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Table of Contents General Information
Head and Neck Cancers
Thoracic Cancers
Abdominal Cancers
Genital/Urinary Tumors
Other Rare Childhood Cancers
To Learn More About Childhood Cancer
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Changes to This Summary (09/30/2008)
About PDQ
General Information
The tumors discussed in this summary are many and different, and the discussion
is arranged in descending order from tumors of the head and neck to tumors of
the urinary system and skin. All of these cancers are rare enough that most pediatric hospitals might see fewer than two cases in a year. Most of these
tumors are more frequent in adults with cancer; thus, much of the information
about these tumors may also be sought through sources relevant to adults with
these tumors.
Back to Top Head and Neck Cancers
Head and neck cancers include cancers of the nose and throat, thyroid tumors, mouth cancer, salivary gland cancer, cancer of the larynx (or voice box), and respiratory tract.
These cancers are discussed below.
Cancer of the Nose and Throat
Cancers that start in the lining of the nasal cavity and throat are called nasopharyngeal cancers. The incidence of this tumor is approximately 1 in
100,000 persons younger than 20 years in the United States.
Nasopharyngeal cancer occurs in association with Epstein-Barr virus (EBV) infection, the virus associated with infectious mononucleosis. This cancer
most frequently spreads to lymph nodes in the neck, which may alert the
patient, parent, or physician to the presence of this tumor. The tumor may
spread to the nose, mouth, and pharynx, causing snoring, nosebleeds, obstruction of the Eustachian tubes, or hearing loss. It may invade the base
of the skull, causing cranial nerve palsy or difficulty with movements of the
jaw (trismus). The cancer may spread to distant sites such as the bones, lungs, and liver.
Treatment combines the use of surgery, radiation therapy, and chemotherapy. Nasopharyngeal cancer generally has spread to bones of the skull and to lymph
nodes in the neck at the time of diagnosis; thus, the principal role of surgery
is to obtain adequate diagnostic material from a biopsy of the involved lymph
node or the primary site. Studies show that combining chemotherapy with radiation therapy is the most effective treatment for this tumor. Refer to the PDQ summary on Nasopharyngeal
Cancer Treatment for more information.
Esthesioneuroblastoma
Esthesioneuroblastoma (olfactory neuroblastoma) is a very rare, small tumor that begins in the olfactory bulb (the organ responsible for the sense of smell) located in the front part of the brain. Most children have a tumor in the nose or throat at the time of diagnosis. The tumor may extend into the eyes, sinuses, and the front part of the brain. Esthesioneuroblastoma occurs more often in boys and usually appears during adolescence. The disease seldom spreads to other parts of the body. Treatment for this cancer is usually surgery and radiation therapy; chemotherapy may also be used. Newer treatments may include sinus surgery done through an endoscope, radiosurgery, or proton beam radiation therapy.
Thyroid Tumors
Tumors of the thyroid (a gland near the windpipe that produces thyroid hormone,
which helps regulate growth and metabolism) are classified as adenomas or carcinomas. Adenomas are benign (noncancerous) growths that may cause
enlargement of all or part of the gland, which extends to both sides of the
neck and can be quite large. Some of these tumors may secrete hormones. Transformation to a malignant carcinoma (cancer) may occur in some cells, which
then may grow and spread to lymph nodes in the neck or to the lungs.
Thyroid carcinomas are rare and occur most often in girls. This cancer usually appears as a lump or mass in the thyroid with possible swelling of the lymph glands in the neck.
Surgery is the treatment required for all thyroid tumors. This is usually removal of all or nearly all of the thyroid and nearby lymph nodes in the neck. Treatment with a radioactive form of iodine is given after surgery to destroy cancer cells and thyroid tissue that remain. After
surgery and treatment with radioactive iodine, hormone replacement therapy must be given to compensate for the lost
thyroid hormone. Regular checkups are required
to determine whether the cancer has spread to the lungs. Patients with thyroid
cancer generally have an excellent survival with relatively few side effects.
Thyroid tumors that recur (come back) are usually treated with radioactive iodine. Even patients with tumor that has spread to the lungs may expect no decrease in
life span after appropriate treatment. (Refer to the PDQ summary on adult Thyroid Cancer Treatment for more information.)
