Childhood Cancer - An Overview
Dr. Madhu Gowda
Pediatric Hematology-Oncology
US population Oct 2017 – 325,239,520
1 in 200 people develop cancer, 35% of them don’t survive
VA population 2016 – 8,000,000
1 in 200 people develop cancer. 35% of them don’t survive
# of children <14yrs in US 2016 –60,975,069
Estimated # of new cancer diagnosis for 2017 –10,270
1 in 6000 will develop cancer1 in 4500 in the 15-19y age grp
Estimated # of deaths due to cancer in 2017 –1190
11% of them will not survive
Average of 10,000 students in each county.
So each school is likely to see <1 child diagnosed with cancer every year.
# of children in Gr 1-12 in VA for 2016 –1,288,481
Improved cancer survival over the
years
The good news
• Childhood cancer is very rare
• The majority of these children survive their cancer.
For all ages:
Incidence of cancer is slowly coming down –by about 1% every year.
For ages <20yrs
Incidence of cancer is slowly going up– by about 0.6% every year.
The Bad News
• 10 % of pediatric deaths
• 2nd most common cause of death in children
• 1st most common cause of death from disease
• Survivors tend to have significant side effects
Non-Medical Considerations
• Emotionally devastating diagnosis
• Affects the entire family and friends
• Multidisciplinary approach – SW, Art, Play, Teachers, etc.
• Requires sensitivity and time
Distribution of Cancers in Children < 15 years of age
• Leukemia - 30%
• Central nervous system - 19%
• Lymphoma - 13% (NHL; Hodgkin’s)
• Neuroblastoma - 8%
• Soft tissue sarcoma - 7%
• Wilm’s tumor - 6%
• Bone tumors - 5%
• Retinoblastoma - 3%
• Liver - 1%
0
10
20
30
40
50 Leuk/Lymphoma 45%
CNS 20%
Neuroblastoma-7%
Rhabdo 7%
Wilms Tumor-6%
Bone Tumors-5%
Retinoblastoma-3%
Rare 6%
Comparison of Adult and Childhood Cancers
OObbsseerrvvaattiioonn CChhiillddhhoooodd CCaanncceerrss AAdduulltt CCaanncceerrss
PPrriimmaarryy SSiitteess Involves tissues Involves organs
HHiissttoollooggyy Sarcomas
(non-epithelial)
87% Carcinomas
(epithelial)
SSttaaggee aatt DDiiaaggnnoossiiss 80% disseminated Often local,
regional
SSccrreeeenniinngg tteessttss HVA/VMA
(neuroblastoma)
Many available
Comparison of Adult and Childhood Cancers (continued)
OObbsseerrvvaattiioonn CChhiillddhhoooodd CCaanncceerrss AAdduulltt CCaanncceerrss
EEaarrllyy ddeetteeccttiioonn Accidental Improves with
screening/education
RReessppoonnssee ttoo
cchheemmootthheerraappyy
Excellent Poor
OOuuttccoommee >80% cure <50% cure
PPrreevveennttiioonn Unlikely Often preventable
What Causes Childhood Cancer?
• Genetics probably play a bigger role than in adults
• We don’t know for sure – an ongoing question for study
• What do parents perceive
Parent’s Perceptions
• Prior Illness/Medicines – 21.1%• Environment – 20.8%• Radiation – 15.5%• Chemicals – 13.6%• Cancer in relatives – 8.2%• Antenatal events – 7.3%• Other – 5.0%• No idea – 4.7%• Diet - 3.8%
CLINICAL DIAGNOSIS
• Often incidental and unexpected
• Prevention is rare
• Screening of little value
• “Early” diagnosis often not possible
– often no therapeutic influence
CLINICAL DIAGNOSISThe Common Complaints
• Ear drainage
• Fever and bone pain
• Headache (morning)
• Lymph nodes
• White dot in eye
• Mass in abdomen or extremity
• Limping
• Weight loss
Principles of Therapy
• Multi-center
• Multi-disciplinary
• Supportive Care
• Biological modifiers
Multi-Center
• Cooperative group trials – Children’s Oncology Group
• “tyranny of small numbers”
• Biology studies, epidemiology studies
• Cell banks
• Account for >90% of pediatric patients
Multi-disciplinary
• Oncologists (chemotherapy)
• Surgeons
• Radiation therapists
• Immunologists
• Pharmacists
• Pain Service/Symptom control
• Leukemia: lasts ~ 3years
– Chemotherapy
– +/- radiation
– +/- bone marrow transplant
• Brain tumors: lasts 6mths to a year upfront, high
risk for recurrence or non-responsiveness
– Surgery
– Radiation
– Chemotherapy
– Bone marrow transplant
• Neuroblastoma: treatment for about 1year
– Chemotherapy
– Surgery
– Bone marrow transplant
– Radiation
– Immunotherapy
– Differentiating agents
• Bone tumors/Organ tumors: treatment for
about 6mths to a year.
– Chemotherapy
– Surgery
– +/- radiation
Supportive Care
• Nursing
• Social work
• Child life
• OT/PT
• Nutrition
• Psychology
• Chaplain
• Educational consultant
Biologic Modifiers
• Gene therapy
• Differentiating agents
• Anti-angiogenesis
• Targeted therapy
Complication of leukemia therapy
• During therapy:
– Anemia
– Thrombocytopenia
– Leukopenia
– Coagulation abnormalities
– Infection
– Mucositis
– Typhlitis (necrotizing enterocolitis)
– Seizures and other neurological complications up to 20% (in ALL)
– Pancreatitis
THE COST OF CURE
• Long term organ effects
• Endocrine/reproductive issues
• Psycho-social impact
• Second malignancy risk
• Insurance/employment issues
‘But it’s worth it!!!!!!!!
