Seven-year-old Peter Mukama struggles to walk and balance on the ground. Mukama is weak. His left eye is covered with a plaster, half of his head is bold and the skin around his face and neck is darker than the rest of the body.
Prossy Bamwiine, his mother, says Mukama was diagnosed with a cancerous brain tumour and the side-effects are a result of radiotherapy, one of the methods of treatment he has been getting to suppress the cancer cells from spreading.
According to Dr. Richard Idro, a neuro paediatrician at Mulago Hospital, although the cases of childhood brain cancers are not many, brain cancers in children are fatal, especially if not detected early and managed properly. Idro says cancerous brain tumours are not discriminative and affect children of any age.
Although the actual cause of brain cancers is unknown, Idro says, just like any other cancer, family history of cancer and exposure to radiation are the most common risk factors among children.
Children who have been treated with chemotherapy and radiotherapy may sometimes develop cancer of the brain as a secondary effect, although it is a rare occurrence, he says
Cancerous brain tumours can either be primary or secondary. Primary cancerous brain tumours develop in the brain, while secondary brain tumours happen when cells from a cancer that started somewhere else in the body spreads to the brain.
Medullo blastoma, which develops at the back of the brain, is common among children and may spread to other parts of the brain, or to the spinal cord. The second common are gliomas, which develop from the supporting cells of the brain known as glial cells.
Signs and symptoms
Dr. Michael Muhumuza, a neuro-surgeon at Mulago Hospital, says the presentation depends on the size of the tumour, location and how it affects the brain.
"The brain is a bonny cage with fixed amount of space. If there is a growing tumour, the bones do not expand. As a result, the tumour compresses the area in the brain, causing pressure in or around the brain," he explains.
John Sserwada of Mulago neuro surgery department says increased pressure comes with a number of complications, for example constant headaches, vomiting, usually in the morning or when a child is eating, seizures and vision problems.
Problems with speech, balance and walking, weakness on one side of the body or changes in behaviour may manifest, depending on where the tumour is located, says Sserwada.
Idro says diagnosis of cancerous brain tumours is usually complicated because the tumours are hidden. The fact that children cannot express themselves better, it is usually difficult to suspect brain tumours.
Locating and getting a clear picture of the tumour requires a brain magnetic scan or resonance image scan. Although not in public facilities, the services are available in private facilities at a about sh750,000.
A CT-scan can also help to locate the tumour. The cost of the scan ranges from sh120,000 to sh150,000 in public facilities and about sh250,000 in private facilities.
Given the complexity of diagnosing childhood brain cancers, Idro cautions parents and caretakers to seek medical help if a child appears unwell with frequent falls than has been previously, walks with unsteady gait, vomits, frequently complains of headache and is sleepy all the time.
Fred Okuku, a physician at the Uganda Cancer Institute, says cancerous brain tumours are treated using surgery.
"The tumour is completely removed and the patient is given radiotherapy to stop the cancer from growing," Okuku explains.
Isreal Luutu, a consultant radiology and ration oncologist Mulago Hospital, estimates that in a month they administer radiotherapy to about four to five children.
He says children from the age of three, qualify to get radiotherapy for a period of five to six years.
However, Luutu says children respond well to treatment, although sometimes the condition may recur, depending on the stage of the cancer.
Okuku says, just like other cancers, the challenge with treating childhood brain cancers is reporting late when the cancer is advanced stages.