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Most common cancers found in kids 14 years and below are leukemia, lymphoma, or cancer of the brain or central nervous system. More than one in four people diagnosed with bone cancer are under 20 years of age.

Similar to adult malignancies, the majority of childhood cancers are caused by changes or mutations in genes, which cause uncontrolled cell proliferation and eventually cancer. Germline variations, which are genetic alterations (or variants) transferred from parents to their offspring, have been linked to an elevated risk of cancer

The types of treatment that a child with cancer receives will depend on the type of cancer and how advanced it is. Common treatments include: surgery, chemotherapy, radiation therapy, immunotherapy, and stem cell transplant.

The types of cancers that occur most often in children are different from those seen in adults. The most common cancers of children are:

• Leukemia
• Brain and spinal cord tumors
• Neuroblastoma
• Wilms tumor
• Lymphoma (including both Hodgkin and non-Hodgkin)
• Rhabdomyosarcoma

Children’s cancers are not always treated like adult cancers. Pediatric oncology is a medical specialty focused on the care of children with cancer. It’s important to know that this expertise exists and that there are effective treatments for many childhood cancers.

What causes cancer in children?

Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic change in single cells, that then grow into a mass (or tumour), that invades other parts of the body and causes harm and death if left untreated. Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.

Some chronic infections, such as HIV, Epstein-Barr virus and malaria, are risk factors for childhood cancer. They are particularly relevant in LMICs. Other infections can increase a child’s risk of developing cancer as an adult, so it is important to be vaccinated (against hepatitis B to help prevent liver cancer and against human papillomavirus to help prevent cervical cancer) and to other pursue other methods such as early detection and treatment of chronic infections that can lead to cancer.

Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors [5]. Further research is needed to identify factors impacting cancer development in children.

This being a Breastfeeding week, let’s learn something on the relationship between Cancer and Breastfeeding. Did you know that women who breastfeed have a lower risk of breast cancer especially before menopause, than women who don’t breastfeed?

Many women are not aware that breastfeeding their babies can help lower their own risk of developing breast cancer; despite the fact that most parents are aware that breastfeeding is the best way to nurture babies and offers them vital health benefits.

Breastfeeding may be more strongly linked to a lower risk of estrogen receptor-negative (Some breast cancer cells require progesterone and/or oestrogen. Hormone receptors are unique proteins found inside these cancer cells. When hormones attach to hormone receptors, the cancer cells with these receptors grow.

Hormone receptor-negative tumors are estrogen receptor-negative (ER-negative) and progesterone receptor-negative (PR- negative). Hormone receptors are not expressed in these tumors. Because of this, they either have few or no hormone receptors.

Approximately 75% to 85% of newly diagnosed breast cancers are hormone receptor-positive, these hormones cane be treated with hormone therapies; hormone theraphy drugs include aromatase inhibitors, tamoxifen, anastrozole, exemestane and letrozole. Hormone receptor-negative breast cancers are not treated with hormone therapies because they don’t have hormone receptors.

Research suggests that breastfeeding women are less likely to develop pre and post-menopausal breast cancer symptoms. And breastfeeding longer than six months can have additional benefits. Most women ignore their breast health, which results in breast cancer, due to which the number of increased breast cancer cases worldwide.

Breastfeeding protects children from cancer, it reduces not only the mother’s chances of cancer but also the child’s. It is therefore beneficial to both mother and child. Studies show that breastfeeding prevents the child from being overweight, that later reduces the risk of many cancers such as pancreatic, post-menopausal breast, endometrial, oesophagal, rectal, and kidney cancers. 

A mother’s hormones are altered by breastfeeding, which may delay the onset of her menstrual cycle and minimize her lifetime exposure to oestrogen and other hormones that may increase her risk of breast cancer. Breastfeeding may also aid in preventing breast cancer-causing mutations in cells.

