Understanding Acute Lymphoblastic Leukemia (ALL) About ALL Leukemia — or cancer of the blood — is the most common childhood cancer. According to the American Cancer Society, about 2,700 children are diagnosed with leukemia in the United States each year. Acute lymphoblastic leukemia, also known as ALL, is the most common form of leukemia that occurs in children. It is characterized by the presence of too many immature white blood cells in the child's blood and bone marrow. While ALL can occur in adults too, treatment is different for children.
The term "acute" refers to the tendency of this disease to progress rapidly. "Lymphoblastic" refers to the white blood cells, which are also called lymphocytes. Normally, lymphocytes mature into an important part of the body's defense system against infections. But in ALL, something happens — researchers do not yet know what, but something interrupts normal cell development. The result is an overabundance of incompetent, "blastic" immature cells. Their presence affects a person in two ways: By crowding. Lymphocytes are made in the bone marrow, the spongy tissue inside the large bones of the body. But other vital blood components are made there, too — red blood cells needed to carry oxygen to tissues, and platelets that are needed to stop bleeding through clotting. When immature lymphocytes crowd out red blood cell production, a child's body does not receive all the oxygen it needs. As a result, he or she may develop anemia. And when immature lymphocytes crowd out platelets, the child bleeds and bruises easily. By invading other organs, such as the spinal cord and brain, liver, or spleen. The presence of lymphocytes in these sites impairs function here, too. Symptoms In its early stages, ALL can mimic common diseases such as the flu or a cold. The difference between ALL and an ordinary, fleeting infection is its persistence, and the fact that the child may begin to bruise easily. Common symptoms for ALL include: - fever
- feeling weak and tired
- pain in bones or joints
enlarged lymph nodes as a result of the overproduction of immature lymphocytes crowding the lymph system - bruises
Understanding Acute Myelogenous Leukemia (AML)
About AML Also called acute nonlymphocytic leukemia or acute myeloid leukemia, AML is primarily a cancer of the bone marrow and lymph nodes. Though it can affect both children and adults, the treatment differs between the two groups. In children, AML is the second most common form of leukemia — acute lymphoblastic leukemia is the most common. The term "acute" refers to the tendency of this disease to progress rapidly. The second term in its name — myelogenous — distinguishes it from a disorder of the lymphocytes. In AML, as in other leukemias, it is the bone marrow that malfunctions as a result of disease. Normally, the bone marrow regulates production of different kinds of cells vital to proper function. But in AML, the regulatory mechanisms go awry and the bone marrow starts producing too many immature and abnormal cells called blasts. These blasts circulate throughout the blood stream and lymph system where they disrupt normal function of organs. Because this disease progresses so rapidly, it is imperative that aggressive treatment at a multidisciplinary medical center begin as soon as possible. Untreated, death can occur in a matter of weeks. - AML is the second most common form of childhood leukemia.
- Remissions are often obtained, but the leukemia can recur
- Unlike other cancers, AML does not occur in stages. Instead, it tends to be found spread throughout the bloodstream at the time of diagnosis, and may have invaded an organ. As a result of its ability to affect the whole body at once, it must be treated aggressively as soon as possible.
Symptoms This disease can go undiagnosed because its early symptoms mimic other common diseases like the flu or other viral or bacterial illnesses. Among the symptoms are: - Fever
- Chills
- Bleeding or bruising easily
- Flu-like illness with malaise, fatigue, joint pain
Understanding Brain Tumors What is a brain tumor? A brain tumor is an abnormal growth of cells in the brain. These cells come from the supporting structure of the brain. There are several types of supporting cells. The type and name of your child's tumor is based on the type of supporting cell that begins to grow abnormally. What is the difference between the brain and the central nervous system (CNS)? The brain is one part of the central nervous system. The CNS is made up of the brain and the spinal cord. What do the terms benign and malignant mean? Why are some tumors called benign versus malignant? This can be confusing. Health professionals often use different words to describe the same disease. Usually a tumor is referred to as malignant when it spreads beyond the original site to other areas or organs. Tumors that begin in the brain usually do not spread to other organs within the body but can sometimes spread in the central nervous system. Even though brain tumors may not spread to other organs, they can cause problems by growing within the head, putting pressure on the normal brain tissue, or destroying healthy tissue. The dictionary defines benign as mild or harmless and malignant as serious and potentially threatening possibly causing death. This means that some brain tumors, made up of very slow growing cells that do not spread to other locations and can be treated with surgery alone, may be considered benign while other tumors might be malignant even though they remain in the same place. Are brain tumors cancer? Again, many different words can be used to describe a brain tumor. A tumor is a mass (lump or cluster) of cells that multiply abnormally for no known reason. Cancer also refers to cells that grow out of control and can spread throughout the body. Some people may not want to call a brain tumor a cancer because it usually does not spread beyond the brain. However, a brain tumor is made of abnormally growing cells that can cause damage. In that sense it is a cancer. How Common are Brain Tumors? Brain tumors are the most common occurring solid tumor in children. They are almost as common as childhood leukemia. Approximately 1,700 brain tumors are diagnosed each year in children in the United States. Primary brain tumors account for 20 percent of all childhood cancer deaths. Because they occur so often in children, brain tumors are a major focus of the work of pediatric oncologists, neurosurgeons, and radiation oncologists. Even so, these tumors are rare compared with many other diseases. Doctors from all over the United States have shared their experience and developed national treatment plans for many types of brain tumors.
