Childhood Cancer (Pediatric Cancer)

What is childhood cancer (pediatric cancer)?

Childhood or pediatric cancer describes a group of cancers that affect children (infants to age 14) and teenagers (age 15 to age 19). Childhood cancer isn’t common, but when it happens, it changes the lives of children with the condition, their parents and caregivers.

Thanks to newer treatments tailored to their needs, more than 80% of children and teenagers were alive five years after a cancer diagnosis. But childhood cancer treatment casts a long shadow. Survivors of childhood cancer have increased risk of second cancers and other medical conditions.

What are common childhood cancer types?

There are three groups of childhood cancers: leukemias and lymphomas, brain tumors and solid tumors. The American Cancer Society estimates that 415 in 1 million children and teenagers will learn they have one of these cancers in 2023.

Leukemias

Leukemias are the most common childhood cancer. The American Cancer Society estimates that in 2023, 53 children in 1 million and 35 teenagers in 1 million will learn they have leukemia. The two main types of leukemia in children and teenagers are:

• Acute lymphoblastic leukemia (ALL), which is cancer in your child’s blood and bone marrow. ALL affects the blood cells that help your child fight infection.
• Acute myeloid leukemia. There are different types of AML but they all affect your child’s blood cells and platelets.

Lymphomas

Lymphomas are cancers in your child’s lymphatic system. There are two lymphoma classes: Hodgkin lymphoma and non-Hodgkin lymphoma. In 2023, an estimated 53 children in 1 million and 22 teenagers in 1 million will learn they have lymphoma.

Hodgkin lymphoma

Hodgkin lymphoma is the most common cancer diagnosed in teenagers but it may affect younger children. Childhood Hodgkin lymphomas are:

• Nodular sclerosis Hodgkin lymphoma, which typically affects teenagers.
• Mixed cellularity Hodgkin lymphoma, which may affect children younger than age 10.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma is more common in teenagers than in children. Non-Hodgkin lymphomas in childhood cancers include:

• Lymphoblastic lymphoma.
• Burkitt lymphoma.
• Diffuse large B-cell lymphoma.
• Anaplastic large cell lymphoma.

Brain tumors

Brain tumors are the most common cancer affecting children and teenagers. Brain tumors can be benign (noncancerous) or malignant (cancerous). There are many types of brain tumors. In 2023, an estimated 33 children in 1 million and 21 teenagers in 1 million will be diagnosed with cancerous brain tumors.

Solid tumors

Solid tumors develop when cancerous cells divide, multiply and eventually bunch up into masses made of cancerous cells. Children and teenagers may develop solid tumors throughout their bodies. Other common solid tumor childhood cancers include:

• Neuroblastoma.
• Wilms tumor.
• Retinoblastoma.
• Bone cancer, including osteosarcoma and Ewing sarcoma.
• Rhabdomyosarcoma.

What are common childhood cancer symptoms?

Many childhood cancer symptoms may look like symptoms of everyday childhood illnesses. Most children experience headaches, stomachaches, bumps and bruises. In general, any symptom that lasts or seems to get worse is something you should discuss with your child’s healthcare provider.

The Childhood Oncology Group uses the acronym CHILDCANCER to list potential childhood cancer symptoms:

• C - Continued, unexplained weight loss.
• H - Headaches, often with early morning vomiting.
• I - Increased swelling or persistent pain in your child’s bones, joints, back or legs.
• L - Lump or mass, especially in your child’s belly (abdomen), neck, chest, pelvis or armpits.
• D - Development of excessive bruising, bleeding or rash.
• C - Constant, frequent or persistent infections.
• A - A whitish color behind the pupil of your child’s eye.
• N - Nausea that persists, or vomiting without having nausea.
• C - Constant tiredness (fatigue) or noticeable paleness.
• E - Eye or vision changes that occur suddenly and persist.
• R - Recurring or persistent fevers of unknown origin, meaning your child has a fever that’s not associated with the flu or other common illnesses. Fever in children is when their temperature is higher than 100.4 degrees Fahrenheit (38 degrees Celsius) (measured rectally); 99.5 degrees F (37.5 degrees C) (measured orally) or 99 degrees F (37.2 degrees C) (measured under their arm).

