Childhood CancerLast Updated: August 06, 2008 This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/08 Overview
Cancer is relatively rare in children. Most cancers (98%) develop in adults, especially in people past middle age. About one out of every six adults will develop cancer during his or her lifetime, while about one out of every 330 children under age 20 will develop cancer. Cancer begins when cells in the body become abnormal and grow uncontrollably. In most types of cancer, these abnormal cells form a solid growth of tissue, called a tumor. In leukemia, a cancer of the blood and blood-forming organs that starts in the bone marrow, these abnormal cells rarely form a solid tumor, but instead crowd other types of cells in the bone marrow. This prevents the production of normal red blood cells, other white blood cells, and platelets (blood components needed for clotting). 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. In general, cancers that occur in children behave differently than cancers in adults. 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.
Cancer in teenagers and young adults 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 such adult cancers 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 support programs for their social and emotional needs. Learn more about Age-Specific Information. Below are the most common types of cancer in teenagers, ages 15 to 19. For more information on each type, select a name below.
Neuroblastoma, Wilms tumor, retinoblastoma, and ependymoma are uncommon in teenagers, accounting for less than 1% of cancers in teenagers when combined. Statistics Cancer, although uncommon in children and teenagers, is the second leading cause of death in children and adolescents. However, most children and teens diagnosed with cancer can be treated successfully. In 2009, an estimated 10,730 children (younger than 14) will be diagnosed with cancer in the United States. It is estimated that 1,380 deaths from cancer 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 people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of children with cancer is around 80%. The overall five-year survival rate of teenagers (ages 15 to 19) with cancer is 76%. For teenagers with cancers such as Hodgkin’s lymphoma, germ cell tumors, thyroid cancer, and melanoma, the five-year survival rate is 90% or greater. 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 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 2009 and the National Cancer Institute Surveillance Epidemiology and End Results (SEER) database. Find out more about basic cancer terms used in this section. Risk Factors and Prevention
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 the genetic disorder Down syndrome, other inherited genetic abnormalities, and previous radiation treatment. Environmental causes (exposure to infectious and toxic substances) are also suspected as a potential cause of some types of childhood cancer. Set up so doctors can learn more about risk factors, the Childhood Cancer Research Network is a study coordinated by the Children's Oncology Group and is intended to become a North American registry of childhood cancer. Once registered with the network, patients and families may be asked if doctors and researchers can contact them in the future to collect information for studies on genetic and environmental factors that may be connected to the development of childhood cancers. Because specific causes have not been identified for each individual childhood cancer, the way to prevent childhood cancer is still unknown. Symptoms
Cancer can be hard to detect in children. Children with cancer may experience the following symptoms. 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 on this list, please talk with your child’s doctor. Continued, unexplained weight loss Diagnosis
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:
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 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 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 patient is given medication to numb the area beforehand and may be given 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 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. 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. 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. Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. 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 body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. 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. To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed. Treatment
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, counselors, and physical and speech therapists, if needed. Special activities for kids with cancer may also be available. The treatment of childhood cancer depends on the type of cancer, the size and location of a tumor, whether the cancer has spread, and the child’s overall health. The following are general descriptions of treatments that may be used as part of a child’s treatment plan. 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 entire tumor and the margin (tissue around the tumor), leaving a negative margin (no trace of cancer in the healthy tissue). Sometimes, removing an entire tumor is not possible, and then doctors will recommend chemotherapy, radiation therapy, or other treatment. 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 information on staging and disease classification. The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, 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 may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Immunotherapy Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function. Examples of immunotherapy include cancer vaccines, monoclonal antibodies, and interferons. Stem cell transplantation/bone marrow transplantation A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because blood stem cells are typically what is being transplanted, not the actual bone marrow tissue. There are two types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level; this testing is called HLA-typing. Most often, a patient’s brother or sister serves as the donor, although unrelated donors can serve as the donor too. Millions of people worldwide have volunteered to donate stem cells for patients who do not have matched family members; matches can be made by searching a computer registry. In addition, a donation of stem cells derived from umbilical cord blood is sometimes considered if family donors are not available. In an AUTO transplant, the patient’s own stem cells are used. The stem cells are obtained from the patient when he or she is in remission from previous treatment. The stem cells are then frozen until they are needed, usually after the high-dose treatment (explained below) is completed. In both types, the goal of transplantation is to destroy cancer cells in the marrow, blood, and other parts of the body and have replacement blood stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system so that, in an ALLO transplant, the donor cells are not rejected by the body. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts from donor cells. Sometimes, ALLO transplants can also be performed after giving lower doses of chemotherapy and/or radiation therapy that are still sufficient to suppress the immune system and allow growth of the donor cells. (These transplants, sometimes termed “mini-transplants” or “reduced intensity transplants” have less immediate side effects, allowing the procedure to be used for older patients.) Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health. For both ALLO and AUTO transplant types, the replacement cells engraft (begin to make new blood cells) and turn into healthy, blood-producing tissue in two to three weeks. Destroying the patient’s own marrow reduces the body’s natural defenses, temporarily leaving the patient at an increased risk of infection. Until the patient’s immune system is back to normal, patients may need antibiotics and blood transfusions. In an ALLO transplant, another major risk is that the donor’s cells will recognize the patient’s body as foreign, causing graft-versus-host disease (GVHD). GVHD may be a serious complication of allogeneic transplants and can be fatal. Other side effects may include liver problems, diarrhea, infections, and rashes. However, GVHD can also be a benefit, in that the donor cells can recognize the cancer cells as foreign and destroy these cells, a mechanism that is one of the major reasons why ALLO transplantation generally works so well over the long term. The risk of GVHD can be reduced with exact HLA-type matching and the use of preventative drugs. In an AUTO transplant, there is little risk of GVHD because the replacement stem cells are the patient’s own cells. However, there is a risk in an autologous transplant that some of the cells that are put back into the patient could still be cancerous. Learn more by reading the Cancer.Net Feature series Understanding Bone Marrow and Stem Cell Transplantation. Recurrent childhood cancer Recurrent cancer is cancer that comes back after treatment. When cancer recurs, testing and treatment must begin again. Doctors will develop a new treatment plan based on a child’s individual circumstances. If treatment fails Although treatment is successful in the majority of childhood cancers, sometimes it is not. 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. Some children may be happier if they can arrange to attend school part-time or keep up other activities and connections. The child’s health-care team can help parents or guardians decide on an appropriate level of activity. 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. More information can be found in Caring for a Terminally Ill Child: A Guide for Parents. The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Cancer.Net has more information on Grieving the Loss of a Child. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment. Clinical Trials Resources
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 to prove that it is safe, effective, and possibly better than a standard treatment. Children 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. If a child is of an appropriate age, they may be asked to participate in a clinical trial. Parents and children decide to participate in clinical trials for many reasons. For some children, a clinical trial is the best treatment option available. Because standard treatments are not perfect, parents and children are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other parents/children 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, parents/children must complete a learning process known as informed consent. During informed consent, the doctor should list all of the options, so the parent/child 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 parent/child 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. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your child’s doctor about possible side effects of the specific treatments he or she will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health. Ask your child’s doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects your child experiences during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net’s section on Managing Side Effects, based on ASCO’s curriculum. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient. For more information on late effects or long-term side effects, please read the After Treatment section or talk with your child’s doctor. After Treatment
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, including cognitive (thought-process) and developmental side effects. These side effects can appear or change as a child grows older. As most children with cancer are cured, the schedule of long-term (life-long) 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 child’s 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 Childhood Cancer Survivorship. 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. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: After Treatment. Current Research
Research for childhood cancer is ongoing. New developments occur often because many children are enrolled in clinical trials. The Children’s Oncology Group Childhood Cancer Survivor Study conducts large clinical trials for most pediatric cancers. The Childhood Cancer Survivor Study conducts long-term, follow-up studies of successfully treated patients to determine the late effects of cancer and its treatment, so new treatments 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 drugs for specific types of cancer to determine whether new treatments are safe and effective. The following advances that may still be under investigation in clinical trials are common to most types of cancer and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your child’s doctor. Reducing a child’s exposure to radiation. Because children have an increased risk of developmental damage and secondary cancers from radiation therapy, doctors prefer to minimize radiation treatments whenever possible. To accomplish this goal, doctors may use chemotherapy with a combination of drugs after surgery or use new drug combinations. And, researchers are investigating new techniques that more precisely focus radiation treatment at the tumor and not the surrounding healthy tissue. Better management of the side effects of chemotherapy and radiation treatment. For example, 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). Additional information on areas of current research for a certain type of cancer can be found in the specific Cancer.Net Guide to Cancer for that cancer type. Questions to Ask the Doctor
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:
Patient Information Resources
American Brain Tumor Association Brain Tumor Society Candlelighters Childhood Cancer Foundation Children's Brain Tumor Foundation Children's Hospice International CureSearch Leukemia Research Foundation Make-A-Wish Foundation National Brain Tumor Foundation National Children's Cancer Society Neuroblastoma Children's Cancer Society Outlook: Life Beyond Childhood Cancer The Brain Tumor Foundation The Childhood Brain Tumor Foundation The Children's Cause for Cancer Advocacy The Leukemia & Lymphoma Society Sarcoma Alliance Sarcoma Foundation of America Starlight Starbright Children's Foundation View all of Cancer.Net's Patient Information Resources. |
