Childhood Cancer – New tests and treatment you should know about

In this article, you will learn about the cancers of childhood, their types, causes, and general symptoms associated with each one of the mentioned cancers. Along with this, the advancement in research has shown that there is a lot of difference between these cancers and cancers of adults due to differences in the anatomy of kids and young adults.

Therefore researchers and oncologists believe that such patients require vivid diagnostic tests and treatments that can complement their anatomy and increase their survival rate after treatment. These new tests and treatments are needed as in adult cancer the doctors just try to save the remaining life of patients, but in the case of childhood cancer, the doctors are in need to save the entire upcoming life of a kid and that to be disease free, active and healthy.

What is childhood cancer?

• Cancer developed in a child, during its early stage of life is known as childhood cancer. It is always upsetting to find out about having cancer at any age in life and is more upsetting to it at this early age.
• Although about 80% of childhood cancers are treatable, only 1% of all types are identified. The main reason behind this is the ignored symptoms and efforts are laid in control planning.
• The approximate standard of the adopted ages includes from 0 years to 14 years and 11.9 months of age. In some special cases, childhood cancer also includes the ages of 15-19 years as well.
• The branch of medicine that is associated with the diagnosis, treatment, and management of childhood cancer is known as pediatric oncology.

Cancer Symptoms

Chemotherapy Side Effects

Lung Carcinoid Tumors

HIPEC (Hyperthermic intraperitoneal chemotherapy)

Types of childhood cancer

S.No	Name of cancer	Definition	Further types
1	Leukemia	Cancer begins in the bone marrow results in the growth of abnormal cells and blocks the production of, normal RBC, WBC, and platelets.	Acute Lymphoblastic Leukemia (ALL), Acute myeloid Leukemia (AML)
2	BST (Brain and Spinal cord Tumors)	Also known as CNS tumor, central nervous system tumor. It is the growth of benign or malignant tumors in any part of the brain or spinal cord affecting motor neuron function. It is more challenging with the pediatric population as their brain is still developing. It is several types depending on which part of the brain is affected or which nerve cancer is affecting which organ.	Oligodendroglioma, Astrocytoma, Ependymoma, Choroid plexus carcinoma, Oligoastrocytoma, Glioblastoma, Ganglioglioma, Desmoplastic infantile ganglioglioma, Pleomorphic xanthoastrocytoma, Anaplastic ganglioglioma, Gangliocytoma, Neurocytoma, Medulloblastoma, Medulloepithelioma, Atypical Teratoid/Rhabdoid tumor, Pineocytoma.
3	Neuroblastoma	It is a tumor of immature nerve cells. It often starts from the adrenal gland and affects the endocrine system	it spreads to other organs such as the kidney, liver, lungs, bones, etc.
4	Lymphatic tumors	It’s a cancer of the lymphatic system when its cell form a tumor. It can be restricted to the lymphatic system and can spread to other systemic organs and organ systems.	Non-Hodgkin Lymphoma – can spread to other systemic organs. Hodgkin lymphoma – in this the tumor is restricted to the lymphatic system.
5	Wilms tumor	If the early cells of the kidney do not develop into glomeruli or nephrons, clusters of the immature cells may form in the kidneys when the baby is born, this mass is known as a Wilms tumor. It only happens in the child age group between 0-14 years of age.	Cancer of the immature kidney is different from adult kidney cancer.
6	Germ cell tumor	tumor in the child’s reproductive organ such as tumors of the testis in boys and ovaries in girls	1) Gonadal germ cell tumors – in the reproductive organ.  2) Extragonadal germ cell tumors – the tumor is present in the reproductive organ but also spread to different parts of the body.
7	Retinoblastoma	A tumor that grows in the eye, especially in the retina.
8	Osteosarcoma	cancer of bones, Ewing sarcoma (cancer of the bone and soft tissue)	It can be a central tumor or a surface tumor.
9	Pleuropulmonary blastoma	Rare lung cancer begins in the chest either pulmonary or pleura.	Is of four types: Type I (cyst made up of air pockets, 10 months old), Type Ir (similar to type I but is regressive and happen in a child older than 10 months), Type II and Type III, both Type II and III require surgery and chemo.
10	Liver tumors	When liver cells form a tumor.	Hepatoblastoma and hepatocellular cancer
11	Rhabdomyosarcoma (RS)	A type of tumor that most commonly begins in the striated skeletal muscles.	Embryonal RS, Botryoid RS, Spindle RS, alveolar and pleomorphic RS, etc.

