Day: July 4, 2016

What Are The Most Common Pediatric Cancers?

Patient Presentation
A group of residents were discussing some of the patients they were caring for on their hematology/oncology rotation. They noted that it had been a very busy rotation with several children needing to be admitted with fever and neutropenia, or problems with their central intravenous catheters that were used for their treatments, and the usual number of children who were being admitted for their routine chemotherapy treatment. “Unfortunately we’ve also had a several patients with new diagnoses too. There was one child with ALL, another with rhabdomyosarcoma and another with a brain tumor. They are all so different to treat and think about so we’ve been learning a lot this month about oncology,” one resident remarked.

Discussion
Cancer occurs in all ages including children. Fortunately cancer is much less common in the pediatric age group accounting for <1% of all cancers yearly in the US. Approximately 10,000 US children under age 15 will be diagnosed with cancer in 2016. More than 80% of those children will survive more than 5 years because of advances in direct cancer treatment and treatment of its complications. Survival rates depend on a number of factors including the type of cancer and location. Despite these good numbers, about 1250 children in the US die yearly from pediatric cancer. After accidents, childhood cancer, suicide/homicide and congenital abnormalities cause similar numbers of deaths in children and teens. Known risk factors are few but include certain genetic mutations or syndromes and ionizing radiation. The World Health Organization does keep data on pediatric cancer worldwide but it is not as consistently available worldwide.

Learning Point
The most common pediatric cancers in the U.S. are:

  • Leukemia
    • 30% of all pediatric cancers
    • Acute lymphoblastic leukemia(ALL) and acute myeloblastic leukemia (AML) are the most common leukemias
    • Found in all ages
    • 5 year survival rate is 85% (all survival rates listed here are from 2005-2011)
    • 5 year survival rate is 89% for ALL and 65% for AML
  • Brain and other central nervous system tumors
    • 26% of all pediatric cancers
    • Can occur in all central nervous system locations but are a little more common in the cerebellum and brain stem than in adults
    • Found in all ages
    • 5 year survival rate is 72%
  • Neuroblastoma
    • 6% of all pediatric cancers
    • Can occur in all areas of peripheral nerves but are more common in the abdomen
    • Common in infants and young children. Rare after age 10 years
    • 5 year survival rate is 78%
  • Wilms tumor (or nephroblastoma)
    • 5% of all pediatric cancers
    • Occurs in one or both of the kidneys
    • Common in toddlers and preschoolers. Uncommon after age 6 years
    • 5 year survival rate is 92%
  • Lymphoma (including both Hodgkin and non-Hodgkin)
    • Hodgkin lymphoma is 3% of all pediatric cancers
      • Occurs in lymph nodes
      • Common in adolescents and young adults, with another peak in mid 50s. Rare in children < 5 years.
      • 5 year survival rate is 98%
    • Non-Hodgkin lymphoma is 5% of all pediatric cancers
      • Occurs in lymph nodes
      • Can occur in all pediatric ages but less common in those < 3 years of age
      • 5 year survival rate is 89%
  • Rhabdomyosarcoma
    • 3% of all pediatric cancers
    • Soft tissue sarcoma is most common.
    • Can occur in any location with skeletal muscle. Occurs in all ages
    • 5 year survival rate is 69%
  • Retinoblastoma
    • 2% of all pediatric cancers
    • Can occur in one or both eyes
    • Often occurs around 2 years of age and is uncommon after age 6 years
    • 5 year survival rate is 97%
  • Bone cancer (including osteosarcoma and Ewing sarcoma)
    • 2-3% of all pediatric cancers
    • Osteosarcoma (2%) is the most common bone tumor. Ewing’s sarcoma is also common (1%).
    • Adolescents more commonly have bone tumors but they can occur at any age.
    • 5 year survival rate for osteosarcoma is 69%

Questions for Further Discussion
1. What type of followup care do survivors of pediatric cancer need?
2. How common are second malignancies after treatment for pediatric cancer? For an answer click here
3. Where can comprehensive cancer centers for pediatric treatment be found?
4. What are PDQ®s for cancer? For an answer click here

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Cancer in Children.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

American Cancer Society. What are the most common types of childhood cancers?
Available from the Internet at ancer.org/cancer/cancerinchildren/detailedguide/cancer-in-children-types-of-childhood-cancers (rev. 1/27/16, cited 4/25/16).

Centers for Disease Control. 10 Leading Causes of Death by Age Group, United States 2014.
Available from the Internet at http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2014_1050w760h.gif (rev.2/25/2016, cited 4/25/16).

American Cancer Society. Cancer Facts and Figures 2016.
Available from the Internet at http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf (rev. 2016 cited 4/28/16).

Centers for Disease Control. United States Cancer Statistics Childhood Cancer. Available from the Internet at https://nccd.cdc.gov/uscs/ChildhoodCancerData.aspx (cited 4/28/16).

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital