Pediatric Cancers

What is pediatric cancers?

The term pediatric cancers (also called childhood cancers) refers to a group of cancers that develop in children and adolescents, usually from birth through the teenage years. Cancer is a disease in which abnormal cells grow and divide without the normal controls that keep healthy tissue in check. In children, cancer behaves differently from cancer in adults. Adult cancers most often start in organs such as the breast, lung, colon or prostate and are frequently linked to lifestyle or long-term environmental exposure. Pediatric cancers, by contrast, more often arise in the blood, the brain and spinal cord, the lymphatic system, the bones, the kidneys and in developing (embryonic) tissues.

The most common types of pediatric cancers include:

• Leukemia – cancer of the blood-forming cells in the bone marrow; the most common childhood cancer group.
• Brain and spinal cord tumors – the most common solid (non-blood) tumors in children.
• Lymphoma – cancer of the lymphatic system, including Hodgkin lymphoma and non-Hodgkin lymphoma.
• Neuroblastoma – a tumor that starts in immature nerve cells, often in the adrenal glands or abdomen, mostly in very young children.
• Wilms tumor – a kidney cancer that mainly affects young children.
• Bone cancers – such as osteosarcoma and Ewing sarcoma, more common in older children and teenagers.
• Soft tissue sarcomas – such as rhabdomyosarcoma, which begins in muscle tissue.
• Retinoblastoma – a cancer of the retina at the back of the eye, typically in infants and toddlers.

Pediatric cancers are rare compared with adult cancers, but they remain an important cause of serious illness in children worldwide. Many childhood cancers respond well to modern treatment, and a large proportion of children who are treated go on to live long lives, although outcomes vary widely by type, stage and individual factors.

Symptoms of pediatric cancers

Pediatric cancers symptoms are often vague and can overlap with common, harmless childhood illnesses. This is one reason a diagnosis can take time. Symptoms depend on where the cancer starts, how large it has grown and whether it has spread. Signs that may prompt a doctor to look more closely include:

• Unexplained, persistent fever or frequent infections
• Unusual tiredness, pale skin or shortness of breath
• Easy bruising, small red or purple spots on the skin (petechiae), or bleeding that is hard to stop
• A lump or swelling, especially in the abdomen, neck, chest, armpit or groin, that does not go away
• Persistent bone or joint pain, limping, or swelling around a bone
• Ongoing headaches, often with early-morning vomiting
• Changes in vision, balance, walking or speech; new seizures
• A white glow in the pupil in photographs, a new squint (crossed eye), or a bulging eye
• Unexplained weight loss or loss of appetite
• Night sweats or itching without a rash
• Unexplained swelling of the testicle

How symptoms appear varies by cancer type. In leukemia, abnormal cells crowd out healthy blood cells, so children may look pale, tire easily, bruise readily and pick up infections. In brain tumors, symptoms come from pressure inside the skull or from the tumor pressing on specific brain areas, producing headaches, vomiting, clumsiness or behavior changes. Lymphoma often shows as painless swollen lymph nodes, sometimes with fever, sweats and weight loss. Abdominal tumors such as neuroblastoma or Wilms tumor may first be noticed as a firm belly mass when a parent bathes or dresses the child. Bone cancers tend to cause localized pain that is worse at night or with activity and may be mistaken for a sports injury or growing pains.

Early-stage disease may cause few or no symptoms. As a cancer grows or spreads, symptoms usually become more persistent and may involve several body systems at once. Any single symptom on this list is far more likely to have an ordinary explanation than to signal cancer, but symptoms that persist, worsen or cluster together deserve medical evaluation.

Causes and risk factors

For most children, the exact pediatric cancers causes are not known. Unlike many adult cancers, childhood cancers are rarely linked to smoking, diet, alcohol or other lifestyle factors, and there is usually nothing a parent did or did not do that caused the disease. Researchers believe most pediatric cancers result from random genetic changes (mutations) in cells during early development, including changes that may occur before birth.

Some factors are associated with a higher-than-average chance of certain childhood cancers:

• Inherited genetic conditions – such as Down syndrome, Li-Fraumeni syndrome, neurofibromatosis, Beckwith-Wiedemann syndrome and inherited retinoblastoma gene changes. Only a small proportion of pediatric cancers are linked to an inherited syndrome.
• Previous cancer treatment – children treated with radiation therapy or certain chemotherapy drugs have a somewhat higher risk of developing a second cancer later.
• High-dose radiation exposure – for example from radiation accidents or, historically, from high-dose medical radiation.
• Weakened immune system – children with immune deficiency disorders or those taking immune-suppressing medicines after an organ transplant have a higher risk of some lymphomas.
• Certain infections – for example Epstein-Barr virus is associated with some lymphomas, and HIV infection raises the risk of certain cancers.
• Age and sex – some cancers cluster at particular ages (neuroblastoma and Wilms tumor in young children; bone cancers in adolescents), and some are slightly more common in boys or girls.

Having a risk factor does not mean a child will develop cancer, and most children who are diagnosed have no identifiable risk factor at all. Research into environmental exposures, such as certain chemicals during pregnancy, is ongoing, but findings so far are not conclusive.

Diagnosis

Pediatric cancers diagnosis begins with a careful medical history and physical examination. The doctor will ask about the child’s symptoms, how long they have lasted, and any family history of cancer or genetic conditions. During the exam, the doctor checks for swollen lymph nodes, an enlarged liver or spleen, abdominal masses, bone tenderness, eye changes and neurological signs such as balance or reflex problems.

If cancer is suspected, tests are chosen based on the likely type and location:

• Blood tests – a complete blood count measures red cells, white cells and platelets and can reveal patterns suggestive of leukemia. Blood chemistry tests assess liver and kidney function. Certain tumors release substances called tumor markers into the blood or urine.
• Imaging – ultrasound is often the first test for abdominal lumps because it uses no radiation. X-rays can show bone changes. Computed tomography (CT) and magnetic resonance imaging (MRI) give detailed pictures of organs, the brain and spine. Positron emission tomography (PET) scans use a small amount of radioactive sugar to find areas of active disease and are commonly used in lymphoma and some sarcomas.
• Bone marrow aspiration and biopsy – a needle draws a small sample of marrow, usually from the hip bone, under sedation or anesthesia. This is the key test for confirming leukemia and for checking whether other cancers have spread to the marrow.
• Tissue biopsy – a surgeon or radiologist removes a small piece of the tumor so a pathologist (a doctor who examines tissue under a microscope) can confirm the diagnosis and identify the exact cancer type. This is usually the definitive step for solid tumors.
• Lumbar puncture (spinal tap) – a sample of the fluid around the brain and spinal cord is checked for cancer cells, particularly in leukemia and some brain tumors.
• Genetic and molecular testing – cancer cells are analyzed for specific gene changes. These results increasingly guide treatment choices and help predict how the cancer is likely to behave.

Once cancer is confirmed, doctors determine the stage (how far a solid tumor has spread) or, for leukemia, the risk group (based on features such as age, white blood cell count and genetic findings). Staging and risk grouping shape the treatment plan and help the care team discuss what to expect. Because pediatric cancers are rare and complex, diagnosis and treatment are typically coordinated by a pediatric oncologist, a doctor who specializes in childhood cancer, working with a multidisciplinary team.

Treatment options for pediatric cancers

Pediatric cancers treatment options depend on the type of cancer, its stage or risk group, the child’s age and general health, and the results of genetic testing. Most children are treated according to standardized protocols developed through international cooperative studies, and many are offered participation in clinical trials. Treatment usually combines several approaches:

• Chemotherapy – medicines that kill fast-dividing cells or stop them from multiplying. Chemotherapy is central to treating leukemia, lymphoma and many solid tumors and may be given by mouth, into a vein or into the spinal fluid. Treatment is delivered in cycles over months and, for some leukemias, over more than two years.
• Surgery – used to remove solid tumors where possible, to obtain tissue for diagnosis, or to place a central venous line for giving medicines. For some tumors, chemotherapy is given first to shrink the tumor and make surgery safer.
• Radiation therapy – high-energy beams directed at the tumor. Because radiation can affect growing tissue, doctors use it selectively in children, often at lower doses or with techniques designed to spare healthy tissue.
• Stem cell (bone marrow) transplant – high-dose chemotherapy followed by infusion of healthy blood-forming stem cells from the child or a donor. This may be used for high-risk or relapsed leukemia, some lymphomas and certain solid tumors such as high-risk neuroblastoma.
• Targeted therapy – drugs designed to block specific molecules that cancer cells depend on. These are available for some pediatric cancers with particular genetic changes.
• Immunotherapy – treatments that help the child’s own immune system recognize and attack cancer cells, including antibody drugs and, for certain leukemias and lymphomas, engineered immune cells (CAR T-cell therapy).
• Observation – in a small number of situations, such as some low-grade tumors or certain infant neuroblastomas that may regress on their own, doctors may recommend close monitoring rather than immediate treatment.

Supportive care is an essential part of treatment. This includes medicines to prevent nausea and infection, blood transfusions, nutritional support, pain management and psychological support for the child and family. Rehabilitation services such as physical therapy, occupational therapy and speech therapy help children regain strength and skills, particularly after surgery for brain or bone tumors. Fertility preservation is discussed where appropriate before treatment begins. Within Acibadem, treatment planning for childhood cancer is coordinated through the Medical Oncology Department together with pediatric, surgical and radiation specialists.

Side effects vary with the treatment used. Short-term effects such as hair loss, mouth sores, fatigue and low blood counts are common and usually improve after treatment ends. Some treatments may cause late effects that appear years later, which is why long-term follow-up is recommended.