What Causes a Brain Tumor? Health professionals honestly do not know what causes a brain tumor. Research has been done for many years to search for causes of brain tumors and is still being conducted today. Past research efforts have investigated areas such as diet, infections, and electromagnetic fields as possible causes; however, none of these factors have been shown to cause brain tumors. We still do not know the cause, but it is likely due to a combination of factors. We do know that brain tumors are not contagious. In some cases, tumors are one part of genetic diseases such as neurofibromatosis and tuberous sclerosis. Children with these diseases have a higher likelihood of developing a brain tumor than other children.
Understanding Hodgkin's Lymphoma About Hodgkin's Lymphoma Hodgkin's lymphoma, or Hodgkin's disease, as it is also called, is one of the many kinds of cancer of the lymphatic system that can affect children and adults. In Hodgkin's disease, a certain kind of cell — called the Reed-Sternberg cell — begins to reproduce uncontrollably. It is the overabundance of this specific kind of cell that distinguishes Hodgkin's lymphomas from non-Hodgkin's lymphomas. The lymph system is the network of vessels that conducts a colorless fluid called lymph throughout your body. As part of the immune system, lymph is an important infection-fighting agent. In certain areas of your body its vessels widen into lymph nodes. This is where the lymphatic system makes and stores infection-fighting cells. If you've had an infection or disease like mononucleosis you've probably felt the lymph nodes in your groin, under your arm, or neck enlarged by infection. Because there is lymph tissue throughout the body, Hodgkin's disease can start almost anywhere — and spread almost anywhere, too. - It is rare in children under age 5.
- In children under age 10 it is more common in boys than in girls.
- It usually affects people between 15-35 years old, and over 50.
- When Hodgkin's disease is detected early and treated properly, as many as 90 percent of the cases can be cured. This is a big change from the prognosis — or outlook — 25 years ago. Before the development of new anti-cancer drugs, the disease was almost always fatal.
- With more advanced forms of Hodgkin's, 50 to 80 percent are considered cured (no disease present 10 years after chemotherapy).
Symptoms In the case of a young child, the parent is the most likely person to find an early sign of Hodgkin's lymphoma: an enlarged, or swollen lymph node in the armpit, groin or neck that feels hard and rubbery, and does not reduce in size for more than three weeks. Because the swelling is usually painless, its presence is often discovered by accident. Older children, teens and adults might find the enlarged node while bathing or showering. Other signs and symptoms include: - Fever that doesn't go away
- Chills
- Continual fatigue, lasting for weeks and not linked to activity
- Night sweats
- Weight loss and loss of appetite
- Severe itching at any place on the body
- Numbness or loss of strength in arms and legs (unusual)
- Loss of bowel or bladder control (unusual)
Understanding Non-Hodgkin's Lymphoma About Non-Hodgkin's Lymphoma Non-Hodgkin's Lymphoma is a family of tumors that originates in the lymph system. The lymph system is a vast network of thin tubes that branch - like blood vessels - throughout the body. These tubes carry a colorless fluid called lymph, which is made up of disease-fighting white blood cells that are an essential part of the body's immune system. These lymph vessels are connected to bean-shaped organs called nymph nodes which are found through the body - pelvis, armpit, neck and abdomen. These structures store and produce white blood cells. Because lymph tissue is found throughout the body, non-Hodgkin's lymphoma can start almost anywhere - and spread to almost any organ, including the liver, spleen and bone marrow. Non-Hodgkin's lymphoma can affect both children and adults. The majority of children with non-Hodgkin's lymphoma are cured. Therapies are aggressive, and are tailored to the type of lymphoma and the stage of the disease. A child's chances for a good recovery depend on his or her age and general health, the cell-type involved, and how quickly the cancer cells reproduce. There are three major types of childhood non-Hodgkin's lymphomas. The types are based on the cell type and size of the cancer, also referred to as histology, as seen under a microscope. They are: - lymphoblastic lymphoma (can be B cell or T cell)
