Pediatric Cancers are the cancers affecting children. There are three major types of Pediatric cancers which are further subcategorized, (1) Leukemia, which is Acute Lymphocytic Leukemia (ALL) and Acute Myeloid Leukemia (AML), (2) Lymphoma, divided into Hodgkin and Non Hodgkin (3) Solid Sarcomas, which include Brain Tumors, Ewing Tumors, Eye Cancers, Germ Cell Tumors, Kidney/Wilms Tumors, Liver cancer, Neuroblastoma, Osteosarcoma, Rhabdomyosarcoma, Skin Cancer, Soft Tissue Sarcoma and Thyroid Cancer. From tomorrow we will cover each of these cancer separaetely
(1) Leukemia (Cancer of the Blood)
Leukemia is a cancer of the blood. Blood cells originate and develop inside Bone marrow, in bones. Red blood cells serve the purpose of transportation of oxygen and nutrients through blood circulation system inside body. White blood cells fight germs and infections and platelets help to stop bleeding. Leukemia is caused when white blood cells multiply uncontrollably and outnumber red blood cells. Leukemias are the most common type of childhood cancers. Leukemia further classified into acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).
Acute Lymphoblastic Leukemia (ALL)
Acute lymphoblastic leukemia (ALL) is cancer of blood in children. It develops in bone marrow particularly, the spongy internal part of bones where new blood is made and spreads to the bloodstream. Mutation in white blood cells which causes them to multiply uncontrollably is the main cause of Leukemia. ALL is the most common cancer in kids, accounting for 25% of all cancers in children under the age of 15. The amount of time between the onset of symptoms and the cancer diagnosis does not change the chances for cure.
Signs and Symptoms include fatigue and anemia ( due to decrease in number of red blood cells), fever and neutropenia (decreased number of healthy white blood cells), thrombocytopenia (decreased platelets), bone pain, enlarged lymph nodes and weight loss.
Acute Lymphoblastic Leukemia is mainly treated with long-term use of chemotherapy with intensive chemo regimens. Consolidation treatment may also need to stop reoccurrence of cancer, therefore consolidated therapy includes, more chemotherapies, a donor transplant and a transplant with patient’s own blood stem cells (that’s is very rare).
Acute Myeloid Leukemia (AML)
The cells that would convert into white blood cells except lymphocytes gives rise to AML. In AML, bone marrow cells donot mature the way they should be. These WBC, often called blast cells, just keep multiplying and post metastasis affect kidney, ovaries, liver and other organs
Signs and Symptoms include fatigue, fever, loss of appetite or weight, night sweats, Dizziness, feeling cold, light-headedness, headaches, shortness of breath, recurring infections and fevers, bruising for no clear reason, frequent or severe nosebleeds, bleeding gums, unusual bleeding, such as from minor cuts, bone or joint pain, a full or swollen belly from leukemia cells in the liver or , swollen spleen, skin rashes , lumps on the body, swollen, painful, bleeding gums, headache, trouble with balance, vomiting, seizures, or blurred vision, enlarged lymph nodes such as in the neck or groin, under arms, or above the collarbone (rare).
Treatment for AML includes chemotherapy, radiation therapy, stem cell transplant and/or immunotherapy with chemotherapy being the most common.
(2) Lymphoma are of many types but the mosson common are Hodgkins and Non Hodgkins/
Hodgkin lymphoma, is a cancer of the lymphoid system. The lymphoid system is made up of various tissues and organs, including the lymph nodes, tonsils, bone marrow, spleen, and thymus. These organs produce, store and carry white blood cells to fight infection and disease. It is rare type of cancer considered rare before the age of five. Hodgkin lymphoma is the most common cancer of teenagers and young adults (age 15-19) group.
