Children in Nigeria with brain tumours have a rough deal in terms of gaining access to quality health care. They have a short life span, as half of them will die within a year of diagnosis and more will die later. There are few reports of effective treatment and survival of brain cancer in children.
What is a brain tumour?
A brain tumour is an abnormal growth of tissue in the brain. Brain tumours may be classified as either benign (not cancerous) or malignant (cancerous), depending on their behaviour. The tumour can either originate in the brain itself, or come from another part of the body and travel to the brain (metastasize).
Most brain tumours in children come from within the brain itself and most are malignant. This is important to note and it means that most childhood tumours are cancerous. Most frequently, they come from “young” cells. These are cells that are still developing (‘immature’ or ‘primitive’ cells) and have not reached full maturity. They are developing at the same time as the child is developing.
Benign or malignant?
A benign tumour does not contain cancer cells and usually, once removed, does not come back. Also, most benign brain tumours have clear borders, meaning they do not invade surrounding brain tissue. On the other hand, malignant brain tumours contain cancer cells. Malignant brain tumours are usually fast growing and invade the surrounding brain tissue. Although malignant brain tumours very rarely spread to other areas of the body, they often recur after treatment (very rapidly).
Treatment of cancer in children
The first and most important point is early diagnosis. Cancer in children causes very subtle early signs that should be appreciated and not ignored by the mother. I say mother, because they are often closest to the child and can sense changes in the nuances of behaviour in the child. The symptoms and signs should also be clearly elucidated by the paediatric doctor.
Often, diagnosis is delayed because pertinent signs are ignored, overlooked or not appreciated. We therefore have a high rate of misdiagnoses and bizarre treatments before the penny drops.
So, your child has a brain tumour?
A doctor breaking the news to parents must show the most empathy and caution. It is not an impersonal and forgettable experience and must be done with utmost regard for the sensitivities of the family. The information provided to the parents and reassurances must be clear and thoughtful. This builds confidence in the doctor — the confidence that allows the parents to entrust their most prized possession to you.
What do you do?
It is very difficult for doctors to tell a parent their child has a brain tumour. It is devastating for parents to hear it and even more difficult to accept subsequent treatment plans. Parents have often refused to believe the diagnosis of brain tumour and so go all over the place seeking a second opinion and a more favourable diagnosis. Sadly, hiding from the truth does no good whatsoever.
If diagnosed with a brain tumour, accept treatment, as early treatment dramatically improves chances of complete recovery. Proper management includes treatment of cancer and moral support to the child. The specific treatment of brain tumours is based on: the child’s health status, clinical condition, urgency required, medications and your personal opinion.
Surgery is often the main mode of treatment and it involves removal of the tumour mass. Removal of the abnormal collection of tumour cells while preserving neurological function is the ultimate goal of surgeons. The aim of surgery is to remove all visible tumour and get rid of it all, if possible. Yes, we aim to do this as safely as possible and without injuring or damaging normal brain structures.
Partial removal is sometimes the only option. This is because there are also certain cases for which surgery is not a possibility due to the risky location of the tumour, such as brainstem gliomas. A biopsy is also done to examine the types of cells the tumour is made of for a diagnosis. This is frequently done if the tumour is in an area with sensitive structures around it that may be injured during removal.
In most cases, however, surgery serves as a temporising measure that will keep a child out of trouble for long enough to get through definitive therapy that will hopefully eliminate the tumour. Brain surgery is usually the easiest part of a child’s treatment.
Other ways of treatment combined with surgery include chemotherapy and radiotherapy. Chemotherapy entails giving high doses of chemical drugs which destroy the tumour cells, while radiotherapy uses radiation to kill the tumour cells.
The way forward in Nigeria
We have to evolve and offer effective cancer treatment locally in Nigeria. We currently do not have a special hospital for cancer treatment in children. The questions I have asked before are as follows:
Where is childhood cancer care available in Nigeria? Who is the expert responsible for treating brain tumours in Nigeria? Should there be a special unit treating children with brain tumours? Where is the national hospital for sick kids? What happened to the plans for a cancer centre in Abuja?
In some other countries, governments, organisations such as oil corporations, banks, big businesses, billionaires and non-governmental organisations set up and brand children’s cancer units. We should encourage this in Nigeria.