Pediatric Cancer

At Loma Linda University Cancer Center, we understand our younger patients have very special needs. That is why we have a dedicated unit in our Children’s Hospital just to care for children with cancer. Patients benefit from our support services that we have specifically designed to help children battling cancer.


Now viewing:

Brain Tumors

What are brain tumors in children?

A brain tumor is an abnormal growth of tissue in the brain. The brain is part of the central nervous system (CNS). The CNS also includes the spinal cord. The main parts of the brain are:  

  • Cerebrum. This is the front of the brain. The cerebrum has two sides, the right and left hemispheres. It controls thoughts, emotions, and speech, and movement. It also helps with understanding information from the senses. This includes seeing, hearing, smelling, touching, and feeling pain.
  • Cerebellum. This is the back of the brain. It organizes muscle movement and helps to maintain posture, balance, and equilibrium.
  • Brainstem. This is the base of the brain. It includes the midbrain, the pons, and the medulla. It is the part of the brain that connects to the spinal cord. It plays a part in controlling muscles and sensations from the body. Part of the brainstem helps control breathing and the heart beat. Many of the cranial nerves start in the brain stem. The cranial nerves carry messages from different parts of the body to the brain

Brain tumors start in the cells of the brain. They can be either of the below:                    

  • Benign. This kind of tumor doesn’t contain cancer cells. In most cases, once a benign tumor is removed, it doesn’t grow back. Most benign brain tumors don’t grow into nearby tissue. These tumors can cause symptoms depending on their size and location in the brain.
  • Malignant. This kind of tumor does contain cancer cells. Malignant brain tumors usually grow fast, and grow into nearby tissue. Malignant brain tumors don’t usually spread to other areas of the body. They may grow back after treatment. 

Brain tumors can occur at any age. Brain tumors that occur in infants and children are very different from adult brain tumors. 

The most common type of brain tumor is a glioma. Gliomas begin from glial cells, which make up the supportive tissue of the brain. There are different types of glioma:

  • Astrocytoma. This type of tumor forms from astrocytes, a type of glial cells. It is the most common brain tumor in children. It is grows most often in the cerebellum. 
  • Brain stem glioma. This tumor is found in the brain stem. Most brain stem tumors can’t be removed with surgery.
  • Oligodendroglioma. This tumor grows in the cells that make the fatty covering of nerve cells called oligodendrocytes. It usually grows slowly. But it usually grows into brain tissue. This makes it very difficult to remove with surgery.
  • Ependymoma. This usually grows in the lining of the ventricles that hold cerebrospinal fluid (CSF), or in the spinal cord.  In children, they are usually near the cerebellum. They often block the flow of the CSF, the fluid that surrounds the brain and spinal cord. This may cause increased pressure in the skull.
  • Optic nerve glioma. This kind of tumor is found in or around the nerves that send messages from the eyes to the brain. It often affects vision. It can also affect hormones since it’s usually at the base of the brain where hormone control is located.                    

Other types of brain tumors include:

  • Primitive neuroectodermal tumor (PNET). This kind of tumor grows more often in children. It can grow anywhere in the brain in the primitive form of nerve cells. One type is the medulloblastoma. This kind of tumor start is found in the cerebellum. They are more common in children than in adults. They tend to grow and spread quickly, but they can often be treated effectively. 
  • Craniopharyngioma. This kind of tumor starts near the pituitary gland. It is usually slow growing. But it can cause symptoms if it presses on the pituitary gland or on nearby nerves. This type of tumor is benign.
  • Mixed glial and neuronal tumors. These tumors are made up of glial and nerve cells.
  • Choroid plexus tumor. This is a rare tumor that starts in the ventricles of the brain. It’s also benign.
  • Schwannoma. This kind of tumor starts in myelin-making cells that surround certain nerves. It’s most common in the nerve in the inner ear that helps with balance. If it grows there, the tumor is called a vestibular schwannoma or an acoustic neuroma. This type of tumor is usually benign. 

What causes a brain tumor in a child?

Most brain tumors are caused by abnormal genes or chromosomes. What causes them to be abnormal is usually not known. Some chemicals may play a part in gene changes. Research is ongoing.

Which children are at risk for a brain tumor?

Children with certain genetic conditions have an increased risk for tumors of the central nervous system. This includes children with:

  • Neurofibromatosis
  • Von Hippel-Lindau disease
  • Li-Fraumeni syndrome
  • Retinoblastoma

Children who have had radiation therapy for other cancers of the head are also at an increased risk for a new brain tumor.

What are the symptoms of a brain tumor in a child?

Symptoms vary depending on size and location of tumor. Symptoms can occur a bit differently in each child.

Growing tumors may cause increased pressure on the brain in the limited space in the skull. This is called increased intracranial pressure or ICP. This isn’t usually the case in babies, since their skull bones haven’t fully grown together. The pressure on the brain may cause symptoms such as:

  • Headache
  • Enlarged head, especially in babies
  • Nausea and vomiting
  • Personality changes
  • Irritability
  • Drowsiness
  • Seizures
  • Coma

Symptoms of brain tumors in the cerebrum can include:

  • Seizures
  • Changes in eyesight or hearing
  • Trouble talking
  • Weakness or paralysis
  • Mood changes, such as feeling depressed

Symptoms of brain tumors in the cerebellum can include:

  • Trouble swallowing
  • Trouble with eye movement
  • Changes in speech
  • Clumsy movements of the hands, arms, feet, or legs
  • Problems walking (ataxia)

Symptoms of brain tumors in the brainstem can include:

  • Weakness
  • Problems walking (ataxia)
  • Muscle stiffness
  • Trouble with eye or other facial movement
  • Trouble swallowing
  • Double vision
  • Hearing loss

The symptoms of a brain tumor can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is a brain tumor diagnosed in a child?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child. This will include a neurological exam. The exam tests reflexes, muscle strength, eye and mouth movement, and coordination. Your child's healthcare provider may refer your child to a cancer specialist (oncologist). Your child may have tests such as:

  • CT scan. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body.
  • MRI. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. Contrast dye may be injected into your child's vein. It helps cancer cells be seen more clearly.
  • Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • Biopsy. Tumor cells are removed and sent to a lab for testing. This is done to determine the type of tumor and how quickly it is likely to grow.
  • Blood tests. Blood tests may be done to check for substances that are released by some tumors. These are called tumor markers.

How is a brain tumor treated in a child?

If your child has been diagnosed with a brain tumor and time allows, you may want your child to see a different oncologist (get a second opinion) before beginning treatment. In fact, your insurance company might require a second opinion. 

Treatment may include one or more of the below:

  • Surgery. Surgery is usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible, while keeping brain function.
  • Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth. 
  • Targeted therapy. These are medicines that kill cancer cells, but don’t harm healthy cells.
  • Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing.
  • High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.

Other treatments may include:

  • Corticosteroids. These treat and prevent swelling in the brain.
  • Antiseizure medicine. These treat and prevent seizures.
  • Ventriculoperitoneal (VP) shunt. A long tube called a shunt may be placed to remove extra fluid from the inside the brain. This helps control the pressure.
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting
  • Antibiotics. These treat and prevent infections.
  • Hormones. Medicines can replace hormones if a tumor affects natural hormone production.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best prognosis. 
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are possible complications of a brain tumor in a child?

A child may have complications from the tumor or from treatment, such as:

  • Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech, or eyesight
  • Problems after surgery, such as infection, bleeding, and problems with general anesthesia
  • Infection and bleeding from chemotherapy
  • Delayed growth and development
  • Learning problems
  • Problems with reproduction (infertility)
  • Return of the cancer
  • Growth of other cancers

How can I help my child live with a brain tumor?

A child with a brain tumor needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. For example, your child may see an eye doctor (ophthalmologist) for vision problems.      

Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists. If your child's speech is affected, he or she may need help from a speech therapist. Your child may also need the help of other therapists for learning or emotional problems. 

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about a brain tumor in a child

  • Brain tumors start in the cells of the brain.
  • Brain tumors can grow at any age. Those that grow in infants and children are very different from those in adults. 
  • The types of brain tumors are based on the cell type and location in the brain.
  • Some common symptoms of brain tumors are headache, nausea and vomiting, and trouble with movement.
  • Most children are treated with surgery, chemotherapy, and radiation therapy. 
  • On-going follow-up is important in order to watch for effects of tumors or treatment and the cancer growing back.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Ewing Sarcoma

What is Ewing sarcoma in children?

Ewing sarcoma is a rare type of cancer. It’s most common in children and teens between the ages 10 and 19. It usually grows in bone, but it can also grow in soft tissue that’s connected to the bone. This may include tendons, ligaments, cartilage, or muscles.

Ewing sarcoma most often grows in:

  • Bones of the legs, hips and pelvis, chest, and arms
  • Soft tissue of the torso, arms, and legs

What causes Ewing sarcoma in a child?

The exact cause of Ewing sarcoma is not known. The cancer may be caused by changes in the DNA of the cells. These changes are not passed on from parents to children. They happen by chance.

What are the symptoms of Ewing sarcoma in a child?

