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Overview of Childhood Cancer

by David N. Korones, MD

Cancer is rare among children, occurring in only 1 of 5,000 children every year. The most common childhood cancers are leukemia (see see Overview of Leukemia), brain tumors, and lymphoma (see see Overview of Lymphoma). Leukemia is responsible for about 33% of cases of childhood cancer, brain tumors for about 21%, and lymphomas for about 8%. Some of the more common cancers that occur mainly in children are Wilms’ tumor, neuroblastoma, rhabdomyosarcoma, and retinoblastoma. Certain uncommon bone cancers–osteosarcoma and Ewing sarcoma (see see Primary Cancerous Bone Tumors)–occur most often in children and young adults.

In contrast to many adult cancers, cancers in children tend to be much more curable. Over 75% of children with cancer survive at least 5 years. Nonetheless, in the United States, cancer kills over 2,000 children each year. Only injuries kill more children annually.

As in adults, doctors use a combination of treatments, including surgery, chemotherapy, and radiation therapy. However, because children are still growing, these treatments may have side effects that do not occur in adults. For example, in children, an arm or a leg treated with radiation may not grow to full size. If the brain is treated with radiation, intellectual development may not be normal.

Children who survive cancer also have more years than adults to develop long-term consequences of chemotherapy and radiation therapy, which include

  • Infertility

  • Poor growth

  • Damage to the heart

  • Development of second cancers, which occur in 3 to 12% of children who survive cancer

Because such severe consequences are possible and treatment is complex, children with cancer are best treated in centers with expertise in childhood cancers.

The impact of being diagnosed with cancer and the intensity of the treatment are overwhelming to the child and family. Maintaining a sense of normalcy for the child is difficult, especially because the child has to be hospitalized frequently and go to a doctor’s office or outpatient center for treatment of the cancer and its complications. Overwhelming stress is typical, as parents struggle to continue to work, be attentive to siblings, and still attend to the many needs of the child with cancer (see see Illness in Children). The situation is even more difficult when the child is being treated at a specialty center far from home.

Did You Know...

  • In the United States, cancer kills 2,000 children a year.

A treatment team can help children and parents manage the difficult situation. The team should include the following:

  • Pediatric cancer specialists (pediatric oncologist and radiation oncologist)

  • Other needed specialists, such as a pediatric surgeon with expertise removing or biopsying childhood cancers, a pediatric radiologist with expertise reviewing imaging studies in children with cancer, and a pathologist with expertise diagnosing childhood cancers

  • The primary care doctor

  • A social worker, who can provide emotional support and help with financial aspects of care

  • A teacher, who can work with the child, the school, and the health care team to make sure that the child’s education continues

  • A psychologist, who can help the child, siblings, and parents throughout treatment

Many centers also include a parent advocate—a parent who had a child with cancer and who can offer guidance to family members.

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