Signs and Symptoms
Lymphadenopathy (swelling of the lymph nodes). Swollen lymph nodes are a common symptom of colds, flu, but in Hodgkin lymphoma, the lymph nodes may be larger than those that occur with common infections, and they do not shrink when treated with antibiotics. The swollen lymph nodes are usually found in the neck or above the collarbone, and less commonly under the arms or in the groin. These are usually painless, firm, rubbery, and are movable in the tissue that surrounds it. The generalized symptoms of lymphoma include: Poor appetite, weight loss, night sweats, fever, fatigue or sense of ill-feeling and itching (pruritus).
Treatment for Hodgkin Lymphoma include chemotherapy, radiation therapy and stem cell transplant.
Non-Hodgkin Lymphoma (NHL)
Lymphoma, or non-Hodgkin lymphoma is a general term used for cancers of the lymphatic system. The lymphatic system is part of the immune system that protects the body from infections. The lymphatic system contains a certain group of cells, called B and T lymphocytes. These type of cells are usually found in the lymph glands, the spleen, the tonsils, adenoids and quite a few other organs and tissues, including the intestinal tract. These B and T lymphocyte cells mutate and become malignant, or cancerous in non-Hodgkin lymphoma,. Non-Hodgkin lymphoma further classified into four types: (1) Burkitt’s lymphoma (2) Diffuse large B-cell lymphoma, (3) Lymphoblastic lymphoma and (4) Anaplastic large cell lymphoma. Non-Hodgkin lymphoma makes up approximately 7% of all children’s cancers. Non-Hodgkin lymphoma occurs more frequently with increasing age, and twice as many boys than girls are diagnosed with non-Hodgkin lymphoma.
Signs and Symptoms are enlarged lymph nodes, which may cause swelling in the neck, underarm or groin. Sometimes the lymph nodes involved are in the stomach or intestines so there may be abdominal swelling pain or constipation, breathing difficulty, such as wheezing or shortness of breath, or high-pitched breathing sounds may occur due to enlarged or swollen lymph glands in the chest pain, unexplained fever, weight loss and night sweats.
The main types of treatment for non-Hodgkin lymphoma are: Chemotherapy, Immunotherapy, Targeted therapy, Radiation and Stem cell transplant. In rare cases, surgery is also used.
(3) Solid Sarcomas
Lump of sick cells stuck together develop solid tumor called Solid Sarcomas. It can develop in many parts of the body including the brain, kidneys, liver and bones. These sick cells crowd out healthy cells. Common types of solid tumor cancers include
- Ewing sarcoma
- Wilms tumors.
Brain Tumors and Central Nervous System Tumors
Brain tumors occur in the central nervous system (CNS) and spinal cord in children. These important organs, CNS and spinal cord work together to control functions necessary to sustain life, such as breathing, heart rate, movement, thinking and learning. Brain produce important substances and chemical mediators which stimulate and control many other organs in the body. Commonly brain tumors donot “metastasize” or spread to far areas of the body which are outside of the brain or the spine. They can recur locally, and they can spread to other areas of the central nervous system. Collectively, they comprise nearly 20% of childhood cancers diagnoses.
There are several different types of brain tumors, description is as following.
Medulloblastoma is the most common malignant brain tumor in children. It grows faster starting in the lower back part of the brain called the posterior fossa and can spread to other parts of the human body. In up to one-third of patients, the tumor would have been spread along brain lining (meninges) and spinal cord at the time of diagnosis.
Signs and Symptoms are associated with vomiting, headache and balance problems
Treatment: The main types of treatment for Medulloblastoma are: Chemotherapy, Immunotherapy, Targeted therapy, Radiation, Stem cell transplant or bone marrow transplant and surgery.
Primative Neuroectodermal Tumor (PNET) and Pineoblastomas
Primative Neuroectodermal Tumor (PNET) and Pineoblastomas tumors develop generally in the upper part of the brain. PNETs and pineoblastomas have a similar pathology to medulloblastomas and are treatment. Brain tumor is generally associated with, the patient’s initial problems including the onset of seizures or eye abnormalities, as well as problems with headache, nausea and vomiting.
