Childhood Cancer
New cases: An
estimated 10,730 new cases were expected to occur among children aged 0
to 14 years in 2009. Childhood cancers are rare, representing less than
1% of all new cancer diagnoses.
Deaths: An
estimated 1,380 deaths are expected to occur among children aged 0 to
14 years in 2009, about one-third of these from leukemia. Although
uncommon, cancer is the second leading cause of death in children,
exceeded only by accidents. Mortality rates for childhood cancer have
declined by 50% since 1975. The substantial progress in pediatric
cancer survival rates is attributable largely to improved treatments
and the high proportion of patients participating in clinical trials.
Early detection: Early
symptoms are usually nonspecific. Parents should ensure that children
have regular medical checkups and should be alert to any unusual
symptoms that persist. These include an unusual mass or swelling;
unexplained paleness or loss of energy; sudden tendency to bruise; a
persistent, localized pain; prolonged, unexplained fever or illness;
frequent headaches, often with vomiting; sudden eye or vision changes;
and excessive, rapid weight loss. According to the International
Classification of Childhood Cancer, childhood cancers include
Leukemia (32.7% of all childhood cancers), which may be recognized by bone and joint pain, weakness, bleeding, and fever
- Brain
and other nervous system(20.7%), which in early stages may cause
headaches, nausea, vomiting, blurred or double vision, dizziness, and
difficulty in walking or handling objects
- Neuroblastoma (6.9%), a cancer of the sympathetic nervous system that usually appears as a swelling in the abdomen
- Wilms tumor (4.8%), a kidney cancer that may be recognized by a swelling or lump in the abdomen
- Non-Hodgkin
lymphoma (4.3%) and Hodgkin lymphoma (3.6%), which affect lymph nodes
but may spread to bone marrow and other organs, and may cause swelling
of lymph nodes in the neck, armpit, or groin; weakness; and fever
- Rhabdomyosarcoma
(3.5%), a soft tissue sarcoma that can occur in the head and neck,
genitourinary area, trunk, and extremities, and may cause pain and/or a
mass or swelling
- Retinoblastoma (2.7%), an eye cancer that usually occurs in children younger than 4 years
- Osteosarcoma (2.7%), a bone cancer that often has no initial pain or symptoms until local swelling begins
- Ewing sarcoma (1.4%), another type of cancer that usually arises in bone, and most often occurs in adolescents.
Treatment: Childhood
cancers can be treated by a combination of therapies (surgery,
radiation, and chemotherapy) chosen based on the type and stage of
cancer. Treatment is coordinated by a team of experts, including
pediatric oncologists, pediatric nurses, social workers, psychologists,
and others who assist children and their families. Because these
cancers are uncommon, outcomes are more successful when treatment is
managed by a cancer center. If the patient is eligible, placement in a
clinical trial should also be considered.
Survival: For
all childhood cancers combined, 5-year relative survival has improved
markedly over the past 30 years, from less than 50% before the 1970s to
80% today, due to new and improved treatments. Rates vary
considerably, however, depending on cancer type. For the most recent
time period (1996-
2004), 5-year survival for
neuroblastoma is 70%; bone and joint, 71%; brain and other nervous
system, 74%; leukemia, 82%; non-Hodgkin lymphoma, 86%; Wilms tumor,
92%; and Hodgkin lymphoma, 96%. Survivors of childhood cancer may
experience treatment-related side effects. Late treatment effects
include
organ malfunction, secondary cancers, and cognitive impairments. The
Children’s Oncology Group (COG) has developed long-term follow-up
guidelines for screening and management of late effects
in survivors of childhood cancer. For more on childhood cancer management, see the COG Web site at: survivorshipguidelines.org.