Oral (Mouth) Cancers
Oral cancer in children or in adolescents is extremely rare. Most oral tumors are benign (not cancer). Malignant tumors include lymphomas (often Burkitt lymphoma) and sarcomas (soft tissue tumors). Oral squamous cell carcinoma (cancer of the thin, flat cells lining the mouth) is the most common type of oral cancer in adults, but is rare in children; adolescents (teens) with oral squamous cell carcinoma should be screened for a condition called Fanconi anemia. Treatment of oral cancer in children may include surgery, chemotherapy, and radiation therapy. (Refer to the PDQ summaries on adult Oropharyngeal Cancer Treatment and Lip and Oral Cavity Cancer Treatment for more information).
Salivary Gland Tumors
Salivary glands are the parts of the mouth and throat that produce saliva. Many of the tumors in these areas arise in the parotid gland. About 15% of
these tumors may arise in the submandibular glands or in the minor salivary
glands under the tongue and jaw. These tumors are most frequently noncancerous
but on very rare occasions may be malignant (cancerous). Sialoblastomas are a type of salivary gland tumor found in the first months of life. They are usually benign (not cancer), but may rarely be cancerous. The malignant lesions include adenocarcinoma, undifferentiated carcinoma, acinic cell carcinomas,
and mucoepidermoid carcinoma. These tumors may occur after radiation therapy and chemotherapy are given for treatment of primary leukemia or solid tumors. Complete surgical removal
is the treatment of choice whenever possible, with additional use of radiation
therapy and chemotherapy. Prognosis (outcome) for patients with these tumors
is generally good. (Refer to the PDQ summary on adult Salivary Gland Cancer
Treatment for more information.)
Laryngeal Cancer and Papillomatosis
Benign and especially malignant (cancerous) tumors of the larynx (voice box)
are rare. Malignant tumors may be associated with benign tumors such as polyps and papillomas. These tumors may cause hoarseness, difficulty swallowing, and
enlargement of the lymph nodes of the neck. Rhabdomyosarcoma (a malignant
tumor of muscle tissue) is the most common malignant tumor of the larynx in the pediatric age group. Squamous cell carcinoma of the larynx should be
managed with surgery and radiation. Laser surgery may be the first type of
treatment used for these cancers.
Papillomatosis of the larynx is a benign overgrowth of tissues lining the
larynx. It is associated with the human papillomavirus (HPV). This condition is not cancerous, but may recur after treatment. These tumors can cause hoarseness
because of their association with wart -like nodules on the vocal cords; they
may extend into the lung and develop into cancer in the larynx. Treatment includes laser surgery. (Refer to the PDQ summary on adult Laryngeal Cancer Treatment for more information.)
Respiratory Tract Cancer with Chromosome 15 Changes
The respiratory tract includes the nose, throat, larynx, trachea, and lungs. Respiratory tract cancer may be caused by a specific chromosome change. Every cell in the body contains DNA (genetic material stored inside chromosomes) that determines how the cell looks and acts. Cancer may develop when part of the DNA from chromosome 15 moves to another chromosome, or when chromosome 15 is broken. This type of cancer may appear in parts of the airway or in other places along the midline of the body, including the thymus, the area between the lungs, and the bladder. It usually cannot be cured.
Back to Top Thoracic Cancers
Thoracic cancers include breast cancer, bronchial adenomas, bronchial carcinoid
tumors, pleuropulmonary blastoma, esophageal tumors, thymomas and thymic carcinomas, tumors of the
heart, and mesothelioma. These thoracic cancers are discussed below.
Breast Cancer
Most tumors that involve the breast during childhood are benign (noncancerous) fibroadenomas that can be watched for change without the need for biopsy. Rarely, such breast tumors will show malignant change with sudden, rapid growth. These are called phyllodes tumors, and require biopsy or surgical removal without mastectomy. Other types of breast cancer have been reported in both males and females younger than 21 years.
There is an increased lifetime risk of breast cancer in patients who were treated for any cancer with radiation therapy to the chest area, including female survivors of Hodgkin lymphoma. Mammograms should start at age 25 or 10 years after radiation therapy to the chest, whichever came last. Treatment options include radiation, chemotherapy, and surgery for children and adolescents with breast cancer. Breast tumors may also occur
as cancers that have spread from other types of cancer such as leukemia, rhabdomyosarcoma, other sarcomas, or lymphoma, particularly in patients infected with the human immunodeficiency virus (HIV).(Refer to the PDQ summary on adult Breast
Cancer Treatment for more information.)