Treatment: The treatment options for Primative Neuroectodermal Tumor (PNET) and Pineoblastomas are: Chemotherapy, Radiation and Surgery.
Gliomas are brain tumors that begin in the glial cells. Glial cells generally surround and support the proper functioning of nerve cells. Astrocytomas are brain tumors that develop in astrocyte cells. Astrocytes are a specific type of glial cell. About half of brain tumors in children are astrocytomas. As most gliomas originate from astrocytes, the terms are often used interchangeably. Gliomas are either low-grade or high-grade which depends on the manner in which they grow and spread. Low-grade ones are localised in the brain and grow slowly whereas the high grade ones grows quicky an also spread faster in the entire brain. These are therefore most common lethal tumors in adults, but can also affect children. Depending on the location of the tumor, the affected patients may have seizures and noticeable paralysis during diagnosis. High-grade gliomas are much more aggressive and they need more intensive treatments.
Treatment: The treatment for Gliomas (Astrocytoma) include: Chemotherapy, Radiation and surgery. Surgery is more recommended by doctors.
Diffuse Intrinsic Pontine Glioma (DIPG)
These high-grade gliomas grow at midst of the nerves coming down the upper spine. Children may be diagnosed with eye movement problems, imbalance, paralysis and swallowing difficulties. Because it cannot be removed surgically and grows aggressively, this is an extremely difficult tumor to cure.
Grade II Epedymoma and the more infectious Grade III ependymoblastoma, usually affectsnchildren under the age of 6 years. These tumors usually are located in the lower back part of the brain (posterior fossa), but may also arise higher in the brain or in the spinal cord. As with medulloblastoma, children with posterior fossa tumors tend to be diagnosed because of vomiting, headache and/or balance problems.
Treatment: The treatment for Ependymoma include: Radiation and Surgery. Surgery is more safe and recommended by doctors.
Spinal Cord Tumors
Spinal cord tumors are of several types including ependymomas, and low- and high-grade astrocytomas.
As a part of Treatment the tumor is eliminated as much as possible without causing more damage to the spinal nerves. For low-grade tumors, at times children get chemotherapy in the same manner as used for low-grade astrocytoma’s. For high-grade spinal cord tumors, children are generally treated with chemotherapy and radiation to the tumor.
Other Rare Brain Tumors
There are some other rare Brain tumors including Choroid Plexus Tumors, papillomas and carcinomas, in infants. These tumors primarily treated with surgical resection and occasionally chemotherapy. The lost common treatment for Craniopharyngiomas is by surgical resection and location based radiation therapy of the tumor and affected surrounding tissues. These Brain sarcomas are treated with maximal surgery, local radiation and chemotherapy appropriate for body sarcomas.
Sigmorning, vomiting, especially in the morning, Eye movement problems and/or vision changes, Unsteady gait or worsening balance, Weakness of one side of the face, the arms or legs, Bulging fontanel ( this is the soft spot on a small child’s head where the bones that make up the skull have not joined completely) or increased head size in infants, Turning of the head or neck to one side, Seizures, Difficulty with speech, problem in swallowing or salvating, Back or neck pain, which makes the child uneasy during night, Other symptoms include: Changes in eating or thirst, Growth problems, Dizziness, Lethargy, irritability or other behavior changes, fall in school performance, Loss of feeling in the arms or legs, unconsciousness, without any previous sign of injury, changes in, or loss of control of, bowel or bladder, Hearing loss, without evidence of infectionns and Symptoms are as frequent headaches, especially after waking up in the
Treatment: Treatment for rare brain tumors often includes surgical removing as much of the tumor as possible, but It also include Radiation therapy and Hormone replacement therapy (HRT)
The “Ewing group of tumors” consists of Ewing sarcoma, Atypical Ewing sarcoma, and peripheral primitive neuroectodermal (PNET) of bone or soft tissue, but the treatment of all are done similarly. A nonheritable chromosomal mutation can be identified in the tumor cells of the Ewing family of tumors. The cause of Ewing family of tumors is not yet known but it is believed this mutation plays an important role. It is second most common bone cancer is Ewing sarcoma in children. It effects mainly long bones of arms and legs, the skull, spin, chest wall and the pelvis. It can also effect the soft tissue devoid of bone. This disease most often occurs in adolescents, with nearly half of cases arising between the ages of 10 and 20. it is more prevalent in males than in females.
