By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center
Cancer is scary. Regardless of their age, many people fear cancer more than other health problems and commonly associate cancer with death. But while the sense of dread associated with cancer is largely universal, the disease itself is actually different in children than in adults and pediatric cancer can be even more frightening to us as parents and family. The good news is that physicians and researchers for childhood cancer have made significant progress in the last generation and the future continues to look hopeful.
In adults, many cancers are preventable and result from environmental influences such as smoking, over-exposure to sunlight, improper diet and chemicals affecting a genetic predisposition to the disease. Adults may have other medical problems that make treatment more complicated or reduce their tolerance to therapy but children's cancers are genetically based. Because they are usually healthy otherwise, children are more tolerant of treatments. On the other hand, children's cancers are commonly more advanced when diagnosed.
Here's the bad news: more than 12,000 children are diagnosed with cancer annually and about 2,300 die from their cancers. One in 330 Americans is diagnosed with cancer before age 20. Some forms of childhood cancer remain resistant to treatment.
Now the good news: as many as 75 percent of children with cancer can now be cured. In particular, childhood leukemia, once considered a death sentence, is now cured more than 80 percent of the time. Death rates for children have improved faster than for any other age group - in fact, many treatments used for adults were first developed to treat pediatric cancer.
Screening is possible for some adult cancers: colon, breast, prostate, and cervix for example. Other cancers commonly cause symptoms early when the disease is localized. There is currently no effective screening for any childhood cancers.
The most common cancers seen in children affect structural tissues, the nervous system, the kidney and the blood. Osteosarcoma and Ewing's sarcoma are tumors of bone. They are typically detected when they become big enough to cause pain or are big enough to be felt by the patient. Rhabdomyosarcoma, a tumor of muscle, is usually apparent as it grows. Pediatric brain tumors have a peak occurrence between ages 5 and 10 but can occur in infants and adolescents. There are many different types of symptoms of brain tumors in children from headache to problems with balance or loss of function. Neuroblastoma, a tumor in the adrenal gland, may be felt as a mass in the abdomen or may spread to and affect another organ. Retinoblastoma arises in the eye and may cause crossed eyes or eye pain and vision disturbance. Leukemias often present with bleeding, bruising, infections, fevers, weakness and so on - symptoms not specific for cancer but enough for parents to realize something is wrong. Lymphoma typically shows up as very large groups of lymph nodes - and since enlarged lymph nodes are common in children this particular symptom can be particularly alarming to parents.
Children need special care when they have cancer. Treatment can be intense and frightening but children's cancer centers have many resources for patients and their families to help them cope and deal with the disease and treatment. At Penn State Children's Hospital for example, the Four Diamonds Fund (http://www.hmc.psu.edu/fourdiamonds/) is a major source of funding for research and support of children with cancer and their families. The division of Pediatric Hematology/Oncology has comprehensive support information on their website: http://www.hmc.psu.edu/hematology/homeguide/index.htm
Some children's cancers have standard treatments, but on occasion newer treatments are administered as part of clinical trials. Clinical trials are programs of treatment based on scientific study and are used in situations where the ideal treatment is not known. Participation in these clinical trials is very important for continued refinements in cancer treatment. Typically, doctors who treat children's cancers, pediatric oncologists, will be involved in these trials or have information about their availability. Information from the National Cancer Institute is available at http://www.cancer.gov/clinicaltrials
Scary as it is, the important message about cancer in children is there are some good treatment options available and progress is being made daily.