When are most childhood cancers discovered?

On average, children are 6 years old when they’re diagnosed with cancer. But childhood cancer may affect children and teenagers of all ages.

What causes childhood cancer?

Experts don’t know the exact cause of childhood cancer, but they’ve developed some theories that may help improve childhood cancer treatment.

All cancer happens when genes mutate and create abnormal cells. In adults, those mutations or changes happen as part of the aging process and/or exposure to carcinogens like tobacco, ultraviolet light from the sun or workplace chemicals. That’s not the case with cancer in children and teenagers.

The U.S. National Cancer Institute estimates 6% to 8% of children and teenagers with cancer have inherited (genetic) disorders that increase their cancer risk. Childhood cancer can also happen during fetal development or early infancy, when fast-dividing cells make mistakes that change DNA and cause genetic mutations that lead to cancer.

What are inherited disorders that increase cancer risk?

Research shows genetic mutations that drive certain inherited disorders also increase the risk of cancer. That said, not everyone with inherited disorders will have cancer. People with these disorders often benefit from having early cancer screening that may detect cancer signs before the condition causes symptoms. Inherited disorders that increase childhood cancer risk include:

• Beckwith-Weidemann Syndrome.
• Familial Adenomatous Polyposis (FAP).
• Li-Fraumeni Syndrome.
• Fanconi Anemia (FA).
• Noonan Syndrome.
• Von Hippel-Landau Disease.

How are childhood cancers diagnosed?

Healthcare providers may use several kinds of tests to diagnose cancer, based on factors like your child’s age, overall health and symptoms. Childhood cancer tests may include:

• Blood tests. Your child’s provider may do blood tests to diagnose conditions such as leukemia and lymphoma.
• Biopsy. Depending on your child’s situation, their provider may do a biopsy to obtain samples of tissue, fluid or growths that a medical pathologist will examine under a microscope.
• Bone marrow biopsy and bone marrow aspiration. These tests help providers detect issues in your child’s bone marrow, where their blood cells are made.
• Lumbar puncture. Providers use this test to get a sample of cerebrospinal fluid (CSF), the clear fluid that surrounds your child’s spine and brain, so they can look for cancer cells or tumor markers. Tumor markers are substances in CSF and other fluids that may be signs of cancer.
• Ultrasound. Ultrasounds use sound waves to create pictures of your child’s internal organs.
• CT scan (computed tomography scan). This test may help providers detect tumors.
• MRI (magnetic resonance imaging). This test uses magnets, radio waves and a computer to create images of the inside of your child’s body. It helps providers detect tumors.
• PET scan (positron emission tomography scan). Providers may combine this imaging test with CT scans to obtain images of your child’s organs and tissues.

Tests show my child has cancer. What should I tell my child?

Experts recommend being open and honest when you talk to your child about cancer. These will be tough conversations, but experts believe children with cancer benefit by knowing what’s wrong and what’s being done to help them. Older children and teenagers typically understand straightforward explanations. If your child is young, ask your child’s child life specialist for ideas on talking about cancer to young children.

How is childhood cancer treated?

Cancer treatment for children and teenagers is often different from treatment for adults. Pediatric oncologists are providers who specialize in childhood cancer diagnosis and treatment. Your child’s pediatric oncologist will develop a treatment plan based your child’s situation, including their age, the type of cancer they have, whether the cancer was caught early and treatment side effects.

Common childhood cancer treatments include:

• Chemotherapy.
• Radiation therapy.
• Stem cell (bone marrow) transplantation.
• Surgery.
• Immunotherapy.

As a parent or caregiver, you’ll need to give informed consent for any treatment your child receives. (Children and adolescents have a voice in this, of course, and teenagers ages 17 to 19 can consent to treatment.)

Take your time to understand how treatment may help your child, treatment side effects and treatment complications. Knowledge is power when it comes to childhood cancer treatment. Understanding treatment goals and side effects will help when you talk to your child about what happens after their diagnosis.

What are the side effects of childhood cancer treatments?

All cancer treatments cause side effects, but side effects vary depending on the treatment type and treatment approach. Regardless of treatment, you may want to consider palliative care. Palliative care can help ease your child’s symptoms and treatment side effects. A palliative care team can also help you understand your child’s treatment options and connect you with support groups.

What are the complications of childhood cancer treatments?

Thanks to newer treatments, children with cancer are living longer. Because they’re living longer, they’re more likely to experience late effects.

Late effects are health issues that surface months and years after diagnosis or treatment. These health issues may include second cancers, which are new and different cancers that develop long after they’ve completed cancer treatment. Late effects may have an impact on your child’s:

• Organs and tissues.
• Growth and development.
• Moods, feelings and mental health.
• Ability to think, learn and remember information.

In some cases, late effects may be life-threatening. Survivors of childhood cancer will need long-term follow-up care, including regular tests to detect signs of late effects.

Can childhood cancer be prevented?

No, it can’t. Healthcare providers and medical researchers don’t know exactly what causes childhood cancers, so it’s hard to say what you can do to keep your child from getting cancer. They do know some inherited disorders increase cancer risk. In those cases, providers may recommend early cancer screening to detect early cancers.

What are survival rates for childhood cancer?

Survival rates in childhood cancer vary depending on the cancer type. For example, 99% of children and 98% of teenagers treated for Hodgkin lymphoma were alive five years after diagnosis. Leukemias are the most common childhood cancers. Data show 88% of children and 76% of teenagers with this condition were alive five years after diagnosis.

If your child has cancer, keep in mind survival rates are estimates based on the experiences of children with the same cancer as your child. That may be all they have in common. What was true for those children may not be true for your child.

Likewise, survival rate estimates are based on data collected over several years. Your child may have a cancer type for which there are new and more effective treatments.

If your child has cancer, survival rates may help you understand what to expect. But they’re only one part of your child’s experience with cancer. Talk to your child’s provider if you’re concerned about survival rates. They’ll help you put survival rate information into perspective.

Are most childhood cancers curable?

According to the World Health Organization, more than 80% of children with cancer are cured. That data is based on the five-year survival rates for the most common childhood cancers.

The term “cure” may also apply when childhood cancer goes into remission. For example, 90% of children and 100% of teenagers treated for acute lymphoblastic leukemia attained remission. That means they don’t have cancer symptoms and tests don’t detect signs of cancer.

It’s natural to wonder if and hope that your child will be cured of cancer. Just like survival rates, your child’s provider is your best resource for information about your child’s situation.

How do I help my child live with cancer?

The best way to help your child is to understand how cancer and cancer treatment will affect their physical and emotional health. Apart from managing cancer symptoms and treatment side effects, children sometimes struggle with being different from their peers. If your child needs help coping with cancer challenges, ask their child life specialist about programs and services for children with cancer. For example, many organizations have cancer survivorship programs that support people throughout their experience with cancer.

When should I seek care for my child?

Seek care for your child if:

• They have cancer treatment side effects that are more intense than you expect.
• They’re in remission, and you notice symptoms that may mean cancer is coming back.

When should I take my child to the emergency room?

Rarely, cancer treatment and symptoms are medical emergencies. Your child’s provider will explain what symptoms are medical issues that need immediate care.

What questions should I ask my child’s healthcare provider?

A childhood cancer diagnosis is often shocking and frightening news. You may need time to process that news. When you’re ready, here are some questions you may want to ask your child’s provider:

• What kind of cancer does my child have?
• How advanced or severe is it?
• What treatments do you recommend?
• What are treatment side effects?
• Will treatments put cancer into remission?
• What are the chances cancer will come back?

What’s the difference between childhood cancer and cancer in adults?

All cancer happens when cells change (mutate), becoming cancerous cells. Research suggests children and adults develop different kinds of cancer. For example, more children than adults have leukemia and neuroblastoma. Children typically receive more intense cancer treatment than adults.

A note from Cleveland Clinic

Every year in the U.S., thousands of parents and caregivers hear the words, “Your child has cancer”. Increasingly, they also hear, “We can treat your child’s cancer, and we may be able to cure your child”. Thanks to newer treatments, more children and teenagers are surviving cancer. More parents and caregivers have hope their children will thrive. That said, many young survivors might experience late effects from childhood cancer and cancer treatment. Childhood cancer survivors will need lifelong follow-up medical support so providers can watch for and treat late effect issues.