tumours that
prevail also differ among children
of different age groups.
“In infants and toddlers, we
see higher rates of tumours in
growing organs, such as the brain,
kidney, liver, and nervous system.
Tumours of the bone, muscle
and connective tissues are more
prevalent among adolescents,”
Dr Loh said.
Cancer predisposition
“While childhood cancers are
driven by genetic cues that have
lost their normal regulation and
control, in general these are
mostly random events and are not
often hereditary or genetically
predisposed,” said Dr Loh.
A study by KKH and National
Cancer Centre Singapore on local
children with brain and solid
tumours found that 10 per cent
had verified mutations associated
with genetic predisposition, but
only half of them had known
family histories of cancer.
“As scientific knowledge
continues to grow, we may
uncover more about paediatric
cancer predisposition
syndromes. Nevertheless, it is
still important to screen for
genetic predisposition syndromes
as they can have important
bearing on family members and
the patient,” he said.
Becoming cancer-free
Over the years, the success rates
of treating childhood cancers
have generally improved, with
over 80 per cent of children and
adolescents being free of the
illness for the long-term. This is
largely attributed to the better
survival outcomes in children with
blood cancers, namely leukaemia
and lymphoma, which account for
about 40 per cent of cancers in
children and adolescents.
However, the situation for
brain and solid tumours is far
less positive. “Such tumours are
notoriously difficult to manage
and complex to treat,” said
Dr Soh Shui Yen, Head and
Senior Consultant, Haematology/
Oncology Service, Department of
Paediatric Subspecialties, KKH.
For instance, over 90 per cent
of children with Wilms tumour
(the most common kidney cancer
in children) and retinoblastoma
(the most common eye cancer in
children) recover from the disease.
However, for some aggressive
childhood cancers, such as diffuse
midline gliomas (an aggressive brain cancer) and stage 4 sarcoma
(a rare cancer in the bone and soft
tissue), the outcomes are dismal.
“It is difficult to advance
treatments via clinical trials due
to the diverse varieties of tumours
and the small numbers of patients
for each tumour type. More
research and global collaboration
will be helpful in expanding
the understanding of these
diseases (find out more about the VIVA-KKH Paediatric Brain and Solid Tumour Programme here) thereby improving
patients’ outcome in the long run,”
Dr Loh said.
Multifaceted therapy
As with adults, children with
cancer are treated using various
combinations of chemotherapy,
surgery, radiotherapy, and/or
cellular-immunotherapy.
“Treatment of complex
oncologic conditions in
children are best supported
by a comprehensive range of
paediatric medical and surgical
specialties as well as paediatric
allied health care in a children’s
hospital,” said Dr Soh.
Patients can be as young as
newborn babies; hence, treatment
must also consider the possibility
of acute and long-term side
effects. All childhood cancer
survivors attend clinics for longterm
follow-up and to check for
potential late effects.
Apart from medical treatment,
a host of support services (play
and music therapy, art therapy,
and child psychology) and staff
(medical social workers and
child-life specialists) ensure that
holistic care is provided to these
young patients.
