What is cancer?
The cell is the building block of life and mate pukupuku / 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 mate pukupuku / cancer.
While 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. Tahi / One cell becomes rua / two, rua / two cells become whā / four, whā / four become waru / 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 among 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 ‘mate pukupuku / 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 childhood cancers are solid tumours and leukaemias.
If the division and reproduction process of our cells goes wrong, abnormal cells are produced. These cells can’t 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 can’t 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 can 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 tumours in other areas. This is called secondary or metastatic mate pukupuku / cancer.
Malignant tumours are classified by stage and grade. You may have heard these words being used. The stage relates to how far the mate pukupuku / cancer has spread in the body and the grade describes the type of cells contained within the tumours.
Mate pukupuku / cancer stages:
- Stage 1: the mate pukupuku / cancer is small and localised and has not spread beyond the original site.
- Stage 2 or 3: the mate pukupuku / cancer has spread into surrounding tissues / structures.
- Stage 4: the mate pukupuku / cancer has spread to other parts of the body (secondary or metastatic mate pukupuku / cancer).
The most common cancers in tamariki / children are those of the bone marrow. This type of mate pukupuku / cancer is known as leukaemia. The bone marrow is a spongy material found in the centre of some of our bones and it produces all our blood cells.
There are 3 types of blood cells:
- Whero / red blood cells that carry oxygen.
- Mā / white blood cells that fight infection.
- Platelets that clot the blood (control bleeding).
Whero / red, mā / white and platelet cells grow from stem cells within the bone marrow. Leukaemia happens when the marrow creates lots of immature blood cells. These cells can’t perform their functions properly because they can’t grow to maturity. The word leukaemia refers to mā / white cells as the disease usually affects their production. Acute Myeloid Leukaemia affects the early mā / white myeloid blood cells and Acute Lymphoblastic Leukaemia affects the lymphoblasts (early lymphoid mā / white blood cells).
The large number of immature cells prevents the production of healthy, mature blood cells. This reduces the body’s ability to fight infection. Production of whero / red cells and platelets is lessened too, and this can result in anaemia and significant bruising.
How is childhood cancer diagnosed?
Tests are needed to give an accurate diagnosis of the mate pukupuku / cancer.
Because there are many different types of mate pukupuku / cancer, the specialists need to know exactly what type of mate pukupuku / cancer your taitamaiti / child has so they can determine the best treatment. The information gained from tests can then be shared among the medical team looking after your taitamaiti / child.
The tests will also determine the stage and the grade of the mate pukupuku / cancer and provide an overall assessment of your child’s general health.
Your taitamaiti / child may not have all these procedures, so think of this overview as for information only. Some of these tests may be conducted only once or, as your taitamaiti / child goes through treatment, certain tests may be done more often to monitor the effectiveness of the treatments.
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’ (harmless) or ‘malignant’ (cancerous)).
Bone marrow aspirate
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 done under sedation or general anaesthetic to ensure it’s as comfortable 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.
Common blood tests are:
- 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 / child in case a blood transfusion is needed.
- Blood culture: provides evidence of infection.
In some cancers such as leukaemia, lymphoma (mate pukupuku / cancer of the lymphatic system), and occasionally brain tumours, mate pukupuku / 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 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 (tumours) are suspected in the chest, bones or puku area. A tumour can look different from healthy tissue under an x-ray.
CT (computerised tomography) scan
The CT scanner takes a series of x-rays of the soft tissues and a computer builds up a 3D picture of the inside of the body. The CT is painless, but your taitamaiti / child may be given a sedative or anaesthetic to ensure they lie still throughout the scan.
MRI (magnetic resonance imagery) scan
Like a CT scan, the MRI builds up a series of pictures of the inside of the body using magnetic waves. The scan is painless but very noisy. Your taitamaiti / child lies within a narrow tunnel and may be given a sedative or general anaesthetic to calm them and ensure they lie still during the procedure.
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 them during the scan.
Sound waves (too high for us to hear) are used 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 often used to examine the puku / stomach 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’.
How is childhood cancer treated?
Your specialist will advise a treatment plan based upon all the information gathered from tests and surgery. If English is not your native language or you have a hearing difficulty, ask the hōhipere / hospital to provide an interpreter or someone to help you. It’s really important that you fully understand all aspects of the treatment your taitamaiti / child will receive.
There are currently toru / three main ways of treating your child’s mate pukupuku / cancer:
- Surgery where the tumour is removed in a surgical operation (only at the mate pukupuku / cancer site).
- Chemotherapy where mate pukupuku / cancer cells are killed with anti-cancer drugs (systemic, whole body).
- Radiotherapy where high energy rays are used to kill mate pukupuku / cancer cells (only at the mate pukupuku / cancer site).
There’s no one single treatment plan that fits everyone because we’re all unique. Your taitamaiti / child will receive an individualised treatment plan based upon the stage and grade of their mate pukupuku / cancer and their overall health.
Your taitamaiti / child may receive a combination of treatments, for example chemotherapy and radiation.