Bronchial Tumors
Bronchial tumors (which are slow-growing cancers in the trachea or large bronchi, the large airways
of the lung), are most often carcinoid tumors in children. Symptoms include cough and spitting up blood, and can sometimes be confused with asthma symptoms like wheezing, resulting in delayed diagnosis. Primary treatment is surgery to remove the tumor and lymph nodes and vessels where cancer may spread. The prognosis for most bronchial tumors in children is excellent, even when the cancer has spread to nearby areas. Rarely, carcinoid tumors develop as aggressive (fast-growing) cancers that are more likely to spread to other areas of the body by the time they are diagnosed. For
bronchial carcinoid tumors, neither chemotherapy nor radiation therapy is
indicated, unless evidence of metastasis (spread of cancer to other areas of
the body) is documented.
Cancers that begin in the epithelial cells that line the surface of the lung are rare, and tend to be advanced when they are diagnosed. The outcome for epithelial cancers of the lung depends on how the cells look under a microscope and the stage of the cancer.
Pleuropulmonary Blastoma
Pleuropulmonary blastomas are rare tumors that usually occur under the tissue covering the lungs. Early-stage pleuropulmonary blastoma develops as a cyst -like tumor in the lung. It usually appears in the first 2 years of life and has a good prognosis. Late-stage tumors are solid and can spread to the brain. When the tumor can be completely removed by surgery at any time during treatment, the chance of recovery is improved. The tumor may recur or spread, in spite of surgical removal. Responses to chemotherapy have been reported and adjuvant chemotherapy may help prevent the tumor from coming back. Radiation may be used
when the tumor cannot be surgically removed. A family history of cancer in
close relatives has been noted for many young patients affected by this tumor.
Esophageal Tumors
Cancer of the esophagus (the muscular tube through which food passes from the throat to the stomach) is rare in the pediatric age group. Symptoms are
related to difficulty in swallowing, and associated weight loss. Treatment
options for esophageal cancer include either radiation therapy or chemotherapy. Prognosis generally is poor for this cancer, which rarely can be completely
removed by surgery. (Refer to the PDQ summary on adult Esophageal Cancer
Treatment for more information.)
Thymomas and Thymic Carcinoma
A cancer of the thymus (an organ in the chest, behind the breastbone) is not
considered a thymoma (cancer) or a thymic carcinoma unless there are cancerous changes of the epithelial cells that cover the organ. The term thymoma usually describes cancers that do not have obvious changes in the epithelial cells. Thymic carcinoma has clear-cut changes of the epithelial cells. Other tumors that involve the thymus gland include lymphoma (cancer that arises in cells of the lymphatic system)
and germ cell tumors (tumors that begin in cells that give rise to sperm or
eggs); these tumors are not true thymomas or thymic carcinomas.
Thymomas and thymic carcinomas are rare in adults as well as children. Various diseases and syndromes are associated with thymomas, including myasthenia gravis,
polymyositis, systemic lupus erythematosus, rheumatoid arthritis, thyroiditis,
Isaacs syndrome, and pure red cell aplasia. Endocrine (hormonal) disorders such as hyperthyroidism, Addison’s disease, and panhypopituitarism can also be
associated with a diagnosis of thymoma or thymic carcinoma.
Cancer of the thymus may be caused by a specific chromosome change. Every cell in the body contains DNA (genetic material stored inside chromosomes) that determines how the cell looks and acts. Cancer may develop when part of the DNA from chromosome 15 moves to another chromosome, or when chromosome 15 is broken. This type of cancer may appear in the thymus or in other places along the midline of the body, including parts of the airway, the area between the lungs, and the bladder. It usually cannot be cured.
Thymomas and thymic carcinomas are usually located in the front part of the chest and are usually
discovered during a routine chest x-ray. Symptoms can include cough,
difficulty with swallowing, tightness of the chest, chest pain, and shortness
of breath, although nonspecific symptoms may occur. These tumors generally are
slow growing but are potentially invasive, with cancer spreading to distant organs or lymph nodes. Surgery is performed with the goal of a complete
removal. Radiation therapy is necessary for patients with invasive thymoma or thymic carcinoma,
whether or not there has been surgery. Chemotherapy is usually reserved for
patients with advanced- stage disease who have not responded to radiation
therapy or steroids. The prognosis for patients with invasive thymoma or thymic carcinoma usually
is poor, although significantly higher survival rates have been reported for
patients with tumors that have not spread to the surrounding areas. (Refer to
the PDQ summary on adult Thymoma and Thymic Carcinoma Treatment for more information.)
