Childhood Cancer – Why Does it Happen & How to Prevent it?


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Evidence Based - Facts Checked

Pediatric malignancies refer to cancer in children belonging to 0 to 19 years of age. It constitutes a small proportion of the overall cancer burden in society; however, it should not be ignored because most of them are curable if diagnosed and treated early. Further, the children cured of childhood cancer have a long productive life and therefore should be given a fair chance of cure.


Incidence of Childhood Cancer

Overall, cancer is the second most common cause of death in children, the first being accidents. It is the most common disease-related cause of death in children. Approximately three lakhs (Three hundred thousand) children aged 0 to 19 years are diagnosed with cancer annually1Steliarova-Foucher E;Colombet M;Ries LAG;Moreno F;Dolya A;Bray F;Hesseling P;Shin HY;Stiller CA; ;. (2017, June) 'International incidence of childhood cancer, 2001-10: A population-based registry study.' Source.

The incidences of cancer are further increasing. The reason is unknown, but it can be hypothesized that more and more number of pediatric cancer are diagnosed nowadays because of improvement in medical diagnostics and dedicated specialized pediatric oncology center to prevent delayed diagnosis or misdiagnosis.


Types of Childhood Cancers

Pediatric cancer or Childhood cancer refers to a heterogeneous group of cancers that can occur in any body part.

Following are the 2 types:-

1. Benign Tumor

Not all childhood tumors are cancer. Most of these are benign tumors2Maitra A. Diseases of infancy and childhood. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Pennsylvania: Saunders; 2010. pp. 447–83.

Quick Note - A benign tumor refers to an abnormal collection of cells at a site that grows in size but does not spread to other parts of the body. 


Some of the examples of benign tumor include an abnormal collection of cells like teratoma, hamartoma, congenital cyst, lipoma, hemangioma, lymphangioma, etc. These differ based on the site of origin and the behavior of these abnormal cell collection.

2. Malignant Pediatric Tumor/Pediatric Cancers

Malignant childhood cancers are broadly classified into two types of malignancies: hematological and solid malignancy:-

a) Hematological Cancers

These are the most common type of childhood cancers which include blood cancers like leukemia, Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

b) Solid-Organ Cancers

These include tumors arising from the epithelium of solid organs

  • Kidney:  Wilms tumor
  • Bone:  Osteosarcoma and Ewing’s sarcoma
  • Muscle: Soft tissue sarcoma, Rhabdomyosarcoma
  • Central Nervous System: Astrocytoma, Medulloblastoma, Ependymoma
  • Adrenal Medulla: Neuroblastoma
  • Liver: Hepatoblastoma, Hepatocellular Carcinoma
  • Retina: Retinoblastoma

Age Wise Distribution of Most Common Childhood Cancers3Steliarova-Foucher E;Colombet M;Ries LAG;Moreno F;Dolya A;Bray F;Hesseling P;Shin HY;Stiller CA; ;. (2017, June) 'International incidence of childhood cancer, 2001-10: A population-based registry study.' Source

0-4 Years

5-9 Years

10-19 Years

Leukemia

Leukemia

Hodgkin’s lymphoma

Neuroblastoma

Neuroblastoma

Thyroid Carcinoma

Wilms Tumor

Ewing’s Sarcoma

Osteogenic Sarcoma

Central Nervous System Tumor

PNET(Primitive Neuroectodermal Tumor)

Hepatocellular Carcinoma

Hepatoblastoma

Hepatocellular Carcinoma

Hepatocellular Carcinoma

Retinoblastoma

Lymphoma

Melanoma

Cell

Rhabdomyosarcoma

Germ cell tumor


What Causes Cancer in Children?

Unlike adults, the cause of childhood cancers is mostly unknown. Certain Genetic factors and environmental factors are known to increase the risk of developing some childhood cancers, but for most childhood cancer cases, the cause remains unknown. Following are some of the causes of childhood cancer:-

1. Genetic Factors

 Genetic mutation can lead to cancer in children. Some of the examples of childhood cancers caused due to genetic factors include Retinoblastoma, Wilms Tumor and Neuroblastoma4Dumoucel S;Gauthier-Villars M;Stoppa-Lyonnet D;Parisot P;Brisse H;Philippe-Chomette P;Sarnacki S;Boccon-Gibod L;Rossignol S;Baumann C;Aerts I;Bourdeaut F;Doz F;Orbach D;Pacquement H;Michon J;Schleiermacher G;. (2014). 'Malformations, genetic abnormalities, and Wilms tumor' Source