- small cell lymphoma, which includes both Burkitt's lymphoma and non-Burkitt's lymphoma
- large cell lymphoma
Symptoms Symptoms can be difficult to diagnose because they are not specific to non-Hodgkin's lymphoma. Symptoms include: - Painless swelling of the lymph nodes
- Possible swelling of the abdomen
- Fever
- Chills
- Weight loss; loss of appetite
- Night sweats
Understanding Neuroblastoma About Neuroblastoma Neuroblastoma is a cancer of the nerve tissues that is most often found in children under 5 years old. In 70 percent of cases, neuroblastoma starts in the adrenal gland, located in the abdomen. Other growth sites it favors in the early stages are nerve tissue of the neck, chest, abdomen, pelvis and near the spine. By the time it is diagnosed it has usually spread (metastasized) to the lymph nodes, liver, lungs, bones or bone marrow. Neuroblastoma is sometimes present at birth, but not detected. In rare cases, however, it can be identified before birth by ultrasound testing of the fetus. - Neuroblastoma is the most common type of cancer in infants.
- The number of new cases of neuroblastoma is greatest among children under 1 year of age and decreases rapidly with age.
- Males are affected slightly more commonly than females.
- Most cases of neuroblastoma are diagnosed before 6 months of age.
- Unlike most cancers, neuroblastoma sometimes disappears — regresses — by itself. Researchers don't know why this is, and can't predict when it will happen.
- In a large percentage of patients, a bone marrow transplant is a successful treatment option.
Symptoms Common symptoms include: - Protruding eyes and dark circles around the eyes.
- Pale color.
- In rare cases, watery diarrhea, uncoordinated or jerky muscle movements and uncontrollable eye movement.
- Enlarged abdomen
Understanding Retinoblastoma About Retinoblastoma Hereditary retinoblastoma makes up 30 to 40 percent of retinoblastoma cases. It can be found in one or both eyes, and is usually found in younger children. When the disease is found in both eyes, it is always the hereditary form. Because of the genetic basis of this disease, siblings need to be examined by an eye specialist, and the parents should meet with a genetic counselor. A child with hereditary retinoblastoma also is at greater risk for developing other kinds of cancer elsewhere in the body later in life. These children should continue to have medical check-ups even after the disease has been treated. Non-hereditary retinoblastoma affects one eye only, and is generally found in older children. There is a slight chance that these children are at greater risk for developing cancer elsewhere in the body later in life. As a result, they should continue to have medical check-ups even after the disease has been treated. Symptoms Parents usually see the first signs and symptoms of retinoblastoma, and this prompts them to seek medical care. They include: - A white pupil, called "leucocoria." This may be most evident in pictures where one pupil appears red (normal) and the other appears white.
- One or both, crossed eye(s).
- Poor vision.
- White spots on the colored part — called the iris — of the eye.
- Red, swollen eye
The persistent presence of one or more of these conditions is good cause to immediately get a medical check-up — especially if other family members now have, or have had in the past, vision problems or cancer.