Tumors of the Heart
Primary tumors of the heart may include benign (noncancerous) and malignant (cancerous) teratoma (a tumor made up of a mixture of tissues), rhabdomyosarcoma (a tumor of muscle tissue), hemangioma (a usually benign tumor made up of blood vessels), and chondrosarcoma (a type of cancer that forms in cartilage). Symptoms include abnormalities of heart rhythm, enlargement of the
heart, fluid in the pericardial sac, and congestive heart failure. Successful
treatment requires surgery (which may include transplantation) and chemotherapy appropriate for the type of cancer that is present.
Benign tumors of heart muscle (rhabdomyomas) usually shrink and go away on their own.
Mesothelioma
Mesothelioma, an extremely rare cancer in children, can involve the tissue coverings of the lung, the heart, or the abdominal organs. These tumors can spread over the surface of organs, without
invading far into the underlying tissue, and may spread to nearby or distant lymph nodes. Mesothelioma may develop after successful treatment of an earlier cancer, especially after treatment with radiation. In adults, these tumors
have been associated with exposure to asbestos, which was used as building
insulation. The amount of exposure required to develop cancer is unknown, and
there is no information about the risk of children exposed to asbestos. (Refer
to the PDQ summary on adult Malignant Mesothelioma Treatment for more
information.)
Back to Top Abdominal Cancers
Abdominal cancers include cancer of the adrenal cortex, stomach
cancer, cancer of the pancreas, colorectal cancer, carcinoid tumors of the lung or intestine, and gastrointestinal stromal cell tumors. These abdominal
cancers are discussed below.
(Refer to the PDQ summary on Wilms Tumor and Other Childhood Kidney Tumors for information about childhood renal cell carcinoma.)
Cancer of the Adrenal Cortex
The adrenal cortex is the outside layer of the adrenal glands. The adrenal glands are a pair of organs near the front side edge of the kidney; their
function is to produce hormones such as glucocorticoid and epinephrine. Cancers in this area are classified as carcinomas and adenomas. Adenomas are
generally benign, whereas adrenocortical carcinomas frequently secrete hormones and may cause the patient to develop masculine traits, regardless of the
patient’s gender. Pediatric patients with adrenocortical carcinoma often have Li-Fraumeni syndrome, an inherited condition that predisposes family members to
multiple cancers, including breast cancer, rhabdomyosarcoma, and osteosarcoma (cancer of the bone).
These tumors can involve the kidneys, lungs, bones and brain. Surgical removal
should be attempted but may not always be possible if the tumor has spread
widely. Additional treatment may include the use of an artificial hormone that
blocks the masculinizing effects of the tumor. The prognosis is generally
excellent for patients who have small tumors that have been completely
removed by surgery, but prognosis can be poor for patients who have large primary tumors or metastatic disease (disease that has spread to other parts of
the body) at diagnosis. Tumor stage is an important factor affecting the chance of recovery for children with adrenocortical tumors. When possible, repeat surgery should be done for tumors that come back and for tumors that spread to the inferior vena cava (a large vein that empties into the heart). (Refer to the PDQ summary on adult Adrenocortical
Carcinoma Treatment for more information.)
Cancer of the Stomach
The frequency of, and death rate from, stomach cancer has declined worldwide
over the past 50 years with the introduction of food preservation practices
such as refrigeration. Symptoms of stomach cancer include vague upper abdominal pain, which can be associated with poor appetite, and weight loss.
Many individuals become anemic but otherwise show no symptoms before the
development of metastatic spread. Other symptoms may include nausea, vomiting, change in bowel habits, poor appetite and weakness, and Helicobacter pylori infection.
Treatment should include surgery. For individuals who cannot have a complete
surgical removal of tissue, radiation therapy may be used along with chemotherapy. Prognosis depends on the extent of the disease at the time of diagnosis and the success of treatment that is appropriate for the clinical situation. Because of the rarity of stomach cancer in the pediatric age group,
little information exists regarding treatment outcomes of children. (Refer to
the PDQ summary on adult Gastric Cancer Treatment for more information.)
