Valley Health Magazine

By Monica Prinzing

Child hood cancers differ from adult cancers

Few people have escaped being touched by cancer. Most of us know someone who either had cancer as a child or acquired the disease as an adult. Sometimes we see children only as small adults, but a closer look reveals that children have needs, desires, and even medical issues that vary greatly from adults. Pediatric oncologists and other caregivers who work with children are especially aware of these differences. Childhood cancers differ from adult cancers in many ways, including:

• Prevalence: More than 12,000 children younger than 15 will be diagnosed with cancer in the United States. However, cancer is still relatively rare in children and teenagers, accounting for less than 1 percent of all cases in the United States. Most cancers (98 percent) develop in adults, especially in people past middle age. About one out of every six adults will develop cancer during his or her lifetime, while about one in 300 children will develop cancer before age 20.

• Type: Childhood cancers tend to occur at different sites from those common in adults. Among the most common childhood cancers are leukemias, lymphomas, brain tumors, and bone cancer. Each of these cancers also occurs in adults, but adult cancers more often strike the lung, colon, breast, prostate, and pancreas. There are some childhood cancers that almost never occur in adults and some cancers that affect adults but virtually never occur in children. Likewise, there are some cancers that can affect both children and adults. Pediatric oncologists deal mostly with diseases that are fundamentally different than adult cancers and therefore require different treatment.

• Risk Factors: Many cancers that affect adults are related to lifestyle factors such as tobacco or alcohol use, poor diet, and/or inactive lifestyle. The causes of most childhood cancers are unknown.

• Growth: Childhood cancers tend to be more aggressive than adult cancers. Typically, cancer is more advanced in children than adults at the time of diagnosis. About 80 percent of children have cancer that has spread to other parts of the body, compared to about only 20 percent of adults at the time of diagnosis. As a result, pediatric oncologists tend to use chemotherapy more often for treatment, even for cancer that is localized at the time of diagnosis. Additionally, the growth and development of a child’s body naturally produces a significant amount of growth hormones, which can increase the cancer growth rate and therefore may call for more intense chemotherapy.

• Research: Since childhood cancer is rare, research is difficult. Many adult cancers can have a research study at a single institution. This isn’t possible with childhood cancer due to the low number of cases. The Children’s Oncology Group (COG) – the world’s largest organization devoted exclusively to childhood and adolescent cancer research – works to identify cancer causes and pioneer new treatments and cures.

• Treatment Facility: Most adults diagnosed with cancer obtain treatment locally from their primary care physicians and cancer specialists. Since childhood cancers are significantly rarer than adult cancers, specialists in many communities do not have ongoing experience managing these diseases. Therefore, children usually are best treated by teams of doctors who specialize in the diagnosis, treatment, and management of childhood cancers.

Such teams are more likely to be located in children’s hospitals, university medical centers, and cancer centers.

More Children Surviving Cancer

While cancer remains the leading cause of death by disease among U.S. children under age 15, most children and teenagers diagnosed with cancer can be treated successfully. With enhanced therapies and supportive care, nearly 85 percent of children treated for cancer today will become long-term survivors, meaning they have been in remission and off treatment for at least three to five years. Fifty years ago only a fraction of affected children lived to see their next birthday. Now, with about 15,000 new cancer survivors every year, nearly one in 250 adults is a childhood cancer survivor. But the same treatments that cure cancer patients may actually put them at risk for long-term health problems.

After triumphing over cancer, the survivor’s ability to lead an active, healthy life and moving forward can sometimes can be a struggle. Experiencing the disease and undergoing common cancer treatments such as surgery, chemotherapy, and radiation, often cause side effects that may occur early on and/or decades later, including:

Physical: Some chemotherapy drugs, other medications, and/or radiation therapy needed for treatment of childhood cancer can result in physical effects in both the short and long-term, including cataracts, infertility, thyroid dysfunction, cardiac dysfunction, secondary cancers, and more. Studies indicate, for example, that bone tumor survivors are more prone to multiple chronic conditions such as severe problems with bones and muscles, hearing loss, and congestive heart failure, while brain tumor survivors are more likely to suffer seizures, hormone diseases, and problems with cognition.

Emotional: Once treatment ends, each survivor experienes their own unique range of feelings, from excitement about their new life to fearing that the cancer will return. They may also struggle with depression due to the loss of a normal childhood and guilt for surviving when others did not.

Social: Survivors often experience a decreased sense of social wellbeing as they attempt to return to the lives they had before treatment.

Educational: Treatment for cancer during childhood or adolescence may affect educational progress due to prolonged absences and reduced energy levels that frequently occur during treatment. Some types of cancer may require therapy to control or prevent the spread of the disease to the brain and/or spinal cord, which can sometimes affect memory and learning abilities.

Spiritual: For many survivors, life takes on new meaning after cancer. Values may change. Some survivors rely on their spiritual beliefs to help them through the illness. Others may feel abandoned.

Financial: The cost of initial and continued medical care can take a financial toll on the survivor and their family. In addition, once the childhood cancer survivor becomes of age, their current state of health may potentially affect their ability to sustain a job, obtain health insurance, and so forth.

Importance of Follow-Up Care & Healthy Habits

About two-thirds of childhood cancer survivors will experience at least one late effect, which will require ongoing medical support. About one-fourth will suffer a serious or life-threatening late effect. Ongoing studies of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helps prevent illness and death from late effects. The National Cancer Institute recommends that consistent follow-up care and a healthy lifestyle are very important for the long-term health of childhood cancer survivors.

• Regular follow-up care is different for each person who has been treated for cancer. The type of care depends on the type of cancer, type of treatment, genetic factors, and the person’s general health and health habits.

• Childhood cancer survivors should have an exam at least once a year. The exams should be done by a health professional who is familiar with the survivor’s risk for late effects and can recognize the early signs of late effects. Blood and imaging tests may also be done. Long-term followup may improve the health and quality of life for cancer survivors and also helps doctors study the late effects of cancer treatments so that safer therapies for newly diagnosed children can be developed.

• Cancer survivors’ quality of life may be improved by behaviors that promote wellbeing, including a healthy diet, exercise, and regular medical and dental checkups. These self-care behaviors are especially important for cancer survivors because of their risk of treatment-related health problems. Healthy behaviors may make late effects less severe and lower the risk of other diseases.

• Avoiding health-damaging behaviors is also important. Smoking, excess alcohol use, illegal drug use, sun exposure, and/or not being physically active may worsen treatment-related organ damage and possibly increase the risk of second cancers. Surviving Childhood Cancer Cancer can strike children and adults alike, but most childhood cancers are very different from adult cancers and require different treatment. Thankfully, more children are surviving cancer due to enhanced therapies, supportive care, and ongoing research. Defeating cancer should include a commitment to long-term wellbeing. Patient and doctor alike must address the potential harmful effects of treatment to increase the chance of living a healthy and productive life.

About the Author: Monica Prinzing is the Senior Writer of Communications and Marketing at Children’s Hospital Central California. She is a former newspaper journalist and also worked as an executive communications specialist in corporate communications and the medical field.