Fighting Childhood Cancer

Although childhood cancer is uncommon, it is the second leading cause of death among children aged 14 years and younger.  Between 1 and 2 children in every 10,000 under 15 years of age are diagnosed with cancer each year in the United States. One out of every 300 boys and 1 out of every 333 girls are expected to develop cancer before the age of 20.  Due to improvements in treatments, research and early diagnosis, death rates for many cancers in children have declined by more than 50%.  However, those who do survive cancer may have to live the rest of their lives with side effects of treatment.  Two out of every 3 children who survive cancer will have at least one chronic health condition.

What is childhood cancer?

Cancer happens when normal cells in a part of the body become out of control and grow quicker than normal.   These abnormal cells can form a lump or mass called a tumor, which can be benign or malignant. Malignant tumors can spread to other parts of the body and invade tissues to interfere with normal cell function.  Although benign tumors do not invade tissues, they can sometimes also cause problems. Besides forming tumors, cancers can also occur in the blood cells.  Unlike adult cancers, more than half of all childhood cancers are leukemia (a cancer of the blood) and brain tumors.  Some of the more common childhood cancers are described below.

§  Leukemia is the most common childhood cancer and is responsible for 30% of all cancers in children. It is a cancer in the sponge-like tissue called bone marrow, which is inside the large bones and produces blood cells that are important to fight off infections and important to overall health. 

§  Brain and other nervous system tumors are the second most common childhood cancers.  They make up 27% of all childhood cancers.

§  Lymphomas, including Hodgkin and Non-Hodgkin’s lymphomas, are the third most common childhood cancers.  It is a cancer of a part of the immune system and begins in the lymph tissues, such as the tonsils or spleen, and can spread to other parts of the body.  Non-Hodgkin’s lymphoma is more common than Hodgkin’s lymphoma in children.  They differ in the type of cancer cells that form the lymphoma.

§  Blastoma is a type of cancer in the precursors of cells, called “blasts,” that originate in the embryo or fetus.  Examples included neuroblastoma, nephroblastoma, and retinoblastoma.

o   Neuroblastoma makes up 7% of cancers in children and is a type of cancer in nerve cells.  It is more common in infants and younger children than older children.

o   Nephroblastoma or Wilms’ tumor occurs in 5% of all childhood cancers. It is a cancer of the kidney. It typically occurs in children at 2 to 5 years of age

o   Retinoblastoma is a type of cancer in the eye and occurs in 4% of cancers in children. It typically occurs in children at 2 years of age.

§  Sarcoma is a rare type of cancer that is developed from connective tissues, such as muscles, fat, blood vessels, and bone.

o   Rhabdomyosarcoma is at type of cancer of the muscles that move parts of our body.  It occurs in 3.5% of childhood cancers.

o   Osteosarcoma is a cancer that occurs in the bone and is most often seen in older children and teenagers.  Ewing’s sarcoma is one type of bone cancer.

What are causes of cancer in children?

In adults, many cancers are influenced by lifestyle or long exposure to the environment. However, this is unlikely in children and the causes of childhood cancer are mainly unknown.  Only a small portion are associated with genetic disorders.  It is likely that many cancers in children result from an abnormality in the early developmental process.

Can childhood cancer be found early?

It is difficult to detect childhood cancers early because many of presenting signs and symptoms are not specific.  These signs and symptoms often look like those presented in common childhood illnesses or injuries.  Most of the time, a child’s cancer is detected when the disease is already at its late stages. This is why it is important for children to have regular medical check-ups, and for parents to alert their doctors if their children have any unusual signs or symptoms that do not go away. 

Most common signs and symptoms

§  Excessive, rapid weight gain or loss

§  Frequent headaches, often with vomiting in the morning

§  Persistent, localized pain

§  Prolonged, unexplained fever or illness

§  Sudden eye or vision changes

§  Sudden tendency to bruise

§  Unusual lump or swelling

§  Unexplained paleness or loss of energy

How can childhood cancer be prevented?

Since there are no lifestyle-related factors and only a few environmental factors that are known to influence childhood cancer, it is hard to prevent a child from getting cancer.  It is very rare that children may inherit genes that increase their chances of getting certain types of cancer.  Children who survive a first cancer may have a slightly higher risk in getting a second cancer compared with children who never have had cancer.  This might be due to the type of the first cancer, prior exposure of radiation or chemotherapy, or an inherited gene. Below are a few ways that you can help reduce your child’s risk of getting certain types of cancer later in life:⁷

§  Adopt a healthy lifestyle.

o   Make sure your child has good eating habits.

o   Make sure he or she gets plenty of exercise to keep a healthy weight.