Breast cancer can be detected during breastfeeding; when a woman feels a lump in the breast during breastfeeding, it could be a sign of breast cancer, and the lumps can disappear after some time but can translate to cancer as a result of mastitis, which is an infection of the breast tissue by a bacteria which blocks milk ducts. Symptoms are swelling and pain in the breast, skin warmth and redness, fever. Fibro adenomas, which are lumps that feel like marble when touched and always move beneath the skin can also be the symptoms.

REFERENCES

Fei, F., Siegal, G. P., & Wei, S. (2022). Characterizing clinicopathologic features of estrogen receptor-positive/progesterone receptor-negative breast cancers. Clinical Breast Cancer, 22(7), e788-e797.

Huang, Y., Ouyang, Y. Q., & Redding, S. R. (2019). Previous breastfeeding experience and its influence on breastfeeding outcomes in subsequent births: a systematic review. Women and Birth, 32(4), 303-309.

Kay, J. E., Cardona, B., Rudel, R. A., Vandenberg, L. N., Soto, A. M., Christiansen, S., … & Fenton, S. E. (2022). Chemical effects on breast development, function, and cancer risk: existing knowledge and new opportunities. Current Environmental Health Reports, 9(4), 535-562.

Rozeboom, B., Dey, N., & De, P. (2019). ER+ metastatic breast cancer: Past, present, and a prescription for an apoptosis-targeted future. American journal of cancer research, 9(12), 2821.

Skilton, M. R. (2022). Obesity and Cancer. Clinical Obesity in Adults and Children, 211-220.

Trabert, B., Sherman, M. E., Kannan, N., & Stanczyk, F. Z. (2020). Progesterone and breast cancer. Endocrine reviews, 41(2), 320-344.

This month provides an opportunity for us all to focus on breast cancer and its impact on those affected by the disease in our community.

The total breast cancer cases notified by county of usual residence between the years 2020 and 2023 amounted to 4,824 people in Kenya, Nairobi County leading with the highest number of diagnosed people at 550 followed by Nakuru County which registered 398 people.

Finding breast cancer early provides the best chance of surviving the disease. While mammograms can help to detect cancer before you can feel a lump, breast self-exams help to be familiar with how your breasts look and feel so you can alert your doctor if there are any changes.

Take the time to ‘get to know’ how your breasts normally look and feel through normal regular activities such as showering, getting dressed, using body lotion or looking in the mirror.

You don’t need to use a special technique, but ensure you look at and feel your breasts regularly. Make sure this includes all parts of your breast, your armpit and up to your collarbone.

For women of all ages, it is recommended that you be breast aware.

Changes to look for include:

• a new lump or lumpiness, especially if it’s only in one breast
• a change in the size or shape of your breast
• a change to the nipple, such as crusting, ulcer, redness or inversion
• a nipple discharge that occurs without squeezing
• a change in the skin of your breast such as redness or dimpling
• An unusual pain that doesn’t go away.

Visit a doctor in case you notice any changes in your breast.

Breast cancer signs

According to doctors, it is quite difficult for breast cancer to get diagnosed for women under 40 because their breasts are denser. This means that a tumour, if present, is not likely to show up in a mammogram.

The most common way to detect breast cancer in younger women is to keep a close check on the changes in your breasts. In fact, according to Healthline, a majority of young women diagnosed with breast cancer discover an abnormality themselves. If you notice any changes in your breast, like changes in the skin, nipple discharge, pain, tenderness, or a lump or mass in the breast or underarm area, please report it immediately to a doctor.

Breast cancer is one of the most common cancers in women and there is a misconception among people that it only happens to older women. While it’s true that most breast cancers are found in women who are 40 years or older, it is imperative to know that it can strike any female at any age.

Pain in any Area of The Breast

Check for pain and tenderness in any area of your breast. While lumps don’t usually hurt, some may cause a prickly sensation. However, pain in your breasts can also be due to numerous other benign reasons and hormonal changes. 

Unusual Nipple Discharge

An unusual nipple discharge that’s clear, red, brown, or yellow (other than breast milk) can be an early sign of breast cancer. If you notice this, consult a doctor for an evaluation.

