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Childhood cancer is
cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
in a child. About 80% of childhood cancer cases in high-income countries are being able to treat with modern treatments and good medical care. Yet, only 10% of children with cancer live in high-income countries where proper treatment and care are available. Children with cancer make up only about 1% of all cancer cases diagnosed globally each year. The majority of children with cancer are in low- and middle-income countries, where it is responsible for 94% of deaths among those under 15 years old. Because new cancer treatments are not easily available in these countries. For this reason, in low and mid-income countries, childhood
cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
is often ignored in control planning, contributing to the burden of missed opportunities for its diagnoses and management. Despite having better care, childhood cancer survivors are still at risk of recurrence and primary cancers. They also face challenges in education, income, and social support compared to the general population and their siblings. In the United States, an arbitrarily adopted standard of the ages used is 0–14 years inclusive, up to age 14 years 11.9 months. However, the definition of childhood cancer sometimes includes adolescents between 15 and 19 years old. Pediatric oncology is the branch of
medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
concerned with the diagnosis and treatment of cancer in children.


Signs and symptoms


Leukemia

This is the most common type of cancer during childhood, and
acute lymphoblastic leukemia Acute lymphoblastic leukemia (ALL) is a cancer of the Lymphocyte, lymphoid line of blood cells characterized by the development of large numbers of lymphoblast, immature lymphocytes. Symptoms may include feeling tired, pale skin color, fever, ...
(ALL) is most common in children. ALL usually develops in children between the ages of 1 and 10 (it could occur at any age). This type of cancer is more prevalent in males and white people. Signs & Symptoms: Frequent delayed diagnosis (early symptoms are nonspecific) * Generalized
malaise In medicine, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. It is considered a vague termdescribing the state of simply not feeling well. The word has exist ...
* Loss of
appetite Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to reg ...
* Low-grade fever *
Pallor Pallor is a pale color of the skin that can be caused by illness, emotional shock or stress, stimulant use, or anemia, and is the result of a reduced amount of oxyhaemoglobin and may also be visible as pallor of the conjunctivae of the eye ...
*
Petechia A petechia (; : petechiae) is a small red or purple spot ( 1 cm in diameter) and purpura (3 to 10 mm in diameter). The term is typically used in the plural (petechiae), since a single petechia is seldom noticed or significant. Causes Physical t ...
e   * Ecchymoses * Bone pain * Significant, unintended, and sudden weight loss Physical examination: * Significant
lymphadenopathy Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. In c ...
* Hepatosplenomegaly should raise suspicion for leukemia. Important: It is recommended that a
complete blood count A complete blood count (CBC), also known as a full blood count (FBC) or full haemogram (FHG), is a set of medical laboratory tests that provide cytometry, information about the cells in a person's blood. The CBC indicates the counts of white blo ...
is obtained (CBC) if any suspicious findings arise.


Central nervous system tumors

This is the second most common
malignancy Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not ...
diagnosed during childhood. Signs and Symptoms *
Ataxia Ataxia (from Greek α- negative prefix+ -τάξις rder= "lack of order") is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in e ...
* Other
gait Gait is the pattern of Motion (physics), movement of the limb (anatomy), limbs of animals, including Gait (human), humans, during Animal locomotion, locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on s ...
disturbances (
hydrocephalus Hydrocephalus is a condition in which cerebrospinal fluid (CSF) builds up within the brain, which can cause pressure to increase in the skull. Symptoms may vary according to age. Headaches and double vision are common. Elderly adults with n ...
due to aqueduct compression) * Cranial nerve abnormalities as a result of brainstem compression


Hodgkin's disease

The likelihood of developing Hodgkin's disease increases during childhood and it peaks in adolescence. Hodgkin's disease Signs and Symptoms * Painless mass in the neck * Persistent cough secondary to a mediastinal mass * ''L''ess commonly:
splenomegaly Splenomegaly is an enlargement of the spleen. The spleen usually lies in the left upper quadrant (LUQ) of the human abdomen. Splenomegaly is one of the four cardinal signs of ''hypersplenism'' which include: some reduction in number of circulat ...
or enlarged axillary or inguinal
lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...
s * Intermittent fever * Drenching night sweats * Loss of greater than 10 percent of total body weight. * Anorexia *
Fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...
* Pruritus * Persistent painless mass


