Cancer is a group of diseases that involve the uncontrolled growth of certain cells in the body. When this happens, cells can grow into a mass called a tumor.
Cancer is relatively rare in children. Most cancers (98%) develop in adults, especially in people past middle age. About one of every six adults will develop cancer during his or her lifetime, but only about one of every 330 children under age 20 will develop cancer.
Cancer in children most often forms in the parts of their bodies that are still growing and changing, such as their blood system, brain, and kidneys. Cancers that occur in children behave differently than most adult cancers.
In most cases, teenagers and young adults who have cancer should be treated at a pediatric oncology center, so they will have access to the latest treatments and receive coordinated care by a team of doctors. This is especially true for teenagers who have lymphoma, leukemia, and bone tumors. The few exceptions are teenagers with adult cancers, such as melanoma, testicular cancer, and ovarian cancer. In these situations, it is appropriate for teenagers to receive treatments that are similar to adults, but also be given access to age-appropriate psychosocial support programs.
Childhood cancer is a general term used to describe a range of cancer types found in children. Below are the most common types of cancer in children 14 and under. For more information on each type, select a name below.
Leukemia (accounts for about 33% of childhood cancer cases), a cancer of the blood and blood-forming organs that starts in the bone marrow
Cancer, although rare in children, is the leading cause of death from disease in children and adolescents. Most children diagnosed with cancer can be treated successfully.
In 2008, an estimated 10,730 children (younger than 14) will be diagnosed with cancer in the United States. It is estimated that 1,490 deaths from this disease will occur this year, nearly one-third from leukemia. Since 1975, the number of deaths from childhood cancer has decreased by almost 50%.
As explained above, there are several types of childhood cancer, and survival rates are different for each. In general, the overall five-year relative survival rate (the percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) of patients with childhood cancer is 80%.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with a particular childhood cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2008.
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 Down syndrome, other inherited genetic abnormalities, and radiation treatment. Environmental causes (infectious and toxic exposures) are suspected as a potential cause of some types of childhood cancer.
Because specific causes have not been identified for each individual childhood cancer, the way to prevent childhood cancer is still unknown.
Cancer can be hard to detect in children. Symptoms of cancer often look like other common childhood illnesses. Any persistent change in a child's health or behavior should be reported to the child's doctor.
The Pediatric Oncology Resource Center (www.acor.org) recommends seeing a doctor if a child has:
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
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. 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 doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
Doctors may use the following tests to diagnose childhood cancer:
Blood tests. Routine blood tests measure the counts of different types of cells in a person's blood. Levels of cells that are too high or too low can indicate the presence of cancer.
Imaging tests
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the child's 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.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRIs may create more detailed pictures of certain areas of the body than CT scans.
Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. A transmitter that emits sound waves is moved over the child's body. A tumor generates different echoes of the sound waves than normal tissue does, so when the waves are bounced back to a computer and changed into images, the doctor can locate a mass inside the body. The procedure is painless.
Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination.
Scans or radioisotope studies. In these procedures, a material (called a tracer) is injected into the child's 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.
Surgical tests
Biopsy. A biopsy removes a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend 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. This is a type of biopsy where a small amount of bone marrow is removed with a needle (usually from the hipbone) to evaluate the bone marrow cells. The doctor will numb the area before the procedure and may use conscious sedation (a type of anesthesia that uses pain relievers and sedatives to induce an altered state of consciousness). 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 takes 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 types 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.
Many of these tests may be repeated during treatment to see what effect the treatment is having on the cancer.
The treatment of childhood cancer depends on the size and location of the tumor, whether the cancer has spread, and the child's overall health.
Clinical trials are the standard of care for the treatment of children with cancer. In fact, more than 60% of children with cancer are treated as part of a clinical trial. Clinical trials are research studies that compare standard treatments (the best treatments available) with newer treatments that may be more effective. Cancer in children is rare, so it can be hard for doctors to plan treatments unless they know what has been most effective in other children. Investigating new treatments involves careful monitoring using scientific methods, and all participants are followed closely to track progress.
To take advantage of these newer treatments, all children with cancer should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. Many times, a team of doctors treats a child with cancer. Pediatric cancer centers often have extra support services for children and their families, such as nutritionists, social workers, and counselors. Special activities for kids with cancer may also be available.
Surgery
Surgery is an operation to remove a cancerous tumor. Many children with cancer will need surgery at some point during their treatment. The goal of surgery is to remove the whole tumor and the margin (healthy tissue around the tumor), leaving a negative margin (no trace of cancer in the healthy tissue). Sometimes removing an entire tumor is not possible.
