Pediatric Oncology

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 Pediatric Oncology


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What is Childhood Cancer Types of Childhood Cancer Cancer in T Teenager eenagerss and Young Adults Adults Statistics Risk Factors and Prevention Signs and Symptoms Diagnostic Diagnost ic T Tests ests Treatment Recurrent Childhood Cancer


Cancer is relatively rare in children. Most cancers (98%) develop in adults, especially in people past middle age. About one out of every six adults will develop cancer during his or her lifetime, while one in 300 boys and one in 333 girls will develop cancer before the age of 20. At the same time, however, there is a lot of  research going on to discover new treatments for childhood cancer. This ongoing research has greatly improved the overall survival rate for children with cancer, which is now approximately 80%.


Cancer begins when normal cells change and grow uncontrollably. In most types of cancer, these cells form a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, (can cerous, meaning it can spread to other parts of the body). In leukemia, a cancer of the blood that starts in the bone marrow, these abnormal cells rarely form a solid tumor, but instead crowd out other types of cells in the bone marrow. This prevents the production of normal red blood cells, other white blood cells, and platelets (the part of the blood needed for clotting).


Cancer in children most often forms in the parts of their bodies that are still growing and changing, such as their blood system, brain and nervous system, and kidneys. Most of the time, there is no known cause for childhood cancers. They may behave very differently from adult cancers.


Leukemia (accounts for about 34% of  Leukemia childhood cancer cases) 

Acute lymphoblastic leukemia (ALL)

Acute myeloid leukemia (AML)


Brain and central nervous system (CNS) tumors (27%), including tumors of the spinal cord         

Astrocytoma Brain stem glioma High-grade glioma Central nervous system Craniopharyngioma Desmoplastic infantile ganglioglioma Ependymoma Medulloblastoma Atypical teratoid rhabdoid tumor


Neuroblastoma (7%), a tumor of immature nerve cells that often starts in the adrenal glands, which are located on top of the kidneys and are part of the body’ body’ss endocrine (hormonal) system


Wilms Tumor (5%), a type of kidn kidney ey tumor


Non-Hodgkin lymphoma (4%) and Hodgkin lymphoma (4%), cancers that begin in the lymph system


Rhabdomyosarcoma (3%), a type of tumor Rhabdomyosarcoma that begins in the striated muscle, which are the skeletal voluntary muscles that people can control. Other, Other, rare soft tissue sarcomas also occur.


Retinoblastoma Retinobl astoma (3%), an eye tumor


Osteosarcoma (3%) and Ewing sarcoma (1%), tumors that begin in the bone


Germ cell tumors, rare tumors that begin in the testicles in boys and ovaries in girls. Even more rarely, rarely, this tumor can begin in other places in the body, including the brain.


Pleuropulmonary blastoma, a rare lung cancer that begins in the chest


Hepatoblastoma and hepatocellular carcinoma, which are liver tumors


There is an increasing amount of research regarding cancer in children diagnosed after the age of 14. As these children are starting to enter young adulthood, they may have unique medical, social, and emotional needs that are different from younger children with cancer. They are part of a group often called adolescents and young adults (AYA).


Most often, teenagers and young adults with cancer should be treated at a pediatric oncology center or at a center where medical oncologists (d (doctors octors who treat cancer with medication) and pediatric oncologists (doctors (docto rs who treat children with cancer) work together to plan treatment. This will ensure that they receive the newest treatments treatments and are cared for by a team of doctors who are familiar with these diseases. This is especially important for teenagers who have lymphoma, leukemia, and bone tumors, since treatment by specialists familiar with these diseases has been shown to improve survival.


Within the AY AYA group, group, there are are also patients patients who have cancers most commonly found in adults, as.melanoma, testicular ovariansuch cancer cancer. Teenagers with thesecancer, cancersand may receive treatments that are similar to adults, but they also need to receive ageappropriate support for their social and emotional needs. In either the pediatric or adult a dult care centers, age-appropriate information and support is very important for children and teens.


In general, cancer in children and teenagers is uncommon, accounting for less than 1% of all cancer cases in the United States. This year year,, an estimated 12,060 children (younger than 15) will be diagnosed with cancer in the United States.


Most children and teenagers diagnosed with cancer can be treated successfully. And, since 1969, the number of deaths from childhood cancer has decreased by 66%. However, cancer remains the second leading cause of  death in this age group, after accidents. It is estimated that 1,340 deaths from cancer will occur this this year.


