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as children are not “little adults”, childhood cancer
is different in many ways from adult cancer. The most common
cancers in adults are breast, cervical, colorectal, lung and
prostate; children almost never contract any of these. Acute
leukemia, central nervous system tumors, neuroblastoma, Wilm’s
tumor, and non-Hodgkin’s lymphomas constitute the top
five diagnoses under 14 years of age. This is in contrast to
Hodgkin’s disease (HD), germ cell tumors, non-Hodgkin’s
lymphomas (NHL), melanoma, and soft tissue sarcomas, which are
more frequent in youngsters 15 to 19 years of age (Table 1).
1. Incidence of most common cancers
in 0 to 14 year olds and 15 to 19 year olds, 1990-1997
Lymphocytic Leukemia (A.L.L.)
Bone Tumors Osteogenic & Ewing's
Source: Task Force on Cancer Prevention, Early Detection and
Treatment in New Jersey. New Jersey Comprehensive Cancer Control
Plan. Report to the Governor, July 2002. Trenton, NJ, New Jersey
Department of Health; 59.
Note: Rates are per 100,000
puts me at risk?
adult cancers have identified risk factors; some adult cancers
may be preventable. However, there is very little evidence to
indicate the causes of childhood cancer other than cancer genetics.
There also has been considerable research into the effects of
environmental contaminants associated with childhood cancer;
however direct causation has not been proven.
survival in children under 14 is a great success story of the
20th century. In the 1960s, the five-year survival rate for
a child diagnosed with cancer was 28%. By the 1990s this had
risen to over 75%. The greatest success was witnessed in acute
lymphoblastic leukemia, a virtually incurable disease in the
1960s with a median survival of six months. Today, more than
75% of the children are cured.
For more information on childhood cancer, log onto:
NCI – Childhood Cancers
NCI – Care for Children & Adolescents with Cancer: Questions and Answers
For information on finding a doctor or treatment facility, log onto: http://www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility
Effects of Cancer
Palliative care is a coordinated, inter-disciplinary
approach to healthcare that enhances the quality of life of
patients with cancer and other illnesses. It targets the physical
and psychological symptoms and spiritual needs of patients
from the time of diagnosis to end-of-life care in all settings.
For more information on Palliative Care, log on to:
Post-Traumatic Stress Disorder (PTSD)
Much of the literature has focused on posttraumatic stress in
relation to the family after a childhood cancer diagnosis, with
an indication of parental symptoms consistent with Post-Traumatic
Stress Disorder (PTSD) (e.g., avoidance, intrusive thoughts,
hypervigilance, etc.) Studies have shown significantly higher
levels of posttraumatic stress symptoms in parents of children
diagnosed with cancer as compared to those parents whose children
have not been diagnosed with a chronic illness. Moreover, study
findings linked parents’ perceived higher levels of social
support to fewer posttraumatic stress symptoms. This confirms
the notion that quality of life of survivors, siblings, and
parents can be improved by addressing impact at time of treatment
and subsequently through psychosocial support at treatment centers.
Late effects of Treatment for survivors of childhood
The available literature has well documented late effects of
treatment for survivors of childhood cancer, whether surgical,
chemotherapy or radiation induced. Adverse effects have been
shown to many organ systems, such as CNS, neuroendocrine, ocular,
dental, musculoskeletal, cardiovascular, pulmonary, gastrointestinal,
hormonal function, fertility, and risks of secondary malignancies.
Nervous System: Neurocognitive deficit (difficulty reading,
language, verbal and non-verbal memory, arithmetic, receptive
and expressive language, decreased speed of mental processing,
attention deficit, decreased IQ, behavior problems, poor school
attendance, poor hand-eye coordination); leukoencephalopathy
(seizures, neurologic impairment); focal necrosis (headaches,
nausea, seizures, papilledema, hemiparesis, speech, learning
and memory deficits); stroke; blindness; ototoxicity (abnormal
speech development, hearing loss); myelitis (paresis, spasticity,
altered sensation, loss of sphincter control); peripheral neuropathy
(generalized weakness, localized weakness, lack of coordination,
tingling and numbness).
Neuroendocrine: Growth hormone deficiency (poor growth/growth retardation);
ACTH deficiency (muscular weakness, anorexia, nausea, weight
loss, dehydration, hypotension, abdominal pain, increased pigmentation);
TRH deficiency (hoarseness, fatigue, weight gain, dry skin,
cold intolerance, dry brittle hair, alopecia, constipation,
lethargy, poor linear growth, menstrual irregularities, pubertal
delay, bradycardia, hypotension); precocious puberty (early
growth spurt, false catch-up, premature sexual maturation);
gonadotropin deficiency (delayed or absent pubertal development,
testi-cular atrophy, infertility, abnormal menses, estrogen
deficiency); hyperprolactinemia (abnor-mal menses, infertility,
galactorrhea, osteopenia, loss of libido, hot flashes, impotency).
system: Dry, red eyes; tearing; ulcerations; tortuous vessels;
pain; de-creased visual acuity; cataracts.
and neck/dental: Decreased saliva, dental decay, thrush,
ulcerations, chronic rhinitis, facial pain, headache, hearing
impairment, chronic ear infections, hair loss.
Musculoskeletal: Muscular hypoplasia, spinal abnormalities (scoliosis, kyphosis,
etc.), limb length discrepancy, pathological fracture, osteoporosis,
osteonecrosis, osteo-cartilaginous exostoses, slipped capito-femoral
Cardiovascular: Cardiomyopathy, valvu-lar damage, pericardial damage, coronary
Pulmonary: Pulmonary fibrosis.
Gastrointestinal: Enteritis, adhesions, esophageal strictures, fibrosis of small
and large intestines, hepatic fibrosis/liver failure.
dysfunction: Hypothyroidism, thyroid nodules, hyperthyroidism.
Infertility: Ovarian failure, premature menopause, decreased or absent sperm
production, testicular atrophy (3;32).
For more information on late effects of treatment, log onto:
The Children’s Oncology Group - Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers
Cancer Control Plan
New Jersey State Cancer