by Dr. Levon Agdere

According to the American Cancer Society, approximately 12,000 children under the age of 21 are diagnosed with cancer every year in the United States. The diagnosis of childhood cancer is  devastating to the parents, the child, and everyone in the child’s life. With this crisis, life becomes anything but normal in a short period of time. The ill child becomes the main focus while other concerns are put on hold. The parents must understand enough about the treatment plan, sign consent forms for treatment, and make important decisions about their child’s care. Parents often describe the ordeal as “being on an emotional roller coaster” or “in a bad dream”. The way they cope reflects their own life experiences, ethnic and cultural backgrounds, and personality.

Our understanding of cancer and how it develops is evolving. Normal body cells grow, divide and die in an orderly fashion. DNA, which is found in every cell, directs these actions. In a normal cell, if the DNA gets damaged either the cell repairs the damage or the cell dies. A cancer cell, however, has damaged DNA, but the cell does not die. Instead, it continues to grow and invades other tissues and body organs, forming a mass or tumor. Some DNA damage are inherited, but most are caused by abnormalities that occur while the cell is reproducing or by environmental factors. Cigarette smoking is one well-known environmental trigger. Often, no identifiable cause for the DNA damage is found.

In leukemia, cancer cells invade the blood and organs and circulate through other tissues where they continue to grow. Cancer cells often travel to the other parts of the body and begin to grow and form new tumors that replace normal tissue. This process is called metastasis.

The types of cancers that occur in children vary greatly from those seen in adults. Leukemia is the most common type of childhood cancer. Different types of leukemia account for about one third (33%) of all childhood cancers. Acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML) are the most common types of leukemia in children. Leukemia may cause bone and joint pain as well as fever, weakness, weight loss and other symptoms. Brain and other nervous system cancers are the second most common cancers in children (21% of all childhood cancers). Most of these cancers involve the brainstem. These cancers can cause headaches, vomiting, blurred or double vision, dizziness, and trouble walking. Less common cancers are neuroblastoma (7%), Wilms tumor (5%), Hodgkin lymphoma (4%), non-Hodgkin lymphoma (4%), rhabdomyosarcoma (3%), retinoblastoma (3%), and bone cancers (osteosarcoma: 3%, Ewing sarcoma: 1%).

Different cancers grow at different rates and respond to different treatments. Chemotherapy, radiotherapy, and surgery are individualized to the particular cancer type. Today, because of medical advances, about 80% of children treated for cancer survive 5 years or more. This is a huge increase from the 1970s when the 5 year survival rate was less than 50%. Most children with cancer in the United States are treated at Children’s Oncology Group (COG). To find a listing of COG institutions by state, visit their website at: www.curesearch.org/resources/cog.aspx.

Unfortunately, treatments that allow these children to survive cans sometimes cause health problems that may appear months or years after treatment. The cancer treatment may impair organ function and lead to growth and developmental issues, including emotional ones. Anxiety, depression, trouble developing relationships, and possible discrimination in employment are possible long-term psychological effects of cancer treatment. Because childhood cancer survivors are living longer, their long-term overall health and long-term side effects have become a focal point of research. Studies have shown that most cancer survivors function well in daily life and society. With strong support from family, other survivors, mental health professionals, and physicians, people who have survived cancer can thrive in spite of the challenges they have faced.