Doctors and researchers don’t know what causes most childhood cancers. A small percentage of cancers can be linked to the genetic disorder Down syndrome, other inherited genetic abnormalities, and previous radiation treatment. Environmental causes (exposure to infectious and toxic substances) are unlikely to cause childhood cancer.


Because specific causes have not been found for each individual type of childhood cancer cancer,, the way to prevent childhood cancer is still unknown.


Cancer can be hard to detect in children. Children with cancer may experience the following symptoms or signs. Sometimes, children with cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.


Continued, unexplained weight loss Headaches, often with early morning vomiting Increased swelling or persistent pain in the bones, joints, back, or legs Lump or mass, especially in the abdomen, neck, chest, pelvis, or armpits Development of excessive bruising, bleeding,

or rash


Constant infections A whitish color behind the pupil Nausea that persists or vomiting without nausea Constant tiredness or noticeable paleness Eye or vision changes that occur suddenly and persist Recurring or persistent fevers of unknown



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Your child’s doctor may consider these factors when choosing a diagnostic test: Age and medical condition Type of cancer suspected Severity of symptoms Previous test results


Blood tests. Routine blood tests measure the number of different types of cells in a person’ss blood. Levels of certain cells that are person’ too high or too low can indicate the presence of cancer.


Biopsy. A biopsy is the removal of a small amount of tissue for examination under a

microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed depends on the location of the cancer. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating evaluating cells, tissues, and organs to diagnose disease).


Bone marrow aspiration. A bone marrow biopsy is the removal of a sample of bone

marrow marrow, , usually from the t he back of the hipbone, to with a needle. The patient is given medication numb the area beforehand and may be given conscious sedation (a type of anesthesia that uses pain relievers and sedatives so the patient is partially awake but does not feel any pain). People who receive conscious sedation are usually able to speak and respond during the procedure and may not have any memory of the procedure afterward.


Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a doctor takes a

sample of cerebrospinal fluid markers (CSF) to look for cancer cells, blood, or tumor (substances found in higher than normal amounts in the blood, urine, or body tissues of  people with certain kinds of cancer). CSF CSF is the fluid that flows around the brain and the spinal cord. Doctors generally give the child an anesthetic to numb the lower back before the procedure.


Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.


Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the

inside of the body with anthese x-ray images machine. Aa computer then combines into detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’ss vein to patient’ t o provide better detail. Specialized pediatric radiology centers are important for these tests, as such centers are aware of the potential risks of radiation exposure with these types of scans.


Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.


Positron emission tomography to mography (PET) scan. A PET scan is a way to create pictures of organs

and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.


Scans or radioisotope studies. In these procedures, a material (called (called a tracer) is injected into the body and then followed with a special camera or x-ray to see where the material goes. These studies can find abnormalities in the liver, brain, bones, kidneys, and other organs.


Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.


Positron emission tomography to mography (PET) scan. A PET scan is a way to create pictures of organs

and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.


Scans or radioisotope studies. In these procedures, a material (called (called a tracer) is injected into the body and then followed with a special camera or x-ray to see where the material goes. These studies can find abnormalities in the liver, brain, bones, kidneys, and other organs.


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Surgery  Surgery is the removal of the tumor, either cancerous or noncancerous, and surrounding tissue during an operation. Many children with a tumor will need surgery at some point during their treatment. A surgical oncologist is a doctor who specializes in treating a tumor using surgery. The goal of surgery is to remove the entire tumor and the margin (tissue around the tumor), leaving a negative margin (no cancer in the healthy tissue). For most childhood tumors, there is microscopic tumor left after

surgery, then doctors recommend chemotherapy, radiationand therapy, or otherwill treatments. Side effects of surgery depend on the location and type of the tumor and whether it has metastasized. Learn more about cancer surgery.


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Chemotherapy  Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is given by mouth or delivered through the bloodstream (injected into the vein, muscle,

spinal fluid, or under theby skin) to reachoncologist, cancer cellsa throughout body. body. in Chemotherapy is given a pediatric doctor who the specializes treating children with cancer. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. The side effects of chemotherapy depend on the individual and the dose used, but they can include increased risk of infection, increased riskside of  effects bleeding, nausea andfatigue, vomiting, loss of appetite, and diarrhea. These usually go away once treatment is finished. Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed prescribed for your child, their purpose, and their potential side effects or interactions with other medications. Learn more about your child’s prescriptions by using searchable drug databases.


