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Overview of Pediatric Cancer

By

Renee Gresh

, Nemours A.I. duPont Hospital for Children

Last full review/revision Jul 2019| Content last modified Jul 2019
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Overall, childhood cancer is relatively rare, with fewer than 13,500 cases and about 1,500 deaths annually among children aged 0 to 14 years. In comparison, there are 1.4 million cases and 575,000 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 is by far the most common, representing about 33% of childhood cancers, brain tumors represent about 25%, lymphomas represent about 8%, and certain bone cancers (osteosarcoma and Ewing sarcoma—see Primary Malignant Bone Tumors) represent about 4%.

Cancers that are exclusive to children include

Currently, it is estimated that there are 350,000 adult survivors of childhood cancer in the United States. 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)

  • Psychosocial effects

Consensus guidelines on screening for and management of long-term consequences are available from the Children's Oncology Group.

Because of the severe consequences and complexity of treatment, children with cancer are best treated in centers with expertise in childhood cancers.

Treatment of childhood cancer depends on the type of cancer and stage. Common treatments include chemotherapy, surgery, radiation therapy, and stem cell transplantation. Immunotherapy is a newer type of treatment that helps the person's own immune system attack the cancer and may be helpful for certain childhood cancers. Different types of immunotherapy include monoclonal antibodies, oncolytic virus therapy, cancer vaccines, chimeric antigen receptor T-cell therapy (CAR T therapy), and bispecific T-cell engagers. The U.S. Food and Drug Administration (FDA) has recently approved the use of CD19 CAR T therapy for pediatric pre-B cell acute lymphoblastic leukemia.

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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