2. Prenatal Exposures

While the fetus is present in the mother's womb, following factors can cause childhood cancers:

a) Radiation exposure

Pregnant females, if exposed to ionizing radiation, especially during the first trimester of pregnancy, increases the risk of cancer in the newborn5R;, D. R. (1997, February). 'Risk of childhood cancer from fetal irradiation' Source.

b) Teratogenic Medicines like Diethylstilbestrol 

Certain drugs have teratogenic effects, i.e., these can cross the pregnant female’s placenta and cause ill effects in the in-utero fetus, leading to an increase in childhood cancer chances6Cogliano VJ;Baan R;Straif K;Grosse Y;Lauby-Secretan B;El Ghissassi F;Bouvard V;Benbrahim-Tallaa L;Guha N;Freeman C;Galichet L;Wild CP;. (2011, December). 'Preventable exposures associated with human cancers.' Source.

c) Alcohol Consumption by Pregnant Mother

Maternal alcohol consumption during pregnancy increases the risk of leukemia in children7Latino-Martel P;Chan DS;Druesne-Pecollo N;Barrandon E;Hercberg S;Norat T;. (2010, May). 'Maternal alcohol consumption during pregnancy and risk of childhood leukemia: Systematic review and meta-analysis' Source.

d) Smoking by  Pregnant Mother

Various studies have shown that maternal smoking increases the risk of cancer in children8Cogliano VJ;Baan R;Straif K;Grosse Y;Lauby-Secretan B;El Ghissassi F;Bouvard V;Benbrahim-Tallaa L;Guha N;Freeman C;Galichet L;Wild CP;. (2011, December). 'Preventable exposures associated with human cancers.' Source.

3. Postnatal Exposures

Post childbirth, certain environmental exposures increase the risk of childhood cancer, which are discussed below:-

a) Radiation

Studies have shown an increased risk of cancer in children who have been exposed to multiple CT scans during childhood for other illnesses9Mathews JD;Forsythe AV;Brady Z;Butler MW;Goergen SK;Byrnes GB;Giles GG;Wallace AB;Anderson PR;Guiver TA;McGale P;Cain TM;Dowty JG;Bickerstaffe AC;Darby SC;. (2013, May). 'Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: Data linkage study of 11 million Australians.' Source.

b) Infection

Certain viral infections like Human Immunodeficiency Virus and Epstein Barr virus infection are associated with certain childhood cancer’s causation10Urayama, K. Y., Ma, X., Selvin, S., Metayer, C., Chokkalingam, A. P., Wiemels, J. L., . . . Buffler, P. A. (2011, April 01). 'Early life exposure to infections and risk of childhood acute lymphoblastic leukemia.' Source.

4. Syndromes

Children suffering from syndromes like Bloom syndrome, Fanconi anemia, Nijmegen Breakage Syndrome, Down’s syndrome etc. are 10 to 20 times more likely to get leukemia than other children11ML;, S. E. (2013, August). Genetic predispositions to childhood leukemia. Source.

5. Previous Cancer Treatment

a) Radiation Therapy

Children who have had radiotherapy for cancer in the past have a slightly greater risk of developing another type of cancer later in their life12Swerdlow AJ;Cooke R;Bates A;Cunningham D;Falk SJ;Gilson D;Hancock BW;Harris SJ;Horwich A;Hoskin PJ;Linch DC;Lister TA;Lucraft HH;Radford JA;Stevens AM;Syndikus I;Williams MV;. (2012, August). 'Breast cancer risk after supradiaphragmatic radiotherapy for Hodgkin's lymphoma in England and Wales: A National Cohort Study.' Source

b) Chemotherapy

Past treatment done with chemotherapy can increase the risk of cancers such as acute leukemia13Mittal, R., Ramaswamy, N. V., Pandita, R., Al Bahar, S., Khalifa, N., & Omar, S. (2010, January). 'Secondary acute myeloid leukemia after successful treatment for osteosarcoma' Source.


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Dr. Poonam Sambhaji (MBBS, Diploma (Child Health) is explaining the Symptoms which parents should watch in their Children for Early Detection of Childhood Cancer

WAKE UP CALL FOR PARENTS!

Specific warning symptoms of cancer should not be neglected, and if present, the parents should promptly schedule an appointment with a pediatric oncologist.