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Radiation therapy  Radiation therapy is the use of high-energy x-rays or other particles such as photons to kill cancer cells. A doctor who

specializesoncologist. in giving radiation to type treatof cancer is called a radiation The mosttherapy common radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body body.. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy brachythe rapy.. A radiation therapy regimen usually 

consists of time. of a specific number of treatments given over a set period Side effects from radiation therapy may include fatigue, mild skin reactions, nausea, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy therapy..


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Immunotherapy  Immunotherapy (also called biologic therapy) is designed to boost the body’ body’ss natural defenses to fight the cancer cancer.. It uses materials made either by the body or in a laboratory to

bolster,, target, bolster or restore immune system function. Examples of immunotherapy include cancer vaccines, monoclonal antibodies, and interferons. Learn more about immunotherapy.


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Stem cell transplantation/bone marrow transplantation  A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called

hematopoietic stem cells.and Hematopoietic stem cells are found both in the bloodstream in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the blood stem cells that are typically being transplanted, not the actual bone marrow tissue. 

Before transplantation, will and talk consider with the patientrecommending and family about the risks of thisdoctors treatment several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health.  health.  


There are two types of stem cell transplantation depending depending on the source of  the replacement blood stem cells: allogeneic (ALLO)) and autologo (ALLO autologous us (AUTO (AUTO). ).


In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level; thisbrother testing or is called HLA-typing. patient’s sister serves as the Most donor,often, a although unrelated donors can serve as the donor, too. Millions of people worldwide have volunteered to donate stem cells for patients who do not have matched family members; your health care team will search a computer registry to look for a match. In addition, the use of stem cells derived from umbilical cord blood is sometimes conside considered red if family donors are not available.


In an AUTO transplant, the patient’ patient’ss own stem cells are used. The stem cells are obtained from the patient when he or she is in remission from previous treatment. The stem cells are then frozen until they are needed, usually after the high-dose chemotherapy (explained below) is completed.


In both types, the goal of transplantation is to destroy cancer cells in the marrow,, blood, and other parts of the body and allow replacement blood marrow stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system so that, in an ALLO ALLO transplant, transplant, the donor cells are not rejected by the body. body. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts from donor cells. Sometimes, ALLO ALLO transplants can also be performed afterare giving lower doses of chemotherapy and/or radiation therapy that still sufficient to suppress the immune system and allow growth of the donor cells. (These transplants, sometimes termed “mini“mini-transplants” or reduced intensity transplants, have less severe immediate side effects, allowing the procedure to be used for more fragile patients.)


For both ALLO and AUTO transplant types, the replacement cells engraft (begin to make new blood cells)tissue and turn healthy, bloodproducing in 10into days to three weeks. Destroying the patient’s own marrow reduces the body’s natural defenses, temporarily leaving the patient at an increased risk of infection. Until the patient’s immune immune system is back to normal, patients may need antibiotics and blood transfusions, and they need to follow certain safety restrictions provided by the health care team to help avoid infections.


In an ALLO transplant, another major risk is that the donor’s cells will recognize the patient’s body as foreign, causing graft-versus-host disease (GVHD). GVHD may be a serious complication of allogeneic transplants and can be fatal. Other side effects may include liver problems, diarrhea, infections, and rashes. However, GVHD can also be a benefit because the donor cells can recognize the cancer cells as foreign and destroy these cells, a mechanism that is one of the major reasons why ALLO transplantation generally works so well over the long term. The risk of  GVHD can be reduced with exact HLA-type matching and the use of preventive drugs.


In an AUTO AUTO transplant, there is little risk of  GVHD because the replacement stem cells are the patient’s own cells. However, there is a risk in an autologous transplant that some of the cells that are put back into the patient could still be cancerous. Learn more about bone marrow and stem cell transplantation.


If the cancer does return after the original treatment, it is called recurrent disease. It may come back in the same same place (call (called ed a local recurrence), nearby (regional recurrence), or in another place in the body (distant recurrence).


When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, your child’s doctor will talk with you about treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, chemotherapy , and radiation therapy) but may be used in a different combination combinati on or given on a different schedule. Your chil child’s d’s doctor may a also lso suggest clinical trials that are studying new ways to treat this type of recurrent cancer.


When cancer recurs, patients and their families often experience emotions such as disbelief or fear. fear. Families are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.



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