Side effects of surgery depend on the location and type of the tumor and whether it has metastasized.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The type of chemotherapy used depends on the type and stage of cancer. Refer to the specific Cancer.Net Guide to Cancer for more specific information on staging and tumor classifications.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
Side effects from radiation therapy include tiredness, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
Immunotherapy
Immunotherapy is the use of substances (made by the body or created in a laboratory) to support or stimulate the body's own immune system to fight the cancer. Immunotherapy is also called biologic therapy. Examples of immunotherapy include cancer vaccines, monoclonal antibodies, and interferons.
Bone marrow transplantation/stem cell transplantation
In a bone marrow transplantation, the doctor first gives high doses of chemotherapy (and sometimes radiation therapy) to destroy all of the child's bone marrow. Then, healthy marrow or blood stem cells are infused into the child's vein. It finds its way to the bones and replaces the destroyed marrow.
When the replacement bone marrow comes from a donor, it is called an allogeneic (ALLO) bone marrow transplantation. The best match for bone marrow comes from a brother or sister. However, other relatives or people who are not related to the child can have a close enough match to provide a successful transplant.
In an autologous (AUTO) transplantation, the child's own bone marrow is used. The blood stem cells or bone marrow are removed and may be treated to eliminate cancer cells, and then they are frozen. The child then receives high-dose chemotherapy, which will damage his or her own bone marrow. The frozen stem cells are thawed and injected to replace the destroyed marrow. Since the child receives his or her own blood or marrow, there is no risk of rejection. One drawback is that if the treatment does not kill all of the cancer cells in the tissue before it is frozen, the collected blood or bone marrow could return cancer into the child's body.
Although the majority of childhood cancers respond well to treatment, some do not. Recurrent cancer is cancer that returns after treatment. When cancer recurs, testing and treatment must begin again. Doctors will develop a treatment plan based on each child's individual circumstances.
If the child's cancer cannot be cured or controlled, the parent or guardian is encouraged to think about where the child would be most comfortable: at home, in a home-like setting elsewhere, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. In all cases, eliminating a child's pain is extremely important.
Some children may be happier if they can arrange to attend school part-time or keep up other activities and connections. The child's treatment team can help parents or guardians decide on an appropriate level of activity.
Doctors and scientists are always looking for better ways to treat patients with childhood cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating childhood cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with childhood cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to childhood cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Diarrhea. Diarrhea is frequent, loose, or watery bowel movements. It is a common side effect of certain chemotherapeutic drugs or of radiation therapy to the pelvis, such as in women with uterine, cervical, or ovarian cancers. It can also be caused by certain tumors, such as pancreatic cancer.
Fatigue (tiredness). Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously impact family and other daily activities, can make patients avoid or skip cancer treatments, and may even impact the will to live.
Mouth sores (mucositis). Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. It occurs in up to 40% of patients receiving chemotherapy treatments. Mucositis can be caused by a chemotherapeutic drug directly, the reduced immunity brought on by chemotherapy, or radiation treatment to the head and neck area.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Skin problems. The skin is an organ system that contains many nerves. Because of this, skin problems can be very painful. Because the skin is on the outside of the body and visible to others, many patients find skin problems especially difficult to cope with. Because the skin protects the inside of the body from infection, skin problems can often lead to other serious problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapeutic drugs leaking out of the intravenous (IV) tube, which can cause pain or burning; peeling or burned skin caused by radiation therapy; pressure ulcers (bed sores) caused by constant pressure on one area of the body; and pruritus (itching) in patients with cancer, most often caused by leukemia, lymphoma, myeloma, or other cancers.
Sleeping problems: hypersomnia, somnolence syndrome, and nightmares. Hypersomnia, also called somnolence, excessive daytime sleepiness, or prolonged drowsiness, is a condition characterized by excessive sleeping or the inability to maintain wakefulness when desired. Somnolence syndrome is a type of hypersomnia associated with cranial radiation therapy (radiation treatment to the head) in children. Symptoms of somnolence syndrome include excessive drowsiness, prolonged periods of sleep (up to 20 hours a day), headaches, low-grade fever, nausea and/or vomiting, and irritability. Nightmares are vivid, frightening dreams that usually cause the dreamer to wake up able to remember part or most of the nightmare. Most people have nightmares from time to time, but the frequency or vividness of nightmares can increase after a cancer diagnosis and during cancer treatment. Possible causes of hypersomnia include some brain cancers in adults (for example, ependymoma or meningioma); some childhood central nervous system (CNS) cancers (for example, brain stem glioma, cerebellar astrocytoma, medulloblastoma); some secondary brain tumors (brain metastases); some chemotherapeutic drugs (for example, teniposide [VM-26], pegaspargase [Oncaspar], thalidomide [Thalomid]); and other prescription and over-the-counter medications (for example, some antidepressants, antinausea medications, opioid pain killers, sedatives, antihistamines, sleeping pills).