§  Avoid serious sunburns by protecting your skin from the sun.

o   Wear sunscreen with sun protective factor (SPF) 15 or higher and with UVA and UVB protection.

o   Make sure your child wears a hat with wide brim to shade face, head, ears, and neck and sunglasses that block both UVA and UVB rays.

o   Make sure he or she seeks shade, especially during midday hours, when UV rays are most intense.

o   Do not allow your child to use tanning beds or sunlamps because they also contain UV rays that are as dangerous as the UV rays from the sun.

§  Get vaccinated

o   Make sure that all of your child’s immunizations are up-to-date.

o   Recommended vaccines include hepatitis B, rotavirus, diphtheria, tetanus, pertussis, Haemophilus influenza, pneumococcal, poliovirus, measles, mumps, rubella, varicella, hepatitis A, meningococcal, and human papillomavirus (HPV).

§  Avoid smoking

o   Tobacco use may increase the risk of lung cancer.

o   Explain to your child why you do not want him or her to smoke.

o   Don’t expose your child to secondhand tobacco smoke because smoke from other people’s cigarettes may also cause lung cancer.

How is childhood cancer treated?

Although the overall frequency of cancer in children has slightly increased, survival rates have improved dramatically over the past years.  Many of these cancers can now be cured due to advancement in treatments and ongoing research.  Treatment is based on the types and/or stages of cancer and usually involves a combination of chemotherapy, surgery, and radiation.  Other treatments of childhood cancer include immunotherapy (use of the body’s immune system to fight cancer cells) and stem-cell transplantation.

Chemotherapy is the use of different drugs together to kill the cancer cells. It is the most widely used treatment for cancer.  Chemotherapy is more aggressive in children than in adults because children can tolerate the side effects of chemotherapy better than adults can.  The most common side from chemotherapy are fatigue, easy bruising or nose bleeds, decreased ability to fight infection, nausea, vomiting, diarrhea, painful mouth sores, hair loss, and red or itchy skin.  Another common treatment is surgery, which is the removal of cancer cells or tumor.  The goal of surgery is to remove the entire tumor and the tissues around the tumor.  Radiation is the use of high-energy x-rays or other particles to kill cancer cells. It is used more cautiously in children than in adults because of the delayed side effects of radiation, which can happen months to years after therapy.  Side effects of radiation are usually less intense than chemotherapy and depend on the area on the body being irradiated and how the therapy is performed.  The most common side effects of radiation are skin reactions, such as rash and skin irritations.  Other common short-term side effects, depending on the location of radiation, are nausea, diarrhea, painful mouth sores, fatigue, and hair loss. 

Is nutrition important during of cancer treatment?

Good nutrition is important for everyone, but especially for children undergoing cancer treatment.  However, malnutrition is common in children with cancer.  This may be due to side effects of cancer treatment.  The following are general steps to help improve oral intake during cancer treatment:

Loss of appetite

§  Offer your children small frequent meals or snacks throughout the day (6-8 meals/snacks per day)

§  Encourage drinks high in nutrients between meals

§  Offer your children their favorite nutritious foods when they are not having treatment

Nausea and vomiting

§  Feed your children 3 to 4 hours before treatment

§  Offer him or her small amounts of cold foods

§  Encourage slow eating

§  Do not give him or her foods that have strong odors

§  Offer clear liquids, such water, between meals

Mouth sores or pain

§  Have your child try soft or pureed bland foods or liquids for easier swallowing

§  Add butter, gravy, sauce or salad dressing to moisten foods that are dry or solid

§  Do not give him or her highly seasoned or hard, rough foods, such as chips or nuts

Changes in taste and smell

§  Do not give your child too much sweet food

§  Offer salty foods (if tolerated), such as hot dogs, pizza, or canned pasta

§  Have him or her try new flavors of foods

Where can I find more information on childhood cancer?

American Cancer Society (ACS)

Toll-free number: 1-800-227-2345

Web site: www.cancer.org

American Childhood Cancer Organization (ACCO)
Toll-free number: 1-800-366-2223
Web site: www.acco.org

Cure Search for Children's Cancer
Toll-free number: 1-800-458-6223
Web site: www.curesearch.org

National Cancer Institute
Toll-free number: 1-800-422-6237
Web site: www.cancer.gov

National Children’s Cancer Society

Toll-free number: 314-241-1600

Web site: www.beyondthecure.org

Written by: Hong-Yen Vi, PharmD candidate

University of Illinois at Chicago

October 2012