Non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma is more common in older children, and it is less prevalent than Hodgkin's disease. Signs and Symptoms If the abdomen is affected * Abdominal pain *
Vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...
or
diarrhea Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration d ...
* Palpable mass and intussusception If mediastinum is affected * Severe dyspnea *
Superior vena cava syndrome Superior vena cava syndrome (SVCS), is a group of symptoms caused by obstruction of the superior vena cava ("SVC"), a short, wide vessel carrying circulating blood into the heart. The majority of cases are caused by malignant tumors within the me ...
If head and neck masses are affected * Palpable mass * Cranial nerve palsies * Nasal obstruction


Neuroblastoma

This cancer is an extracranial solid tumor commonly diagnosed in childhood. Signs and Symptoms * Dysfunction of the location of the primary tumor * Anorexia * Abdominal pain * Distention.


Wilms' tumor

This malignancy presents as an abdominal mass in a child. Signs and Symptoms * Abdominal pain * Gross hematuria *
Hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...
* Fever.


Malignancies of the musculoskeletal system

A tumor that arises in the
musculoskeletal system The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their Muscular system, muscular and Human skeleton, skeletal systems. ...
often presents as a mass, a painful extremity, or, occasionally, a pathologic fracture. Signs and Symptoms * Pain awakens a child at night * Significant extremity dysfunction (when trauma is not involved)


Genetic syndromes associated with cancer

The cause of
cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
is not yet well understood. Several chromosomal disorders and constitutional syndromes are associated with it.


Learning problems

Children with cancer are at risk for developing various cognitive or learning problems. These difficulties may be related to brain injury stemming from cancer itself, such as a
brain tumor A brain tumor (sometimes referred to as brain cancer) occurs when a group of cells within the Human brain, brain turn cancerous and grow out of control, creating a mass. There are two main types of tumors: malignant (cancerous) tumors and benign ...
or
central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
metastasis Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...
or from side effects of cancer treatments such as
chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...
and
radiation therapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a therapy, treatment using ionizing radiation, generally provided as part of treatment of cancer, cancer therapy to either kill or control the growth of malignancy, malignant cell (biology), ...
. Studies have shown that chemo and radiation therapies may damage the brain
white matter White matter refers to areas of the central nervous system that are mainly made up of myelinated axons, also called Nerve tract, tracts. Long thought to be passive tissue, white matter affects learning and brain functions, modulating the distr ...
and disrupt brain activity. This cognitive problem is known as post-chemotherapy cognitive impairment (PCCI) or "chemo brain." This term is commonly used by cancer survivors who describe having thinking and memory problems after cancer treatment. Researchers are unsure what exactly causes chemo brain, however, they say it is likely to be linked to either cancer itself, the cancer treatment, or be an emotional reaction to both. This cognitive impairment is commonly noticed a few years after a child endures cancer treatment. When a childhood cancer survivor goes back to school, they might experience lower test scores, problems with memory, attention, and behavior, as well as poor hand-eye coordination and slowed development over time. Children with cancer should be monitored and assessed for these neuropsychological deficits during and after treatment. Patients with brain tumors can have cognitive impairments before treatment and radiation therapy is associated with an increased risk of cognitive impairment.
Parents A parent is either the progenitor of a child or, in humans, it can refer to a caregiver or legal guardian, generally called an adoptive parent or step-parent. Parents who are progenitors are first-degree relatives and have 50% genetic meet. ...
can apply their children for special educational services at school if their cognitive learning disability affects their educational success.


Risk factors

Risk factors are any genetic or environmental exposure that increases the chances of developing a pathological condition. Some examples are age, family history, environmental factors, genetics, and economic status among others.


Demographic risk factors

* Childhood cancer varies by age, sex, ethnicity, and race. Its incidence peaks in
infancy In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to juveniles of ...
with about 240 cases/million/year. * This rate decreases to 128 cases per million from five–nine years of age, and it rises again to 220 cases/million. * Slight male dominance for most childhood cancers.


Environmental factors

* High dos
ionizing
radiation and prior chemotherapy are accepted causes of childhood cancer, each raising risk severalfold (4-7).