Signs and Symptoms include pain and swelling, loss of appetite, fever, malaise, fatigue, weight loss, back pain and “sciatic–like” symptoms in patients with tumors in the pelvis.
Treatment: Treatment for Ewing sarcoma include chemotherapy, surgery and targeted radiotherapy which focused at 3D-conformal radiation therapy and Intensity-modulated radiotherapy.
Retinoblastoma (Eye Cancer)
Retinoblastoma is a rare eye cancer . Childhood retinoblastoma originates in a part of the eye called the retina. The retina is a thin layer of nerve tissue . Retinoblasts (immature cells of the retina) multiply during gestation and early life to make enough cells to create the retina. Retinoblastoma is a cancer that affects these retinoblasts, causing them to multiply too much, and limit the process of differentiation. Retinoblastoma in children can occur in one eye (unilateral) or both eyes (bilateral). It is affecting 300 children each year. This disease occurs most often in children under the age of 4 years, with 80% of cases occurring under age 3 years and virtually none above age 6 years. Most children (99%) with eye cancer generally get cured.
Signs and Symptoms: A pupil that looks white or black instead of red when light hits it, a crossed eye (looking either toward the nose or toward the ear), poor vision, a red, painful eye and an enlarged pupil
Treatment: Treatment for Retinoblastoma is chemotherapy (intra-arterial or systemic) to reduce the tumor size. Chemotherapy followed by followed by some form of local treatment and possibly radiation therapy and surgery. Treatment may prolong from months till years particularly in eyes treated with cryotherapy and/or photocoagulation after chemotherapy.
Germ Cell Tumors
The term “germ cell” originate from the term “geminate,” which means giving life. In humans, germ cells produce specialized cells needed for reproduction: sperm cells in boys and egg cells in girls. Germ cell cancer is an unheard and an uncommon tumor that affects children, teens, and adults. in the US around 900 children and adolescents have been diagnosed with germ cell tumors every year, of which about 4% of all childhood cancers. These tumors most commonly appear in the testes for boys and the ovaries for girls. However, these tumors can also arise in the abdomen and pelvis, the mediastinum. Germ cell tumors may be malignant (life-threatening) or benign (not life-threatening). Infectious germ cell tumors are of several types such as immature teratoma, yolk sac tumor, embryonal carcinoma, and choriocarcinoma. Testes or ovaries can get affected by this cancer which can also spread to other parts of the body. in the benign category of germ cell tumors certain kinds of teratomas is included (a type of tumor that may contain several different types of tissue). Compared to malignant tumors benign tumors are easy to treat but they can also cause problems because of their size.
Signs and Symptoms: It appears as painless mass in the scrotum (the skin that holds the testicles), Abdominal pain or constipation. Mediastinal tumors, once larger, they are associated with chest pain, shortness of breath and wheezing.
Treatment: Surgery and chemotherapy are most recommended treatments options for Germ Cell Tumors.
Another rare form of childhood tumor is sacrococcygeal teratomas. Which appear generally in the form of mass that protrudes around the anus and are usually diagnosed in newborns and could be surgically removed. Being internal these tumors may grow unnoticed for longer period of time (months) and later become malignant.
Signs and Symptoms include Pain, constipation and urinary retention
Treatment include post birth pediatric surgery.
Kidney cancer in children called Wilms tumor and it is the very common form cancer . About 500 children are diagnosed with Wilms tumor in the United States each year and about 75% of those patients are under 5 years old. Other than the above renal cell carcinoma is also a kind of kidney cancer which affect young children in the age group of 15 to19, clear cell carcinoma (in children below the age 4) and rhabdoid tumor (in infants).