Cancer of the Pancreas
Tumors of the pancreas (a gland in the abdomen that makes pancreatic juices and
produces hormones) are rare in children and adolescents. Tumors included
within the general category can arise at any site in the pancreas. Most
pancreatic tumors do not secrete hormones, although some tumors secrete insulin, which can lead to symptoms of weakness, fatigue, hypoglycemia, and
coma. If a tumor interferes with the normal function of the islet cells (cells in the pancreas that produce hormones), patients may have watery diarrhea or abnormalities of salt balance. At times, there is obstruction of the head of
the pancreas, which is associated with jaundice and gastrointestinal bleeding.
Treatment includes various surgical procedures to remove the pancreas and duodenum or part of the pancreas. For pediatric patients, the effectiveness of radiation therapy is not known. Chemotherapy may be useful for treatment of localized or metastatic pancreatic carcinoma, although few cases have been
successfully treated. Pancreatoblastoma may be treated with combination chemotherapy given before or after surgery. Response rates and survival rates generally are not
good. (Refer to the PDQ summary on adult Pancreatic Cancer Treatment for more
information.)
Colorectal Cancer
Cancer of the large bowel is rare in the pediatric age group: one person per one million younger than 20 years in the United States annually. In children, more than half of colon tumors begin on the right side, compared with adults, who have more colon tumors on the left side. Colon cancer in children is often linked to a family colorectal cancer syndrome, or inherited pattern. There is an increasing risk of colorectal cancer in members
of families with a family history of intestinal polyps, which can lead to the
development of multiple adenomatous polyps (benign tumors). Juvenile polyps
are not associated with an increased incidence or risk of cancer.
Colorectal cancer usually presents with symptoms related to the site of the
tumor. Changes in bowel habits are associated with tumors of the rectum or
lower colon. Tumors of the right colon may cause more subtle symptoms but are
often associated with an abdominal mass, weight loss, decreased appetite, and
blood in the stool. Any tumor that causes complete obstruction of the
large bowel can cause bowel perforation and spread of the tumor cells within
the abdominal cavity.
Colorectal carcinoma is rarely diagnosed in a pediatric patient; however, vague gastrointestinal symptoms should alert the physician to investigate this
possibility. Most patients present with evidence of metastatic disease (cancer
that has spread to other body parts), either as gross tumor or as microscopic deposits in lymph nodes, on the surface of the bowel, or other organs within
the abdomen. Complete surgical removal should be the primary aim of the surgeon, but in most instances, this is impossible; removal of large portions of
tumor provides little benefit for the individuals with extensive metastatic
disease. Most patients with microscopic metastatic disease generally develop
gross metastatic disease, and few individuals with metastatic disease at
diagnosis become long-term survivors.
Current therapy includes the use of radiation therapy for rectal and lower
colon tumors, in conjunction with chemotherapy. (Refer to the PDQ summaries on
adult Colon and Rectal Cancer Treatment for more information.)
Carcinoid Tumors
Carcinoid tumors can involve the lining of the lung or the large or small bowel and may not be cancer. Most lung lesions are not cancerous. Treatment of metastatic carcinoid tumors of the large bowel or stomach becomes more
complicated and requires treatment similar to that given for colorectal cancer.
(Refer to the PDQ summary on Gastrointestinal Carcinoid Tumors Treatment for more information.)
Gastrointestinal Stromal Cell Tumor
Gastrointestinal stromal cell tumor (GIST) usually begins in cells in the wall of the gastrointestinal tract. It may or may not be cancerous.
This tumor is usually found in adults older than 40 years and is rare in children. GIST in children younger than 10 years is more common in girls. Symptoms of GIST include anemia caused by gastrointestinal bleeding. Most tumors in children are found in the stomach. A small number of children with GIST are found to have Carney complex, a rare, inherited disorder.Treatment of GIST is different for children than for adults, and includes surgery to remove the tumor. In children, unlike in adults, GIST is not caused by changes in DNA. When these changes are not found, treatment with imatinib mesylate (Gleevec), a new kind of cancer drug that blocks these changes, is not recommended as adjuvant treatment. Some adolescents and young adults with GIST have tumors that are caused by DNA changes and are treatable with imatinib mesylate. All patients with GIST should have their tumors examined for DNA changes.
Back to Top Genital/Urinary Tumors
Genital/urinary tumors include bladder cancer, ovarian cancer, cervical cancer, and vaginal cancer. These
cancers are discussed below.