Genetic factors

Identified Cancer Predisposition Syndromes * Li-Fraumeni syndrome (TP53) * Hereditary breast or ovarian cancer (BRCA ) * Colorectal cancer/polyposis syndromes * Familial retinoblastoma (RB1) * Familial and genetic factors are identified in 5-15% of childhood cancer cases. In <5-10% of cases, there are known environmental exposures and exogenous factors, such as prenatal exposure to
tobacco Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
,
X-ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...
s, or certain medications. In turn citing: * * For the remaining 75-90% of cases, however, the individual causes remain unknown. In most cases, as in
carcinogenesis Carcinogenesis, also called oncogenesis or tumorigenesis, is the formation of a cancer, whereby normal cell (biology), cells are malignant transformation, transformed into cancer cells. The process is characterized by changes at the cellular, G ...
in general, the cancers are assumed to involve multiple
risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...
s and variables. In turn citing: > Aspects that make the risk factors of childhood cancer different from those seen in adult cancers include: *Different, and sometimes unique, exposures to environmental hazards. Children must often rely on adults to protect them from toxic environmental agents. *Immature physiological systems to clear or metabolize environmental substances *The growth and development of children in phases known as "developmental windows" result in certain "critical windows of vulnerability". Also, a longer life expectancy in children allows for a longer time to manifest cancer processes with long latency periods, increasing the risk of developing some cancer types later in life. Advanced parental age has been associated with an increased risk of childhood cancer in the offspring. There are preventable causes of childhood malignancy, such as delivery overuse and misuse of ionizing radiation through computed tomography scans when the test is not indicated or when adult protocols are used.


Diagnosis


Types

The most common childhood cancers (birth-14 years old) are
Leukemia Leukemia ( also spelled leukaemia; pronounced ) is a group of blood cancers that usually begin in the bone marrow and produce high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or '' ...
(28%), central nervous system tumors (27%), and Lymphomas (12%). In 2020-2022, 1.9 per 100,000 children died from cancer. In 2005, 4.1 of every 100,000 young people under 20 years of age in the U.S. were diagnosed with leukemia, and 0.8 per 100,000 died from it. The number of new cases was highest among the 1–4 age group, but the number of deaths was highest among the 10–14 age group. In 2005, 2.9 of every 100,000 people 0–19 years of age were found to have cancer of the brain or central nervous system, and 0.7 per 100,000 died from it. These cancers were found most often in children between 1 and 4 years of age, but the most deaths occurred among those aged 5–9. The main subtypes of brain and central nervous system tumors in children are: astrocytoma, brain stem glioma,
craniopharyngioma A craniopharyngioma is a rare type of brain tumor derived from pituitary gland embryonic tissue that occurs most commonly in children, but also affects adults. It may present at any age, even in the prenatal and neonatal periods, but peak inciden ...
, desmoplastic infantile
ganglioglioma A ganglioglioma is a rare, slow-growing primary central nervous system (CNS) tumor which most frequently occurs in the temporal lobes of children and young adults. They are mixed cell tumors containing both neural ganglionic cells and neural gli ...
, ependymoma, high-grade
glioma A glioma is a type of primary tumor that starts in the glial cells of the brain or spinal cord. They are malignant but some are extremely slow to develop. Gliomas comprise about 30% of all brain and central nervous system tumors and 80% of ...
, medulloblastoma and atypical teratoid rhabdoid tumor. Other, less common childhood cancer types are: * Neuroblastoma (6%,
nervous system In biology, the nervous system is the complex system, highly complex part of an animal that coordinates its behavior, actions and sense, sensory information by transmitting action potential, signals to and from different parts of its body. Th ...
) * Wilms tumor (5%,
kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...
) *
Non-Hodgkin lymphoma Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredn ...
(4%, blood) * Childhood rhabdomyosarcoma (3%, many sites) *
Retinoblastoma Retinoblastoma (Rb) is a rare form of cancer that rapidly develops from the immature cells of a retina, the light-detecting tissue of the eye. It is the most common primary malignant intraocular cancer in children, and 80% of retinoblastoma cas ...
(3%, eye) *
Osteosarcoma An osteosarcoma (OS) or osteogenic sarcoma (OGS) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchyme, mesenchymal origin (and thus a sarcoma) and that exhi ...
(3%,
bone cancer A bone tumor is an neoplastic, abnormal growth of tissue in bone, traditionally classified as benign, noncancerous (benign) or malignant, cancerous (malignant). Cancerous bone tumors usually originate from a cancer in another part of the body su ...
) * Ewing sarcoma (1%, many sites) *
Germ cell tumor A germ cell tumor (GCT) is a neoplasm derived from primordial germ cells. Germ-cell tumors can be cancerous or benign. Germ cell tumors typically originate from the gonads (ovary and testis), but can arise in other areas of the body. Extragon ...
s (5%, many sites) * Pleuropulmonary blastoma (lung or
pleural cavity The pleural cavity, or pleural space (or sometimes intrapleural space), is the potential space between the pleurae of the pleural sac that surrounds each lung. A small amount of serous pleural fluid is maintained in the pleural cavity to enabl ...
) * Hepatoblastoma and hepatocellular carcinoma ( liver cancer) * Juvenile myelomonocytic leukemia


Medical specialties

Overall, treating childhood cancer requires a multidisciplinary team of doctors, nurses, social workers, therapists, and other community members. Here is a brief list of doctors that can treat childhood cancer: *''Pediatric oncologist'': These doctors specialize in treating childhood cancers. *''Pediatric hematology-oncologist:'' These doctors specialize in treating blood diseases in children. *''
Pediatric surgeon Pediatric surgery is a medical specialty, subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults. History Pediatric surgery arose in the middle of the 1879 century as the surgical care of birt ...
'': These doctors specialize in performing surgery on children. *''Adolescent and young adult oncology (AYA)'': AYA is a branch of medicine that deals with the prevention, diagnosis, and treatment of cancer in adolescents and young adults, often defined as those aged 13–30. Studies have continuously shown that while pediatric cancer survival rates have gone up, the survival rate for adolescents and young adults has remained stagnant. Additionally, AYA helps patients with college concerns, fertility, and a sense of aloneness. Studies have often shown that treating young adults with the same protocols used in pediatrics is more effective than adult-oriented treatments. Other specialties that can assist the treatment process include radiology, neurosurgery, orthopedic surgery, psychiatry, and endocrinology.


Treatment

Childhood cancer treatment is individualized and varies based on the severity & type of cancer. In general, treatment can include surgical resection,
chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...
,
radiation In physics, radiation is the emission or transmission of energy in the form of waves or particles through space or a material medium. This includes: * ''electromagnetic radiation'' consisting of photons, such as radio waves, microwaves, infr ...
therapy, or immunotherapy. Recent medical advances have improved our understanding of the genetic basis of childhood cancers. Treatment options are expanding, and
precision medicine Precision, precise or precisely may refer to: Arts and media * ''Precision'' (march), the official marching music of the Royal Military College of Canada * "Precision" (song), by Big Sean * ''Precisely'' (sketch), a dramatic sketch by the Eng ...
for childhood cancers is a rapidly growing area of research. The
side effects In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually used ...
of chemotherapy can result in immediate and long-term treatment-related comorbidities. For children undergoing treatment for high-risk cancer, more than 80% experience life-threatening or fatal toxicity as a result of their treatment.


Psychosocial Care

Psychosocial care of children with cancer is also important during the cancer journey, but the implementation of evidence-based interventions need to be further spread across pediatric cancer centers. In general, psychosocial care can include therapy with a psychologist or psychiatrist, referral to a social worker, or referral to a pastoral counselor. Family-centered psychosocial care is one approach that can be used to not only support the patient's psychosocial well-being but also support the parents and any caregivers of the patient.


