Pediatric Cancer

Pediatric cancer refers to cancer occurring in children and adolescents, typically under the age of 18.
While it is relatively rare compared to adult cancers, pediatric cancer remains a leading cause of disease-related death in this age group.
Incidence Rate: 16.8 cases per 100,000 children.
There has been significant progress over the past three decades in reducing mortality rates:
- Over 50% decrease in cancer-related deaths among children.
- Five-year survival rate has improved to approximately 80%.
- This improvement is largely due to advances in interventions and early detection, highlighting the necessity for ongoing research and innovation in pediatric oncology.

Advanced interventions are increasingly recognized for causing adverse effects, which include:
- Functional Impairments: These may affect daily activities and overall quality of life.
- Cognitive Changes: Impacting learning and memory, leading to difficulties in academic performance and daily functioning.
Late Effects of Cancer Treatment: Pediatric cancer survivors may suffer from a range of long-term complications:
- Cognitive Deficits: Commonly affecting memory and attention span.
- Cardiovascular and Pulmonary Diseases: Particularly following chemotherapy or radiation treatments.
- Endocrine Abnormalities: Resulting from treatment on the central nervous system, head, neck, or gonads. Examples include:
- Short stature.
- Hypothyroidism.
- Delayed secondary sexual development.
- Musculoskeletal Issues: Such as scoliosis or spinal shortening.
- Survivors have a 10-fold increased risk of developing a second malignancy compared to children who have never had cancer.
These risks necessitate long-term monitoring and supportive care for survivors.

Leukemia: The most common pediatric cancer, originating in blood-forming cells in the bone marrow.
- Definition: Characterized by the production of nonfunctional white blood cells (leukocytes) in excessive amounts.
- Types of Leukemia:
- Acute Lymphoblastic Leukemia (ALL):
  - Accounts for 80% of pediatric leukemia cases.
  - Frequently diagnosed in children aged 2-5 years.
  - Treatment typically involves chemotherapy for 2-3 years with a survival rate over 90%.
- Acute Myelocytic Leukemia (AML):
  - More prevalent in infants aged 0-2 years.
  - Treated with chemotherapy; however, with a lower survival rate of 63%, highlighting the need for advancements in treatment.
Brain and Central Nervous System Tumors:
- Second most common malignancy in children and third in adolescents.
- Types include:
- Astrocytomas.
- Medulloblastomas.
- Ependymomas.
- Typically develop in the posterior fossa region of the brain.
Bone Tumors and Soft Tissue Sarcomas:
- Significant types include osteosarcomas and Ewing sarcomas, primarily affecting adolescents.
Lymphomas: Less common but significant:
- Affect the lymphatic system, can occur in lymph nodes, the spleen, bone marrow, thymus, and organs like the brain and liver.
- Types include Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Staging Classification:
- Higher stage numbers indicate more severe disease.
- Oncologists use these classifications to develop optimized treatment protocols for patients.
Understanding staging aids physical therapists (PTs) in anticipating the adverse effects of treatments and managing activity limitations effectively.

Physical therapists working with pediatric cancer survivors need to understand:
- The location of tumors and surrounding tissues that were affected or preserved during treatment.
- This knowledge is vital for identifying and addressing impairments and developing effective intervention strategies.
Radiation Therapy:
- Involves exposing tumors to ionizing radiation, which damages the DNA of affected cells, hampering their ability to replicate.
- Note: Radiation does not differentiate between healthy and cancerous tissue.

Definition: Use of drugs to eradicate tumors or slow their growth, prolonging survival, and mitigating adverse effects.
Types include:
- Traditional cytotoxic agents,
- Act by disrupting DNA structures, inhibiting DNA/RNA synthesis, or preventing cell division to control tumor growth.
Whole-Body Radiation Therapy:
- Applied short-term, often in conjunction with high-dose chemotherapy.
- Caution on using whole-body radiation in young children due to side effects on growing bodies.
Acute Effects of Treatment:
- Common acute effects include:
- Anemia
  - Symptoms: Fatigue, reduced endurance, headache, dizziness.
- Bone marrow damage, leading to immune suppression.
- Other impacts:
  - Loss of appetite.
  - Constipation/diarrhea.
  - Mucositis (inflammation of the mucous membrane).
  - Alopecia (hair loss).
  - Hearing loss, peripheral neuropathy, neurocognitive changes, and myopathy.
  - Osteoporosis and osteonecrosis.
Late Effects of Treatment:
- Potential long-term complications include:
- Pulmonary dysfunction.
- Cardiac issues.
- Endocrine and reproductive dysfunction.
- Osteoporosis and sensory loss.

Physical therapy plays a vital role in supporting pediatric cancer patients but involvesunique considerations:
- Awareness of stressors affecting patients and families, including emotional and physical treatment tolls.
- Knowledge of medical treatment protocols to provide safe, effective care.
- Close monitoring of lab values to ensure optimal timing and adaptation of therapy sessions.
- Sensitivity to treatment side effects:
- Anemia or fatigue can hinder participation in therapy.
Infection Control:
- Importance of maintaining strict cleanliness and hygiene for toys, equipment, and hand-washing to minimize infection risks due to compromised immune systems.
Goals of Physical Therapy:
- Enhance mobility, endurance, and overall quality of life for pediatric cancer patients.