Understanding Osteosarcoma Osteosarcoma (also called osteogenic sarcoma) This is the most common type of primary malignant bone cancer. Osteosarcomas have subtypes, which include conventional osteosarcoma, parosteal, juxtacortical, Paget's or secondary-induced bone sarcomas (radiation-induced). Although it can occur at any age, osteosarcoma is typically found in teenagers and young adults and is slightly more common in males. Any bone in the body can be affected but the most common sites are the arms or legs, particularly around the knee and shoulder. Osteosarcoma treatment includes chemotherapy for any tumor that has greater than 10% chance of spreading elsewhere in the body. After a course of chemotherapy called induction therapy, the local disease is then managed by surgical removal of the primary tumor and reconstruction. If the primary tumor cannot be completely removed, amputation is occasionally required. After the management of the primary tumor, additional chemotherapy is focused on the possibility of microscopic disease in the bloodstream and lung that is undetectable. The principle behind the chemotherapy is to eradicate this disease before it begins growing. The course of treatment for osteosarcomas generally takes 10-12 months from the time of diagnosis, with chemotherapy followed by local control of the primary tumor, and then post-surgical control of any residual microscopic disease with additional chemotherapy for a total of 8-10 months. Chondrosarcoma This is a cancer of the cartilage although can also grow within a bone or on its surface. It is most typically found in middle-aged adults. Chondrosarcoma is usually a slow-growing tumor and the most common sites are the pelvis, shoulder and the upper part of the arms and legs. The treatment for chondrosarcomas relies heavily on surgical removal, since there is limited response to radiation and/or chemotherapy. One of the reasons for aggressive treatment is that 10% of low-grade tumors have been reported to develop a much more aggressive biologic behavior, a process called dedifferentiation. Ewing's sarcoma This is a tumor that occurs primarily in younger patients between the ages of 5 and 30 years of age. Any bone can be affected, but the pelvis, thigh bone and shin bone are the most common sites. Like osteosarcoma, this cancer is slightly more common in males than females. The prognosis for Ewing's sarcoma depends on the stage of the disease. If there is no evidence of disease outside of the local site, overall 60% of those patients will be cured. If the tumor is in a long bone such as the femur or humerus, is smaller than 8 centimeters in diameter and confined to the local site, the cure rate is 80+%. Even patients with metastatic disease to the lung may be cured. Patients with Ewing's sarcoma usually respond dramatically to chemotherapy. A major difference between osteosarcoma and Ewing's sarcoma is treatment of the local disease may be done with radiation therapy rather than surgery alone. Our center believes that the complications of radiation therapy are sufficient that when we can use surgery with an acceptable result to the patient and family, we prefer surgical treatment over primary radiation in Ewing's sarcoma.
Understanding Rhabdomyosarcoma About Rhabdomyosarcoma This is the most common soft tissue malignant tumor in children. It can arise in any muscle in the body, but is most common in the head and neck area as well as the area of the pelvis. Diagnosis The usual presenting symptom of the sarcoma is a painless mass. When pain appears, the tumor generally develops to its advanced stage. X-rays, CT or MRI scans are helpful to diagnose them. X-rays are especially useful for tumors of the arms and legs. CT scans (similar to x-rays) are used to look at the tumor but are also done on the chest to determine if the cancer has spread to the lungs. The lungs are the most common site for these tumors to spread. MRI (magnetic resonance imaging) scans use magnetic waves to take more detailed pictures of tumors and may be critical to the planning of surgery and/or radiation therapy. For an accurate diagnosis and to determine the type of sarcoma, a tissue biopsy is required and must be done before treatment starts. Treatment Most treatment protocols call for intense intravenous chemotherapy for about 12 weeks to shrink the tumor. Then a decision is made regarding "local control" of the tumor. Can the tumor be surgically removed, or will it need to be treated with radiation, or will it require both? Typically, another 24 weeks of chemotherapy follows the surgery and/or radiation.
Understanding Wilm's Tumor About Wilms Tumor If a child has cancer of the kidney it is most likely Wilms tumor — it accounts for 95 percent of kidney, or renal cancers, in children under the age of 14. Also called nephroblastoma, Wilms tumor is a mass of cancer cells that grows in kidney tissue. The kidneys filter and clean the blood, and produce urine. Though there is a pair of kidneys — they are fixed to the back wall of the abdominal cavity, with one on each side of the backbone — in most cases of Wilms tumor, only one kidney is affected. This is a disease primarily of young children. At the time of diagnosis most Wilms tumor patients are less than 5 years old. - Between 400-500 new cases of Wilms tumor are diagnosed each year in the U.S.
- About six percent of all cancers in children are Wilms tumor.
- Clinical trials over the past 22 years have been associated with improved long-term survival rates for children with Wilms tumor. The long-term survival approached 90 percent for most patients, and 95 percent for those with the most favorable prognosis. Careful use of surgery, and combination chemotherapy and radiation therapy, where necessary, has produced these results.
Symptoms The disease usually has no symptoms that are obvious to the child or parent. Instead, the hard mass of the tumor is most often felt by the physician's hands during a routine exam of the abdomen. Parents might also find a lump in the belly. Only rarely will the child complain of fever, aches or blood in the urine.
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