Play Therapy

One type of psychosocial care for children with cancer is play therapy, which means that the child is using an essential part of childhood to increase mental and physical well-being while reducing the negative emotions that come from being in the hospital. Children need to engage in play, even if they are in a hospital. Some types of play therapy use distraction tactics for intervening on anxiety, while also allowing children to communicate their feelings by reflecting on abilities and emotions that they are using as they adapt to the new environment of the hospital. There are multiple types of play therapy, including medical play, pretend play, or direct play. Medical play reduces anxiety and stress by using medical tools or equipment to explain fears of treatments, procedures, and hospital settings''.'' Other types of play therapy include drawing therapy, painting therapy, puzzle therapy, and storytelling. Drawing, painting, storytelling, and puzzle play therapy are relaxing techniques that do not take too much energy from the patient, so they can avoid fatigue while also engaging in psychosocial and mental development, and creativity. Further, these are accessible types of therapy for children as they are easy to engage in, affordable, and liked by children. Drawing, painting, puzzle therapy, and storytelling as play therapy techniques all help to reduce anxiety and fear in a hospital setting, which also helps to increase cooperative behavior in children with cancer. Play therapy is effective not only for just the children but also for improving relationships between hospital staff and children. Improving this relationship can lead to children being more open about their fears and anxieties and help them gain a sense of independence. In children with Leukemia, it has been found that play therapy decreases adverse psychosocial outcomes, like pain and fatigue.


Family Therapy

Family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and ...
is important because it allows for bonding time within a family, which can increase social support for both the patient and the family. Family therapy is child-parent interaction based, giving the family time to have conversations and understand what they are feeling. Parents are able to be supported in having conversations about treatment or medical conditions, where they may have had trouble beforehand. By incorporating care for each member, families are better able to reach a state of life that was similar to the one before a diagnosis. Starting therapy at diagnosis before treatment can be more beneficial because it will also act as a preventative measure. The time of diagnosis is when families tend to be most stressed and carry the most negative emotions. Family therapy can be used for all ages. Children at younger ages can benefit from play therapy and children at older ages need more communication-based therapy. Overall, family therapy can improve the quality of life of children with cancer and improve mental health. It can also alleviate the effects of depression, anxiety, and poor quality of life that other family members have.


Palliative Care

Aspects such as pain, fatigue, nausea and vomiting, and anxiety were improved in children with the use of specialty
palliative care Palliative care (from Latin root "to cloak") is an interdisciplinary medical care-giving approach aimed at optimizing quality of life and mitigating or reducing suffering among people with serious, complex, and often terminal illnesses. Man ...
. Children's overall quality of life improved, with some experiencing fun events towards the end of life. Families gained positive satisfaction from these programs.


Prognosis

With the advancement of new treatments for childhood cancer, 85% of individuals who had childhood cancer now survive five years or more. This is an increase from the mid-1970s when only 58% of children with childhood cancer survived five years or more. However, this survival rate is dependent on many factors such as the type of cancer, age of onset, location of the cancer, cancer stage, and if there is any genetic component to cancer. Survival rate is also impacted by socioeconomic status and access to resources during treatment. Since adult survivors of childhood cancer are living longer, these individuals may experience long-term complications that are associated with their cancer treatment. This can include problems with organ function, growth and development, neurocognitive function and academic achievement, and risk for additional cancers. Premature
heart disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina pectoris, angina, myocardial infarction, heart attack), heart failure, ...
is one example of a major long-term consequence seen in adult survivors of childhood cancer. These individuals are eight times more likely to die of heart disease than other people, and up to one quarter of the children treated for cancer develop some type of cardiac abnormality, mainly left ventricular systolic dysfunction although this may be asymptomatic or too mild to qualify for a clinical diagnosis of heart disease. Survivors of childhood cancer, previously treated with anthracycline
chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...
(including mitoxantrone) or
radiotherapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a treatment using ionizing radiation, generally provided as part of cancer therapy to either kill or control the growth of malignant cells. It is normally delivered by a linear particle ...
in which the heart was exposed, are at increased risk of
cardiomyopathy Cardiomyopathy is a group of primary diseases of the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. A ...
. Childhood cancer survivors are also at risk of sustaining adverse effects on the kidneys and the liver. Specific cancer treatments such as cisplatin, carboplatin, and radiotherapy are known to cause kidney damage. The risk of liver damage is increased in those who have had radiotherapy to the liver and in those with other risk factors, such as a higher body mass index or chronic viral
hepatitis Hepatitis is inflammation of the liver parenchyma, liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), Anorexia (symptom), poor appetite ...
. Certain treatments and liver surgery may also increase the risk of adverse liver effects in childhood cancer survivors. To help monitor for these long-term consequences, a set of guidelines has been created to facilitate long-term follow-up for childhood, adolescent, and young adult cancer survivors. This guides healthcare professionals on providing high-quality follow-up care and appropriate monitoring. These guidelines also help healthcare providers collaborate with oncology specialists to create recommendations specific to an individual patient.


