While others may not be able to share the pain and mental anguish of your child’s cancerous illness, we deeply understand what you are feeling right now. The unfortunate illness of your child has turned your hopes and dreams into sorrow and anxiety. Your daily trips to and from the hospital, taking care of your children, holding back your tears, standing by their side, and supporting them in undergoing painful injections, blood and bone marrow draws have not only greatly affected your normal lives, but also left you physically and mentally exhausted and mentally drained. In the past, childhood cancer could be regarded as an incurable disease, but in recent years, through various researches, the chances of curing this disease have been greatly improved. At the hospital, the doctors and medical staff will do their best to cure your children and give them a chance to live again. As parents, you should take a positive attitude to help your children through this difficult time. We hope that this booklet will provide you with some practical information about childhood cancer, so that you can have a better understanding of your children’s condition, give them more encouragement and comfort, support them, strengthen their confidence and will to treat the disease, and work hand in hand with them to overcome the cancer. What is cancer? Under normal circumstances, cells in the human body will continuously carry out pro-metabolism and renewal. After each cell divides from the mother cell, it will gradually mature and take up its assigned functions. Eventually, the cell ages and is replaced by a new cell. This series of metamorphosis process, in line with the needs of the body, constantly and regularly. However, once the cells in the body have changed, the cancer cells will grow and divide uncontrollably, resulting in more and more of them, and destroying normal tissues in the vicinity. Another characteristic of cancer cells is that they can spread to other places in the body, such as the lymph nodes, liver, lungs and bones. After spreading or metastasizing to these places, the cancer cells will continue to divide and destroy the normal functions of these organs. Types of Cancer in Children: The types of cancer in children are very different from those in adults. The most common type of cancer in children is leukemia, also known as blood cancer, which accounts for about 30% of the total number of cancers. Brain cancer, lymphoma, neuroblastoma and nephroblastoma follow. Less common are leiomyosarcoma, bone cancer, liver cancer, retinoblastoma and embryonal tumors. Incidence The incidence of childhood cancer does not vary greatly around the world, with about 12 out of 100,000 children developing cancer each year. Causes The causes of most childhood cancers are not understood. However, children with Down’s syndrome, congenital immunodeficiency disorder, or those who have received certain chemotherapeutic drugs or radiation therapy have a higher chance of developing cancer. Liver cancer may be associated with hepatitis B infection, and some retinoblastomas are hereditary. Symptoms: The symptoms of childhood cancer are usually not obvious at the initial stage, and different types of cancer may have different symptoms; Leukemia: persistent fever (usually lasts for three to four weeks), pallor (anemia), easy to bleed (e.g., petechiae, ecchymosis, easy to bleed, and bleeding from the teeth for no apparent reason), obvious swelling of lymph nodes, and bone pain. Brain cancer: headache, vomiting, and loss of balance, resulting in unsteady walking and easy falling. Other cancers: may cause hard lumps in the abdomen, bulging eyeballs, white light in the pupils, and strabismus for no apparent reason. All of the above may be caused by cancer, so the doctor will need to examine the child further to confirm the diagnosis. Diagnosis When a child is suspected of having cancer, the doctor will conduct a detailed examination and laboratory tests to: Determine the diagnosis and find out the main location of the cancer cells. Find out if the cancer has spread or metastasized to other parts of the body. Tests usually performed on children include: 1. Blood test: Blood is drawn from a blood vessel for various tests. 2. X-ray: Blood is drawn from a blood vessel for various tests. 3. Ultrasound: Ultrasound is used to find out where the cancer is located. This test is especially helpful in diagnosing those cancers that arise in the abdomen. 4. CT scan: It can help to find out the location of cancer in the head, chest and abdomen. Magnetic Resonance Imaging (MRI) scan: It is similar to computerized scanning, but it can show the location of certain cancers more clearly, such as brain cancer and bone cancer. 6. Isotope Scan: A small amount of radioactive isotope is injected into the blood, which can identify the correct location and degree of spread of some tumors. 7. Bone marrow examination: A needle is used to draw out bone marrow fluid from the bone for laboratory tests. This test can help diagnose blood cancers and also determine whether the cancer cells of other cancers have spread or metastasized to the bone marrow. Because drawing bone marrow may cause pain, the child may be given a sedative and local anesthetic before the bone marrow is drawn. 8. Lumbar puncture: Sometimes, in order to check whether the cancer has spread or metastasized to the central nervous system, lumbar puncture is needed to collect cerebrospinal fluid for laboratory tests to check whether there are cancer cells in the cerebrospinal fluid. 9. Urinalysis: If a child suffers from neuroblastoma, the amount of adrenaline metabolized (Vanyl Mandellic Acid) in his urine will be increased, so urinalysis can help to determine the diagnosis of this disease. 10.Bacterial culture: Samples of blood, urine or some secretions of the child’s body are taken for bacterial culture, which can check whether the child is infected by other bacteria in addition to cancer. All of the above tests are commonly used, and the doctor will choose the appropriate tests according to the patient’s condition. Some of these tests may be frightening to the child, so it is important to explain as much as possible before the test is performed to put the child at ease, as his or her cooperation is important for the treatment to be carried out. Treatment After the examination, the doctor will decide on the treatment to be given to the child. The length of treatment depends on the nature and severity of the cancer. Although the methods used may vary from center to center, the principles of treatment are basically the same. Cancer treatments can be categorized into one main group: Anti-cancer drugs: Most childhood cancers require the use of anti-cancer drugs (chemotherapy). Doctors will choose the most appropriate treatment method according to the drug properties of individual drugs and the needs of the child. Drugs are given orally, intravenously, intramuscularly or subcutaneously, or by injection, to control the growth of cancer cells and to destroy them. Surgery: For localized tumors, surgery can usually be used to remove them. Some tumors cannot be removed immediately at the time of initial diagnosis, and may need to undergo chemotherapy first, and then undergo surgical resection only after the tumor has shrunk. Radiotherapy: Radiotherapy, also known as electrotherapy, can control the growth of certain tumors or destroy residual cancer cells left after surgery. Chance of cure After years of research efforts, especially in the application of drugs, the chance of cure for childhood cancer has been greatly improved. The actual chance of cure depends on the type of cancer, the location of the tumor, and whether the cancer has spread to other parts of the body at the time of disease onset. There are also other factors, such as whether the child has taken the medication on time and whether there are any complications. Take the most common form of acute lymphoblastic leukemia as an example, about 60% to 70% of children can be cured, while the chance of cure for early-stage nephroblastic carcinoma is more than 90%. However, the chance of cure for neuroblastic carcinoma is usually lower because the cancer has already spread to other parts of the body at the time of diagnosis. Side effects and complications caused by anti-cancer treatments When doctors administer anti-cancer drugs to children, the drugs interfere with the metabolism, growth and division of cells in the body. Those cells that are actively dividing, which have cancer cells in them, are affected. Cancer cells are destroyed, but other normal cells in the body are also affected to some extent, resulting in a variety of side effects and complications, but fortunately the affected normal cells recover. There are six common side effects or complications arising from chemotherapy treatment for children: 1. Hair loss: Many anti-cancer drugs will cause hair loss in children. This phenomenon has no effect on the child’s physical health, but it has a great psychological impact on him/her. They may become the butt of jokes from other students and friends and develop an inferiority complex. Fortunately, hair loss is only a temporary phenomenon and hair will grow back in time. Before the hair grows back, parents can prepare hats or wigs for their children to alleviate their feelings of inferiority. In addition, before the child returns to school, parents should contact the school and ask the teacher to explain the situation to other students and not to make fun of the child. 2. Vomiting: Many anti-cancer drugs can cause vomiting, so the doctor will usually give the child this medicine to minimize the frequency of vomiting. If the vomiting is severe, the doctor will give the child glucose drops to prevent dehydration. If the vomiting is not too serious, the child should eat small meals and avoid overeating, which will help reduce the vomiting. 3. Anemia: Because the bone marrow function is affected by the anti-cancer drugs, the child may become anemic and thus tired and lack of energy. If necessary, blood transfusion can be given to increase the blood pigment. 4. Infection: After receiving anti-cancer drugs, the immune system will be suppressed and the number of white blood cells to fight against germs will be greatly reduced, making them susceptible to bacterial infection. They will be prone to pneumonia and other infections (the most common symptom is fever). If the child is infected, he or she will have to receive antibiotic injections to control the growth and spread of bacteria. 