Bladder Cancer
Bladder cancer is extremely rare in children. The most common carcinoma to
involve the bladder is transitional cell carcinoma, which generally presents
with blood in the urine. The diagnosis and treatment of bladder cancer are the
same for children, adolescents, and adults. Adolescents who develop this tumor are often prone to the development of other cancers. Bladder cancer in
adolescents may develop as a late effect of certain chemotherapy drugs given
for other childhood tumors or leukemia. (Refer to the PDQ summary on adult Bladder Cancer Treatment for more information.)
Ovarian Cancer
Most ovarian tumors in children are benign (noncancerous). The most common cancers that affect the ovaries are of germ cell origin (beginning in cells that give rise to sperm or eggs); these are more common in children than
in adults. Common symptoms of ovarian cancer include painful periods and pain in the abdomen. Treatment is stage related and may include surgery, radiation therapy, and chemotherapy. (Refer to the PDQ summaries on Childhood Extracranial Germ Cell Tumors Treatment, Ovarian Epithelial Cancer Treatment, Ovarian Germ Cell Tumors Treatment, or Ovarian Low Malignant Potential Tumors Treatment for
more information.)
Carcinoma of the Cervix and Vagina
Cancer of the cervix and vagina is very rare in children and adolescents. Most young patients diagnosed with cancer of the cervix or vagina were exposed to a drug called diethylstilbestrol (DES) before birth when it was given to their mothers. DES was given to pregnant women between 1945 and
1970 to keep them from losing their babies (miscarriage).
The most common symptom of cancer of the cervix or vagina is vaginal bleeding. Treatment includes surgery followed by radiation and possibly chemotherapy.
Back to Top Other Rare Childhood Cancers
Other rare childhood cancers include multiple endocrine neoplasia syndrome, skin cancer, chordoma, and cancer of unknown primary site. These other rare childhood
cancers are discussed below.
Multiple Endocrine Neoplasia Syndrome
Multiple endocrine neoplasia syndromes (abnormal and uncontrolled cell growth) are familial disorders that include cancerous changes in more than one endocrine organ at the same time (endocrine tissue secretes hormones). These changes may
include hyperplasia (overgrowth of tissue) or benign (noncancerous) tumors.
The distinct involvement of multiple glandular structures are referred to as MEN-1 (Werner syndrome) which may involve tumors of the pituitary gland and parathyroid, adrenal, gastric, and pancreatic structures. Patients and family members at risk for MEN-1 should have both genetic screening and physical examinations.
MEN-2a (Sipple
syndrome) is associated with medullary thyroid carcinoma, parathyroid
hyperplasia, and adenomas as well as pheochromocytoma; MEN-2b is associated
with medullary thyroid carcinoma, parathyroid hyperplasia, and adenomas as well
as pheochromocytoma, mucosal neuromas, and ganglioneuromas. An additional
complex is referred to as the Carney complex, which is associated with benign tumors of the heart, skin, breast, head or neck.
Patients with the MEN 2a syndrome should have surgery to remove the thyroid between the ages of 5 and 8 in order to prevent cancer. Family members of patients with the MEN 2a syndrome should be tested in early childhood, before age 5, for the abnormal gene that leads to this type of cancer. If they are found to have this genetic change, they should have surgery to remove the thyroid and replace it with a transplant of one of their own parathyroid glands by a certain age, depending on the type of genetic change found.
Patients with the MEN 2b syndrome may have a slender body build, long and thin
extremities, a high arch palate, and “funnel chest” (sunken chest) or an abnormally high arch in the foot. The lips may appear thickened because of tumors in the mucous membranes. In this
syndrome, medullary thyroid cancer may be particularly aggressive; therefore,
the thyroid should be removed in infancy to prevent cancer in these affected children.
Hirschsprung disease (a condition present at birth that causes blockage of the large intestine due to lack of muscle contractions) is also associated with medullary thyroid carcinoma. Patients with Hirschsprung disease should be screened for genetic changes that may be linked to this cancer. If such changes are found, surgery to remove the thyroid in order to prevent cancer may be considered.
The outcome for patients with the MEN-1 syndrome is generally good, provided
adequate treatment can be obtained for parathyroid, pancreatic, and pituitary
tumors. The outcome for patients with the MEN-2a syndrome is also generally
good, but the possibility exists for recurrence of medullary thyroid carcinoma
and pheochromocytoma. Medullary thyroid cancer in children with MEN-2b may be difficult to cure. For patients with the Carney complex, prognosis depends
on how often heart, skin, or other tumors recur.
Treatment of medullary thyroid carcinoma may include a clinical trial of a tyrosine kinase inhibitor, a drug that interferes with cell communication and growth and may prevent tumor growth, taken by mouth.