Signs and Symptoms

S.No.	Name of cancer	Symptoms
1	leukemia	General discomfort, loss of appetite, low fever, pale skin(pallor), the appearance of red and purple color spots, bruises, bone pain, and unintended weight loss.
2	CNS tumor	Ataxia (incoordination in muscles), accumulation of CSF in the brain, double vision, headache, seizures, vomiting, mental impairment, and brainstem compression.
3	Lymphatic tumors	Polyp structure in the neck, loss of appetite, fatigue, itching, loss of weight, night sweats, fever, abdominal pain, diarrhea, vomiting, and shortness of breath and in case of affected mediastinum there will be a superior vena cava syndrome.
4	Neuroblastoma	Fast-spreading tumor or dislocating tumor, anorexia, abdominal pain, bloating, and swelling in stomach and belly area.
5	Wilms tumor	Abdominal pain, blood in urine, high blood pressure, fever, nausea, vomiting, varicocele, palpable mass, and loss of appetite.
6	Germ cell tumor	Pain in the affected area, difficulty passing stool, constipation, urinary retention (inability to urinate), cough, and difficulty breathing.
7	Retinoblastoma	White pupil, poor vision, enlarged pupil, red eye, pain in the eye, different colored irises, crossed eye, disoriented eye, etc.
8	Osteosarcoma	Gradually worsening pain in bones and joints, the mass of lump in and around shoulder, neck, and leg area, back pain, and loss of bowel control
9	Pleuropulmonary blastoma	Stress shock due to escaped air into the lung cavity from the cyst, lung infection, cough, fever, pain, bloody cough,
10	Liver tumors	Pain in the right abdomen, unexplained weight loss, a lump under ribs, enlarged liver, weakness, fatigue, and jaundice-like symptom.
11	Rhabdomyosarcoma	Ear and nose bleeding, symptoms of sinus infection, abdominal pain, vomiting, constipation, bulging of the eye, mass lump.

Risk Factors

These are the factors that can elevate the chances of getting cancer. These do not directly cause cancer, however, can influence it. A child with so many risk factors might never get cancer and one with no risk factors get cancer. Pediatric oncologists do not know the exact causes of childhood cancer. They might be due to

1. Demographic factors- childhood cancer differs from one another by age, sex, genetic make-up, and race. It is believed that males are more prone to get it than females.
2. Environmental factors – such as ionizing radiation, cigarette smoke, and UV light,   can be a risk factor for developing cancer. If the pregnant woman is exposed to tobacco, X-Rays, previous chemoradiation, or certain drugs, that can cause cancer, it can also be a factor for the child to develop cancer.
3. Hereditary factor – about 5 % of all cancers are developed due to genetic mutation. Such factors include- extra chromosomes, turner syndrome, Klinefelter syndrome, Down syndrome, etc.
4. Inherited syndromes – Li-Fraumeni syndrome (associated with the development of breast cancer), Beckwith-Wiedemann syndrome (growth disorder, symptoms include large body size at time of birth, large tongue, low blood sugar, taller body at the time of birth), Fanconi anemia (bone marrow cancer, results in the low production of all types of blood cells), Noonan syndrome (in complement development of parts of the body, therefore lack particular functions), and Von Hippel- Lindau syndrome (a syndrome that causes tumors to grow in different parts of the body, at beginning these tumors are benign but can develop into malignant if not treated at right time).

Diagnostic tests for childhood cancer

Blood test – it includes the complete blood count. This is done to see the complete blood profile. In cancer situations, it is done to monitor the complete status of the blood profile and to see if the treatment is responding or not, especially in the case of leukemia or lymphoma. It measures the white blood cells, red blood cells, differential white blood cells, hemoglobin, hematocrit, mean corpuscular volume, and platelets count.

Biopsy – it is a surgical procedure in which a tumor is removed surgically and examined under the microscope. It is a confirmatory test that marks the presence of cancer as the live cell status is checked and the mutated cells distinguish from the normal cell in terms of their structure and cell growth. The location of the tumor and the affected body organ decides the type of biopsy to be done. The sample was sent to a pathological lab where the pathologist examine it under a microscope. There are further many types of biopsies –