Symptoms can occur a bit differently in each child. They can include:

  • Pain around the site of the tumor that may come and go, but gets worse over time, with activity, and at night
  • Swelling  around the site of the tumor
  • A lump (mass)
  • Fever
  • Weight loss
  • Feeling tired

The symptoms of Ewing sarcoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is Ewing sarcoma in children diagnosed in a child?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child.  Your child may be referred to a specialist. This may be a bone specialist (orthopedic surgeon) or a bone cancer specialist (orthopedic oncologist). Your child may have tests such as:

  • X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body tissues.
  • Blood tests. The blood is tested to look for signs of Ewing sarcoma. Genetic testing may also be done to look for DNA changes that can cause the cancer.
  • CT scan. This test uses a series of X-rays and a computer  to make detailed images of the body.
  • MRI. This test uses large magnets, radio waves, and a computer to make detailed images of the inside of the body.
  • Bone scan. A small amount of dye is injected into a vein. The whole body is scanned. The dye shows up in areas where there may be cancer.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
  • Tumor biopsy. A sample of the tumor is taken. It may be taken with a needle or by a surgical cut (incision). It is checked under a microscope for cancer cells. A biopsy is needed to diagnose neuroblastoma. 

Part of diagnosing cancer is called staging. Staging checks the size and location of the main tumor, if it has spread, and where it has spread. Ewing sarcoma may be stage 1, 2, or 3 with sub-stages. Talk with your child's oncologist about your child's stage and what it means. Staging also helps to decide the treatment.

How is Ewing sarcoma in children treated in a child?

Treatment will depend on the stage and other factors. The cancer can be treated with any of the below:

  • Surgery. Surgery may be done to try to save the arm or leg. This is known as limb-salvage or limb-sparing surgery. Or surgery may be done to remove an arm or leg (amputation). Surgery may be done to remove tumors in other parts of the body. Surgery is usually followed by chemotherapy or radiation therapy.
  • Chemotherapy. These are medicines that kill cancer cells. They are usually given before surgery. They may also be given after surgery. Your child may have a port or catheter inserted in order to receive the medicines into a vein (IV). Chemotherapy is given in cycles with periods of rest.
  • Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill cancer cells or stop them from growing. It may be used when a tumor is hard to remove with surgery.
  • High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced. This treatment may be used when there is a high risk of cancer returning.
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are possible complications of Ewing sarcoma in a child?

A child may have complications from the sarcoma or from treatment, such as:

  • Infection or bleeding from surgery
  • Loose or broken grafts or rods from limb-salvage surgery
  • Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising and bleeding, and feeling tired from chemotherapy
  • Burns, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancers from radiation
  • Emotional and physical challenges from amputation
  • Heart and lung problems
  • Problems with growth and development
  • Learning problems
  • Changes in sexual development
  • Problems with the ability to have children (fertility) in the future
  • Return of the cancer
  • Growth of other cancers

How can I help my child live with Ewing sarcoma?

A child with a Ewing sarcoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists.

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about Ewing sarcoma in children

  • Ewing sarcoma is a rare group of cancers that usually occur in the bone, but can also occur in soft tissue. 
  • X-ray and other imaging tests may be used in diagnosing Ewing sarcoma. A biopsy is needed to make a definite diagnosis.
  • Ewing sarcoma is treated with chemotherapy followed by surgery and/or radiation therapy. High-dose chemotherapy and stem cell transplant may be used in some children.
  • Continuous follow-up care during and after treatment is necessary.
  • Many complications can occur from the cancer and from the treatment. The complications may be short- or long-term.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Germ Cell Tumors

What are germ cell tumors?

Germ cell tumors are malignant (cancerous) or nonmalignant (benign, noncancerous) tumors that are comprised mostly of germ cells. Germ cells are the cells that develop in the embryo (fetus, or unborn baby) and become the cells that make up the reproductive system in males and females. These germ cells follow a midline path through the body after development and descend into the pelvis as ovarian cells or into the scrotal sac as testicular cells. Most ovarian tumors and testicular tumors are of germ cell origin. The ovaries and testes are called gonads.

Germ cell tumors are rare, accounting for about two to four percent of all cancers in children and adolescents younger than age 20. Germ cells are the cells that develop in an unborn baby and become the cells that make up the reproductive system in males and females.

Tumor sites outside the gonad are called extragonadal sites. The tumors also occur along the midline path and can be found in the head, chest, abdomen, pelvis, and sacrococcygeal (lower back) area.

Germ cell tumors are rare. Germ cell tumors account for about 2 to 4 percent of all cancers in children and adolescents younger than age 20.

Germ cell tumors can spread (metastasize) to other parts of the body. The most common sites for metastasis are the lungs, liver, lymph nodes, and central nervous system. Rarely, germ cell tumors can spread to the bone, bone marrow, and other organs.

What are the symptoms of germ cell tumors?

The following are the most common symptoms of germ cell tumors. However, each child may experience symptoms differently. Symptoms vary depending on the size and location of the tumor and may include:

  • A tumor, swelling, or mass that can be felt or seen
  • Elevated levels of alpha-fetoprotein (AFP)
  • Elevated levels of beta-human chorionic gonadotropin (ß-HCG)
  • Constipation, incontinence, and leg weakness can occur if the tumor is in the sacrum (a segment of the vertebral column that forms the top part of the pelvis) compressing structures
  • Abdominal pain
  • Abnormal shape, or irregularity in, testicular size
  • Shortness of breath or wheezing if tumors in the chest are pressing on the lungs

The symptoms of germ cell tumors may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How are germ cell tumors diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for germ cell tumors may include:

  • Biopsy. A sample of tissue is removed from the tumor and examined under a microscope.
  • Complete blood count (CBC). This measures size, number, and maturity of different blood cells in a specific volume of blood.
  • Additional blood tests. These tests may include blood chemistries, evaluation of liver and kidney functions, tumor cell markers, and genetic studies.

Multiple imaging studies, including:

  • Computed tomography (CT) scan. This is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Magnetic resonance imaging (MRI). This is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body, without the use of X-rays.
  • X-ray. This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Ultrasound (also called sonography). This is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

What is the treatment for germ cell tumors?

Specific treatment for germ cell tumors will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history
  • Extent of the disease
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include(alone or in combination):

  • Surgery (to remove the tumor and involved organs)
  • Chemotherapy
  • Radiation
  • Bone marrow transplantation
  • Supportive care (for the effects of treatment)
  • Hormonal replacement (if necessary)
  • Antibiotics (to prevent or treat infections)
  • Continuous follow-up care (to determine response to treatment, detect recurrent disease, and manage the late effects of treatment)

Hepatoblastoma/Liver Cancer

What is hepatoblastoma in children?

Hepatoblastoma is a very rare cancer. It’s a tumor that starts in the liver. The cancer cells are similar to fetal liver cells. It usually affects children less than 3 to 4 years of age. It usually doesn’t spread (metastasize) to other areas of the body.

What causes hepatoblastoma in a child?

The cancer is caused by a change in a gene. The reason why this happens is not known.

Which children are at risk for hepatoblastoma?

Some genetic health conditions increase a child's risk. These include:

  • Beckwith-Wiedemann syndrome
  • Wilson disease
  • Porphyria cutanea tarda 
  • Familial adenomatous polyposis
  • Tyrosinemia
  • Glycogen storage diseases
  • Alpha1-antitrypsin deficiency

What are the symptoms of hepatoblastoma in a child?

Symptoms vary depending on the size and of the tumor and whether it has spread. Symptoms can occur a bit differently in each child. They can include:

  • Lump (mass) in the belly (abdomen)
  • A swollen abdomen
  • Pain in the abdomen
  • Loss of appetite
  • Weight loss
  • Nausea and vomiting
  • Yellow color to the skin or whites of the eyes (jaundice)
  • Fever
  • Itchy skin
  • Enlarged veins on the belly 

The symptoms of hepatoblastoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is hepatoblastoma diagnosed in a child?

You may take your child to the healthcare provider because of a lump, swelling, or pain in the belly abdomen, or other symptoms. The healthcare provider will ask about your child's symptoms. He or she will examine your child, focusing on the abdomen. Your child may need to see a specialist in diagnosing and treating cancer in children (pediatric oncologist). Your child may have tests such as:

  • Blood tests. These tests look for signs of illness. They check for blood clotting problems, liver and kidney function, tumor markers, gene problems, and more.
  • Ultrasound (US) exam. Sound waves are used to create images. This may be one of the first tests used to look at the liver.
  • CT scan. A series of X-rays and a computer are used to make images of the body. This may be done to look at blood vessels in the liver.
  • MRI. Large magnets, radio waves, and a computer are used to make detailed images of the inside of the body. This may also be done to look at blood vessels in the liver.
  • Bone scan. A small amount of dye is injected into a vein. The whole body is scanned. The dye shows areas where there may be cancer cells.
  • Tumor biopsy. A sample of the tumor is taken and checked with a microscope for cancer cells. A biopsy is needed to diagnose hepatoblastoma. The biopsy may be done with a needle or with surgery.

Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging cancer, but most range from stage 1 to stage 4. Hepatoblastoma has different staging methods. One method may be used before surgery and one after. Talk with your child's oncologist about your child's stage and what it means.

How is hepatoblastoma treated in a child?

If your child has been diagnosed with hepatoblastoma, you may want your child to see another oncologist. This means to get a second opinion. Your insurance company may require a second opinion.

Treatment will depend on the stage and other factors. The cancer can be treated with any of the below:

  • Surgery. This may be done to take a sample of the tumor for diagnosis. And it may be done to remove as much of the tumor as possible (resection). Surgery may also be done to remove tumors in other parts of the body, such as in the lungs.
  • Chemotherapy. These are medicines that kill cancer cells. They may be given before or after surgery. They are delivered into a vein (IV) or by shot (injection), or by mouth (oral). The medicines may also be delivered to the liver. This is done with a tube (catheter) into the liver's main artery. This is called chemoembolization of hepatic artery. The medicine is mixed with a substance that blocks the flow of blood to the tumor. This causes problems with the tumor's growth.
  • Liver transplant. If a tumor can’t be removed, the liver may be removed and replaced with a liver from a donor.
  • Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill cancer cells or stop them from growing. This is being studied for use in treating hepatoblastoma.
  • Watchful waiting. This means not starting treatment until symptoms appear or change. This may be done for some children with Stage 1 cancer.
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are possible complications of hepatoblastoma in a child?

A child may have complications from the sarcoma or from treatment, such as:

  • Infections and bleeding from surgery
  • Rejection of the new liver
  • Problems with anti-rejection medicines
  • Increased infections, bruising and bleeding, vomiting, diarrhea, hair loss, and tiredness with some chemotherapy medicines
  • Problems with growth and development
  • Heart, kidney, or lung problems
  • Problems with liver function
  • Spreading cancer (metastasis)
  • Cancer that grows back
  • Growth of new cancers

How can I help my child live with hepatoblastoma?

A child with a hepatoblastoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment.

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about hepatoblastoma in children

  • Hepatoblastoma is a very rare cancerous (malignant) tumor that starts in the liver. 
  • Symptoms include a lump (mass), swelling, or pain in the belly (abdomen).
  • Diagnosis is done with blood tests, imaging, and biopsy.
  • It may be treated with surgery, chemotherapy, and other methods.
  • Follow-up care is needed to watch for complications and cancer that grows back.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Hodgkin Lymphoma

What is Hodgkin lymphoma in children?

Hodgkin lymphoma is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system. It helps to fight diseases and infections. The lymphatic system also helps with balancing fluids in different parts of the body. The lymphatic system includes:

  • Lymph. This is a fluid that contains lymphocyte cells.
  • Lymph vessels. These are tiny tubes that carry lymph fluid throughout the body.
  • Lymphocytes. These are a type of white blood cells that fight infections and disease. Burkitt lymphoma grows from B-cells, one type of lymphocyte.
  • Lymph nodes. These are small bean-shaped organs. They are in the underarm, groin, neck, chest, abdomen, and other parts of the body. They filter the lymph fluid as it moves around the body.
  • Other organs and body tissues. The lymphatic system includes the bone marrow where blood is made. And it includes the spleen, thymus, tonsils, and digestive tract.

Hodgkin lymphoma causes abnormal growth of the cells in the lymphatic system. Over time, the body is less able to fight infection and the lymph nodes swell. Hodgkin lymphoma cells can also spread (metastasize) to other organs and tissues. It’s a rare disease in children. It affects boys more often than girls.

What causes Hodgkin lymphoma in a child?

The exact cause of Hodgkin lymphoma is not known. Genes and some viral infections may increase a child’s risk of having Hodgkin lymphoma. Conditions that are linked to Hodgkin lymphoma are listed below. But because Hodgkin lymphoma is so rare, the risk is still very low.                         

  • Epstein-Barr virus, which causes mononucleosis (mono)
  • HIV, the virus that causes AIDS
  • Having a brother or sister with Hodgkin lymphoma

What are the symptoms of Hodgkin lymphoma in a child?

Symptoms can occur a bit differently in each child. They can include:

  • Painless swelling of the lymph nodes in the neck, underarm, groin, or chest
  • Trouble breathing (dyspnea)
  • Coughing
  • Chest pain
  • Fever
  • Night sweats
  • Tiring easily (fatigue)
  • Loss of appetite
  • Weight loss
  • Itching skin (pruritus)
  • Frequent viral infections such as colds, flu, sinus infections

The symptoms of Hodgkin lymphoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is Hodgkin lymphoma diagnosed in a child?

Your child's healthcare provider will ask about your child's medical history and symptoms. He or she will examine your child.  Your child may have tests such as:

  • Blood and urine tests. Blood and urine are tested in a lab.
  • Chest X-ray. The chest X-ray shows the heart, lungs, and other parts of the chest.
  • Lymph node biopsy. A sample of tissue is taken from the lymph nodes. It’s checked with a microscope for cancer cells. A lymph node biopsy is needed to diagnose Hodgkin lymphoma.
  • CT scan. This may be done for the abdomen, chest, and pelvis. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body.
  • MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. This test is used to check the brain and spinal cord. Or it may be used if the results of an X-ray or CT scan unclear. 
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.

Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging used for Hodgkin lymphoma. Talk with your child's healthcare provider about the stage of your child's cancer. One method of staging Hodgkin lymphoma is the following:

  • Stage I. The cancer is in a single lymph node region or organ.
  • Stage II. The cancer is in 2 or more lymph node regions on the same side of the body. Or the cancer has spread from one lymph node into a nearby organ.
  • Stage III. The cancer is in lymph node regions on both sides of the body. It also includes which organs and areas involved.
  • Stage IV. The cancer is in the lymphatic system and has spread to other areas of the body (metastasis).

Staging also includes whether a child has certain symptoms, and includes:

  • Asymptomatic (A). No fever, night sweats, or weight loss.
  • Symptomatic (B). Symptoms of fever, night sweats, or weight loss.

How is Hodgkin lymphoma treated in a child?

Most children with Hodgkin lymphoma are treated successfully and cured. Treatment will depend on the stage and other factors. Hodgkin lymphoma can be treated with any of the below:

  • Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth. 
  • Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing.
  • Surgery. Surgery may be done to remove tumors.
  • High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.
  • Monoclonal antibodies. This is a type of targeted therapy that kills cancer cells without harming healthy cells.
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 

Your child will need follow-up care during and after treatment to:

  • Check on your child's response to the treatment
  • Manage the side effects of treatment
  • Look for returning or spreading cancer

Some treatments may be hard on your child, but they increase the chance of your child living a long time. Discuss the side effects of treatment with your child's healthcare provider.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:              

  • Getting medical treatment right away is important for the best prognosis. 
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are possible complications of Hodgkin lymphoma in a child?

Possible complications depend on the type and stage of the lymphoma. They include:

  • Increased risk of infection
  • Heart disease
  • Lung problems
  • Increased chance of growing other cancers
  • Trouble reproducing (infertility)
  • Death

Treatment may also cause complications. They include:

  • Increased risk of bleeding
  • Increased risk of infection
  • Nausea and vomiting
  • Diarrhea
  • Poor appetite
  • Sores in the mouth
  • Hair loss

How can I help my child live with Hodgkin lymphoma?

You can help your child manage his or her treatment in many ways. For example:

  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.
  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.

When should I call my child's healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about Hodgkin lymphoma in children

  • Hodgkin lymphoma is a type of cancer in the lymphatic system. 
  • Most children with Hodgkin lymphoma are treated successfully and cured.
  • Symptoms of Hodgkin lymphoma include painless swelling of the lymph nodes in the neck, underarm, groin, or chest, trouble breathing, night sweats, fever, and feeling tired.
  • A lymph node biopsy is needed to diagnose Hodgkin lymphoma.
  • Treatment may include a medicines, radiation, stem cell transplants, and surgery.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Leukemia

What is leukemia in children?

Leukemia is cancer of the blood. It’s the most common form of cancer in childhood. The cancer cells grow in bone marrow and go into the blood. The bone marrow is the soft, spongy center of some bones. It makes blood cells. When a child has leukemia, the bone marrow makes abnormal blood cells that don’t mature. The abnormal cells are usually white blood cells (leukocytes). The bone marrow also makes fewer healthy cells. The abnormal cells reproduce very quickly. They don’t work the same as healthy cells. A child has symptoms when he or she has more abnormal cells and less normal cells.

The types of blood cells include:

  • Red blood cells (erythrocytes). Red blood cells carry oxygen. When a child has a low level of healthy red blood cells, this is called anemia. A child may feel tired, weak, and short of breath.
  • Platelets (thrombocytes). Platelets help with blood clotting and stop bleeding. When a child has low levels of platelets, he or she bruises and bleeds more easily.
  • White blood cells (leukocytes). These fight infection and other disease. When a child has low levels of white blood cells, he or she is more likely to have infections. The types of leukocytes are:
  • Lymphocytes. There are 2 types: B lymphocytes and T lymphocytes. These cells grow from lymphoblasts in the bone marrow.
  • Granulocytes. There are 3 types: neutrophils, basophils, and eosinophils. These cells grow from myeloblasts in the bone marrow.
  • Monocytes. These cells grow from monoblasts in the bone marrow.

