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Overview of Childhood Cancer

By

Kee Kiat Yeo

, MD, Harvard Medical School

Reviewed/Revised May 2023
VIEW PROFESSIONAL VERSION

In the United States, the overall incidence of cancer in children and adolescents has increased over time. From 1975 to 2022, rates increased by approximately 0.8 per 100,000 each year. However, death rates decreased from 1970 through 2019 by 71% in children (from 6.3 to 1.8 per 100,000) and by 61% in adolescents (from 7.2 to 2.8 per 100,000).

Despite improvements in survival rates, cancer remains a major cause of death among children. In the United States, cancer is the second most common cause of death among children 1 to 14 years old (surpassed only by accidents) and is the fourth most common cause of death among adolescents 15 to 19 years old.

Some of the most common cancers that occur in children or adolescents also occur in adults:

Cancers that occur only in children are

In contrast to many cancers that affect adults, cancers that occur mainly in children tend to be much more curable. Over 80% of children and adolescents with cancer survive at least 5 years. In the United States in 2018, it was estimated that there were approximately 500,000 adult survivors of childhood cancer (that is, they are adults who were first diagnosed with cancer before 20 years of age).

Complications of cancer treatment

Similar to cancer care in adults, doctors use a combination of treatments, including surgery Surgery for Cancer Surgery is a traditional form of cancer treatment. It is the most effective in eliminating most types of cancer before it has spread to lymph nodes or distant sites (metastasized). Surgery may... read more , chemotherapy Chemotherapy and Other Systemic Cancer Treatments Systemic treatments are those that have effects throughout the body rather than being applied directly to the cancer. Chemotherapy is a form of systemic treatment that uses drugs to kill cancer... read more , and radiation therapy Radiation Therapy for Cancer Radiation is a form of intense energy generated by a radioactive substance, such as cobalt, or by specialized equipment, such as an atomic particle (linear) accelerator. Radiation preferentially... read more . Immunotherapy Immunotherapy for Cancer Immunotherapy is used to stimulate the body's immune system against cancer. These treatments target specific genetic characteristics of the tumor cells. The genetic characteristics of tumors... read more (a newer type of treatment that uses the immune system to attack the cancer) and targeted therapy (medications that target specific parts of the cancer cells and destroy them) are being studied and are being used more often to treat cancer in children. However, because children are still growing, these treatments may have side effects that typically 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, cognitive development may not be normal. (See also Cancer Treatment Principles Cancer Treatment Principles Treating cancer is one of the most complex aspects of medical care. It involves a team that encompasses many types of doctors working together (for example, primary care doctors, gynecologists... read more .)

Children who survive cancer are also more prone to developing long-term consequences of chemotherapy, surgery, and radiation therapy, which may include

  • Infertility

  • Poor growth

  • Delayed or no puberty

  • Damage to the heart and other organs

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

  • Psychologic and social problems

  • Developmental or neurologic problems or both

Because such severe consequences are possible and treatment is complex, children with cancer are best treated in centers where experts have experience treating childhood cancers.

The risk of having a second cancer depends on the type of first cancer. The risk also depends on whether radiation therapy was used to treat the first cancer or what type of chemotherapy was used.

Care team for cancer treatment

The impact of being diagnosed with cancer and the intensity of the treatment can be overwhelming to the child and family. Maintaining a sense of normalcy for the child may be difficult, especially because the child may have to be hospitalized frequently and go to a doctor’s office or outpatient center for treatment of the cancer. It is common for parents to feel an overwhelming sense of stress as they struggle to continue to work, be attentive to siblings, and still attend to the many needs of their child who has cancer (see Chronic Health Problems in Children Chronic Health Problems in Children Severe illness, even if temporary, can provoke a great deal of anxiety in children and their families. Chronic health problems may persist for months or forever. They may be severe enough to... read more ). The situation is even more difficult when the child is being treated at a specialty center far from home.

Did You Know...

  • Rates of cancer cases in children in the United States are increasing, but survival rates have also significantly improved.

Children and parents need a pediatric treatment team to help manage this difficult situation. Pediatric doctors are doctors who specialize in the care and treatment of babies, children, and adolescents. The team should include the following:

  • Pediatric cancer specialists (pediatric oncologist and radiation oncologist)

  • Pediatric oncology nurse, a registered nurse who cares for and educates children who have cancer and their families

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

  • The primary care doctor (pediatrician)

  • Child life specialists, who work with children and families in hospitals and other settings to help them cope with the challenges of hospitalization, illness, and disability

  • 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 school liaison, who can also help the child and family interact with the teacher and school

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

Children who are newly diagnosed with cancer should be evaluated by a cancer genetics team for genetic mutations that can predispose people to cancer.

Many treatment teams also include a parent advocate. A parent advocate is another parent who had a child with cancer and who can offer guidance to families.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • American Cancer Society: If Your Child Is Diagnosed With Cancer: A resource for parents and loved ones of a child who has cancer that provides information about how to cope with some of the problems and questions that come up just after a child is diagnosed

  • American Cancer Society: Cancer Facts & Figures 2023: A resource providing details about specific types of cancers, including numbers of new cancer cases and deaths, survival statistics, and information about symptoms

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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