Breast Changes

Look for changes in shape, swelling, and difference in size, texture, or temperature of either one or both breasts.

Unexplained Redness/Rash

Early warning signs of breast cancer can include unexplained redness, swelling, itchiness, or rash on one or both breasts.

Swelling around the Collarbone or Armpit

Consult your doctor if you notice swelling around your collarbone or under the arm. It could be a sign that the breast cancer has spread to the lymph nodes in that area.

While these are some of the early signs of breast cancer, it is important to remember that these can also be caused by benign conditions. It’s always best to consult a doctor so that they can evaluate and help you determine whether it is cause for concern.

Apart from this, it’s also important to keep in mind that often, women with breast cancer have no symptoms. This is why regular breast screening is important to detect it. The main tool to diagnose breast cancer is a mammogram, which basically shows normal and abnormal breast tissue.

It is recommended that women should start getting mammograms when they cross the age of 40 and should continue getting one every 1 or 2 years. Meanwhile, for women above the age of 20, monthly breast self-examination is recommended.

The National Cancer Registry of Kenya (NaCaRe-KE) was established in 2021 and launched in the same year.  The first report on the status of cancer in Kenya, utilized 6,778 records for the period July 2021 to June 2022, notified from 42 facilities across 21 counties.  From the report, it is established that three most common cancers are breast (15.1%), cervix (13.3%) and oesophagus (11.8%). 

The total breast cancer cases notified by county of usual residence between the years 2020 and 2023 amounted to 4,824 people, Nairobi County leading with the highest number of diagnosed people at 550 followed by Nakuru County which registered 398 people. Counties that diagnosed the least number of breast cancer as notified to NaCaRe-KE included Turkana, Tana River and Wajir that registered 3, 2 and 1 cases respectively as shown in table 1 below.

Table 1: Distribution by County of Usual Residence per Year – Filtered by Date of diagnosis

County of Usual Residence	2020	2021	2022	2023	TOTAL
Nairobi County	1	51	354	144	550
Nakuru County	96	105	130	67	398
Nyeri County		96	179	94	369
Kiambu County		14	199	70	283
Machakos County		30	112	77	219
Mombasa County	4	20	23	143	190
Meru County	61	27	65	24	177
Makueni County		8	96	49	153
Kirinyaga County	1	33	69	49	152
Muranga County		6	111	35	152
Embu County	2	36	75	27	140
Kitui County	22	19	59	32	132
Kakamega County		23	65	40	128
Kajiado County		9	47	36	92
Laikipia County	10	13	36	33	92
Nyandarua County	10	17	39	15	81
Kisumu County		15	37	28	80
Kilifi County	4	9	7	59	79
Kisii County	1	7	37	30	75
Siaya County		10	26	22	58
Uasin Gishu County	1	29	21	7	58
Taita Taveta County		13	21	19	53
Bungoma County		16	16	14	46
Busia County		15	17	11	43
Vihiga County		8	15	20	43
Nandi County		5	13	24	42
Kwale County	1	3	4	26	34
Baringo County	6	12	4	5	27
Homa Bay County	1	5	9	12	27
Migori County		3	15	9	27
Tharaka Nithi County		6	15	5	26
Trans Nzoia County		9	8	9	26
Kericho County	1	8	10	5	24
Nyamira County		4	6	14	24
Bomet County		10	10	2	22
Narok County		6	5	9	20
Garissa County		4	8	1	13
Lamu County	1	2	1	6	10
Isiolo County			5	2	7
Marsabit County		2	1	3	6
West Pokot County		2	2	2	6
Elgeyo Marakwet County		2	2	1	5
Mandera County			5		5
Samburu County	1		2	1	4
Turkana County		1	1	1	3
Tana River County			1	1	2
Wajir County			1		1
Non-resident			16	4	20
Missing	357	207	33	3	600
TOTAL	581	920	2,033	1,290	4,824

Distribution by County of Notification per Year – Filtered by Date of Diagnosis

Distribution by County of notification means the county in which the cancer case was diagnosed. From table 2 below, it is noted that Nairobi County leads by 2150 of cases notified; meaning therefore that most people seek cancer medication at the capital city.

