The Medical Minute: On the watch for pediatric cancers

Amid the first steps, playdates and training wheels, no parent wants to hear the word “cancer.” Fortunately, few will, but it’s always smart to be tuned in for signals that might warrant a closer look.

Each year, more than 15,000 children and young adults are diagnosed with cancer and nearly 2,000 children under the age of 19 die, making cancer the number one killer of children through disease.

The five-year survival rate for childhood cancer is 80%.

“Childhood cancer is very rare,” says Dr. Lisa McGregor, interim chief of pediatric hematology and oncology at Penn State Health Children’s Hospital. “Even if you notice something new, it will most likely be caused by something other than cancer.”

Be on the lookout

That said, parents should not ignore several characteristic symptoms that call for consultation with a pediatrician.

A lump in your child’s abdomen may indicate an abdominal mass. Swollen lymph nodes that remain enlarged for more than a few weeks, especially in the absence of respiratory disease, may indicate leukemia or lymphoma. Pale skin and unexplained bruising can be a red flag for leukemia. A new headache that is intense in the morning or accompanied by vomiting may indicate a brain tumor.

Leukemia is the most common cancer in children, followed by tumors of the central nervous system, such as in the brain and spinal cord, McGregor said.

For the vast majority of children, there are no recommended cancer screening tests, and studies have shown that getting the cancer earlier doesn’t affect the course of the disease for the most common cancer, leukemia, she said.

Genetic factors are important

A small percentage of children who develop cancer — about 10% — have a genetic predisposition that their parents may or may not be aware of.

This predisposition only comes to light when the first case of cancer in the family occurs, indicating that other family members will have the opportunity to be tested for the predisposition, said Dr. Daniel McKeone, director of the Pediatric Cancer Predisposition Clinic at Penn State Health Children’s Hospital — one of only 50 such dedicated centers nationwide.

Familial adenomatous polyposis carries a risk for several cancers, including colon and liver. Because the risk of liver tumors is greatest up to the age of 7, children with this predisposition are screened every six months with ultrasound and blood tests. When the risk of colon cancer increases by age 10, they begin annual endoscopies, McKeone said.

The clinic is also seeing children with Li-Fraumeni syndrome, caused by a mutation or change in the TP53 gene, which normally acts as a tumor suppressor gene. These children are at much higher risk of developing any form of cancer, and often at a young age. They need constant whole-body monitoring with MRIs.

“Parents will come to our clinic where they will meet with a genetic counselor and me to talk about very specific plans for how their child’s cancer risk will be managed,” McKeone said.

The clinic and support staff guide the family through the complex journey of dealing with a child’s predisposition. That includes coordinating care from multiple specialists, coping with the stress and often guilt of passing on a genetic predisposition, and connecting parents with resources that can help them talk to other family members and the children themselves about the risks of a way they can understand.

“I call our clinic the quarterback. We really need to be that resource coordinating the team and making sure we remove any barriers to care,” said McKeone. “Some parents have first-hand experience with these cancers or have seen it in other family members, and others don’t. . Either way, it can be a major cause of stress.”

Some genetic predispositions, such as the BRCA gene mutation that can cause breast and ovarian cancer, are not screened for during childhood, as the risk mainly occurs until young adulthood.

In most of these genetic cancer syndromes, children have a 50% risk of inheriting the gene mutation from a parent, McKeone said.

Stay on track

The most important thing parents can do to keep their children healthy is stay on track with visits to their child, the doctors said.

“For example, at your child’s regular checkups, your pediatrician will look at your child’s eye with an ophthalmoscope — that’s an early screening for eye cancer,” McGregor said. “Your child’s pediatrician is your first line of defense.”

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles incorporate the expertise of educators, physicians and staff and are designed to provide timely, relevant health information of interest to a broad audience.

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