There are different types of leukemia in children. Most types are either acute or chronic. Acute develops quickly, over days or weeks. Chronic develops more slowly, over months or years. Some of the types of leukemia that occur in children include:

  • Acute lymphocytic (lymphoblastic) leukemia (ALL). This is the most common type of leukemia in children. It starts from the lymphoblasts, the cells that form lymphocytes in the bone marrow.
  • Acute myelogenous (myeloid, myelocytic, non-lymphocytic) leukemia (AML). This is the second most common type of leukemia in children. It starts from the myeloblasts or myeloid cells that form many white blood cells, plus red blood cells and platelets. 
  • Hybrid or mixed lineage leukemia. This type is rare. It is a mix of ALL and AML.
  • Chronic myelogenous leukemia (CML). This type is also rare in children.  Like AML, it starts from the myeloblasts or myeloid cells that form many white blood cells, plus red blood cells and platelets. 
  • Chronic lymphocytic leukemia (CLL). This type is extremely rare in children. Like ALL, it starts from the lymphoblasts, the cells that grow lymphocytes in the bone marrow.
  • Juvenile myelomonocytic leukemia (JMML). This is a rare type of cancer that doesn’t grow quickly (acute) or slowly (chronic). It also starts from myeloblasts or myeloid cells. 

What causes leukemia in children?

The exact cause of leukemia in children is not known. There are certain conditions passed on from parents to children (inherited) that increase the risk for childhood leukemia. But, most childhood leukemia is not inherited. Researchers have found changes (mutations) in genes of the bone marrow cells. These changes may occur early in a child's life or even before birth. But they may occur by chance (sporadic).

Who is at risk for childhood leukemia?

The risk factors for childhood leukemia include:

  • Exposure to high levels of radiation
  • Having certain inherited syndromes, such as Down syndrome and Li-Fraumeni syndrome
  • Having an inherited condition that affects the body's immune system
  • Having a brother or sister with leukemia

What are the symptoms of leukemia in children?

The symptoms depend on many factors. The cancer may be in the bone marrow, blood, and other tissue and organs. Other tissue and organs may be affected. These may include the lymph nodes, liver, spleen, thymus gland, brain, spinal cord, gums, and skin.

Symptoms can occur a bit differently in each child. They can include:

  • Pale skin
  • Feeling tired, weak, or cold
  • Dizziness
  • Headaches
  • Shortness of breath, trouble breathing
  • Frequent or long-term infections
  • Fever
  • Easy bruising or bleeding, such as nosebleeds or bleeding gums
  • Bone or joint pain
  • Belly (abdominal) swelling
  • Poor appetite
  • Weight loss
  • Swollen lymph glands (nodes)

The symptoms of leukemia can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is leukemia diagnosed in children?

Your child's healthcare provider will ask many questions about your child's symptoms. He or she will examine your child. Your child's healthcare provider may recommend blood tests and other tests. A complete blood count (CBC) provides the number of red blood cells, different types of white blood cells, and platelets. If the results are abnormal, your child's healthcare provider may recommend that your child see a pediatric cancer specialist (pediatric oncologist). The oncologist may want your child to have additional tests including:

  • Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
  • Blood tests. Tests like flow cytometry and immunohistochemistry. These tests determine the exact type of leukemia. DNA and chromosome tests may also be done.
  • CT scan. This test uses a series of X-rays and a computer to make detailed images of the body.
  • MRI. This test uses large magnets, radio waves, and a computer to make detailed images of the inside of the body.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body tissues.
  • Ultrasound (sonography). This test uses sound waves and a computer to create images.
  • Lymph node biopsy. A sample of tissue is taken from the lymph nodes. It’s checked with a microscope for cancer cells.
  • Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.

How is leukemia treated in children?

Your child may first need to be treated for low blood counts, bleeding, or infections. Your child may receive:

  • Blood growth factors to increase the production of blood cells in the bone marrow
  • Blood transfusion with red blood cells for low blood counts
  • Blood transfusion with platelets to help stop bleeding
  • Antibiotic medicine to treat any infections

Treatment will depend on the stage and other factors. Leukemia can be treated with any of the below:

  • Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV) or spinal canal, injected into a muscle, or taken by mouth. Chemotherapy is the main treatment for leukemia in children. Several medicines are often given at different times. It’s usually done in cycles, with rest periods in between. This gives your child time to recover from the side effects.
  • Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing. Radiation may be used in certain cases.
  • High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.
  • Targeted therapy. These medicines may work when chemotherapy doesn’t. For example, it may be used to treat children with chronic myeloid leukemia (CML). Targeted therapy often has less severe side effects.
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 

There are 3 stages in the treatment of acute leukemia. They include:

  • Induction. This is a combination of chemotherapy and radiation. It’s done to stop the bone marrow from making abnormal cells. The goal is to no longer being able to detect cancer cells. This is called remission. Your child may be in the hospital for long periods of time. He or she will also have frequent visits to the oncologist.
  • Intensification. This is also called consolidation. This is ongoing chemotherapy treatment for about 1 to 2 months. This is done even when leukemia cells are not found. 
  • Maintenance. This is smaller doses of chemotherapy for a longer period of time. It can last from months to years. Your child may also have periods of chemotherapy at higher doses during this time.

The bone marrow can start making abnormal cells again (relapse) during any stage of treatment. This can occur months or years after treatment has ended.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are possible complications of leukemia in a child?

A child may have complications from the tumor or from treatment. They may also be short-term or long-term.

Treatment may have many side effects. Some side effects may be minor. Some may be serious and even life-threatening. Your child may take medicines to help prevent or lessen side effects. You’ll be given instructions about what you can do at home.

Possible complications of leukemia can include:

  • Serious infections
  • Severe bleeding (hemorrhage)
  • Thickened blood from large numbers of leukemia cells

Another possible complication is superior vena cava syndrome. The superior vena cava is the large blood vessel that supplies blood to the upper body. If your child has an enlarged thymus gland in the chest, it can press on the superior vena cava. It may cause very serious symptoms and be life-threatening.

Possible long-term complications from the leukemia or the treatment can include:

  • Return of the leukemia
  • Growth of other cancers
  • Heart and lung problems
  • Learning problems
  • Slowed growth and development
  • Problems with the ability to have children in the future
  • Bone problems such as thinning of bones (osteoporosis)

What can I do to prevent leukemia in my child?

Most childhood cancers, including leukemia, can’t be prevented. The risk from X-rays and CT scans is very small. But healthcare providers advise against them in pregnant women and children unless absolutely needed.

How can I help my child live with leukemia?

A child with leukemia needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the cancer returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the cancer or from treatment.

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about leukemia in children

  • Leukemia is cancer of the blood. The cancer cells develop in the bone marrow and go into the blood. Other tissue and organs that may be affected include the lymph nodes, liver, spleen, thymus gland, brain, spinal cord, gums, and skin.
  • When a child has leukemia, the bone marrow makes abnormal blood cells that do not mature. The abnormal cells are usually white blood cells (leukocytes). And with leukemia, the bone marrow makes fewer healthy cells. 
  • Common symptoms of leukemia in children include feeling tired and weak, easy bruising or bleeding, and frequent or long-term infections.
  • Leukemia is diagnosed with blood and bone marrow tests. Imaging may be done to look for signs of leukemia in different parts of the body.
  • Chemotherapy is the main part of treatment leukemia in children.
  • A child with leukemia may have complications from the leukemia and from the treatment.
  • Ongoing follow-up care is needed during and after treatment.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Skin Cancer

What is melanoma/skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. In the U.S. alone, more than 2 million Americans will be diagnosed in 2013 with nonmelanoma skin cancer, and more than 76,000 will be diagnosed with melanoma, according to the American Cancer Society.

Fortunately, skin cancers are rare in children. Limiting exposure to sunlight in children and teens may pay large dividends in preventing skin cancers later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma later in life.

What are the symptoms and signs of skin cancer?

The following are the most common symptoms of melanoma. However, each individual may experience symptoms differently.

Symptoms may include:

  • Change in the size, shape, or color of a mole
  • Oozing or bleeding from a mole
  • A mole that looks different from your other moles or feels itchy, hard, lumpy, swollen, or tender to the touch

Because most malignant melanoma cells still produce melanin, melanoma tumors are often shaded brown or black. Melanoma can also appear on the body as a new mole. Melanoma can spread quickly to other parts of the body through the lymph system, or through the blood. Like most cancers, melanoma is best treated when it is diagnosed early.

The symptoms of melanoma may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How to find melanoma early

It is important to examine your child's skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Larger moles that are present at birth and atypical moles, have a greater chance of becoming malignant. Recognizing changes in your child's moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage.

The warning signs are:

Normal mole / melanoma Sign   Characteristic
Asymmetry   When half of the mole does not match the other half
 
Border   When the border (edges) of the mole are ragged or irregular
 
Color   When the color of the mole varies throughout
 
Diameter   If the mole's diameter is larger than a pencil's eraser
Photographs Used By Permission:
National Cancer Institute
     

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while others may show few or none. New moles, moles that have grown or changed, and moles that are itchy or bleeding should be checked by your child's doctor. Always consult your child's doctor if you have questions about a mole or other skin lesion.

How is skin cancer diagnosed?

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. Examining your children (and yourself) is usually the first step in detecting skin cancer. The following suggested method of examination comes from the AAD:

  • Examine your child's body front and back, then the right and left sides, with arms raised.
  • Look carefully at your child's forearms, the back of his or her upper arms, and the palms of the hands. Check between the fingers and look at the nail beds.
  • Look at backs of his or her legs and feet, spaces between the toes, the toenail beds, and the soles of the feet.
  • Examine the back of his or her neck and scalp.
  • Check his or her back, buttocks, and genital area.
  • Become familiar with your child's skin and the pattern of moles, freckles, and other marks.
  • Be alert to changes in the number, size, shape, and color of pigmented areas.
  • Follow the ABCD Chart when examining moles of other pigmented areas and consult your child's doctor promptly if you notice any changes.

