PEDIATRIC CANCER

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Overall, childhood cancer is relatively rare. In 2021 in the US, an estimated 10,500 children aged 0 to 14 years will be diagnosed with cancer and slightly over 1100 children will die of it. An estimated 5090 adolescents will be diagnosed with cancer and about 590 will die of it. In comparison, an estimated 1.9 million adults will be diagnosed with cancer and about 608,000 will die of it. However, cancer is the 2nd leading cause of death among children, following only injuries (1).

 

Childhood cancers include many that also occur in adults. Leukemia is by far the most common, representing about 28% of childhood cancers, brain tumors represent about 27%, lymphomas represent about 12%, and certain bone cancers (osteosarcoma and Ewing sarcoma—see Primary Malignant Bone Tumors) represent about 4% (1).

 

Cancers that are exclusive to children include (1)

 

Neuroblastoma (6% of cases)

Wilms tumor (5% of cases)

Rhabdomyosarcoma (3% of cases)

Retinoblastoma (2% of cases)

In the US in 2015, it was estimated that there were 429,000 adult survivors of childhood cancer (ie, first diagnosed before age 20; 2). Children who survive cancer have more years than adults to develop long-term consequences of chemotherapy, surgery, and radiation therapy, which include

 

Infertility

Poor growth

Cardiac damage

Development of second cancers (in 3 to 12% of survivors, varying with their initial cancer and type of treatment)

Psychosocial effects

Developmental and/or neurologic deficits

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, stage, and/or risk classification. 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.

 

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

 

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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