5. Bleeding: The function of platelets is to help stop bleeding. The production of platelets may also be affected by anti-cancer drugs and the number of platelets may drop, resulting in easy bleeding and unexplained ecchymosis on the skin. At this time, the doctor should input platelets for the patient to prevent serious bleeding. 6. Stomatitis: After receiving anticancer drugs, the mucous membrane of the mouth is prone to ulcers. Therefore, the patient should pay special attention to oral surgery and often use antiseptic solution to wash mouth and brush teeth. In addition to the more common side effects mentioned above, various bodily functions of the sick child, such as heart, kidney, brain, lung or liver function, reproduction and growth ability, etc., may sometimes be affected. Fortunately, serious after-effects are infrequent. How to take care of a sick child after discharge 1. Special attention should be paid to taking anti-cancer drugs on time, otherwise the chance of cancer recurrence will be greatly increased. 2. During the treatment period, the resistance of the sick child will be weaker than that of normal people, so he/she should go to crowded public places less frequently in order to minimize the chance of being infected. In addition, they should avoid contracting measles and chicken pox. If a sick child comes into contact with a child with measles or chickenpox, he/she should contact the attending doctor to see if he/she needs to receive a globulin injection. Parents are also advised to inform the school in advance that if there are students with chickenpox or measles in the class, they should be separated from the sick child because the condition of the sick child may be serious if he/she is infected with a contagious disease. 3. The sick child should return to the hospital for follow-up consultation and continue to receive any outstanding treatment. Even if the treatment has been completed, the child should return to the hospital for regular check-ups to see if there is any sign of recurrence of the disease. 4. Family members should try their best to let the child lead a normal life again, for example, encouraging the child to play sports, go to school, and play with siblings and other children. 5. When taking care of a sick child, parents should not over-pamper him, but should take into account the feelings and needs of other children in the family. 6. In terms of diet, basically any food can be allowed to be eaten by the child without having to abstain from eating. Nutritious food, such as fresh fruits, vegetables, meat, fish, eggs and milk, etc., will help the child’s body to recover and increase his resistance, and there is no need to take expensive supplements. Parents can prepare wigs or hats for the sick child when his/her hair has not grown back to normal to reduce his/her sense of inferiority. Vaccination During the treatment period, children with cancer should not receive live-cell vaccination, including BCG vaccine, polio vaccine, measles vaccine, mumps vaccine and measles vaccine; however, diphtheria, tetanus and whooping cough vaccines contained in mixed shots are acceptable. How to explain the illness This is a difficult question to answer. Depending on the age of the child and his or her ability to understand things, parents have to decide how to explain the illness to them. In principle, parents should be honest with the child and be consistent in their explanations. To the child, appropriate explanations can increase the child’s trust in his parents, reduce his anxiety and pain, and make the child more active in cooperating with doctors and nurses in the fight against cancer. In fact, even if parents do not disclose their illnesses to their children, many children will sense the seriousness of their illnesses through their parents’ unknowing anxiety. If there is a lack of proper communication between the parents and they do not face up to the problem, things may backfire. Not only will the child feel alone, but he or she may even develop a hatred for the parents. For young children, parents can use analogies to explain their illnesses. For example, they can tell them that there are “bad bugs” in their blood that are damaging their health, and that they need to stay in the hospital for treatments, tests, and medications if they want to beat the “bad bugs. For children over 8 years of age, as they are generally very alert and skeptical, they should be given detailed explanations of their illness and the treatment procedures they have to face. Individual and family counseling: Parents and family members will be greatly shocked when they learn that their children are suffering from cancer. Initially, they may be alarmed, and then they will feel anxious, uncertain and distressed. As for the sick children, although they leave their cozy homes and stay alone in an unfamiliar environment, they will indeed be alarmed and very anxious, coupled with the fact that they have to undergo blood sampling and injections from time to time, which will give rise to infinite fear. In response to these problems, members of the Little Soldiers Association will offer a helping hand to the sick children and their families.