1. Non-Specific Signs of Childhood Cancer

Following are certain non-specific symptoms that are early signs of childhood cancer. These are generally misdiagnosed by some healthcare practitioners and are therefore called non specific signs of childhood cancer14EL;, D. T. (2007, August). 'Diagnosis delays in childhood cancer: A review.' Source.

a) Unexplained Weight Loss

Weight loss despite proper diet or weight loss due to loss of appetite.

b) Unexplained Fever

High-grade fever more than 102 degrees Fahrenheit with chills and rigor followed by night sweats or moderate fever for more than two week

c) Unexplained Malaise

Sudden irritable behavior with signs of weakness and lack of physical activity

d) Loss of Appetite

Sudden decrease in the appetite along with the other symptoms as discussed should be considered as a wake up call to schedule an appointment with a pediatric oncologist.

e) Pallor

The child appears pale, weak, and malnourished. Further, the hair and skin lacks luster, and the cheek, lips, palm, and soles appear whitish. These may be signs of cancer associated with blood.

f) Bruises

The parents should consider taking an appointment with a pediatric oncologist

- If minor trauma leads to massive bleeding

- There are frequent bruises on the child’s body without any trauma

- If there are frequent nose bleeds

g) Delay in Growth and Development

A child born completely normal (average body weight, without any disease, ailment) and exhibiting proper development suddenly starts to lose interest in activities and shows delay in developmental milestones.

h) Decreased Immunity

Frequent infections, multiple hospital visits, relapse of symptoms after the infection is controlled.

i) Skin changes

The appearance of red spots on the skin (Petechiae)


2. Red Flag Signs of Childhood Cancer

Following are the red flag signs of childhood cancer, which the parents should monitor vigorously:-

Red Flag Signs of Central Nervous System Tumors15Goldman, R. D., Cheng, S., & Cochrane, D. D. (2017, March 27). 'Improving diagnosis of pediatric central nervous system tumours: Aiming for early detection.' Source

  • A child with early morning headache and vomiting, or any form of weakness in the limbs
  • Uncontrolled body movements called seizures
  • Imbalance while walking
  • Slurring in the speech

Red Flag Signs for Bone and Soft Tissue Tumor16George, A., & Grimer, R. (2012, May). 'Early symptoms of bone and soft tissue sarcomas: Could they be diagnosed earlier?' Source

  • Abnormal swellings in any part of the body like abdomen, back, limbs, which is rapidly                    growing in size, is painless but firm and is fixed to underlying bone or muscle
  • Frequent fractures
  • Pain in bone and joints

Red Flag Signs for Retinoblastoma – Retina (Eye) Cancer17Parulekar, M. V. (2018). 'Detecting retinoblastoma.' Source

  • A rapid change in vision
  • White eye reflex in the pupil, i.e., the pupil appears white in color instead of regular black or            brown
  • An unexplained bulge in the eye
Retinoblastoma

  An Unexplained Bulge in the Eye - Source

  •   Recently developed blindness in one eye
  • A squint in the eye i.e., the child’s eye may look either toward nose or ear
  • Squint in Eye

     Squint in the Eye - Source

    Red Flags Sign of Lymphoma & Leukemia

    • Enlarged lymph node more than 1 cm in size (firm, nodular, painless, mobile, or fixed to underlying structure) commonly seen in the neck, armpit (axilla), and groin area – below the abdominal region (inguinal)
    Lymph Node in Neck

    Enlarged lymph node in Neck - Source

    Lymph Node in Axilla

    Enlarged lymph node in Axilla (Arm Pit) - Source

  • Enlarged liver suggested by abdominal swelling in the right side. (Diffused Abdominal Swelling)
  • Pain in bone and joints   



  • Prevention of Childhood Cancers

    Unlike adult cancers, the cause of childhood cancers is mostly unknown. This is the reason why there are no standard screening programs for the early detection of childhood cancers. Most of them are not associated with adult risk factors like smoking, alcohol, occupational exposure, toxins, chemicals, etc. However, some well-recognized risk factors can be prevented.

    In-Utero Exposure to Radiation

    Medical radiation exposure can be minimized by avoiding x-ray and CT scans during pregnancy. Pregnant females can opt for ultrasound and MRI scans because these do not involve ionizing radiation.

    Avoid Alcohol, Tobacco and Chemical Exposure

    Pregnant females should avoid smoking, alcohol and chemical exposures

    Be Careful with Medicines

    Pregnant females should be well aware of drugs and medicines not to be taken. For example taking teratogenic medications can harm the fetus as it can cross the placenta.