Table 2: Distribution by County of Notification per Year – Filtered by Date of Diagnosis

County of Usual Res	2020	2021	2022	2023	TOTAL
Nairobi County	218	215	1,288	429	2,150
Nakuru County	128	126	124	82	460
Nyeri County		117	143	125	385
Machakos County	101	73	78	65	317
Mombasa County	18	31	7	242	298
Uasin Gishu County		116	79	36	231
Kakamega County		89	49	42	180
Kisumu County		34	42	71	147
Meru County	61	32	25	23	141
Embu County	3	47	65	24	139
Makueni County			56	19	75
Kitui County	22	13	17	14	66
Bomet County	20	11	13	4	48
Taita Taveta County		13	15	13	41
Kiambu County			4	31	35
Kisii County			2	28	30
Nandi County			3	24	27
Garissa County	10	3	8	2	23
Laikipia County			5	5	10
Muranga County			10		10
Kirinyaga County				8	8
Vihiga County				3	3
TOTAL	581	920	2,033	1,290	4,824

In terms of distribution of cancer type in the breast (primary site), Breast NOS (excludes Skin of breast C44.5) accounts for 94.44% of the all cancers of the breast; 4556 of the total 4824 as notified between 2020 and 2023. Breast NOS in simple terms is the Invasive Ductal Carcinoma of Breast, Not Otherwise Specified (NOS), they are invasive breast cancers, which have a tendency to be aggressive and spread. This subset comprises the largest group and also the most common type of breast cancers as seen in table 2 below.

Table 3: Distribution of Cancer Type by /year – Filtered by Date of Diagnosis:

Primary Site	2020	2021	2022	2023	TOTAL
Breast NOS (excludes Skin of breast C44.5)	542	893	1,957	1,164	4,556
Upper outer quadrant of breast	10	12	20	27	69
Central portion of breast	2	1	20	28	51
Upper inner quadrant of breast	3	5	7	19	34
Overlapping lesion of breast	19	6	6	3	34
Axillary tail of breast			11	17	28
Lower inner quadrant of breast	4		9	8	21
Nipple		3	1	15	19
Lower outer quadrant of breast	1		2	9	12
TOTAL	581	920	2,033	1,290	4,824

In Kenya, the majority of breast cancer cases discovered are at stage IV, accounting for 37.2% of all cases as seen in table 4 below. This is the leading factor towards mortalities as late discoveries reduces the likelihood of survival. Early screening of breast cancer increases the chances of managing the disease through prompt treatment and care, therefore increasing the chances of survival.

Table 4: Distribution by Stage at Diagnosis per Year – Filtered by Date of Diagnosis:

Stage at Diagnosis	2020	2021	2022	2023	TOTAL	Percentage
In situ		2	20	36	58	2.6%
Stage I	12	18	56	29	115	5.1%
Stage II	25	67	235	210	537	23.8%
Stage III	44	144	256	264	708	31.4%
Stage IV	56	171	372	241	840	37.2%
TOTAL	137	402	939	780	2258	100.0%

A brain tumor is a growth of cells in the brain or near it. Brain tumors can happen in the brain tissue. Brain tumors also can happen near the brain tissue. Nearby locations include nerves, the pituitary gland, the pineal gland, and the membranes that cover the surface of the brain.

Brain tumors can begin in the brain. These are called primary brain tumors. Sometimes, cancer spreads to the brain from other parts of the body. These tumors are secondary brain tumors, also called metastatic brain tumors.