Neuroblastoma

What is neuroblastoma in children?

Neuroblastoma is a cancerous tumor. It grows in nerve tissue of babies and young children. The cancer cells grow in young nerve cells of a baby growing in the womb. These cells are called neuroblasts. It’s is the most common cancer in babies under age 1. It’s rare in children older than age 10. 

Neuroblastoma affects:

  • Nerve fibers along the spinal cord
  • Clusters of nerve cells (ganglia) along the nerve fibers
  • Nerve-like cells in the adrenal glands

In most cases, neuroblastoma starts in the adrenal glands or the nerve fibers in the abdomen. Other common places for it to grow include the nerve fibers near the spine in the chest, neck, or lower belly (pelvis). 

What causes neuroblastoma in a child?

The cancer is caused by changes in the DNA of the cells. In most children, this happens by chance. A small number of children inherit the risk from their parents.

What are the symptoms of neuroblastoma in a child?

The symptoms vary depending on the size and location of the tumor and if it has spread. Symptoms can also occur a bit differently in each child.                                                                                                             

Symptoms of a tumor in the belly (abdomen) can include:

  • A lump in the abdomen
  • Swelling in the abdomen
  • Loss of appetite
  • Weight loss
  • Swelling of the legs
  • Swelling of the scrotum
  • Feeling full
  • Pain

Symptoms of a tumor in the chest can include:

  • A lump in the chest
  • Swelling in the face, neck, arms, or chest
  • Headache
  • Dizziness
  • A change in mental state
  • Coughing or trouble breathing
  • Trouble swallowing
  • Drooping eye lids and other eye changes
  • Changes in feeling or movement of the arms or legs

Symptoms of a neuroblastoma that has spread to other parts of the body can include:

  • Enlarged lymph nodes
  • Bone pain or limping 
  • Weakness, numbness, or inability to move arms or legs
  • Bruising around the eyes
  • Bulging eyes
  • Lumps on the head
  • Feeling tired or weak
  • Frequent infections
  • Easy bruising or bleeding

A neuroblastoma may release hormones. This is called paraneoplastic syndrome. It can cause symptoms such as:

  • Constant diarrhea
  • Fever
  • High blood pressure
  • Fast heart rate
  • Flushing or redness of skin
  • Sweating

A neuroblastoma can also cause opsoclonus-myoclonus-ataxia syndrome. This can lead to symptoms such as:

  • Quick eye movements
  • Muscle twitching
  • Trouble with coordination

The symptoms of neuroblastoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is neuroblastoma diagnosed in a child?

You may take your child to the healthcare provider because of a lump, swelling, or other symptoms. Most of the time, neuroblastoma has spread by the time it is diagnosed. Your child's healthcare provider will ask about your child's medical history and symptoms. He or she will examine your child. Your child may be referred to a specialist in diagnosing and treating cancer in children (pediatric oncologist).Your child may have tests such as:

  • Blood and urine tests. Blood tests check for signs of disease in the body. Your child may also have urine and blood tests to check for hormones released by the tumor.
  • Ultrasound exam (US). Sound waves and a computer are used to create images. An ultrasound may be done to check your child's belly (abdomen), kidneys, or to guide a needle in a biopsy
  • X-ray.  X-rays may be done to check your child's chest or bones
  • CT scan. X-rays and a computer are used to make images of the body.  Scans of the belly (abdomen), lower belly (pelvis), or chest may be done. Contrast dye may be used. A CT scan may also be used to guide the needle in a biopsy.
  • MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. This test is used to check the brain and spinal cord.
  • Bone scans. A small amount of dye is injected into a vein. The whole body is scanned. The dye shows up in areas of bone where there may be cancer.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • Metaiodobenzylguanidine (MIBG) scan. A small amount of radioactive iodine called MIBG is injected into a vein. The dye travels through the blood and attaches to cancer cells. Scans may be taken over a few days.
  • Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
  • Tumor biopsy. A sample of the tumor is taken. It may be taken with a needle or by a surgical cut (incision). It is checked under a microscope for cancer cells. A biopsy is needed to diagnose neuroblastoma. 

Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging used for neuroblastoma. Talk with your child's healthcare provider about the stage of your child's cancer. One method of staging neuroblastoma is the following:

  • Stage 1. The tumor is on one side of the body. It has not spread. It is able to be removed by surgery (resectable).
  • Stage 2A. The tumor is on one side of the body. It has not spread. It can’t be fully removed by surgery.
  • Stage 2B. The tumor is on one side of the body. Lymph nodes on that side of the body have cancer cells. It may or may not be able to be fully removed by surgery
  • Stage 3. The tumor affects both sides of the body. It may have spread to nearby lymph nodes. Or it’s on one side of the body, but lymph nodes nearby or on the other side of the body have cancer cells. Or it is in the middle of the body and can’t be fully removed by surgery.
  • Stage 4. The tumor has spread (metastasized) to distant lymph nodes, bone marrow, liver, skin, or other organs (except as defined in stage 4S).
  • Stage 4S ("special" neuroblastoma). This stage is for a child younger than 12 months. This tumor is on one side of the body. It may have spread to lymph nodes on that side of the body, but not the other side. It has spread to the liver, skin, or bone marrow.

How is neuroblastoma treated in a child?

Treatment will depend on the stage and other factors. The cancer can be treated with any of the below:

  • Surgery. Surgery is often done to remove as much of the tumor as possible (resection). Surgery may not be possible if the cancer has spread too far.
  • Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth. They may be given before or after surgery. Or they may be the main treatment if surgery is not possible. The medicine is given in cycles, with rest periods in between.
  • Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing. Radiation may be outside of the body (external) or inside the body (internal). Radioactive iodine (MIBG) is given into a vein (IV). Your child will stay in the hospital for this treatment.
  • High-dose chemotherapy/radiation with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine and/or radiation. This causes damage to the bone marrow. After the chemotherapy and/or radiation, the stem cells are replaced.
  • Immunotherapy. This treatment helps the body's immune system attack cancer cells. It is also used when there is a high risk of cancer returning.
  • Retinoid therapy. Retinoid medicine may be given after high-dose chemotherapy/radiation and stem cell transplant. It may be used when there is a high risk of cancer returning.
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:    

  • Getting medical treatment right away is important for the best prognosis. 
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are the possible complications of neuroblastoma in a child?

A child may have complications from the tumor or from treatment, such as:

  • Bleeding or infection after surgery
  • Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising and bleeding, and feeling tired from chemotherapy
  • Burns, hair loss, and feeling tired from radiation
  • Nausea and diarrhea from radiation to the belly (abdomen)
  • Problems with growth and development
  • Heart and lung problems
  • Changes in sexual development
  • Problems with the ability to have children (fertility) in the future
  • Return of the cancer
  • Growth of other cancers
  • A high risk of serious bleeding (consumption coagulopathy) (rare)

How can I help my child live with a neuroblastoma?

A child with a neuroblastoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists.                                                     

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about neuroblastoma in children

  • Neuroblastoma is a cancerous (malignant) tumor that begins in nerve tissue of infants and very young children. 
  • The symptoms of neuroblastoma vary greatly depending on size, location of the tumor and whether it has spread. Common symptoms are a lump or swelling.
  • Neuroblastoma is diagnosed with blood and urine tests, imaging tests, and biopsy.
  • Treatment of neuroblastoma may include surgery, chemotherapy, radiation therapy, high-dose chemotherapy/radiation with stem cell transplant, and other medicines.
  • Continuous follow-up care during and after treatment is necessary

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma (NHL) in children?

NHL is a type of cancer in the lymphatic system. The lymphatic system is part of the immune system. It helps to fight diseases and infections. The lymphatic system also helps with balancing fluids in different parts of the body. The lymphatic system includes:

  • Lymph. This is a fluid that contains lymphocyte cells.
  • Lymph vessels. These are tiny tubes that carry lymph fluid throughout the body.
  • Lymphocytes. These are a type of white blood cells that fight infections and disease. NHL lymphoma grows from B-cells, one type of lymphocyte.
  • Lymph nodes. These are small bean-shaped organs. They are in the underarm, groin, neck, chest, abdomen, and other parts of the body. They filter the lymph fluid as it moves around the body.
  • Other organs and body tissues. The lymphatic system includes the bone marrow where blood is made. And it includes the spleen, thymus, tonsils, and digestive tract.

NHL causes abnormal growth of the cells in the lymphatic system. Over time this causes tumors to grow. The cells can also spread to other organs and tissues in the body (metastasis).  NHL is a rare disease in children.  It can occur at any age, and affects boys more often than girls. 

NHL in children comes in 3 types:

  • Lymphoblastic lymphoma. This type usually involves one kind of lymphocytes call T-cells (T-lymphocytes). It causes a tumor in the chest and swollen lymph node(s). It may affect the bone marrow and brain and spinal cord (central nervous system).
  • Burkitt and non-Burkitt lymphoma. These types grow fast. These types of lymphoma usually include large tumors in the belly (abdomen). They may affect the bone marrow and central nervous system.
  • Large cell non-Hodgkin lymphoma. This affects the B-cell or T-cell lymphocytes. In children, it doesn’t usually grow as fast as other lymphomas. It usually affects the lymphatic system and other parts of the body such as the lungs, jaw, skin, and bones. Types of large cell non-Hodgkin lymphoma include diffuse large B-cell lymphoma and anaplastic large cell lymphoma (ALCL). 

