Overview of Childhood Cancer
Cancer is rare among children. In the United States, there are fewer than 13,500 cases and about 1,500 deaths each year among children aged birth 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. About 33% of childhood cancers are leukemia. Some other cancers include brain tumors, lymphoma, and certain bone cancers (osteosarcoma and Ewing sarcoma of bone). About 25% of childhood cancers are brain tumors, about 8% are lymphomas, and about 4% are bone cancers.
Cancers that occur only in children are
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. Currently, it is estimated that there are 350,000 adult survivors of childhood cancer in the United States.
As in adults, doctors use a combination of treatments, including surgery, chemotherapy, and radiation therapy. Immunotherapy (a newer type of treatment that uses the immune system to attack the cancer) and targeted therapy (drugs 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 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. (See also Cancer Treatment Principles.)
Children who survive cancer also have more years than adults to develop long-term consequences of chemotherapy and radiation therapy, which include
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.
How often second cancers develop depends on what the first cancer was and on which chemotherapy drugs were used to treat the first cancer.
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 may have 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 Chronic Health Problems in Children). The situation is even more difficult when the child is being treated at a specialty center far from home.
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
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
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.