Many different types of primary brain tumors exist. Some brain tumors aren’t cancerous. These are called noncancerous brain tumors or benign brain tumors. Noncancerous brain tumors may grow over time and press on the brain tissue. Other brain tumors are brain cancers, also called malignant brain tumors. Brain cancers may grow quickly. The cancer cells can invade and destroy the brain tissue.

Brain tumors range in size from very small to very large. Some brain tumors are found when they are very small because they cause symptoms that you notice right away. Other brain tumors grow very large before they’re found. Some parts of the brain are less active than others. If a brain tumor starts in a part of the brain that’s less active, it might not cause symptoms right away. The brain tumor size could become quite large before the tumor is detected.

Brain tumor treatment options depend on the type of brain tumor you have, as well as its size and location. Common treatments include surgery and radiation therapy.

Types

There are many types of brain tumors. The type of brain tumor is based on the kind of cells that make up the tumor. Special lab tests on the tumor cells can give information about the cells. Your health care team uses this information to figure out the type of brain tumor.

Some types of brain tumors usually aren’t cancerous. These are called noncancerous brain tumors or benign brain tumors. Some types of brain tumors usually are cancerous. These types are called brain cancers or malignant brain tumors. Some brain tumor types can be benign or malignant.

Benign brain tumors tend to be slow-growing brain tumors. Malignant brain tumors tend to be fast-growing brain tumors.

Types of brain tumors include:

• Gliomas and related brain tumors. Gliomas are growths of cells that look like glial cells. The glial cells surround and support nerve cells in the brain tissue. Types of gliomas and related brain tumors include astrocytoma, glioblastoma, oligodendroglioma and ependymoma. Gliomas can be benign, but most are malignant. Glioblastoma is the most common type of malignant brain tumor.
• Choroid plexus tumors. Choroid plexus tumors start in cells that make the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. Choroid plexus tumors are located in the fluid-filled cavities in the brain, called the ventricles. Choroid plexus tumors can be benign or malignant. Choroid plexus carcinoma is the malignant form of this type of brain tumor. It’s more common in children.
• Embryonal tumors. Embryonal tumors begin in cells that are left over from fetal development. The cells, called embryonal cells, stay in the brain after birth. Embryonal tumors are malignant brain tumors that happen most often in babies and young children. The most common type of embryonal tumor is medulloblastoma. It’s usually located in the lower back part of the brain, called the cerebellum.
• Germ cell tumors. Germ cell tumors start in reproductive cells, called germ cells, that go on to become the sperm and egg cells. Germ cells are mostly in the ovaries and testicles. But sometimes they’re in other parts of the body, including the brain. When germ cell tumors happen in the brain, they’re often located near the pineal gland or the pituitary gland. Germ cell tumors are mostly benign. They’re more common in children.
• Pineal tumors. Pineal tumors start in and around the brain’s pineal gland. The pineal gland is located in the center of the brain. It makes a hormone called melatonin that helps with sleep. Pineal tumors can be benign or malignant. Pineoblastoma is a malignant type of pineal tumor that’s most common in children.
• Meningiomas. Meningiomas are brain tumors that start in the membranes around the brain and spinal cord. Meningiomas are usually benign, but sometimes they can be malignant. Meningiomas are the most common type of benign brain tumor.
• Nerve tumors. Nerve tumors are growths that happen in and around nerves. The most common type that happens in the head is acoustic neuroma, also called schwannoma. This benign tumor is located on the main nerve that connects the inner ear to the brain.
• Pituitary tumors. Brain tumors can begin in and around the pituitary gland. This small gland is located near the base of the brain. Most tumors that happen in and around the pituitary gland are benign. Pituitary tumors happen in the pituitary gland itself. Craniopharyngioma is a type of brain tumor that happens near the pituitary gland.
• Other brain tumors. Many other types of rare tumors can happen in and around the brain. Tumors can start in the muscles, blood vessels and connective tissue around the brain. Tumors can form in the bones of the skull. Malignant brain tumors can start from the germ-fighting immune system cells in the brain. This type of brain cancer is called primary central nervous system lymphoma.

