Cancer- There, I Said It!

Cancer.  It's a diagnosis so feared that many are unable to even say the word. If someone does says it, they feel compelled to knock on wood, to ward cancer off like an evil spirit. In the Pediatric Emergency Department, the fear often becomes real when a child has a headache.  Kids get headaches just like adults, but with a kid parents worry if this could be the worst: is this a brain tumor? Fortunately, brain tumors are rare. When a child comes in with a headache, part of the pediatrician's job is to acknowledge the parent's fear so that we can alleviate the anxiety. The vast majority of child headaches are benign- viruses, stress, and migraines.  We discuss with the parents why their child does not have a brain tumor, so that they can smile, have a chuckle at their fear, and go "whew!" How we think about cancer has evolved dramatically over the past two generations.  40 years ago, cancer in a child was hard to talk about because it was a death sentence. The most common childhood cancers are leukemia and brain tumors.  When children were diagnosed with one of these, almost none survived.  It was not a "nice" death either, with bleeding, pain, bad smells, and slow deterioration. Then in the 1950s, doctor-scientists began to figure out how to treat the incurable disease. These doctors were brilliant, dedicated, and desperate.  They despaired of their small, suffering patients and were willing to try anything, hoping to learn how to win some lives back.  The experimental treatments were painful, seldom worked, and would be impossible to try today in our medical-legal climate.  But through years of agonizing trial-and-error, they did begin to learn, and begin to win. By the time I started training in 1989, treatment of leukemia was a tremendous success story.  The cure rate of these cancers had gone from 0% to over 90%.  There began new thinking about cancer. First, we had to begin to talk about it openly and honestly, so that we could diagnosis and begin to treat it.  Second, if the cancer couldn't be cured, the task was to help the child and family accept death, and make that death as painless and "nice" as possible. Now we need to overcome our fear in order to learn about cancer.  The first cancer to discuss is the most common- leukemia. Leukemia is bone marrow cancer.  Bone marrow manufactures the blood cells: white blood cells to fight infection, red blood cells to carry life-giving oxyen throughout the body, and platelets that help make clots and stop bleeding.  Leukemia is bone marrow cells gone amok.  The cancerous marrow cells overgrow and crowd out good cells.  Instead of making the crucial blood products, the marrow cranks out tons of useless "blasts," dummy white blood cells.  Leukemia has been called "liquid cancer," as opposed to brain tumors and other "solid" tumors. The signs of leukemia relate to the lack of blood cells.  Without enough red blood cells, the patient becomes pale and fatigued.  Without platelets, he bruises easily and the bruises heal slowly.  Without working white blood cells, the child is easily infected and runs fevers. Fortunately, leukemia is easy to detect with a simple blood test: the CBC (Complete Blood Count of the three kinds of blood cells). The next most common childhood cancer is brain tumors.  Most headaches can be diagnosed as benign by history and a neurologic exam, without a CT scan.  CT scan can see tumors, but uses a lot of radiation and thus can cause cancer itself.  We don't use it unless we must.  Benign headaches come and go, are easily treated with ibuprofen and tylenol, and are easily attributed to other causes. "Red flags" for brain cancer are headaches that wake the child at night and early morning, vomiting with headache, and headaches that are steady and don't come and go.  Brain cancer is much harder to treat than leukemia, often requiring surgery, chemotherapy, and radiation, and the cure rates are less optimistic. So If you want to face your fear and learn even more about childhood cancer, go to Kidshealth.org. This site has well written and detailed information for parents, to help you say the word.