    Regular Checkup

    Regular checkups during pregnancy should be done thoroughly for early detection of any congenital malformation or growth abnormalities that may be associated with any syndrome which may result in childhood cancer

    Follow Ups for Cancer Survivors

    Childhood cancer survivors should follow up closely for early detection of second primary or relapse of  cancer


    Cases of childhood cancer are less however it is always better to be vigilant with the symptoms that you might notice in your child. Remember, an early diagnosis in cases of childhood cancer results into a successful treatment. 



    This content is medically reviewed by Dr. Umang Singal, Dr Poonam Sambhaji and written by Dr. Isha Jaiswal

    Last Medical Review Date - 4th December 2020


    References

    1. 1
      Steliarova-Foucher E;Colombet M;Ries LAG;Moreno F;Dolya A;Bray F;Hesseling P;Shin HY;Stiller CA; ;. (2017, June).
      International incidence of childhood cancer, 2001-10: A population-based registry study.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/28410997/
    2. 2
      Maitra A. Diseases of infancy and childhood. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors.
      Robbins and Cotran Pathologic Basis of Disease. 8th ed. Pennsylvania: Saunders; 2010. pp. 447–83
    3. 3
      Dumoucel S;Gauthier-Villars M;Stoppa-Lyonnet D;Parisot P;Brisse H;Philippe-Chomette P;Sarnacki S;Boccon-Gibod L;Rossignol S;Baumann C;Aerts I;Bourdeaut F;Doz F;Orbach D;Pacquement H;Michon J;Schleiermacher G;. (2014).
      Malformations, genetic abnormalities, and Wilms tumor.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/23970395/
    4. 4
      R;, D. R. (1997, February).
      Risk of childhood cancer from fetal irradiation.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/9135438/
    5. 5
      Cogliano VJ;Baan R;Straif K;Grosse Y;Lauby-Secretan B;El Ghissassi F;Bouvard V;Benbrahim-Tallaa L;Guha N;Freeman C;Galichet L;Wild CP;. (2011, December).
      Preventable exposures associated with human cancers.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/22158127/
    6. 6
      Latino-Martel P;Chan DS;Druesne-Pecollo N;Barrandon E;Hercberg S;Norat T;. (2010, May). Maternal alcohol consumption during pregnancy and risk of childhood leukemia: Systematic review and meta-analysis.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/20447918/
    7. 7
      Mathews JD;Forsythe AV;Brady Z;Butler MW;Goergen SK;Byrnes GB;Giles GG;Wallace AB;Anderson PR;Guiver TA;McGale P;Cain TM;Dowty JG;Bickerstaffe AC;Darby SC;. (2013, May). Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: Data linkage study of 11 million Australians.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/23694687/
    8. 8
      Urayama, K. Y., Ma, X., Selvin, S., Metayer, C., Chokkalingam, A. P., Wiemels, J. L., . . . Buffler, P. A. (2011, April 01).
      Early life exposure to infections and risk of childhood acute lymphoblastic leukemia.
      Retrieved December 7, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165002/
    9. 9
      ML;, S. E. (2013, August).
      Genetic predispositions to childhood leukemia.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/23926459/
    10. 10
      Swerdlow AJ;Cooke R;Bates A;Cunningham D;Falk SJ;Gilson D;Hancock BW;Harris SJ;Horwich A;Hoskin PJ;Linch DC;Lister TA;Lucraft HH;Radford JA;Stevens AM;Syndikus I;Williams MV;. (2012, August).
      Breast cancer risk after supradiaphragmatic radiotherapy for Hodgkin's lymphoma in England and Wales: A National Cohort Study.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/22734026/
    11. 11
      Mittal, R., Ramaswamy, N. V., Pandita, R., Al Bahar, S., Khalifa, N., & Omar, S. (2010, January). Secondary acute myeloid leukemia after successful treatment for osteosarcoma.
      Retrieved December 7, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941602/
    12. 12
      EL;, D. T. (2007, August).
      Diagnosis delays in childhood cancer: A review.
      Retrieved December 7, 2020, from https://pubmed.ncbi.nlm.nih.gov/17620277/
    13. 13
      Goldman, R. D., Cheng, S., & Cochrane, D. D. (2017, March 27).
      Improving diagnosis of pediatric central nervous system tumours: Aiming for early detection. Retrieved December 7, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367991/
    14. 14
      George, A., & Grimer, R. (2012, May).
      Early symptoms of bone and soft tissue sarcomas: Could they be diagnosed earlier?
      Retrieved December 7, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957506/
    15. 15
      Parulekar, M. V. (2018).
      Detecting retinoblastoma.
      Retrieved December 7, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998392/ 

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