Quality of Life in Survivors

Usually, Quality of Life improves with time since diagnosis, especially for children with solid tumors and hematological malignancies. Children with a CNS tumors, on the other hand, show little or no improvement over time. Quality of Life is often measured both during and after treatment, but international comparisons of both outcomes and predictors are hindered by the use of a large number of different measurements. Recently, a first step for a joint international consensus statement for measuring Quality of Life in survivors of childhood cancer has been established.


Epidemiology

Epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...
is the study of the distribution and determinants of disease frequency in the human population and the study of how to control health problems. Internationally, the greatest variation in childhood cancer incidence occurs when comparing high-income countries to low-income ones. In turn citing: This may result from differences in being able to diagnose cancer, differences in risk among different ethnic or racial population subgroups, as well as differences in
risk factors In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often ...
. An example of differing risk factors is in cases of pediatric
Burkitt lymphoma Burkitt's lymphoma is a cancer of the lymphatic system, particularly B lymphocytes found in the germinal center. It is named after Denis Parsons Burkitt, the Irish surgeon who first described the disease in 1958 while working in equatorial Africa ...
, a form of
non-Hodgkin lymphoma Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredn ...
that sickens 6 to 7 children out of every 100,000 annually in parts of
sub-Saharan Africa Sub-Saharan Africa is the area and regions of the continent of Africa that lie south of the Sahara. These include Central Africa, East Africa, Southern Africa, and West Africa. Geopolitically, in addition to the list of sovereign states and ...
, where it is associated with a history of infection by both Epstein-Barr virus and
malaria Malaria is a Mosquito-borne disease, mosquito-borne infectious disease that affects vertebrates and ''Anopheles'' mosquitoes. Human malaria causes Signs and symptoms, symptoms that typically include fever, Fatigue (medical), fatigue, vomitin ...
. In industrialized countries, Burkitt lymphoma is not associated with these
infectious diseases infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
.
Non-Hispanic white Non-Hispanic Whites, also referred to as White Anglo Americans or Non-Latino Whites, are White Americans who are classified by the United States census as "White" and not of Hispanic or Latino origin. According to annual estimates from the Unit ...
children often have a better chance of survival compared to other racial and ethnic groups. Where an individual lives is one of the biggest determinants of health in the world, as illness and healthcare options can vary by an individual's
postal code A postal code (also known locally in various English-speaking countries throughout the world as a postcode, post code, PIN or ZIP Code) is a series of letters or numerical digit, digits or both, sometimes including spaces or punctuation, inclu ...
.


United States

In the United States, cancer is the second most common cause of death among children between the ages of 1 and 14 years, exceeded only by unintentional injuries such as injuries sustained in a car wreck. More than 16 out of every 100,000 children and teens in the U.S. were diagnosed with cancer, and nearly 3 of every 100,000 died from the disease. In the United States in 2012, it was estimated that there was an incidence of 12,000 new cases, and 1,300 deaths, from cancer among children 0 to 14 years of age. Cancer is the second leading cause of death in males and fourth in women under the age of 20 in the United States. The survival rate of children with cancer has improved since the late 1960s which is due to improved treatment and public health measures. The estimated proportion surviving 5 years from diagnosis increased from 77.8 percent to 82.7 percent to 85.4 percent for those diagnosed in the 1990s, 2000s, and 2010–2016. Statistics from the 2014 American Cancer Society report: ''Note: Incidence and mortality rates are per 1,000,000 and age-adjusted to the 2000 US standard population. Observed survival percentage is based on data from 2003 to 2009.''