Living with pediatric cancers and outlook

Outcomes for children with cancer have improved substantially over recent decades, and many children treated today are expected to survive long term. However, prognosis varies greatly. Some types, such as certain leukemias, Hodgkin lymphoma, Wilms tumor and retinoblastoma, generally respond very well to treatment. Others, including some brain tumors, high-risk neuroblastoma and cancers that have spread widely or returned after treatment, remain more difficult to treat. Your child’s care team is the best source of information about what to expect in your specific situation, and they may be cautious about giving precise figures because every child’s case is different.

Treatment can last many months and disrupts school, friendships and family routines. Children may need periods in the hospital and may be more vulnerable to infection when their blood counts are low. Hospital-based teachers, child life specialists, social workers and psychologists can help children keep up with schoolwork and cope with anxiety, changes in appearance and time away from friends. Siblings and parents also often need support.

After treatment ends, children enter a phase of follow-up care. Regular visits check for signs that the cancer has returned and for late effects of treatment, which can include effects on growth, heart or lung function, hearing, fertility, learning and the risk of a second cancer. Survivors are usually advised to keep a written summary of their treatment and to continue lifelong health monitoring as they move into adult care. Many childhood cancer survivors go on to attend school, work and have families, though some live with long-term health issues that require ongoing management.

Frequently asked questions

What is pediatric cancers and how is it different from adult cancer?

Pediatric cancers are cancers that develop in children and adolescents. They differ from adult cancers in the types that occur (more often leukemia, brain tumors and embryonic tumors), in their causes (rarely lifestyle-related), and often in how they respond to treatment. Children are also still growing, so treatment plans pay particular attention to protecting normal development.

What are the earliest pediatric cancers symptoms parents should watch for?

Early symptoms are often nonspecific and may include persistent fever, unusual tiredness, paleness, easy bruising, a lump that does not go away, ongoing bone pain, morning headaches with vomiting, or a white reflection in the pupil in photos. Most of these have harmless causes, but symptoms that persist beyond a couple of weeks, worsen, or occur together should be checked by a doctor.

What are the main pediatric cancers causes?

In most cases the cause is unknown. Pediatric cancers are thought to arise mainly from random genetic changes in developing cells, sometimes beginning before birth. A small proportion is linked to inherited genetic syndromes, prior radiation or chemotherapy, or immune system problems. Childhood cancer is not caused by anything a parent did during pregnancy or infancy in the vast majority of cases.

How is pediatric cancers diagnosis confirmed?

Diagnosis usually requires a combination of blood tests, imaging such as ultrasound, MRI or CT, and a sample of tissue or bone marrow examined by a pathologist. For leukemia, a bone marrow test is typically the confirming step; for solid tumors, a biopsy is usually needed. Genetic testing of the cancer cells then helps define the exact subtype and guide treatment.

What pediatric cancers treatment options are available?

Standard options include chemotherapy, surgery, radiation therapy, stem cell transplant, targeted therapy and immunotherapy, often used in combination and following established protocols. Some children take part in clinical trials. Supportive care, rehabilitation and psychological support are considered part of treatment. The plan depends on the specific cancer type, its stage or risk group and the child’s age.

Can pediatric cancers be cured?

Many children with cancer are treated successfully and remain cancer-free long term, and doctors often use the word cure when a child has stayed in remission for a number of years. However, the likelihood varies widely by cancer type and stage, and no outcome can be guaranteed. Your child’s oncologist can explain what the evidence suggests for your child’s particular diagnosis.

Can pediatric cancers be prevented?

There is currently no known way to prevent most childhood cancers, because they are not usually linked to lifestyle or environmental factors that can be changed. Families with a known inherited cancer syndrome may be offered genetic counseling and, in some cases, regular screening so that any cancer is found early.

When to see a doctor

Most childhood symptoms are caused by common infections or minor injuries and settle on their own. Nevertheless, a child should be seen by a doctor if symptoms are persistent, unexplained or getting worse, especially if several occur together. Seek medical attention promptly for any of the following red-flag signs:

• A lump or swelling anywhere on the body that is growing or has lasted more than two weeks
• Fever that keeps returning or lasts more than a few days without a clear cause
• Unusual pallor, extreme tiredness, or shortness of breath during normal activity
• Easy or unexplained bruising, pinpoint red spots on the skin, nosebleeds or bleeding gums
• Persistent headaches, particularly with vomiting in the morning
• New weakness, loss of balance, difficulty walking, changes in speech, or a seizure
• Changes in the eye, such as a white pupil in photographs, a new squint, bulging or vision loss
• Bone or joint pain that persists, wakes the child at night, or causes limping without injury
• Unexplained weight loss, loss of appetite or night sweats
• Swelling of the abdomen or a firm mass felt in the belly

Call emergency services or go to the nearest emergency department immediately if a child has a seizure for the first time, becomes very drowsy or difficult to wake, has severe or sudden breathing difficulty, has heavy bleeding that will not stop, or shows signs of a serious infection such as high fever with a stiff neck, a rapidly spreading rash or confusion. Children who are already receiving cancer treatment and develop a fever should be assessed urgently, because their immune system may be weakened.