What causes non-Hodgkin lymphoma in a child?

Researchers do not know the exact cause of NHL. Genes and some viral infections may increase a child’s risk of having NHL. Conditions that are linked to NHL include:                                                     

  • Epstein-Barr virus, the virus that causes mono (mononucleosis)
  • HIV, the virus that causes AIDS
  • Having a second cancer because of chemotherapy and radiation therapy
  • Certain hereditary immune system conditions
  • Taking anti-rejection medicines after organ transplant

What are the symptoms of non-Hodgkin lymphoma in a child?

In many cases, NHL in children may not cause symptoms until it has grown or spread. Most children have advanced disease at the time of diagnosis. This is because the symptoms start suddenly, and the tumors tend to grow fast. A child can become very sick in a few days to a few weeks.

Signs and symptoms vary depending on the type of NHL. Symptoms of a belly (abdominal) tumor can include:

  • Abdominal pain
  • Nausea and vomiting
  • Fever
  • Trouble with bowel movements (constipation)
  • Poor appetite

Symptoms of a chest tumor include:

  • Trouble breathing
  • Pain with deep breaths
  • Cough or wheezing
  • Swelling and a blue color of the skin of the head and arms 

Other symptoms may include:

  • Painless swelling of the lymph nodes in neck, chest, abdomen, underarm, or groin
  • Fever
  • Sore throat
  • Bone and joint pain
  • Night sweats
  • Tiring easily (fatigue)
  • Weight loss
  • Poor appetite
  • Itching of the skin
  • Recurring infections

The symptoms of NHL can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is non-Hodgkin lymphoma diagnosed in a child?

Your child's healthcare provider will ask about your child's medical history and symptoms. He or she will examine your child.  Your child may have tests such as:

  • Blood and urine tests. Blood and urine are tested in a lab.
  • Lymph node biopsy. A sample of tissue is taken from the lymph nodes. It’s checked with a microscope for cancer cells. A lymph node biopsy is needed to diagnose NHL.
  • Chest X-ray. The chest X-ray shows the heart, lungs, and other parts of the chest. This test may be done to see if NHL has spread to lymph nodes in the chest. 
  • CT scan. This may be done for the abdomen, chest, and pelvis. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body.
  • MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. This test is used to check the brain and spinal cord. Or it may be used if the results of an X-ray or CT scan unclear. 
  • Ultrasound. This is also called sonography. Sound waves and a computer are used to make pictures of blood vessels, tissues, and organs.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
  • Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.
  • Pleural or peritoneal fluid sampling. Fluid is removed from around the lungs (pleura) or abdomen (peritoneum). The fluid is checked for cancer cells.                                                   

Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging used for NHL. Talk with your child's healthcare provider about the stage of your child's cancer. One method of staging NHL is the following:

  • Stage I. The lymphoma is in only 1 place. It’s either in a lymph node or one other part of the body. It is not in the chest or abdomen. 
  • Stage II. The lymphoma is in 2 or more places. It’s all in either the upper or lower part of the body. It’s not in the chest. 
  • Stage III. The lymphoma is in the chest or spine, or it has spread throughout the abdomen. Or it is both in the upper and lower parts of the body, but is not in bone marrow or the brain or spinal cord (central nervous system).
  • Stage IV. The lymphoma is in the bone marrow, the brain and spinal cord, or all three when it is first found.

How is non-Hodgkin lymphoma treated in a child?

Treatment will depend on the type and stage. NHL can be treated with any of the below:

  • Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth. 
  • Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing.
  • Surgery. Surgery may be done to remove tumors.
  • Monoclonal antibodies. This is a type of targeted therapy that kills cancer cells without harming healthy cells.
  • High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.
  • Antibiotic medicines. These help to prevent or treat infections.
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 

Your child will need follow-up care during and after treatment to:

  • Check on your child's response to the treatment
  • Manage the side effects of treatment
  • Look for returning or spreading cancer

With treatment, most children with NHL go on to live long lives. With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:           

  • Getting medical treatment right away is important for the best prognosis. 
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are the possible complications of non-Hodgkin lymphoma in a child?

Possible complications depend on the type and stage of the lymphoma, and can include:

  • Increased risk of infection
  • Heart disease
  • Lung problems
  • Increased chance of growing other cancers
  • Trouble reproducing (infertility)
  • Death

Treatment may also cause complications. They include:

  • Increased risk of bleeding
  • Increased risk for infection
  • Nausea and vomiting
  • Diarrhea
  • Poor appetite
  • Sores in the mouth
  • Hair loss

How can I help my child live with non-Hodgkin lymphoma?

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about non-Hodgkin lymphoma in children

  • NHL is a type of cancer in the lymphatic system. 
  • Symptoms depend on what part of the body is affected. There may be symptoms from tumors in the belly (abdomen) or chest. Other symptoms include painless swelling of lymph nodes, trouble breathing, night sweats, fever, and feeling tired.
  • A lymph node biopsy is needed to diagnose NHL. Many other tests are also done.
  • Treatment may include a medicines, radiation, stem cell transplants, and surgery.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
 

Osteosarcoma/Bone Cancer

What is osteosarcoma in children?

Osteosarcoma is cancer of the bone. The cancer (malignant) cells make immature bone cells (osteoid). Osteosarcoma is rare, but it is the most common type of bone cancer in children and teens. It is most common when teens have growth spurts. That is between the ages of 13 and 16. 

The cancer most often grows in the ends of long bones, especially the bottom of the thigh bone (femur) and the top of the larger shin bone (tibia). The top of the upper arm bone (humerus) is another common place it grows.

The types of osteosarcoma include:

  • High-grade. This is fast-growing cancer. Most osteosarcoma in children is high-grade. There are several sub-types of high-grade osteosarcoma.
  • Intermediate-grade. This type is uncommon. It is between high- and low-grade.
  • Low-grade. This is slow-growing cancer. There are two sub-types of low-grade.

What causes osteosarcoma in a child?

The exact cause is not known. The cancer may be caused by changes in the DNA of the cells. In most cases, these changes are not passed on from parents to children. They happen by chance.

Which children are at risk for osteosarcoma?

A child with one of certain rare genetic cancer syndromes may be at higher risk of osteosarcoma. Having radiation or chemotherapy treatment for other cancers also increases the risk.

Other risk factors for osteosarcoma include:

  • Age between 10 and 30 years
  • Tall height
  • Male sex
  • African-American race
  • Certain bone diseases         

What are the symptoms of osteosarcoma in a child?

Symptoms can occur a bit differently in each child. They can include:

  • Pain at the site of the tumor
  • Swelling  at the site of the tumor
  • Lump (mass) in the area
  • Increased pain with activity or at night

The symptoms of osteosarcoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is osteosarcoma diagnosed in a child?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child.  Your child may be referred to a specialist. This may be a bone specialist (orthopedic surgeon) or a bone cancer specialist (orthopedic oncologist). Your child may have tests such as:

  • X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body tissues.
  • Blood tests. Some test results may be abnormal with osteosarcoma. For example, liver tests and the erythrocyte sedimentation rate (ESR) may be higher than normal.
  • CT scan. This test uses a series of X-rays and a computer to make detailed images of the body.
  • MRI. This test uses large magnets, radio waves, and a computer to make detailed images of the inside of the body.
  • Bone scan. A small amount of dye is injected into a vein. The whole body is scanned. The dye shows up in areas where there may be cancer.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • Biopsy of the tumor. A sample of the tumor is taken and checked under a microscope for cancer cells. A biopsy is needed to diagnose osteosarcoma. The biopsy may be done with a needle or with surgery.

Part of diagnosing cancer is called staging. Staging checks the size and location of the main tumor, if it has spread, and where it has spread. Osteosarcoma may be stage 1, 2, or 3 with sub-stages. Or it may be stage 1, 2, 3, or 4. Talk with your child's oncologist about your child's stage and what it means. Staging also helps to decide the treatment.

How is osteosarcoma treated in a child?

Treatment will depend on the stage and other factors. The cancer can be treated with any of the below:

  • Surgery. Surgery may be done to try to save the arm or leg. This is known as limb-salvage or limb-sparing surgery. Or surgery may be done to remove an arm or leg (amputation). Surgery may be done to remove tumors in other parts of the body.
  • Chemotherapy. These are medicines that kill cancer cells. They are usually given before surgery. They may also be given after surgery. Your child may have a port or catheter inserted in order to receive the medicines into a vein (IV). Chemotherapy is given in cycles with periods of rest.
  • Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill cancer cells or stop them from growing. It is not often used to treat osteosarcoma. It may be used when a tumor can’t be fully removed with surgery. Or it may be used to slow the growth of a tumor and control symptoms. Radioactive medicines may also be given into a vein (IV).
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 
  • Supportive care. Growth factor may be given to help the bone marrow make blood cells. Other medicines may be given for side effects of treatment. Pain medicines may also be given.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are the possible complications of osteosarcoma in a child?