• Needle biopsy – in this a special type of needle is used to collect different types of samples such as fine needle aspiration biopsy (FNAB – it uses a very fine needle to collect samples), core needle biopsy (it uses a slightly larger needle than the one used FNAB to collect sample like mass structure), Vacuum-assisted bioscopy (in this a specially designed needle-like suction device is used to collect the tissue sample).
• Image-guided biopsy – imaging techniques like ultrasound, fluoroscopy, CT scan, X-ray, and MRI are used to collect the sample. This is done using these imaging techniques when the doctor is unable to feel or find cancer or the tumor is located deep inside the body.
• Excisional biopsy – it is the surgical removal of the tumor, a cut is made into the body to remove the tumor and then stitched back. The severity depends upon the location of the tumor.
• Skin biopsy – it involves the procedure, of punch biopsy (in which a cylindrical device is pushed under the skin layer to collect the sample) and shaves biopsy (in which the upper layer is scrapped off to collect the sample from the lower skin layer).
• Endoscopic biopsy – it uses a thin tube attached to the camera that is inserted either through the mouth or nose into the body via, the esophagus, stomach, bladder, and joints. This helps the doctor see inside the body and take the sample from the exact location for biopsy.
• Laparoscopic biopsy – this is the same as endoscopic biopsy but it is for the abdomen and pelvis region. In this, the small tube with a camera known as a laparoscope is inserted into the abdomen region and then the sample is taken from the affected region.
• Bone marrow aspiration or biopsy – in this the fluid (aspiration) or the tissue (biopsy) from the bone marrow is taken via needle to check for blood cancers. The sample is taken from the lower back near the hip region.
• Liquid biopsy – in this the blood sample is taken to perform a biopsy. This is a new technique and is not done for many cancers, although this is the easiest biopsy and can be done multiple times.

Lumbar Puncture – this procedure is done to take CSF as a sample. CSF is a fluid that runs in the brain and spinal cord. The following procedure is performed by sedating the lower back and then a sample is taken. Tumor markers are found in higher amounts in the blood, urine, and body fluid/ tissue of people who have cancer.

Ultrasound – it is an imaging procedure that uses high-frequency sound waves to make a picture of an internal organ.

CT scan – it uses X-rays to create multiple images of the internal organ from different angles. These pictures are then combined using the computer to produce a 3D image of the organ. It gives us a clear picture of the location and size of the tumor. The CT- scan uses a special dye given intravenously or via pills to give more detailed images.

MRI – this procedure is exactly the same as CT-Scan. The only difference is, this uses a magnetic field to create an image not X-rays.

PET scan – this is used in combination with a CT scan and in this a radiolabelled sugar is given to the patient. Sugar is consumed by the body as an energy source, since cancer cells need more energy, they absorb more sugar. This is then scanned and the cancer cells are seen as more fluorescent than normal cells.

Radioisotopes Study – in this a tracer substance is injected into the body and then traced using X-rays or a camera.  This procedure is used to see abnormalities inside the organs.

Molecular sequencing – in this the blood or any appropriate sample is taken and then sent to the sequencing lab, where the whole genome of a human being is studied for any mutation and changes. This is the fastest method to know the cause, site, type, and metastasis of cancer. This allows the oncologists to devise the targeted therapy for the patent. This use NGS (Next-Generation Sequencing) method to provide more informative and fast results.

Biomarker test- it is a test to study the proteins, genes, and other bio-marker substances in the body to look for cancer. As each individual has a unique pattern of biomarkers for cancer and these patterns decide the type and time period of cancer treatment.  People with hard tumors and blood cancer are eligible for such testing. It is a test that can help oncologists to advise the personalized diagnosis, treatment, and preventive strategies to treat cancer. It is also known as liquid biopsy combined with genetic or genomic testing.Some examples include- whole-exome sequencing, whole-genome sequencing, tumor mutational burden, and germline mutations.

Advancement in the treatment of childhood cancer

Chemotherapy – it is a therapy used to kill fast-growing cancer cells in the body. It is used to make tumors small and prepare the body for surgery or any other treatment, or to kill cancer cells that remain after surgery, improve the effectiveness of other treatments, and stop the recurrence or spread of cancer to other body parts.

Hormone therapy – it is done to treat cancer and to ease the symptoms of cancer. It works generally on two pathways in the body, one is the block the production of a hormone in the body and the other is to alter or reduce its activity. It is used for cancers that use hormones to grow tumors such as prostate, thyroid, breast, etc. If used in conjunction with other therapies, then its working action will be the same as that of chemotherapy, i.e., to reduce the tumor before surgery, to kill the remaining cancer cells after surgery, and to stop its spread. Further, this can have side effects like hot flashes, nausea, diarrhea, fatigue, weakened bones, etc. 

Hyperthermia – it is also known as thermal therapy, it uses heat to kill cancer cells. The patient’s body is heated to 113 degrees Fahrenheit which kills tumor cells with minimal to no harmful effect on normal cells. The substances used to produce heat in this therapy includes microwaves probe, radio waves, ultrasound, laser, and fluid such as blood or chemo drugs are also used as hating material (perfusion), HIPEC, etc.

