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Overview of Pediatric Cancer

by David N. Korones, MD

Overall, childhood cancer is relatively rare, with fewer than 11,000 cases and about 1,500 deaths annually among children aged 0 to 14 yr. In comparison, there are 1.4 million cases and 565,000 deaths annually among adults. However, cancer is the 2nd leading cause of death among children, following only injuries.

Childhood cancers include many that also occur in adults. Leukemia (see Leukemias) is by far the most common, representing about 33% of childhood cancers, brain tumors represent about 21%, lymphomas (see Lymphomas) about 8%, and certain bone cancers (osteosarcoma and Ewing sarcoma—see Primary Malignant Bone Tumors) about 4%. Cancers that are exclusive to children include neuroblastoma (7% of cases), Wilms’ tumor (5%), rhabdomyosarcoma (3 to 4%), and retinoblastoma (3%).

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

  • Infertility

  • Poor growth

  • Cardiac damage

  • Development of second cancers (in 3 to 12% of survivors)

Consensus guidelines on screening for and management of long-term consequences are available from the Children’s Oncology Group at http://www.survivorshipguidelines.org/ .

Because of the severe consequences and complexity of treatment, 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 given the need for frequent hospitalizations and outpatient visits and potentially painful procedures. 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. The situation is even more difficult when the child is being treated at a specialty center far from home.

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