Childhood cancer is a diverse and heterogeneous group of rare cancers that are unified by the age of the cohort, childhood cancer is defined as the group of cancer that arises between birth and 19 years of age.

Care for cancer, like so many other diseases, reflects the inequalities and inequities in our societies. The impact on children is devastating. Each year, an estimated 400 000 children are diagnosed with cancer around the world. The vast majority of these children live in low- and middle-income countries, where treatment is often unavailable, unaffordable or of poor quality. The survival rate for these children is estimated to be between 15% and 45%. This compares to a survival rate of more than 80% in high-income countries.

We continue to raise awareness about childhood cancer and express support for children and adolescents with cancer, survivors and their families. This is in line with WHO Global Initiative on Childhood Cancer, which aims at reaching at least a 60% survival rate for children with cancer by 2030.

This new target represents a doubling of the global cure rate for children with cancer. The aims of the Initiative are two-fold: to increase prioritization of childhood cancer through awareness raising at global and national levels and to expand the capacity of countries to deliver best practice in childhood cancer care. 

The institute is working to improve primary prevention of childhood cancers through:

• Mitigation of risk factors and their determinants
• Enhancing access to appropriate cancer screening services for early detection
• Strengthening the referral pathway for patients with cancer and those suspected to have cancer
• Promotion of access to optimal diagnostics, treatment, palliative care and survivorship
• Strengthening cancer information systems, registration and surveillance

This can be achieved through multi-sectorial approach which will involve both health and non-health sectors. It will also involve the recognition of the best practices and scientific evidence supported through monitoring and evaluation and research.

The types of cancers that occur most often in children are different from those seen in adults. The most common cancers of children are:

• Leukemia
• Brain and spinal cord tumors
• Neuroblastoma
• Wilms tumor
• Lymphoma (including both Hodgkin and non-Hodgkin)
• Rhabdomyosarcoma
• Retinoblastoma
• Bone cancer (including osteosarcoma and Ewing sarcoma)

A gastrointestinal stromal tumor (GIST) is a type of tumor that occurs in the gastrointestinal tract, most commonly in the stomach or small intestine. This type of tumor is thought to grow from specialized cells found in the gastrointestinal tract called interstitial cells of Cajal (ICCs) or precursors to these cells. Affected individuals can develop one or more tumors. GISTs are usually found in adults between ages 40 and 70; rarely, children and young adults develop this type of tumor.

Small tumors may cause no signs or symptoms. However, some people with GISTs may experience pain or swelling in the belly area (abdomen), nausea, vomiting, loss of appetite, or weight loss. Sometimes, tumors cause bleeding into the gastrointestinal tract, which may lead to low red blood cell counts and, consequently, weakness and tiredness. Bleeding into the intestines may cause black and tarry stools, and bleeding into the throat or stomach may cause vomiting of blood.

Affected individuals with no family history of GIST typically have only one tumor (called a sporadic GIST). People with a family history of GISTs (called familial GISTs) often have multiple tumors and additional signs or symptoms, including noncancerous overgrowth (hyperplasia) of other cells in the gastrointestinal tract and patches of dark skin on various areas of the body. Some affected individuals have a skin condition called urticaria pigmentosa (also known as maculopapular cutaneous mastocytosis), which is characterized by raised patches of brownish skin that sting or itch when touched.

A rare form of GIST, called succinate dehydrogenase (SDH)-deficient GIST, tends to occur in childhood or young adulthood and affects females more commonly than males. In this form, tumors are almost always in the stomach. Individuals with an SDH-deficient GIST have a high risk of developing other types of tumors, particularly noncancerous tumors in the nervous system called paragangliomas and noncancerous lung tumors called pulmonary chondromas. When GISTs occur in combination with paragangliomas, the condition is known as Carney-Stratakis syndrome; the combination of GISTs, paragangliomas, and pulmonary chondromas is known as Carney triad; and the combination of GISTs and pulmonary chondroma is known as incomplete Carney triad.