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cancer-in-children

Childhood Cancer

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Cancer is uncommon in children. Most cancers (98%) develop in adults, and it is most common in older adults. About one out of every six adults will develop cancer during his or her lifetime, while one in 300 boys and one in 333 girls will develop cancer before the age of 20.

At the same time, there is a lot of research going on to discover new treatments for childhood cancer. This ongoing research has greatly improved the overall survival rate for children with cancer, which is now more than 80%.

What is Childhood Cancer?

Cancer begins when normal cells change and grow uncontrollably. In most types of cancer, these cells form a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous).Benign tumors are usually slow-growing and do not spread to other parts of the body (metastasize). Malignant cancers can grow rapidly and spread to other parts of the body. In leukemia, a cancer of the blood that starts in the bone marrow, these abnormal cells very rarely form a solid tumor, but instead crowd out other types of cells in the bone marrow. This prevents the production of normal red blood cells, otherotherwhite blood cells, and platelets (the part of the blood needed for clotting).

Cancer in children can occur anywhere in the body, including the blood and lymph node system, brain and central nervous system (CNS), and kidneys. Most of the time, there is no known cause for childhood cancers. Childhood cancers may behave very differently from adult cancers.

Types of childhood cancer

Childhood cancer is a general term used to describe a range of cancer types and noncancerous tumors found in children. Childhood cancer may also be called pediatric cancer. Below are the most common types of cancer in children under 15 years old. For more information on each type, select a name below.

1) Leukemia (accounts for about 34% of childhood cancer cases)

Acute lymphoblastic leukemia (ALL)

Acute myeloid leukemia (AML)

2) Brain and CNS tumors (27%), including tumors of the spinal cord

Astrocytoma

Brain stem glioma

Central nervous system

Craniopharyngioma

Desmoplastic infantile ganglioglioma

Ependymoma

High-grade glioma

Medulloblastoma

Atypical teratoid rhabdoid tumor

Neuroblastoma (7%), a tumor of immature nerve cells that often starts in the adrenal      glands, which are located on top of the kidneys and are part of the body’s endocrine (hormonal) system

Wilms tumor (5%), a type of kidney tumor

Non-Hodgkin lymphoma (4%) and Hodgkin lymphoma (4%), cancers that begin in the lymph system

Rhabdomyosarcoma (3%), a type of tumor that begins in the striated muscles, which is part of the skeletal voluntary muscles that people can control. Other, rare soft tissue sarcomas also occur.

Retinoblastoma (3%), an eye tumor

Osteosarcoma (3%) and Ewing sarcoma (1%), tumors that usually begin in the bone

Germ cell tumors, rare tumors that begin in the testicles in boys or ovaries in girls. Even more rarely, this tumor can begin in other places in the body, including the brain.

Pleuropulmonary blastoma, a rare kind of lung cancer

Hepatoblastoma and hepatocellular carcinoma, liver tumors

Cancer in teenagers and young adults

There is an increasing amount of research regarding cancer in children diagnosed after the age of 14. As these children are starting to enter young adulthood, they may have unique medical, social, and emotional needs that are different from younger children with cancer. They are part of a group often called adolescents and young adults (AYA).

Most often, teenagers and young adults with cancer should be treated at a pediatric oncology center or at a center where medical oncologists (doctors who treat cancer with medication) and pediatric oncologists (doctors who treat children with cancer) work together to plan treatment. This will ensure that they receive the newest treatments and are cared for by a team of doctors who are familiar with these diseases. This is especially important for teenagers who have lymphoma, leukemia, or bone tumors, since treatment by specialists familiar with these diseases has been shown to improve survival.

Within the AYA group, there are also patients who have cancers most commonly found in adults, such as melanoma, testicular cancer, or ovarian cancer. Teenagers with these cancers may receive treatments that are similar to adults, but they also need to receive age-appropriate support for their social and emotional needs. In either the pediatric or adult care centers, age-appropriate information and support is very important for children and teens.

Below are the most common types of cancer in teenagers, ages 15 to 19. For more information on each type, select a name below.

Hodgkin lymphoma (16%) and Non-Hodgkin lymphoma (8%)

Germ cell tumors , including testicular cancer and ovarian cancer (16%)

CNS tumors (10%)

Thyroid cancer (7%)

Melanoma (7%)

ALL (6%)

Soft tissue sarcoma (7%)

Osteosarcoma (5%)

AML (5%)

Ewing sarcoma (2%)

Other cancers (12%)

Symptoms & Signs

Cancer can be hard to detect in children. Children with cancer may experience the following symptoms or signs. Sometimes, children with cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

Many of the symptoms can be described using an acronym provided by The Pediatric Oncology Resource Center. If you are concerned about a symptom or sign on this list, please talk with your child’s doctor.

Continued, unexplained weight loss
Headaches, often with early morning vomiting
Increased swelling or persistent pain in the bones, joints, back, or legs
Lump or mass, especially in the abdomen, neck, chest, pelvis, or armpits
Development of excessive bruising, bleeding, or rash

Constant infections
A whitish color behind the pupil
Nausea that persists or vomiting without nausea
Constant tiredness or noticeable paleness
Eye or vision changes that occur suddenly and persist
Recurring or persistent fevers of unknown origin

Your child’s doctor will ask you questions about the symptoms your child is experiencing to help find out the cause of the problem, called a diagnosis. This may include how long your child has been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your child’s health care team about symptoms your child experiences, including any new symptoms or a change in symptoms.

Risk Factors and Prevention

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do.

Doctors and researchers don’t know what causes most childhood cancers. A small percentage of cancers can be linked to the genetic disorder Down syndrome, other inherited genetic abnormalities, and previous radiation treatment. Environmental causes (such as exposure to infectious and toxic substances) are unlikely to cause childhood cancer.

Diagnosis

Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy or surgery to remove as much of the tumor as possible is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your child’s doctor may consider these factors when choosing a diagnostic test:

Age and medical condition

Type of cancer suspected

Severity of symptoms

Previous test results

In addition to a physical examination, the following tests may be used to diagnose childhood cancer:

Blood tests. Routine blood tests measure the number of different types of cells in a person’s blood. Levels of certain cells that are too high or too low can indicate the presence of certain types of cancer.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but except for certain types of brain tumors, only a biopsy can make a definite diagnosis. The type of biopsy performed depends on the location of the cancer. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Bone marrow aspiration. A bone marrow biopsy is the removal of a sample of bone marrow, usually from the back of the hipbone, with a needle. The skin in that area is usually numbed with medication beforehand, and other types of anesthesia (medication to block the awareness of pain) may be used. People who receive conscious sedation are usually able to speak and respond during the procedure and may not have any memory of the procedure afterward.

Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a doctor uses a needle to take a sample of cerebrospinal fluid (CSF) to look for cancer cells, blood, or tumor markers (substances found in higher than normal amounts in the blood, urine, or body tissues of people with certain kinds of cancer). CSF is the fluid that flows around the brain and the spinal cord. Doctors generally give the child an anesthetic to numb the lower back before the procedure.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. It is important to have this test done in a pediatric specialty center where they can be supervised by pediatric radiologists. These centers are aware of the potential risks of radiation exposure from a CT scan.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s vein. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Scans or radioisotope studies. In these procedures, a material (called a tracer) is injected into the body and then followed with a special camera or x-ray to see where the material goes. These studies can find abnormalities in the liver, brain, bones, kidneys, and other organs.  

Many of these tests may be repeated during and after treatment to determine the effectiveness of the treatment.

After these diagnostic tests are done, your child’s doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor categorize or describe the cancer; this is called staging.

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