Signs and Symptoms consist of a lump or mass in the abdomen of an otherwise well child which may cause abdominal pain, Blood in the urine, High blood pressure, Fever, Diarrhea, Weight loss, Urogenital infections, Anemia, breathlessness, generally feeling tired and unwell, Nausea and vomiting
Treatment: The general treatment for these children is surgery to remove the recurrent cancer, radiation therapy and chemo, often with drugs different from those used during first treatment.
One of the largest and vital organ of the body is liver. It helps store nutrients from food, produce bile and removes harmful chemicals from the body through detoxification process. Malignant or cancer causing liver cells develop liver cancer cells. There are two main types of liver cancer in Hepatoblastoma and Hepatocellular Carcinoma (HCC). Hepatoblastoma is the most common liver cancer affecting children, occurring most frequently in infants and children age 2 months to 3 years. Hepatocellular Carcinoma occurs most frequently in children age 10-16 years. In the U.S. every year 100 odd kids are affected with hepatoblastoma. Generally Hepatoblastoma and hepatocellular carcinoma attribute to 1-2% of cancers in children.
Signs and Symptoms include swelling or enlargement of the abdomen caused by the tumor enlarging. Loss of appetite, Weight loss, Nausea & vomiting, stomach pain, Jaundice, Unequal growth of one part of the body compared to another and Early signs of puberty
Treatment: Treatment for liver cancer include Surgery for primary stage of liver cancer which consist of A liver transplant or Surgery to remove the cancer from your liver (liver resection). Radiofrequency ablation (RFA) treatment uses radio waves to heat up the cancer cells until they are killed off. Microwave ablation, Injecting alcohol into the tumor, Chemoembolisation, Radioembolisation, Biological therapy, Chemotherapy and Radiotherapy are also common treatments.
Second most common solid tumor is Neuroblastoma in childhood, which affecting about 7% of all children with cancer. It is also very common solid cancer in infants as well. There are over 700 cases each year in the U.S. Neuroblastoma generally originates in the adrenal glands (which are located on top of each kidney). However, tumors can begin anywhere in the body including chest, neck and pelvis. The cells that make up neuroblastoma tumors are called neuroblasts. In this type of cancer, the neuroblasts grow and divide without the usual growth checkpoints and controls, leading to the growth of a cancerous mass of cells known as tumor.
Signs and Symptoms consist of Abdominal swelling, pain, Constipation, Difficulty in urination if a tumor is present in the abdomen.Common signs are eithier A lump or a bump in the neck along with bending of the eyelid, a small pupil, and lack of sweating on the same side of the face, Bone pain, Fatigue, Bleeding and bruising, Fever, Difficulty breathing if the tumor is present in the chest, Weakness or paralysis, High blood pressure, Rapid heartbeat and Persistent diarrhea
Treatment: Treatment options for Neuroblastoma are surgery, chemotherapy, Radiation therapy, Stem cell transplantation/bone marrow transplantation, Retinoid therapy and Immunotherapy.
Bone cancer is known as Osteosarcoma. During the development stage, destruction or bone damage starts in immature bone cells and result in weakening of the bone. Cancer development in soft tissue outside the bone is very rare phenomena. This type of cancer most often begins in the thigh or shin bones. Upper arm bone, close to the shoulder is most common region for the development of cancer. Osteosarcoma affects about 400 children and adolescents under the age of 20 each year, and it most commonly affects adolescents during the growth spurt.
Signs and Symptoms are pain in the bone or joint, a painless swelling or a noticeable mass in the arm or leg, a broken bone that occurs without injury or with insignificant injury, stiffness or swelling of joints, back pain or loss of control on bowel or bladder functions related to a tumor in the pelvis
Treatment: Chemotherapy is an important part of treatment for Osteosarcoma, other treatments include radiotherapy and surgery.
Rhabdomyosarcoma (RMS) is a cancer of muscles cells in children. It is also known as cancer of soft tissue. In the U.S. alone, approx. 350 new cases are reported each year in children under the age of 20. Approximately 66% of pediatric rhabdomyosarcoma cases are found in children under 6. RMS can arise in any muscle of the body, but the most common sites are adjacent to the base of the skull (Para meningeal), around the eye (orbital), head, neck, cheek or lip, arms, legs (extremities), Urinary, reproductive organs (genitourinary system), bladder, vagina, prostate and soft tissue around the testicles. Rhabdomyosarcoma is also divided into two major subtypes which is based on the tumor cell microscopic physiology:
- Embryonal rhabdomyosarcoma (ERMS): This affects almost 60-70% children making it a very common type.
- Alveolar rhabdomyosarcoma (ARMS): It is commonly found in adolescents.
Signs and Symptoms show growing mass or swelling, blood in the urine, difficulty urinating, bleeding from the vagina. For tumors presenting adjacent to the base of skull, the cancer can cause facial asymmetry, blurred vision, difficulty breathing, ear bleeding or discharge, headaches and facial pain. Swelling or bulging around the eye. Extremity tumors (those in the arms or legs) often present as a rapidly enlarging, firm mass.
Treatment: Treatment in patients with rhabdomyosarcoma (RMS) involves a combination of surgery, chemotherapy, and radiation therapy
Skin cancer is generally called Melanoma which begins in melanocytes. These are the cells that give pigment (color) to skin, hair, and eyes. Most melanomas occur in the skin, although they can also occur in the eye. Although, melanoma is not the most common skin cancer but it is the most serious one. Out of 60,000 cases found each year in US 450 are under 20.
Signs and Symptoms
The warning signs of skin melanoma classified as A B C D E’s of melanoma and it include: A for asymmetry: The two halves of the mole do not match. B for border irregularity: fuzzy and irregular border of moles. C is for color variegation: In addition to brown or black, other colors are present. D is for diameter: 0.6 cm or about ¼ of an inch. E is for evolving: The mole has changed in size, shape or color, Bleeding moles, itches and developed a break in the skin.
Treatment: Most common treatments for skin cancer include Surgery, Radiotherapy, Chemotherapy, Immunotherapy and Photodynamic therapy (PDT)
Soft Tissue Sarcoma
Cancer of Connective tissue is known as Soft Tissue Sarcoma. It includes various tissues of the body including muscle, fat, and fibrous tissue. The most prevalent sarcomas in children are the rhabdomyosarcoma (muscle), osteosarcoma (bone cells), and Ewing sarcoma (of the bone). However, about there are more than 50 other types of soft tissue sarcomas that affect around 900 children each year.
Soft Tissue Sarcomas is further categorized as following,
- Synovial sarcoma
- Malignant peripheral nerve sheath tumor
- Embryonal sarcoma of the liver
- Desmoplastic round cell tumor
- Desmoid tumors
- Rhabdoid tumors
- Epithelioid sarcoma
- Alveolar soft part sarcoma
- Undifferentiated Sarcoma
The thyroid gland is present below the Adam’s in the front of the neck. It is a butterfly shaped organ. The thyroid gland produce hormones that regulate the body’s response to hot and cold senses, the energy level of the body, and weight and appetite. Thyroid cancer in children is rare and often curable. Exposure to head and neck irradiation results in an increased risk. Only one in every 1,200 children under 20 are affected by thyroid cancer in the United States each year. There is nearly 95%. survival rates among children.
Thyroid cancer is further divided into following four types.
- Papillary thyroid carcinoma
- Follicular thyroid carcinoma
- Medullary thyroid carcinoma
- Anaplastic thyroid carcinomas
Sign and Symptoms include trouble breathing, trouble swallowing and changes in a child’s voice.
Treatment: Thyroid cancer is commonly treated by one or a combination of treatments such as Surgery, Hormonal therapy, Radioactive iodine (radioiodine) therapy, External-beam radiation therapy, Chemotherapy and Targeted therapy.
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