Pediatric cancer is always frightening to think about, but the good news is that many childhood cancers are highly treatable now. More than 80 percent of kids who get cancer today survive five years or longer. 

Patients with pediatric cancers are usually treated at specialized children’s cancer centers such as the one at Yale Medicine. Here pediatricians, surgeons, oncologists, and radiation oncologists work as a team to ensure the best possible treatment for each child.

"A child's parents or caregivers are always involved with every stage of diagnosis and treatment," says Kenneth Roberts, MD, PhD, director of the Pediatric Radiotherapy Program at Yale Medicine.

Children can develop all types of cancer, but some are more common in young people. Those cancers often form due to DNA changes early in life, sometimes even before birth, that cause cells to replicate uncontrollably. The following are the most common types of pediatric cancers:

• Leukemia
• Brain and spinal cord tumors
• Neuroblastoma
• Wilms tumor
• Lymphoma

Other pediatric cancers include rhabdomyosarcoma (which forms in muscle tissue), retinoblastoma (which forms in the eye), and bone cancer (including osteosarcoma and Ewing sarcoma). Children can sometimes develop other cancers more common in adults, but that is very rare.

If cancer is suspected, your child’s pediatrician performs a physical exam and may order such imaging tests as X-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI) scans to get a closer look at internal organs and tissues.

If imaging tests reveal an unusual mass, a tissue sample is extracted through a biopsy and examined under a microscope by a pathologist to determine whether suspicious cells are cancerous. If cancer is found, it will be given a stage (from 0 to IV), depending on how advanced the cancer is and whether it has spread. More imaging tests, such as CT, MRI, positron emission tomography (PET), or bone scans, may be ordered to assist with the staging process.

If leukemia is suspected, your child will have blood and bone marrow tests to measure blood-cell levels. Blood is usually drawn from the arm, but in young children may be taken from other parts of the body.

A leukemia diagnosis typically requires a bone marrow aspiration and a biopsy, which involve a needle injection just above the hip, used to remove a small amount of liquid bone marrow and bone-marrow tissue. A spinal tap (or lumbar puncture) may also be needed.

Most pediatric cancers are treated with surgery, chemotherapy, radiation, or a combination of those therapies.

Chemotherapy drugs, administered intravenously, attack the fast-growing cells that comprise most pediatric cancers. Pediatric cancers tend to respond better to chemotherapy than some adult cancers. But chemotherapy kills healthy cells along with cancerous ones. Such side effects as hair loss, nausea, vomiting, and low blood counts may occur, sometimes along with such long-term side effects as infertility and nerve damage.

Radiation is also used to treat pediatric cancers. Children lie on a table while X-ray beams target their tumors. To keep them still, young children may be sedated with anesthesia. Treatment sessions last fewer than 30 minutes, and may occur daily over several weeks.

Some childhood cancers, like certain brain tumors, may be treated with more concentrated radiation called Gamma Knife Radiosurgery. Still other types may be treated with brachytherapy: Tiny radioactive pellets are inserted into the body to release radiation only to the area near the tumor.

“It’s important to get everybody comfortable with what we’re proposing to do,” says Dr. Roberts. “That’s often the key to success so the patient can undergo treatment without any anxiety and understand that we’re trying to help them.”

Today’s radiation and other therapeutic treatments are much more targeted than they once were, and doctors can minimize damage to surrounding tissues. Still, radiation could cause lasting damage to children, especially the very young. Depending on radiation dose and volume of treatment sessions, reduced bone or muscle growth to areas exposed to treatment may be a side effect. The decision to use any therapy depends on an analysis of risks and benefits.

For decades, Yale Medicine has been a part of the Pediatric Oncology Group, now the Children’s Oncology Group, a global network of more than 200 hospitals dedicated to curing cancer in children. Along with these other institutions, Yale Medicine is committed to providing patients access to cutting-edge clinical trials and the newest and best treatments for childhood cancers.

“One of the great things about being part of Yale Medicine is to watch new discoveries in the laboratory make their way into the clinic to improve outcomes, improve cure rates, and develop treatment schemes that have fewer side effects,” says Dr. Roberts.

Yale Medicine is also the only provider of Gamma Knife Radiosurgery services in the state of Connecticut, as well as one of the most experienced and best equipped children’s cancer centers in the Northeast.