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COMMON CHILDHOOD CANCERS

Dr. Sarah Livelo 20 May 2022
COMMON CHILDHOOD CANCERS

While most cancers are typically seen in adults, children are not exempt from experiencing malignancies. Out of every 100,000 children, approximately 18 are diagnosed with cancer. This roughly translates to 400,000 kids with newly diagnosed malignancies per year. Lymphohematopoietic cancer affects 40% of cases; lymphomas and leukemias fall under this category. In the United States, cancer is one of the most common causes of death from disease in children.

Causes of Childhood Cancers

Unfortunately, most cases of pediatric malignancies are idiopathic (unknown). Numerous studies have not found a consistent cause for various types of cancer. However, about 5% are due to genetics (i.e., inherited from the family, or mutated genes). Specific genes may be passed down from generation to generation; sometimes, these genes are inactivated in previous generations but become activated by triggers. Research suggests that long-term exposure to certain substances in the environment, aging, or a combination of both can lead to the activation of genes that ultimately lead to cancerous growths. However, these specific triggers are difficult to pinpoint and isolate.

There are also syndromes and diseases that are closely linked to a higher chance of developing malignancies. Some examples of these genetic conditions include Down syndrome, Li-Fraumeni syndrome, neurofibromatosis, tuberous sclerosis, Beckwith-Wiedemann syndrome, and xeroderma pigmentosum.

Common Cancers in Children 0-1 year old

In this age group, blastomas are the most common. These are cancerous growths made up of fast-growing precursor cells. Also known as blasts, these cells have not fully differentiated into specific types of cells in the body, and thus are only found in fetuses and infants.

Neuroblastoma

Neuroblastomas are made up of neuroblasts, the precursor cells of neurons and other nerve cells in the body. There is no known specific cause for this type of cancer. Symptoms vary, depending on the location of the tumor. Some examples include weight loss, decreased appetite, fatigue, irritability, a swollen or painful stomach, masses in the neck or skin, leg numbness or weakness, bruising around the eyes, or bone pain.

Nephroblastoma / Wilms tumor

Nephroblastoma is the most common childhood cancer found in the abdominal area, as well as the most common kidney cancer in children. These tumors are made up of primitive kidney cells. Wilms tumor may be due to gene mutations that control how the kidney develops in infants, although only 1% of kids with this malignancy have relatives with the same condition. Some signs and symptoms include an abdominal mass, abdominal pain, tea-colored or bloody urine, fever, abnormal blood pressure, or anemia.

Retinoblastoma

Retinoblastoma is an uncommon eye cancer of the retina, mainly affecting kids aged 5 years and below. It is composed of retinal eye cells that continuously grow into a mass. Unlike other types of cancer, as much as 40% of cases can be traced back to genetics. Both eyes are affected by most patients. Sometimes, retinoblastoma can be suspected as early as the first few days of life-based on a physical examination of the eyes, wherein light directed on the eyes forms a white reflection when seen through a special medical scope.

Rhabdomyosarcoma

Rhabdomyosarcoma is the uncontrolled growth of precursor muscle cells. This may be found in various areas of the body, such as the head, neck, abdomen, or extremities. Unlike previously mentioned types of malignancies, this particular type may also be found in adolescents. Affected children may have an abdominal mass, changes in the eyes (blurring vision, protruding eyeballs, or swelling), or changes in the throat (difficulty swallowing or hoarseness).

Hepatoblastoma

Hepatoblastoma is one of the rare infant malignancies — among infants diagnosed with cancer, only 1% come from the liver. This type of cancer is usually seen in those 18 months old and below. Some signs and symptoms associated with hepatoblastoma include an abdominal mass, abdominal pain, decreased appetite or weight loss, diarrhea, fever, and irritability.

Medulloblastoma

Medulloblastoma is the most common brain cancer in children, usually found in the cerebellum. About 20-25% of pediatric brain tumors are medulloblastomas. Some studies have connected this type of cancer to childhood CMV infection, immune disorders during pregnancy, or a family history of Li-Fraumeni syndrome, Fanconi anemia, and Turcot syndrome. Most patients have morning headaches, nausea, vomiting, blurry vision, clumsiness, and problems with walking normally.

Common Cancers in Older Children

Leukemia

Leukemia is overall the most common childhood cancer. In this type of malignancy, the bone marrow produces too many immature white blood cells that fail to develop further. Over time, the bone marrow produces more immature cells as compared to mature red blood cells and white blood cells. This impairs the body’s immune system and makes it harder to distribute oxygen and nutrients throughout the body.

Unlike other malignancies, these immature immune cells can easily access blood vessels, and may be found in different organs, like the kidneys, ovaries, brain, and spinal cord. Signs and symptoms of leukemia are fever, recurring infections, easy bleeding, bruising, abdominal swelling, decreased appetite or weight loss, swollen lymph nodes, pallor, and easily getting tired.

Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma (NHL) is a familiar category of childhood cancers, affecting about 7% of pediatric cases, mostly teenagers. Similar to leukemia, NHL is due to excessive immune cells, in this case called lymphocytes. Unlike leukemia, these malignant cells are concentrated on lymphoid tissues that may be found throughout the body, such as the lymph nodes, abdomen, facial bones, and the spleen. Affected children may have a fever, night sweats, decreased weight, and lymph node masses. Lymphoma has many subtypes, each with its own set of specific symptoms.

Pediatric Gliomas

Gliomas are the most common category of pediatric CNS tumors (cancer of the brain and the spinal cord). These tumors are made up of glial cells, specialized nerve cells that support neurons in the brain. Studies show that genetics also plays a role in the development of gliomas.

There are different kinds of gliomas, such as ependymomas, astrocytomas, and brain stem gliomas. Because of this, patients may experience various symptoms, depending on what kind of glioma they have and how severe it is. In general, tumors that occupy space in the brain and spinal cord place additional pressure that the body can’t compensate for. This leads to symptoms like headache, nausea, vomiting, irritability, loss of appetite, delays in neurodevelopment, blurry vision, changes in behavior, problems with balance, and seizures.

Treatment Options in Childhood Cancer

Treating and managing pediatric malignancies may not be the same as in adult cancers. Fortunately, research through clinical trials and modern technology have increased childhood cancer survival rates from 60% to an average of 85-90%, although this may still differ depending on the type of cancer and the stage of diagnosis. Not all types of cancer are eligible for all these treatment options, and for some other types, a combination of therapies may be warranted. Oncologists and other specialists usually decide on the best treatment plan on a case-to-case basis.

There are two main types of treatment options in pediatric cancer: localized treatments and systemic treatments. Local treatments aim to treat at the specific tumor site, while systemic treatment involves administering medications that can circulate around the body.

Localized Treatments

Under local treatments, surgery is the most commonly known option. This often entails undergoing a major surgical procedure by trained specialists, using medical instruments to surgically remove the cancerous mass or tissue. Surgery may be done before or after other cancer therapies, while for certain types of cancers, surgery alone is sufficient for treatment.

Cryosurgery is a special procedure that makes use of a probe to deliver liquid nitrogen to the tumor, destroying these tissues through extreme cold. Examples of cancers that utilize cryosurgery include retinoblastoma, orbital tumors, and hepatic tumors. In contrast, radiofrequency ablation (RFA) uses intense heat to destroy malignant tissues. Cancers of solid organs like the liver and lungs may be treated with RFA.

In radiation therapy, specialized medical equipment is used to introduce ionizing radiation to the affected area, killing cancer cells or preventing their growth. This option may be used for brain tumors, head and neck tumors, and lymphomas. Sometimes, surrounding healthy tissue may also be affected, causing symptoms such as hair loss, skin changes, fatigue, and low blood counts.

Systemic Treatments

For systemic treatments, chemotherapy is the most frequently used choice. Cytotoxic drugs that prevent cell growth are introduced to the body to kill cancer cells. Unfortunately, most of these drugs do not specifically target cancerous tissue and may also affect healthy cells with quick growth rates. This leads to well-known side effects of chemotherapy, such as low blood counts, fatigue, nausea, vomiting, diarrhea, and hair loss.

Bone marrow transplants involves implanting healthy cells in charge of producing blood cells (hematopoietic stem cells), to replace cancers of the blood, such as lymphoma and leukemia. It is also known as hematopoietic stem cell transplantation (HSCT).

Immunotherapy

One of the newer treatment options for cancer is immunotherapy. It involves boosting and activating the body’s immune response, allowing these cells to target cancerous tissues and destroy them effectively. More research is underway to further refine immunotherapy for children.

Support for Children with Cancer

Children diagnosed with malignancy may experience a wide range of emotions when their condition is divulged to them, such as anxiety, sadness, and anger. Emotional and psychosocial support are also important aspects in the overall management of childhood cancer. Parents, guardians, relatives, and close friends may also need emotional guidance and support — online and offline communities are of particular benefit to these groups.

Side effects are common when undergoing therapy for cancer. Parents, guardians, and the medical team should pay attention to any signs and symptoms that may develop during and after the course of therapy. Adjustments to the treatment regimen may be needed if these side effects are severe or may make it difficult to complete the regimen.

Summary

Childhood cancers affect around 9,000 children per year. While some are genetic in nature, many malignancies are idiopathic in nature. For infants, blastomas are the most common cancers seen, while lymphomas and leukemias are seen more in older children. Various treatment options are available, including surgery, radiation therapy, chemotherapy, and immunotherapy. Continuous monitoring for any adverse effects and psychosocial support for both the child and their family should not be neglected and are part of the management of pediatric malignancies.

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About the Author:
Dr. Sarah Livelo is a licensed physician with specialty training in Pediatrics. When she isn't seeing patients, she delves into healthcare and medical writing. She is also interested in advancements on nutrition and fitness. She graduated with a medical degree from the De La Salle Health Sciences Institute in Cavite, Philippines and had further medical training in Makati Medical Center for three years.

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