Skin Cancer (Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma)
Melanoma is thought to be the most common skin cancer in children, followed by basal cell and squamous cell carcinomas. The incidence of melanoma in children
and adolescents represents approximately 1% of the new cases of melanoma that
are diagnosed annually in the United States. Melanoma is most often found in children aged 10 years or older, and is slightly more often found in girls than boys. In most instances, melanoma in the pediatric population is similar to that of adults in relation to site of
presentation, symptoms, description, and spread, although thickness does not seem to predict how likely it is to be cured. Melanoma may grow faster in children than in adults. In most children and adolescents, melanoma is found as localized cancer with no sign of spread and can usually be cured. In children and adolescents with melanoma that has spread to the lymph nodes or distant parts of the body, the prognosis appears to better than the prognosis for adults with melanoma in similar stages. The reason for this difference is not known.
The most common cause of skin cancer of any type is exposure to the ultraviolet (UV) portion of sunlight. Other causes may be related to chemical carcinogenesis, radiation exposure, immunodeficiency, or immunosuppression. The person who is most likely to develop a melanoma is easily sunburned, has
poor tanning ability, and generally has light hair, blue eyes, and pale skin.
Worldwide, there is an increasing incidence of both melanoma and nonmelanoma
skin cancers. Melanoma presents as a relatively flat, dark-colored lesion that may enlarge, penetrate the skin, or metastasize.
Melanomas may be congenital (present at birth). They are sometimes associated
with large congenital black spots known as melanocytic nevi, which may cover
the trunk and thigh. Children with hereditary immunodeficiencies have an
increased lifetime risk of developing melanoma.
Individuals with atypical moles, which include raised lesions (that may or may
not bleed) and various color hues (brown, tan, pink, black) are at an increased
risk of having melanoma and having children affected by these premalignant lesions. Basal cell carcinoma generally appears as a raised lump or ulcerated lesion, usually in areas with previous sun exposure. Squamous cell carcinomas
are usually reddened lesions with varying degrees of scaling or crusting; they
have an appearance similar to eczema, infections, trauma, or psoriasis.
Basal and squamous cell carcinomas are generally curable with surgery alone,
but the treatment of melanoma requires greater consideration because of its
potential for metastasis. Surgery for melanoma depends on the size, site,
level of invasion, and metastatic extent or stage of the tumor. If the melanoma has not spread beyond the lymph nodes, adjuvant biologic therapy may be given to increase the chances of a cure. If the melanoma has spread beyond the lymph nodes, treatment may include a combination of chemotherapy and biologic therapy. There are clinical trials for melanoma available to children aged 10 years or older. Information about ongoing clinical trials is available from the NCI Web site.
Chordoma
Chordoma is a very rare type of bone tumor that may develop along the spine at any point from the base of the skull to the tailbone. Chordomas start in clusters of cells leftover from spinal column development in the embryo. These cells normally disappear, but very rarely they remain and grow into tumors. In children and adolescents, especially girls, chordomas often develop in the clivus, a bone at the base of the skull. Symptoms vary and may include pain and nerve trouble. When chordoma recurs, it usually comes back in the same area, but may appear in the lungs or other areas of bone.
Standard treatment includes surgery and radiation therapy. The best results are seen with proton beam therapy, a special kind of high-energy radiation that is different from an x-ray.
Cancer of Unknown Primary Site
Cancer can form in any tissue of the body and can spread from the primary site (the place where the cancer first began to grow) to other parts of the body. Cancer that has spread from the place in which it started to other parts of the body is called metastatic cancer. Metastatic cancer cells usually look like cells in the type of tissue where the cancer began. For example, breast cancer cells that spread to the lung look like breast cancer cells, not lung cancer cells. Sometimes metastatic cancer cells are found in the body, but tests do not find a primary tumor. If cancer cells are found in the body but the place where the cancer started cannot be identified, the disease is called cancer of unknown primary site. Treatment is based on what the cancer cells look like under a microscope, the patient's symptoms, and the extent of the cancer in the body. Treatment is usually chemotherapy or radiation therapy.
Back to Top To Learn More About Childhood Cancer
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Back to Top Changes to This Summary (09/30/2008)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
The PDQ database contains listings of groups specializing in clinical trials.
The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
The PDQ database contains listings of cancer health professionals and hospitals with cancer programs.
Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
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