September is Childhood Cancer Awareness Month

In the United States each year, more than 15,000 kids and young adults are diagnosed with cancer—that’s about 42 per day.

Though the 5-year-survival rate for childhood cancers has reached 80 percent, nearly 2,000 kids under age 19 die each year, making cancer the leading killer of children by disease.

In 2016, over 300,000 kids and young adults were diagnosed worldwide.

Childhood cancers are much different from adult cancers due to four specific obstacles and issues:

1) Adult cancers and children's cancers can not be treated with the same medicines.

2) Most federal research funding is dedicated to adult cancers. This leaves children's cancers with treatments that can be decades old and toxic, affecting a child development. Specialized treatments need to be developed for children.

3) For the most part the causes of childhood cancer are unknown. Research must be done to determine what causes these diseases in children.

4) Survivors of childhood cancer often suffer from lifelong damage to their organs causing additional medical issues.

The most common childhood cancers include neural and brain tumors, leukemia, lymphomas and sarcomas.

Brain & Neural Tumors

These types of cancer affect the brain or nervous system.

Brain Tumors

Brain tumors, tumors that grow inside the skull, are among the most common types of childhood cancer in the United States.

Treatment for children depends on where the tumor is and the type of cancer. The treatment can be different than adults and may include surgical tumor removal, chemotherapy or/and radiation.

Some late effects from treatment and tumor removal include seizures, hearing or vision loss or impairment, learning disabilities and more.

The 5-year survival rate can range anywhere from 30- 95 percent depending on the cancer type.

Neuroblastoma

Neuroblastoma, a cancer that forms in a child’s nerve tissue, can form in the adrenal glands, neck, chest or spinal cord. Sometimes, the disease can even start growing before a child is born. Nearly 90 percent of the time cases are diagnosed in children under 5 years old.

Treatment for this cancer includes surgery, radiation, chemotherapy, immunotherapy, stem cell transplant or a combination of all of them. Even if a child has no evidence of disease, they still need to go through all the treatment, which can take over a year.

Children who survive neuroblastoma can suffer from a variety of late effects including hearing loss, inner-ear damage, neurological disorders of the eye, infertility and more.

The 5-year survival rate for children with low-risk neuroblastoma is higher than 95 percent, but for children in the high-risk group, the 5-year survival rate can be as low as 40-50 percent. It has a long-term survival rate of only 15 percent.

Retinoblastoma

Retinoblastoma is a cancer which occurs in the retina of a child’s eye and most often affects kids who are under 6 years old. About 200 to 300 children are diagnosed with retinoblastoma each year in the U.S. Many families discover their child has retinoblastoma when the pupil of their child’s eye has a white glow seen in photographs.

Children with retinoblastoma may undergo laser surgery, radiation, chemotherapy or, in some cases, a child’s eye may be removed. They can also receive cryotherapy (freezing therapy) in conjunction with laser therapy and chemotherapy.

Late effects from treatment may include blindness, vision impairment, reduced kidney function, hearing loss, delays in growth development, increased risk of other cancers and more.

Currently, the 5-year survival rate for children with retinoblastoma is 97 percent. However, survival rates are lower in children whose cancer has spread.

Sources: U.S. National Library of Medicine, American Cancer Society, The New England Journal of Medicine, National Cancer Institute

Leukemia

Leukemia and other diseases of the blood and bone marrow may affect red blood cells, white blood cells and platelets.

Common types of leukemia found in childhood cancer are:

• Acute lymphoblastic leukemia (ALL): a fast growing form of leukemia that occurs when the bone marrow makes too many immature lymphocytes (a type of white blood cell).
• Acute myeloid leukemia (AML): a type of leukemia in which the bone marrow makes a large number of abnormal blood cells.
• Juvenile myelomonocytic leukemia: this type of leukemia forms when too many bone marrow stem cells become two types of white blood cells. Some of these cells never become mature white cells.
• Chronic mylegenous leukemia: a form of leukemia that occurs when too many bone marrow stem cells become a type of white blood cell called granulocytes. Some of these cells never become mature white cells.

Treatment for children with leukemia is tailored to each child, depending on their illness. Chemotherapy and radiation are often used. At times, a blood or marrow transplantation (BMT) may be recommended.

The 5-year survival rate is dependent on each type of leukemia. For children with ALL, it is more than 85 percent overall. For children with AML, the 5-year survival rate now ranges between 60-70 percent. For children with juvenile myelomonocytic leukemia, it is about 50 percent. Chronic types of leukemia have a 5-year survival rate of about 60-80 percent.

Sources: U.S. National Library of Medicine, American Cancer Society, National Cancer Institute

Lymphoma

Lymphoma, the third most common type of childhood cancer, forms in the lymph system which is part of the body’s immune system. There are two main categories of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. Doctors determine the type of lymphoma by looking at the cancer cells under a microscope.

Hodgkin Lymphoma

In Hodgkin lymphoma, a certain kind of cell — called the Reed-Sternberg cell — begins to reproduce uncontrollably. It’s the overabundance of this specific kind of cell that distinguishes Hodgkin lymphoma from non-Hodgkin lymphoma.

About 6 percent of childhood cancers are Hodgkin lymphoma and it’s most often found in adolescents ages 15 to 19.

Treatment for this cancer may include chemotherapy, radiation, targeted therapy, surgery or a combination of these options.

Non-Hodgkin Lymphoma

There are three main types of childhood non-Hodgkin lymphomas (NHL). The types are based on the cell type and size of the cancer:

• Lymphoblastic lymphoma (accounts for about 20 percent of childhood NHLs)
• Mature B-cell lymphoma, including Burkitt lymphoma/leukemia (about 51 to 62 percent of NHLs)
• Large cell lymphoma (about 10 percent of NHLs)

Non-Hodgkin lymphoma is more common than Hodgkin lymphoma in children up to age 14, with about 500 cases diagnosed in the U.S. each year.

Treatment for non-Hodgkin lymphoma depends on the type of lymphoma, and options may include chemotherapy, targeted therapy, surgery or stem cell transplant.

The 5-year survival rate for children and adolescents with Hodgkin lymphoma is 95 percent. The 5-year survival rate for non-Hodgkin lymphoma varies from 60 to over 90 percent depending on the type of lymphoma, the location and size of the tumor(s) and other factors.

With more children surviving lymphomas, doctors are now focused on finding safer, less toxic treatments to reduce the risk of late effects such as heart and cognitive issues, growth development and infertility.

Sources: American Cancer Society, Mayo Clinic and National Cancer Institute

Sarcomas

Sarcomas are cancerous tumors that develop in the soft tissue and bone.

Osteosarcoma

The most common bone cancer, osteosarcoma, tends to occur in teenagers. The cancer usually starts in osteoblasts, which are a type of bone cell that becomes new bone tissue.

Standard treatment for teens and children typically includes chemotherapy and/or radiation, surgery to remove a tumor, targeted therapy or samarium. Teenagers and children can also enter clinical trials to treat the disease.

Why we need better, safer treatments:

Children and teens who endure osteosarcoma treatment may suffer from late effects including secondary cancers, learning and memory problems, infertility, organ complications and more.

Survival rates for osteosarcoma patients vary depending on if the cancer has spread or not. If the cancer has spread beyond the main tumor, a child’s 5-year survival rates ranges from 15-30 percent, unless it has only spread to the lungs. In that case, the survival rate is 40 percent. If the cancer stays contained, the 5-year survival rates ranges from 60-80 percent.

Other Cancers

Childhood cancers can also be found in the liver, kidneys and gonads.

Liver Cancer

This cancer develops in the tissues of the liver, one of the largest organs in the body. There are two main types – hepatoblastoma and hepatocellular carcinoma.

Hepatoblastoma, the most common of the two types, is most often found in children under age 5. Hepatocellular carcinoma usually affects older children and adolescents.

Treatment for this cancer may include surgery, transplant, chemotherapy, radiation or a combination of these options. Because childhood liver cancer is relatively rare, the National Cancer Institute recommends that all patients be considered for a clinical trial.

Some late effects from treatment and tumor removal include problems with the heart, kidneys and nerves and hearing loss.

The 5-year survival rate for children with hepatoblastoma is 70 percent. The 5-year overall survival rate for children and adolescents with hepatocellular carcinomas is 42 percent, though the rate is dependent on the stage of the cancer and other factors.

Kidney Tumors

Wilms tumor, also known as nephroblastoma, is the most common type of kidney cancer in children, with about 650 cases diagnosed in the U.S. each year.

Treatment Wilms tumor may include surgery, chemotherapy, radiation or a combination of these options.

Some late effects from treatment and tumor removal include reduced kidney function, issues with the heart, lung or reproductive system and delayed development.

The 5-year survival rate for children with Wilms tumor is 90 percent, though the rate varies depending on factors such as the makeup of the tumor, age and stage of disease.

With more children surviving lymphomas, doctors are now focused on finding safer, less toxic treatments to reduce the risk of late effects such as heart and cognitive issues, growth development and infertility.

Germ Cell Tumors

Germ cells form as a fetus (unborn baby) develops. These cells are part of a male or female’s reproductive system, but sometimes they develop into tumors that are either malignant (cancerous) or benign (not cancerous).

Germ cell tumors can develop in the central nervous system, including the brain. They can also develop outside the brain; those tumors are called extracranial and can be grouped into two main types: gonadal or extragonadal.

Extracranial germ cell tumors make up about 3 percent of all childhood cancers for children under age 15. They are more common in adolescents ages 15 to 19, representing 14 percent of cancers for this age group.

Treatment for this cancer may include surgery and chemotherapy. Radiation may be used if the germ cell tumor is in the brain.

Some late effects from treatment and tumor removal include problems with the heart, kidneys, reproductive system and hearing.

The 5-year survival rate for children with germ cell tumors varies widely based on the type of tumor, location, stage, age of patient and other factors.

Overall, germ cell tumors are relatively rare in children, making it difficult for researchers to study and advance treatment options.

Sources: Children’s Oncology Group, National Cancer Institute, American Cancer Society