CANCERS OF CHILDHOOD
Overview
Cancer develops when a single cell proliferates uncontrollably and the cell is independent of the laws governing the remainder of the body. The balance between cellular division and cellular loss is disrupted leading to uncontrolled cellular growth. According to the National Cancer Institute (NCI) in 2017, there was an estimated 10,270 new cases of cancer in children aged 0 to 14 years in the United States (NCI, 2017). Childhood cancer is a devastating diagnosis that can affect family dynamics. Nurses are at the forefront of care when it comes to caring for the child with an oncological disease.
Background
Fewer than 1% of all cancers are found in children (American Cancer Society, 2016). Out of more than 10,000 new cases annually, about 10% of these children die from their disease (NCI, 2017). Although survival rates continue to improve, and more than 80% of children with cancer survive 5 years or more, cancer remains the leading cause of death from disease among children (American Cancer Society, 2016). The types of cancer that develop in children are different from those in adults. The most common types of childhood cancers aged 0 to 14 years include acute lymphocytic leukemia (ALL), brain tumors, and neuroblastoma. The adolescent and young adult (AYA) aged 15 to 29 years population is a unique group of patients. The incidence of cancer in this age group represents 2% of all cancers. The most common types of cancers in the United States for patients aged 15 to 19 years old include lymphoma, germ cell tumors, brain tumors, malignant melanoma, and ALL (Kline, 2014).
The etiology of childhood cancer is unknown although it is likely that the interaction among many different factors both environmental and host contribute to its development (Kline, 2014). Only 5% of all childhood cancers are caused by an inherited mutation (NCI, 2017). With an inherited mutation, there are DNA changes in every cell in the body that may be linked to an increased risk to develop cancer, or these inherited mutations lead to syndromes that can predispose a child to cancer (American Cancer Society, 2016). For example, children with Down syndrome are at increased risk for the development of ALL and acute myelogenous leukemia (Fragkandrea, Nixon, & Panagopoulou, 2013). Most pediatric cancers are not caused by inherited DNA changes, but rather they develop as a result of an acquired mutation that occurs in one cell in the body during cellular division, and it has the potential to escape apoptosis and proliferate uncontrollably (American Cancer Society, 2016). Unlike adult cancers, lifestyle factors are not associated with the development of childhood cancer. There are a few environmental factors such as radiation exposure that may increase a child’s risk for the development of cancer.
36Cancer diagnosis in children is often delayed because the presenting symptoms are nonspecific and resemble benign conditions like a common viral illness (Fragkandrea et al., 2013). The diagnosis of pediatric cancer includes a thorough history and examination, labs, imaging, or tissue biopsy. There is oftentimes a lag time between presenting symptoms and diagnosis, which creates a great deal of uncertainty for the family. Treatment varies according to the type of malignancy and may include chemotherapy, radiation therapy, surgery, or bone marrow transplant.
Clinical Aspects
ASSESSMENT
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