A child may have complications from the osteosarcoma or from treatment, such as:

  • Infection or bleeding from surgery
  • Loose or broken grafts or rods from limb-salvage surgery
  • Hair loss, mouth sores, nausea, vomiting, diarrhea, increased infections, easy bruising and bleeding, and feeling tired from chemotherapy
  • Burns, hair loss, nausea, diarrhea, poor bone growth, organ damage, and new cancers from radiation
  • Emotional and physical challenges from amputation
  • Heart and lung problems
  • Problems with growth and development
  • Learning problems
  • Changes in sexual development
  • Problems with the ability to have children (fertility) in the future
  • Return of the cancer
  • Growth of other cancers

How can I help my child live with osteosarcoma?

A child with osteosarcoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists.

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about osteosarcoma in children

  • Osteosarcoma is cancer of the bone. It’s rare, but it is the most common type of bone cancer children and teens.
  • Symptoms can include bone pain, swelling, or a lump (mass).
  • The cancer may show up on an X-ray or on other imaging tests. It is diagnosed with a biopsy.
  • The biopsy and surgery should be done by an orthopedic surgeon with experience treating osteosarcoma.
  • Treatment is usually chemotherapy and surgery. Surgery may be limb-sparing or amputation.
  • Ongoing follow-up care during and after treatment is needed.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Retinoblastoma/Eye Cancer

What is retinoblastoma in children?

Retinoblastoma is a rare cancer of the retina of the eye. The retina is in the back of the eye. It’s the part of the eye that receives light. Retinoblastoma is the most common tumor affecting the eye in children. It almost always occurs in children less than 5 years old.

What causes retinoblastoma in a child?

The cancer is caused by a change in a gene. It may be a gene passed down from parents (inherited). Or it may be a gene change that happens by chance (sporadic).

In 1 out of 3 children with retinoblastoma, it’s present at birth (congenital). Of these children, 1 out of 4 has a form passed on from parents. It usually affects both eyes. It also increases the risk of other cancers such as sarcoma and melanoma.

In 2 out of 3 children with retinoblastoma, it occurs by chance. In these cases, it affects only one eye. There is not an increased risk of other cancers.

What are the symptoms of retinoblastoma in a child?

Symptoms may affect one or both eyes. Symptoms can occur a bit differently in each child. They can include:

  • Leukocoria. This is an abnormal white reflection from the retina of the eye. The dark center part of the eye (pupil) actually looks white. This may only be seen in a dark room or in a photo.
  • Strabismus (lazy eye). This is when the eyes are misaligned. The eyes don’t move together or look in the same direction.

Less common symptoms may include:

  • Pain, redness, or swelling of one or both eyes
  • Trouble seeing

Most of the time, retinoblastoma has not spread (metastasized) to other areas of the body when it’s diagnosed. If it has spread, other symptoms may include:

  • Loss of appetite
  • Weight loss
  • Vomiting
  • Headache
  • Neurologic problems such as weakness, numbness, and trouble with movement
  • Lump (mass)

The symptoms of retinoblastoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is retinoblastoma diagnosed in a child?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child and pay close attention to the eyes. The healthcare provider will likely advise that your child see an eye specialist (ophthalmologist).

The ophthalmologist will check your child's eyes with special tools. Your child may need a dilated indirect ophthalmoscopic exam. Your child may be given anesthesia medicine to sleep through the exam.

Your child may need other tests such as:

  • Ocular ultrasound. This test uses sound waves to create images of the eyes. 
  • CT scan. A series of X-rays and a computer are used to make images.
  • MRI. Large magnets, radio waves, and a computer are used to make detailed images.
  • Blood tests. Your child’s blood may be tested for signs of disease, and for gene changes.

A child may be diagnosed with no symptoms. This may be the case if you have a family history of retinoblastoma. Your child may have eye exams often to check for signs of the cancer. 

Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging cancer. Retinoblastoma tumors are staged in 5 groups lettered A through E. The groups are based on how likely it is that the eye will be saved. Talk with your child's healthcare provider about the stage of your child's cancer and what it means.

How is retinoblastoma treated in a child?

Most children in the U.S. with retinoblastoma have very good prognoses. This means they have a good chance of recovery.

Your child will be treated by a team of different types of healthcare providers, such as:

  • Ophthalmologist
  • Children’s cancer specialist (pediatric oncologist)
  • Retina specialist
  • Specialist in using radiation to treat cancer (radiation oncologist)
  • Others types of healthcare providers

Specific treatment for retinoblastoma will be determined by your child's healthcare providers based on:

  • Your child's age, health, and health history
  • Extent of the disease
  • Your child's tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Many of the treatment methods require sleep medicine (anesthesia). Treatment may include the following:  

  • Surgery. In some cases, surgery may be done to remove the eye. This is called enucleation. This is not needed for all retinoblastomas. They eye socket and eye are replaced with an implant and artificial eye.
  • Chemotherapy. Anti-cancer medicines may be given into a vein (IV) or by mouth (systemic). The medicines may reduce the size of the tumor so that other treatments can work better.
  • Radiation therapy.  Internal radiation (brachytherapy) may be done. External radiation is not often done. Radiation may be used when other treatment doesn’t work well. A small container (plaque) with radioactive material is placed near the tumor. The plaque is placed and removed during surgery. This may be used to treat some smaller tumors.
  • Laser therapy or photocoagulation. A laser is used to destroy the blood supply to the tumor. This is used on some smaller tumors.
  • Thermotherapy. Light is used to destroy cancer cells. This may be used for some small tumors. Or, it may be used with chemotherapy or radiation for larger tumors.
  • Cryotherapy. A tool is used to freeze and kill the cancer cells.
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are the possible complications of retinoblastoma in a child?

A child may have complications from the cancer or from treatment, such as:

  • Detached retina
  • Spreading of the cancer (metastasis)
  • Loss of eyesight
  • Side effects of chemotherapy such as tiredness, bruising and bleeding, mouth sores, infections, vomiting, and diarrhea
  • Bleeding or infection from surgery
  • Growth of other cancers
  • Heart or kidney problems
  • Problems with growth and development

How can I help my child live with retinoblastoma?

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

A child with retinoblastoma needs ongoing care. Your child will be cared for by a team of healthcare providers. They will treat any late effects of treatment and to watch for signs or symptoms of the tumor growing back. The healthcare providers will also check your child with imaging tests and other tests.

If your child has an implant and artificial eye, he or she should wear protective eyewear during activities that may harm the eye.

Family members may want to see a genetic counselor to learn more about the risk of retinoblastoma.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:                                              

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about retinoblastoma in children

  • Retinoblastoma is a rare cancer of the retina of the eye. The retina is in the back of the eye. It’s the part of the eye that receives light.
  • The cancer may be passed on from parents (inherited) or it may occur by chance (sporadic).
  • The most common symptoms are an abnormal white reflection from the retina (leukocoria) and misaligned eyes (strabismus).
  • It’s diagnosed by a dilated indirect ophthalmoscopic exam.
  • In the U.S., the prognosis for most children with retinoblastoma is very good.
  • There are many treatments for retinoblastoma including surgery, chemotherapy, radiation therapy, laser therapy, and cryotherapy.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Rhabdomyosarcoma/Soft Tissue Cancer

What is rhabdomyosarcoma in children?

Rhabdomyosarcoma is a type of cancer. It starts in cells that grow into skeletal muscle cells. The cells are called rhabdomyoblasts. Skeletal muscles control all of a person’s voluntary muscle movements. The cancer is most common in children under age 10, but it is rare. It can form anywhere in the body. The most common places are:

  • Head and neck, such as near an eye, in the throat, or in the sinuses
  • Urinary and reproductive organs, such as the bladder, prostate gland, or any female organs
  • Arms and legs
  • Chest and belly (abdomen)                                                                                                              

There are 2 main types of rhabdomyosarcoma:

  • Embryonal. This is the most common type. It’s more common in younger children.
  • Alveolar. This is more common in older children and teenagers. This type grows more quickly. It’s more likely to spread to other areas of the body (metastasize).

What causes rhabdomyosarcoma in a child?

The exact cause of rhabdomyosarcoma  is not known. Changes in the genetic material in cells (DNA) may cause the cells to turn into cancer.

Which children are at risk for rhabdomyosarcoma?

Some health conditions that are passed down through families (genetic) increase a child's risk. These include:

  • Li-Fraumeni syndrome
  • Neurofibromatosis
  • Beckwith-Wiedemann syndrome
  • Costello syndrome

What are the symptoms of rhabdomyosarcoma in a child?

Symptoms depend on the location and the size and of the tumor. There may be no symptoms until the tumor is very large. The main symptom may be a lump or swelling that may be painful. Other symptoms can occur a bit differently in each child.

A growth near the eye can cause:

  • Bulging  eye
  • Trouble with vision

A growth in the ear or sinuses can cause:

  • Ear pain
  • Headache
  • Sinus congestion

A growth in the urinary or reproductive organs can cause:

  • Bleeding
  • Pain when urinating
  • Pain with bowel movements

A growth in the abdomen can cause:

  • Pain
  • Vomiting
  • Trouble having bowel movements (constipation)

Symptoms of advanced rhabdomyosarcoma may include:

  • Bone pain
  • Cough
  • Weakness
  • Weight loss

The symptoms of rhabdomyosarcoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is rhabdomyosarcoma diagnosed in a child?

Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child.  Your child may be referred to a child cancer specialist (pediatric oncologist). Your child may have tests such as:

  • Blood and urine tests. Blood and urine are tested in a lab.
  • X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body tissues.
  • CT scan. This test uses a series of X-rays and a computer to make detailed images of the body.
  • MRI. This test uses large magnets, radio waves, and a computer to make detailed images of the inside of the body.
  • Ultrasound (sonography). This test uses sound waves and a computer to create images.
  • Bone scan. A small amount of dye is injected into a vein. The whole body is scanned. The dye shows up in areas where there may be cancer.
  • Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
  • Tumor biopsy. A sample of the tumor is taken. It may be taken with a needle or by a surgical cut (incision). It is checked under a microscope for cancer cells. A biopsy is the only way to know for sure if the tumor is cancer.
  • Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
  • Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord. This test may be done for rhabdomyosarcoma of the head and neck.

Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging cancer, but most range from stage 1 to stage 4. Talk with your child's healthcare provider about the stage of your child's cancer and what it means.

How is rhabdomyosarcoma treated in a child?

Treatment will depend on the location, stage, and other factors. The cancer can be treated with any of the below:

  • Surgery. The goal of surgery is to fully remove the tumor. This is called resection. The surgery will be done to avoid loss of function and deformation as possible. A surgeon who specializes in the body area of tumor growth may be needed. This may be a head and face (craniofacial) surgeon, or an ear, nose, and throat (otolaryngologist) doctor. It may be a brain surgeon (neurosurgeon) or bone doctor (orthopedist). Or it may be another type of doctor. 
  • Chemotherapy. These are medicines that kill cancer cells. They are always used to treat rhabdomyosarcoma. Some medicines may be given by mouth. But most are given through a vein (IV).
  • Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill cancer cells or stop them from growing. It may be used when a tumor is hard to remove with surgery. Radiation therapy is usually given along with chemotherapy.
  • Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. 
  • Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcome and to lessen side effects.

What are the possible complications of rhabdomyosarcoma in a child?

A child may have complications from the tumor or from treatment. They may include:

  • Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech, or eyesight
  • Problems after surgery, such as infection, bleeding, and problems with general anesthesia
  • Infection and bleeding from chemotherapy
  • Delayed growth and development
  • Learning problems
  • Problems with reproduction (infertility)
  • Return of the cancer
  • Growth of other cancers

How can I help my child live with rhabdomyosarcoma?

A child with rhabdomyosarcoma needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. For example, your child may see an eye doctor (ophthalmologist) for vision problems.

Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists. If your child's speech is affected, he or she may need help from a speech therapist. Your child may also need the help of other therapists for learning or emotional problems. 

You can help your child manage his or her treatment in many ways. For example:

  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
  • If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
  • Get emotional support for your child. Find a counselor or child support group can help.
  • Make sure your child attends all follow-up appointments.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Key points about rhabdomyosarcoma in children

  • Rhabdomyosarcoma is a rare type of cancer that starts in the cells that develop into skeletal muscle cells (rhabdomyoblasts). These are the muscles that your child controls (voluntary).
  • It can occur almost anywhere in the body. The most common places are the head and neck; urinary and reproductive organs; arms and legs; and chest and belly (abdomen).
  • Symptoms depend on the size and the location of the tumor. A lump or swelling, pain, bleeding, trouble urinating or having bowel movement are some symptoms.
  • Tests include different imaging studies and biopsy of the tumor.
  • Treatment includes surgery, chemotherapy, and radiation therapy.
  • Ongoing follow-up care during and after treatment is needed.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Wilms Tumor/Kidney Cancer

What is Wilms tumor?

Wilms tumor is a cancerous tumor that starts in the cells of the kidney. It’s the most common type of kidney cancer in children. It’s usually found by the time a child is age 3 or 4. The tumor can be very large before it’s found. And it may spread (metastasize) to other body tissues. The most common site for Wilms tumor to spread to is the lungs. But it may also spread to the liver, lymph nodes, other kidney, brain, and bones.

What causes Wilms tumor?

Most cases of Wilms tumor occur by chance with no clear cause. Defects in genes affect the growth of kidney cells. But it’s not common for Wilms tumor to run in families.

Who is at risk for Wilms tumor?

A small number of children with Wilms tumor also have a syndrome caused by abnormal genes, such as:

  • WAGR
  • Denys-Drash
  • Beckwith-Wiedemann

Some birth defects may increase the chance of Wilms tumor. For example, a boy with defects of the penis or testicle may be more at risk. Talk with your child's healthcare provider if you want more information about these conditions.

What are the symptoms of Wilms tumor?

Symptoms can occur a bit differently in each child. They can include:

  • A  lump in the belly (abdomen)
  • Swelling of the belly
  • Pain in the belly, but some children have no pain
  • Blood in the urine
  • Fever
  • High blood pressure (hypertension)

Many of these symptoms may be caused by other health problems. But it is important to see your child's healthcare provider if you notice these symptoms. Only a healthcare provider can tell if your child has cancer.

How is Wilms tumor diagnosed?

If your child's healthcare provider thinks your child might have Wilms tumor, certain exams and tests will be needed to be sure. Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child.  Your child may have tests such as:

  • Abdominal ultrasound. This test uses sound waves and a computer to create pictures of blood vessels, tissues and organs. It can show the kidney, the tumor, and blood vessels of the kidney. It can also help show if there are any tumors in the other kidney or other parts of the belly.
  • Abdominal CT scan. This test uses a series of X-rays and a computer to make detailed images of the belly (abdomen). CT scans are much more detailed than standard X-rays.
  • MRI. This test uses magnets, radio waves, and a computer to make detailed images of the body. MRI can show if cancer has spread to other parts of the body (metastasized). It can also show if there are cancer cells in the lymph nodes or other nearby organs. 
  • Chest X-ray. An X-ray is done with a small amount of radiation. It can show if there the cancer has spread to the lungs.
  • Blood and urine tests. These can check how well the kidneys and liver are working and check overall health.
  • Biopsy. A small piece of tissue is removed and checked with a microscope for cancer cells. Samples of the tumor, nearby lymph nodes, and other tissue may be taken. A biopsy can also show the type of tumor. A biopsy of kidney tissue may not be done with some tumors.

How is Wilms tumor treated?

Most children with Wilms tumor can be cured. Treatment will depend on the size and location of the tumor and other factors. Your child will be treated by specialists with experience in treating Wilms tumor. They may include a pediatric surgeon and a pediatric cancer specialist (oncologist). The cancer can be treated with any of the below:

  • Surgery. This is done to take out the affected kidney (nephrectomy). Removing only part of the kidney is not advised for most children. Samples of the kidney that is removed are studied. Samples of nearby lymph nodes may also be taken and checked for signs of cancer.
  • Chemotherapy. These are medicines that kill cancer cells. They are used to destroy cancer cells before or after surgery. They are also used to treat cancer that has spread or grows back.
  • Radiation therapy. These are high-energy X-rays or other types of radiation. Radiation is used to kill cancer cells or stop them from growing. It may be used to treat cancer that has spread or grows back.
  • Supportive care. Cancer treatment can cause side effects. Medicines and other treatments can be used to help ease side effects such as pain, fever, infection, and nausea and vomiting.
  • Clinical trials. Ask your child's healthcare provider if there are any new treatments being tested that may work well for your child. 

Your child will need follow-up care during and after treatment to:

  • Check on your child's response to the treatment
  • Manage the side effects of treatment
  • Look for returning or spreading cancer

Some treatments may be hard on your child, but they increase the chance of your child living a long time. Discuss the side effects of treatment with your child's healthcare provider.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

  • Getting medical treatment right away is important for the best outcomes. 
  • Ongoing follow-up care during and after treatment is needed.
  • New treatments are being tested to improve outcomes and to lessen side effects.

You can ask your child's healthcare provider about survival rates and what you might expect. But remember that statistics are based on large groups of people. They can't be used to say what will happen to your child.

What are possible complications of Wilms tumor?

Possible complications can include:

  • Side effects of chemotherapy or radiation therapy, such as heart failure or growth of a new type of cancer
  • Problems from surgery, such as bleeding or infection
  • Pregnancy problems in the future
  • Cancer that grows back or spreads
  • Death

Your child's care team will review what complications you need to consider based on your child's specific treatment plan.

How is Wilms tumor managed?

You can help your child manage his or her treatment in many ways. For example:

  • Learn as much as you can about Wilms tumor. This can help you make the best decisions for your child.
  • Get emotional support for your child. Finding a counselor or child support group can help.
  • Make sure your child gets to all appointments and treatment visits.
  • Your child may have trouble eating. A dietitian may be able to help.
  • Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.

Your child may need to:

  • Be checked for Wilms tumor if he or she has a condition that increases the chance of developing Wilms tumor
  • Have genetic testing and counseling

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

  • Symptoms that get worse
  • New symptoms
  • Side effects from treatment

Be sure to ask the healthcare provider about any problems or changes you should watch for and what you should do if you notice them.

Key points about Wilms tumor

  • Wilms tumor is cancer that starts in the cells of the kidney.
  • It’s most often found in children between ages of 3 and 4.
  • It may not cause any symptoms and may not be diagnosed until it’s large.
  • Surgery, chemotherapy, radiation therapy may be used to treat Wilms tumor.
  • Most children with Wilms tumor can be cured with treatment.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.