After treatment for childhood cancer ends, talk with your child's doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your child's recovery for the coming months and years. All children treated for cancer should have life-long, follow-up care.
Many of the current treatments that are effective in curing childhood cancer are associated with short-term and long-term side effects. As most children with cancer are cured, long-term (lifelong) follow-up care is based on the dosage and specific chemotherapy drugs used in treatment, as well as the dosage of radiation therapy. Recommendations for follow-up care according to the risk of possible late effects of treatment have been developed by the Children's Oncology Group and can be found at CureSearch.org.
Based on the type of treatment the child received, the doctor will determine what examinations and tests are needed to check for long-term side effects and the possibility of secondary cancers. Your doctor can recommend the necessary screening tests. Follow-up care should also address the child's quality of life, including any developmental or emotional concerns. Learn more about Late Effects of Childhood Cancer.
The child's family is encouraged to organize and keep a record of the child's medical information, so that as the child enters adulthood, he or she has a clear, written history of the diagnosis and details of the treatment given. The doctor's office can help you compile this, and it should include recommendations from the doctor about the schedule for follow-up care. This information will be valuable to doctors who care for your child during his or her lifetime.
Children who have had cancer can also enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating a balanced diet, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child's needs.
New developments in childhood cancer occur often because many children are enrolled in clinical trials. The Childrens Oncology GroupChildhood Cancer Survivor Study conducts large clinical trials in most pediatric cancers. The Childhood Cancer Survivor Study conducts long-term, follow-up studies of successfully treated patients to define late effects of cancer and its treatment, so new clinical trials can be developed to avoid serious side effects. Other groups, including the Pediatric Brain Tumor Consortium and the New Approaches to Neuroblastoma Therapy Consortium, perform studies of investigational drugs to determine whether new therapies are safe and effective. The following developments are common to most types of cancer:
Reducing a child's exposure to radiation. Because children are at increased risk for experiencing developmental damage and secondary cancer from radiation therapy, doctors prefer to minimize radiation treatments whenever possible. To accomplish this goal, doctors are using multidrug chemotherapy after surgery and using new drug combinations, or they are using techniques that allow the radiation treatment to be focused only at the tumor and not the surrounding healthy tissue.
Better management of the side effects of chemotherapy and radiation treatment. For instance, a drug called pegfilgrastim (Neulasta) may help patients produce more white blood cells after radiation treatment and chemotherapy. Doctors are also studying chemoprotective drugs that may help protect the body from the harmful effects of chemotherapy, especially mucositis (mouth sores).
Regular communication with your child's doctor is important in making informed decisions about his or her health care. Consider asking the following questions of your child's doctor:
What exact type of cancer has been diagnosed?
What stage is the cancer? What does this mean?
How often do you treat my child's tumor type?
Who is part of the treatment team, and what does each team member do?
What treatment options are available?
What treatment do you recommend? Why?
What is the goal of this treatment?
What side effects, both in the short-term and long-term, are possible?
Candlelighters Childhood Cancer Foundation
3910 Warner St.
Kensington, MD 20895-0498
Toll Free: 800-366-2223
Phone: 301-962-3520 www.candlelighters.org
Children's Brain Tumor Foundation
274 Madison Ave., Ste. 1004
New York, NY 10016
Phone: 212-448-9494 www.cbtf.org
Children's Hospice International
901 N. Pitt St., Ste. 230
Alexandria, VA 22314
Toll Free: 800-24-CHILD (800-243-4453)
Phone: 703-684-0330 www.chionline.org
CureSearch
Children's Oncology Group
National Childhood Cancer Foundation
4600 East West Hwy., Ste. 600
Bethesda, MD 20814-3457
Toll Free:800-458-NCCF (6223) www.curesearch.org
Leukemia Research Foundation
2700 Patriot Blvd., Ste. 100
Glenview, IL 60026-8021
Phone: 847-424-0600 www.leukemia-research.org
Make-A-Wish Foundation
3550 N. Central Ave., Ste. 300
Phoenix, AZ 85012-2127
Toll Free: 800-722-WISH (9474)
Phone: 602-279-WISH (9474) www.wish.org
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