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A Closer Look at Childhood Cancer

Each year, 12,400 children are diagnosed with cancer. A conversation with Lisa Diller, MD, clinical director of Pediatric Oncology at Dana-Farber/Children's Hospital Cancer Center offers a closer look at how cancer is diagnosed and treated in kids.

Should I worry that my child will get cancer?It's normal for parents to be concerned about their child's health, but the reality is that childhood cancer is, thankfully, very rare. In fact, childhood cancers account for only around one percent of all cancer cases in the U.S.
In general, your best course of action is to make sure that your child gets regular medical checkups. If you have concerns about specific signs or symptoms that persist, talk with your child's doctor about them.

What signs or symptoms might cause a child's doctor to suspect cancer?It's difficult to list cancer symptoms, because cancer is so diverse. Diagnosis is further complicated because many signs and symptoms, such as fever, bruising, and headaches, are normal in healthy children.
My experience has shown me that pediatricians are extremely skilled at distinguishing the usual bumps and pains from the concerning ones. They sense which symptoms truly need evaluation and astutely order tests, using the character, duration, and severity of symptoms - and oftentimes instinct - to help them.

What advice do you give parents whose child has been diagnosed with cancer?I tell parents of kids with most pediatric cancers to stay positive. Cure rates have been steadily improving for decades now, and that's not by accident. We've had significant advances in treatment, resulting in cure or long-term remission for the majority of pediatric cancer patients. For example, the cure rate for the most common childhood cancer diagnosis, acute lymphoblastic leukemia (ALL), is now at more than 80 percent.
I also remind parents that our intent with ALL and most other pediatric cancers is to cure the disease, not to buy time. Many families' base their experience with cancer on what they've seen in older relatives, but it's important to remember that the prognosis in children is usually good.

Is it important to seek care at a cancer center that specializes in pediatrics?Absolutely. Children with cancer have special needs that can be best met by cancer centers staffed by doctors and other experts who specialize in treating children. Brain tumor care is a great example of this: pediatric neurosurgeons, neurologists, neuropathologists and neurooncologists are skilled at diagnosing childhood tumors like medulloblastoma and optic glioma, which are rarely seen by our adult medicine colleagues.
Additionally, treating a child with cancer has an impact on the entire family, so care usually involves professionals beyond just doctors and nurses. Children's cancer centers are staffed by a range of specialists who support and educate the entire family, including social workers, nutritionists, psychologists, physical therapists, and resource specialists. Psychologists and social workers, in particular, work to help family members deal with the unique stresses and challenges that can arise when a loved one is being treated for cancer.

How is cancer in children treated?Depending on the child's diagnosis, they will either be seen in an outpatient facility or admitted to a hospital for care. The patient will undergo preliminary tests, which may include MRI scans, blood work, or X-rays. This process may take several days, but the goal is to arrive at an accurate diagnosis.
Throughout this process, we'll have a team of pediatric specialists working to help the child and his or her family. This team of specialists usually includes an oncologist, surgeon, radiation oncologist, pathologist, and radiologist, all working together to evaluate test results, make a diagnosis, and design a treatment plan.
Treatments for children with cancer can include chemotherapy, radiation therapy, immunotherapy (improving the body's ability to fight tumors), surgery, and stem cell transplantation. All of these treatments are designed to destroy cancer cells. Children may have one kind of treatment or a combination of treatments, depending on their cancer. Most patients get combination therapy, which is a combination of treatments.

How can I help if someone I know has a cancer diagnosis in their family?Many parents comment on how helpful neighbors and friends have been during their child's cancer treatments, volunteering to care for other children at home, making meals, and even driving visitors to see the patient. But one of the most important things you can do is to ask what the family needs, and be respectful of their privacy. Even well-meaning relatives and friends can overwhelm parents.
I tell families to be direct about what they need - and what they don't need. When friends offer help, suggest specific tasks. One idea that we often recommend is telling friends to donate blood, because cancer patients of all ages often need transfusions of blood or blood products, such as platelets. Even if the donations don't directly benefit the child they know, more blood will be available for other sick children.

Where can parents get more information about cancer?If you're looking online, stick with information from reliable cancer institutions, like the NCI at www.cancer.gov or the American Society of Clinical Oncology at www.cancer.net. Both of these sites are very informative and authoritative.
Parents and children can also visit the resource rooms at comprehensive cancer centers like Dana-Farber to access books, brochures, and videos, and meet with resource specialists to learn more about a diagnosis.

To learn more about Dana-Farber/Children's Hospital Cancer Center, visit www.danafarberchildrens.org or follow the Twitter feed at www.twitter.com/ChildCancerCare.

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