Introduction

Cancer is a rare disease among children, occurring in only 1 of 5,000 children every year. Although the most common childhood cancers are leukemia, lymphoma, and brain tumors, these cancers also occur in adults, and the diagnosis and treatment are similar in adults and children. Several of the more common cancers that occur mainly in children are Wilms' tumor, neuroblastoma, and retinoblastoma.

In contrast to many adult cancers, cancers in children tend to be much more curable. About 75% of children with cancer survive at least 5 years. Nonetheless, cancer kills over 2,000 children each year.

As in adults, doctors use a combination of treatments, including surgery, chemotherapy, and radiation therapy. However, because children are still growing, these treatments may have side effects that do not occur in adults. For example, in a child, an arm or leg that received radiation may not grow to full size. Children who receive radiation to the brain may not have normal intellectual development.

Children who survive cancer have more years than adults to develop long-term consequences of chemotherapy and radiation therapy, such as infertility, poor growth, damage to the heart, and even development of second cancers (which occurs in 3 to 12% of children who survive cancer). Because of these significant possible consequences and the complexity of treatment, children with cancer are best treated in centers with expertise in childhood cancers.

The impact of being diagnosed with cancer and the intensity of the treatment are overwhelming to the child and family. It is difficult for the health care team and the family to maintain a sense of normalcy for the child, especially considering the child's frequent hospitalizations and office visits for treatment of the cancer and its complications. Overwhelming stress is typical, as parents struggle to continue to work, be attentive to siblings, and still attend to the many needs of the child with cancer (see Section 23, Chapter 287). The situation is even more difficult when the child is being treated at a specialty center far from home. The treatment team should include pediatric cancer specialists, other needed specialists, and the primary care doctor. Other essential personnel are a social worker (who can provide emotional support and help with financial aspects of care), a teacher (who can work with the child, the school, and the health care team to ensure that the child's education continues), and a psychologist (who can help the child, siblings, and parents throughout treatment). Many centers also include a parent advocate--a parent who had a child with cancer who can offer guidance to family members.