Overview of Pediatric Cancer

In the US, 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) (1 General references In the US, 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... read more ).

Cancer is a major cause of pediatric mortality. In the US, 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.

Many of the most common cancers that occur in children or adolescents also occur in adults. These include (1 General references In the US, 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... read more )

Cancers that occur exclusively in children include (1 General references In the US, 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... read more )

In the US in 2018, it was estimated that there were 483,000 survivors of childhood cancer (ie, first diagnosed before age 20; 4 General references In the US, 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... read more ). Children who survive cancer have more years than adults to develop long-term consequences of chemotherapy, surgery, and radiation therapy, which may include

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 Staging A diagnosis of cancer may be suspected based on history and physical examination but requires confirmation by biopsy and histopathologic examination. Sometimes the first indication is an abnormal... read more , grade, and/or risk classification. Common treatments include chemotherapy Chemotherapy Systemic cancer therapy includes chemotherapy (ie, conventional or cytotoxic chemotherapy), hormone therapy, targeted therapy, and immune therapy (see also Overview of Cancer Therapy). The number... read more , surgery Surgery for Cancer Surgery is the oldest effective cancer therapy. It can be used alone or in combination with other modalities (see also Overview of Cancer Therapy). The size, type, and location of the cancer... read more , radiation therapy Radiation Therapy for Cancer Radiation therapy can cure many cancers (see also Overview of Cancer Therapy), particularly those that are localized or that can be completely encompassed within a radiation field. Radiation... read more , and stem cell transplantation Hematopoietic Stem Cell Transplantation Hematopoietic stem cell (HSC) transplantation is a rapidly evolving technique that offers a potential cure for hematologic cancers ( leukemias, lymphomas, myeloma) and other hematologic disorders... read more .

Immunotherapy Immunotherapy of Cancer A number of immunologic interventions, both passive and active, can be directed against tumor cells. (See also Immunotherapeutics.) In passive cellular immunotherapy, specific effector cells... read more 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 Active Specific Immunotherapy A number of immunologic interventions, both passive and active, can be directed against tumor cells. (See also Immunotherapeutics.) In passive cellular immunotherapy, specific effector cells... read more , chimeric antigen receptor (CAR) T-cell therapy Passive Cellular Immunotherapy A number of immunologic interventions, both passive and active, can be directed against tumor cells. (See also Immunotherapeutics.) In passive cellular immunotherapy, specific effector cells... read more , and bispecific T-cell engagers. CD19 CAR T-cell therapy is used in pediatric pre-B cell acute lymphoblastic leukemia.

In addition, targeted therapy is another newer treatment approach that has been developed to target proteins that control how cancer cells proliferate and metastasize. These therapies typically target a specific genetic mutation and are the foundation of precision medicine. Several different kinds of targeted therapy are used in pediatric cancers with specific mutations. Some examples of targeted therapy include imatinib for the treatment of chronic myeloid leukemia and larotrectinib for the treatment of solid tumors with NTRK gene fusions.

Children who are newly diagnosed with cancer should be evaluated for a cancer predisposition syndrome by a cancer genetics team. A cancer predisposition syndrome is a germline genetic mutation that increases the chances of developing cancer at an earlier age compared to the risk for the general population.

The psychosocial impact of being diagnosed with cancer and the intensity of the treatment may be overwhelming to the child and family. Maintaining a sense of normalcy for the child is difficult, especially given the need for frequent hospitalizations, 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.