A cancer diagnosis is upsetting at any age, but especially for children and their families.
The good news for these young cancer patients is that many types of cancer that were once fatal now have cure rates exceeding 80 percent — surpassing that of adult cancers — thanks to research and the development of new therapies.
Each year at Baystate Children’s Hospital in Springfield, we diagnose about 30 new cases of childhood cancer.
Although pediatric cancer is rare, more children ages 1 through 19 die from cancer each year than from heart disease, influenza and pneumonia, chronic respiratory disease, cerebrovascular disease, septicemia and diabetes mellitus combined.
While rare, the incidence rate of childhood cancers has also risen slightly from 13 children per 100,000 in 1975 to more than 17 children per 100,000 since 2007.
Thankfully, rates of survival have been improving for children diagnosed with the disease because of better treatments and follow-up care, especially in developed countries like the United States. It is estimated that death rates from cancer among children 14 years of age and younger have declined by 65 percent from 1970 to 2016 in our country.
Overall, more than 80 percent of children with cancer survive five years or more, but the percentage can be much lower for specific cancer types. Research is essential in addressing this and in increasing survival rates among all types of childhood cancer, which differs greatly from cancer in adults.
In his State of the Union Address, President Donald Trump indicated he would ask Congress for $50 million a year over the next 10 years to fund research into childhood cancers.
According to the latest statistics from the National Cancer Institute, which is part of the National Institutes of Health, it is estimated that about 11,000 new cases of cancer will be diagnosed this year among children from birth to 14 years of age and some 1,180 children are expected to die from the disease.
Leukemias and lymphomas, both cancers of blood cells, as well as brain and other central nervous system tumors are the most common cancers diagnosed in children 14 years of age and younger.
What causes pediatric cancer to develop is largely unknown, especially since environmental factors, which often play a role in the development of cancer in adults, are typically not a factor in children.
A mutation in a gene controlling cell growth is what contributes to the development of all cancers. However, the genetic alterations leading to cancer in children often differ from those in adults. The types of cancer that result call for different forms of treatment.
Most treatment of childhood cancers today involves standardized protocols — receiving the same treatment as another child with the same cancer elsewhere — often involving a combination of surgery, radiation and chemotherapy for which there are new and better drugs, and methods to help children deal with the side effects of treatment.
The most common types of leukemia in children are acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML).
In 2017, the Food and Drug Administration approved a type of immunotherapy called chimeric antigen receptor (CAR) T-cell therapy for patients up to the age of 25 whose B cell acute lymphocytic leukemia has not responded well to other treatments or has returned.
The therapy, which genetically modifies part of a patient’s own immune system — antibody-producing cells called T cells — to fight the cancer, has shown great success in terms of disease remission in patients who had little hope from other therapies for such an outcome. The success, combined with the more than 90 percent five-year survival rate of children with ALL who respond to more traditional treatment such as chemotherapy, has helped statistically boost the overall five-year survival rate for childhood cancer.
Unfortunately, while advanced treatments today result in more than 80 percent of children surviving their cancers, these very survivors are at a lifelong risk for health problems — called late effects — that can develop months or years after their treatment.
They will require follow-up care and increased surveillance for the rest of their lives so that we can identify and treat any complications that may result from their earlier treatment. We have a Late Effects Clinic at Baystate Children’s Hospital and provide programs for childhood cancer survivors to help ensure effective treatment and longterm monitoring.
Similar to other pediatric cancer programs across the country, we participate in the Children’s Oncology Group, which is supported by the National Cancer Institute, and offer the latest in clinical trials to our patients.
Baystate Children’s Hospital sees families from all over western Massachusetts for treatment of benign hematology blood disorders, such as sickle cell anemia and thalassemia, to more serious and intense childhood cancers ranging from leukemia to brain cancer.
Dr. Matthew Richardson is chief of pediatric hematology/oncology at Baystate Children’s Hospital.