Childhood Cancer

Childhood cancer describes a group of cancers that affect children ages 0 to 19. It includes pediatric cancers (affecting infants to children age 14) and adolescent cancers (affecting children age 15 to 19).

Approximately 15,000 children in the U.S. get diagnosed with cancer each year. Thanks to newer treatments tailored to their needs, more than 8 out of 10 kids are still alive five years later.

But childhood cancer treatment casts a long shadow. Your child will need lifelong care to keep tabs on the impact this disease can have on their health.

Types of childhood cancers

There are three groups of childhood cancers:

• Leukemias and lymphomas
• Brain and spinal cord tumors
• Solid tumors

Leukemias and lymphomas

Leukemia and lymphoma are blood cancers. Leukemia is the most common type of childhood cancer. It starts in your child’s bone marrow (where blood cells get made). Lymphoma starts in blood-forming cells in your child’s lymphatic system. It’s the third most common type.

The main types of childhood leukemias are:

• Acute lymphoblastic leukemia (the most common childhood cancer diagnosis)
• Acute myeloid leukemia

The most common childhood lymphomas are:

• Hodgkin lymphoma (especially nodular sclerosis and mixed cellularity Hodgkin lymphoma)
• Non-Hodgkin lymphoma (especially Burkitt lymphoma, diffuse large B-cell lymphoma, anaplastic large-cell lymphoma and lymphoblastic lymphoma)

Brain and spinal cord tumors

Brain and spinal cord tumors are the third most common type of childhood cancer. Pediatric brain cancers affect over 5,000 kids in the U.S. each year. They happen when cells that are a normal part of your child’s central nervous system transform into cancer cells. Types include:

• Choroid plexus carcinoma
• Embryonal tumor
• Ganglioglioma
• Glioma
• Medulloblastoma
• Pineoblastoma

Solid tumors

Solid tumors develop when cancerous cells divide, multiply and form masses. They can develop throughout a child’s body. Solid tumor childhood cancers include:

• Bone cancer, including osteosarcoma and Ewing sarcoma
• Germ cell tumor(may also be a type of brain tumor)
• Hepatoblastoma
• Neuroblastoma
• Retinoblastoma
• Rhabdomyosarcoma
• Wilms tumor

Symptoms of childhood cancer

Childhood cancer symptoms can look like symptoms of common childhood illnesses. After all, most kids experience headaches, stomachaches, and bumps and bruises that don’t mean cancer. Still, any symptom that lasts or gets 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 neck, chest, armpits, belly or pelvis
• D: Development of excessive bruising, bleeding or a 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 nausea
• C: Constant tiredness (fatigue) or noticeable paleness (pallor)
• E: Eye or vision changes that occur suddenly and persist
• R: Recurring or persistent fevers not associated with the flu or other common illnesses

Childhood cancer causes

Cancer happens when genes change (mutate) and create abnormal cells. The abnormal cancer cells make more copies that crowd out healthy cells. Without treatment, the cancer can spread (metastatic cancer).

In adults, genetic mutations usually happen with age and long-term exposure to carcinogens, like tobacco, ultraviolet light from the sun or workplace chemicals. That’s not typically the case with childhood cancer. Instead, mutations arise for reasons researchers are still trying to figure out. They may happen before or after your child’s born.

Cancer research has allowed healthcare providers to identify mutations in some childhood cancers. The mutations are usually different from those found in the adult versions of the same cancers. This information about gene changes may help your child’s provider choose the most effective treatment plan for your child.

Risk factors

Doctors do know that some inherited (genetic) disorders increase cancer risk. In the U.S., approximately 8 to 10 out of every 100 children with cancer have an associated genetic disorder.

Genetic disorders that increase childhood cancer risk include:

• Beckwith-Weidemann syndrome
• Familial adenomatous polyposis (FAP)
• Fanconi anemia (FA)
• Li-Fraumeni syndrome
• Noonan syndrome
• Von Hippel-Landau disease

It’s important to remember that not every child with these disorders develops cancer. But if your child has one of these conditions, their provider may recommend cancer screenings that detect cancer signs early.

How doctors diagnose childhood cancers

Healthcare providers use several tests to diagnose cancer, including:

• Blood tests. Blood tests check for irregularities in your child’s blood cells that may be signs of cancer.
• Imaging tests. These tests allow your child’s provider to see images of your child’s organs or tissue. Examples include CT scans, MRIs, PET scans and ultrasounds.
• Biopsy. A biopsy obtains samples of fluid or tissue. A pathologist examines the samples under a microscope to check for cancer cells.
• Bone marrow biopsy and bone marrow aspiration. These tests obtain a sample of bone marrow (where blood cells are made) to check for cancer.
• Lumbar puncture. This test checks your child’s cerebrospinal fluid (CSF) for cancer cells or tumor markers. CSF is the clear fluid that surrounds your child’s spine and brain.
• Genetic tests. These tests check for genetic mutations associated with specific childhood cancers. They may help your child’s provider choose the best treatments.

How are childhood cancers treated?

Childhood cancer treatments include:

• Chemotherapy. The most common childhood cancer treatment, chemotherapy uses drugs to kill cancer cells. Your child will get treatment in cycles. Cycles include treatment days and recovery days.
• Radiation therapy. This treatment uses a machine to deliver radiation that shrinks or destroys tumors. Or your child’s provider may implant a device that delivers radiation to a tumor.
• Stem cell transplant. This treatment may be an option if your child has leukemia or lymphoma. First, a provider uses high-dose chemotherapy to kill cancer cells. Then, your child will receive an infusion of healthy blood-forming cells from a donor.
• Surgery. Sometimes, surgeons are able to remove solid tumors completely. Other times, your child may need surgery alongside other treatments.
• Immunotherapy and targeted therapy. Immunotherapy helps your child’s immune system fight cancer better. Targeted therapy attacks cancer cell weaknesses that are related to specific gene mutations. As newer cancer therapies, these treatments may only be available in a clinical trial.

A clinical trial is a study that tests the effectiveness of new cancer treatments. They’re essential when it comes to fighting cancer. Your child’s provider may recommend taking part in one if other treatments haven’t helped enough. They may recommend getting both the clinical trial treatment and the standard treatment.

The goal is to give your child every opportunity to access the best care.

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 (no signs or symptoms of cancer) and you notice symptoms that may mean cancer is coming back

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

How curable is childhood cancer?

More than 8 out of 10 children with cancer in high-income countries with easy access to care 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, 9 out of 10 children with acute lymphoblastic leukemia attain remission (no more signs or symptoms of cancer).

It’s important to remember, though, that survival rates are estimates. They don’t reflect the unique factors that will impact your child’s experience. This is why it’s important to talk to your child’s healthcare provider about your child’s prognosis (likely future outcome). They’ll help you put this information into perspective.

What is the life expectancy of a childhood cancer survivor?

While childhood cancer is often curable, the impact of the disease may affect your child’s long-term health. According to a recent study, survivors of childhood cancer may have shorter lifespans than their peers. They’re more likely to experience health issues in adulthood. Issues include heart problems, hormone-related conditions and secondary cancers.

But not everyone’s risk is the same. Much depends on your child’s diagnosis and treatment. For example, stem cell transplants often cause late effects. Treatment with surgery and low-dose chemo is less likely to cause future issues.

Regardless, all childhood cancer survivors need long-term follow-up care. These follow-ups include regular tests to detect signs of late treatment effects.

Is there anything I can do to help 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 a child life specialist for ideas on talking about cancer to them.

As your child’s caregiver, be their full-time advocate. You know your child best. Take cues from them and be the support they need every step of the way.