Cryotherapy – it is the use of extremely cold temperatures to kill cancer cells. It uses an instrument known as a cryoprobe to freeze and kill tumor cells and tissues. It is done without open surgery and the patient recovers quickly with the least pain as a side effect. It is the most efficient therapy for skin cancer and cancer of the retina in children. The freezing agent used is liquid nitrogen, argon gas, and liquid nitrous oxide. These can be applied externally as if cancer is present at the surface of the skin or internally, the cut is made in the skin and a cryoprobe is inserted to eradicate the tumor.

Immunotherapy – it is a therapy to improve the immune system. It employs the strengthening Of the WBCs, related organs, and tissues. Such therapies can be given intravenously, orally, as a cream, or spray, and can be given directly into the bladder.    This includes the following therapies –

• Immune checkpoint inhibitors – in these certain drugs are given to patients that block the checkpoint of the immune system, allowing the system to produce a more intense response against cancer cells than before.
• Monoclonal antibodies – these are proteins given to patients in order to better mark the cancer cells, so if tumor cells are now seen in the body, they will be identified more specifically and will easily be targeted by the immune system.
• T-cell transfer therapy –in this therapy, the T-cells already present in or around your tumor are taken out, redesigned, and grown on a large scale. Then these synthesized T-cells are injected back intravenously to fight cancer. In this way, this treatment improvises the action of T-cells and makes them strong.
• Therapeutic vaccines – It is the vaccines that help to develop the immune system for an already existing disease, such as cancer. Unlike traditional vaccines, which prevent you from developing any disease, this builds the immune system to fight the disease after getting sick. Although this is an ongoing research topic, still the studies so far are quite promising. And research for the treatment of brain cancer in childhood is going on.
• Immune system modulators– these are the drugs given to enhance the immune response of a patient, either target-based response or general immune response.

Photodynamic therapy – PDT employs the use of photo-sensitive drugs, which get activated using a light source from a laser, or photodiode. Once the cancer cells absorb the photosensitizers then using a LED of a certain wavelength, these create a radical oxygen that kills cancer cells. It may also rupture the blood vessel or trigger an immune response against cancer cells.

Radiation therapy – is the use of high radiation to degrade the DNA of the cancer cells. Once it damages the DNA to an unrepairable state, the cancer cells die automatically. These dead cells then broke down and passed out of the body via lysozymes. It is done for weeks, and those cells die for weeks and months after completion of the therapy. It is given either via an external beam for superficial tumors or via an internal beam for deep-rooted tumors. The choice of radiation therapy to be given depends upon the type, size, location, the closeness of the tumor to sensitive tissue, past medical record, age and sex of the patient, etc.

Stem cell transplant – it is done to restore the stem cells in patients whose stem cells have been destroyed using some kind of extensive radiation or chemotherapy. This will restore stem cells which eventually produce healthy RBCs, WBCs, and platelets. This will increase the immune response, oxygen concentration, and clotting efficiency of respective stem cells. It can be done either using the stem cells of the patient only (autologous), stem cells from a blood relative / stranger (allogeneic), or stem cells from an identical twin if the patient has one (syngeneic). It is generally used to treat patients with blood cancers. This therapy can be affected by the type of transplant, prior treatment, cancer type, spread rate, health status before getting cancer, etc.

Surgery – it is the procedure to remove your cancer tumor, done by the onco-surgeon.  The surgeon will do either open surgery, make an incision in the body and cut the tumor out and stitch the cut back, or minimum invasion surgery, such as endoscopy but this time not to take a sample but to remove the entire tumor with the help of the camera. The surgeon can also remove the entire tumor, debulk the tumor or just ease the cancer symptoms. Although severe pain and a chance of getting an infection are side effects.

Targeted therapy – this therapy aims at the protein responsible for growth, spread, and division. These are generally small molecular drugs or monoclonal antibodies. The small molecular drugs are small enough to enter the cell, therefore use to target internal targets. Monoclonal antibodies on the other hand are the protein designed n labs to target especially the tumor cells. The presence of this protein then increases the immune response of the cancer cells.  For the formulation of these targeted proteins, the tumors are tested, and for these biomarker tests are used. This therapy is helpful in assisting the immune system to kill cancer cells, hinder the growth of cancer cells, block signals from blood vessels, provide substances that kill cancer cells, and starve the cancer cell-required hormones.

 Frequently Asked Questions