Pediatric Oncology

ONCOL 255 - Intro to Oncology. University of Alberta

What is the incidence rate of childhood cases of cancer per 1 000 000 children

153 cases per 1 million

what is the mortaltity rate of childhood cases of cancer per 1 000 000

26 cases per 1 million

in high income countries, ______ % of children are cured

80

in low inchome country, up to ____ x more likely to die from cancer

10 x

incidence of childhood cancer has ______ since 1992, but moretality has _____ due to improvements in cancer treatments

stayed the same; decreased

what is the childhood cancer ratio for male to female

1.2:1

how does the cancer incidence in children (0-14) differ from teenagers (15-19)

Children

• most common cancer is leukemia (31%), Lymphoma and CNS cases

Teenages

• lymphoma numbers increase and huge increase in carcinomas and melanomas

3 risk factors for childhood cancers

1. Exposure to ionizing radiaiton

2. second hand smoke/alcohol during pregnancy

3. genetic disorders

3 examples of genetic disorders that incrase cancer predisposition

1. down syndrome

2. Li-Fraumeni

3. Von Hippel-Landau

4. Fanconi Anemia

Is cancer the main cause of childhood mortality?

no trauma and suicide is the leading cause

• cancer is the smallest cause aside from cardiovascular

how has survival probability increased in the past 40 years

increased from 63% to 85%

• increased by 20%

Two pros of work with children

• more fun

• healthy organs and few co-morbidities

Two cons of working with children

• often uncooperative

  • need to gain trust of child and parent being able to treat them

• need to factor in growth and development for treatment

Differences between childhood and adult cancer biology and origin

children

• random non-inherited genetic mutations that occur in life

• increase incidence in some genetic disorders

  • were not 100% sure what causes childhood cancers

Adults

• many factors are due to environmental and lifestyle risk factors

• more associated with chronic inflammation, prolonged exposure to carcinogens and age-related genetic mutations

Differences between children and adult cancers in term of characterization and behaviour

children

• childhood tumors are characterized by histology

• tend to spread more rapidly than adult cancers

• biopsy is required

Adults

• develop more slowly

• categorized by anatomic site

Differences between children and adult cancer types of cell

children

• childhood cancers tend to involve cells that are actively growing and developing

  • commonly affects blood cells, nervous systems, and bone or muscle cells

Adults

• more likely originate from epithelial cells (carcinomas)

Differences between children and adult cancers treatment approaches

Children

• treatment of childhood cancers often involves multimodal theray

• typicall treated aggressive as the goal is to cure the pediatric cancers

Adult

• cancer treatment focuses on managing the disease, particularly in older adults

• treatment often involves a balance between extending life and maintaining QoL

Differences between children and adult cancers long term considerations

children

• long-term survival and QoL are major concerns

• survivors of childhood cancer require lifelong follow-up care to monitor and address late effects

Adults

• in adults the focus is on managing comorbid conditions

• the prescence of other chronic diseases can complicate cancer treatment

Differences between children and adult cancers long term considerations

Children

• overall childhood cancers have a high survival rate, but can vary differ depedning on type of cancer and resources

  • low and middle income countries, survival rates are often lower due to delayed diagnosis

Adult

• prognosis differs on type of cancers and stage of diagnosis

• survival rates are lower for advanced stage or for associated with lifestyle factors

Differences between children and adult cancer - long term effects

• survivors of childhood cancer are at risk for longer term health issues like secondary cancers, heart disease, infertility

Adult

• long term effects of cancer treatmetn in adults can include chronic pain, fatigue, and emotional distress

Typical symptoms of childhood cancer

typicaly non-specific symptoms but relatively acute

• fever

• anorexia

• pain

• headaches

• enlarged lymph nodes

obvious symptoms of childhood cancers

mass

enlarged lymph nodes

bruises (leukemia)

neurological signs (brain tumor)

the three Rs of children cancer management

• review

• refer

• reassure

childhood malignanices move ____ than adult cancers

more rapidly and aggressively

Overall prognosis of childhood cancers

82% survival

what three diseases have an overall prognosis of 90-95%

• Hodgkins

• Wilms

• ALL

what diseases have prognosis below 50%

• Stage 4 solid tumors

• certain brain tumors

what novel type of therapt is helping change the treatment trajactory of child cancer

targeted therapies

impact of cancer diagnosis on child

• developmental issues

• loss of autonomy

• hair loss

• school re-entry

impact of cancer diagnosis on parent

• more difficult than if they were ill themselves

• guilt and anxiety

• advocacy

• marital issues

impact of cancer diagnosis on family

• whole family illness

• financial issues

• geography issues