Sub-Saharan Africa

A large number of children in Africa live in low- and middle-income countries where there is limited access to prevention or treatment of cancer. The under-five mortality rate ( U5MR), a robust indicator of child health, is 109 per 1,000 live births. The proportion of childhood cancer is higher in Africa than in
developed countries A developed country, or advanced country, is a sovereign state that has a high quality of life, developed economy, and advanced technological infrastructure relative to other less industrialized nations. Most commonly, the criteria for eval ...
, at 4.8%. Kids with cancer are disadvantaged compared to kids in developed countries; therefore their statistic for childhood cancer is higher. In sub-Saharan Africa, 10% of children die before their 5th birthday, yet it is not due to cancer; communicable diseases such as
malaria Malaria is a Mosquito-borne disease, mosquito-borne infectious disease that affects vertebrates and ''Anopheles'' mosquitoes. Human malaria causes Signs and symptoms, symptoms that typically include fever, Fatigue (medical), fatigue, vomitin ...
,
cholera Cholera () is an infection of the small intestine by some Strain (biology), strains of the Bacteria, bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea last ...
, and other infections are the leading cause of death. Children with cancer are often exposed to these preventable infections and diseases. Tumor registries only cover 11% of the African population, and there is a significant absence in death registration, making the mortality database unreliable. Overall, there is a lack of reliable data, as there is limited funding and many diseases are largely unknown to this population.


United Kingdom

Cancer in children is rare in the UK, with an average of 1,800 diagnoses every year but contributing to less than 1% of all cancer-related deaths. Age is not a confounding factor in mortality from the disease in the UK. From 2014 to 2016, approximately 230 children died from cancer, with brain/CNS cancers being the most commonly fatal type.


Foundations and fundraising

Currently, there are various organizations whose main focus is fighting childhood cancer. Organizations focused on childhood cancer through cancer research and/or support programs include: Childhood Cancer Canada,
Young Lives vs Cancer Young Lives vs Cancer, the operating name for "CLIC Sargent", is a charity in the United Kingdom formed in 2005. Young Lives vs Cancer is the 12th largest cancer charity in the UK with a focus on children, young people and their families. Its c ...
and the
Children's Cancer and Leukaemia Group A child () is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. The term may also refer to an unborn human being. In English-speaking countries, the legal definition of ''child ...
(in
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
), Child Cancer Foundation (in
New Zealand New Zealand () is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and List of islands of New Zealand, over 600 smaller islands. It is the List of isla ...
), Children's Cancer Recovery Foundation (in
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
), American Childhood Cancer Organization (in
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
), Childhood Cancer Support (Australia) and the Hayim Association (in
Israel Israel, officially the State of Israel, is a country in West Asia. It Borders of Israel, shares borders with Lebanon to the north, Syria to the north-east, Jordan to the east, Egypt to the south-west, and the Mediterranean Sea to the west. Isr ...
). Alex's Lemonade Stand Foundation allows people across the US to raise money for pediatric cancer research by organizing lemonade stands. The National Pediatric Cancer Foundation focuses on finding less toxic and more effective treatments for pediatric cancers. This foundation works with 24 different hospitals across the US in search of treatments effective in practice. Childhood Cancer International is the largest global pediatric cancer foundation. It focuses on early access to care for childhood cancers, focusing on patient support, and patient advocacy. According to estimates by experts in the field of pediatric cancer, by 2020, cancer will cost $158 million annually for both research and treatment which marks a 27% increase since 2010. Ways in which the foundations are helped by people include writing checks, collecting spare coins, bake/lemonade sales, donating portions of purchases from stores or restaurants, or Paid Time Off donations as well as auctions, bike rides, dance-a-thons. Additionally, many of the major foundations have donation buttons on their respective websites. In addition to advancing research focusing on cancer, the foundations also offer support to families whose children are affected by the disease. The estimated total cost for one child with cancer (medical costs and lost parental wages) is $833,000. Organizations such as the National Children's Cancer Society and the Leukemia and Lymphoma Society can provide financial assistance for the costs associated with childhood cancer like medical care, home care, child care, and transportation.


Importance of family support

The emotional challenges that a parent may encounter can disrupt their child's treatment, parenting, and support for the child who is ill and their siblings, and impact overall family stability. Therefore, having a support network during this time is important. Different foundations fund support groups within hospitals and online for parents and families to aid in the coping process. Targeted support for siblings of children with cancer is also warranted. Resources that account for family context, age, and gender can help siblings process cancer-related emotional reactions. These targeted resources help promote family activities and normal family functioning while enhancing family adjustment over time. The foundations for pediatric cancer all fall under the 501(c)3 designation which means they are tax-exempt non-profit organizations. The "International Childhood Cancer Day" occurs annually on February 15.


References

{{Authority control Pediatric cancers