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What are the Warning Signs of Pediatric Cancer?

Early signs or symptoms of childhood cancer are difficult to recognize because they may also indicate far more common illnesses and injuries.
Children often get bumps and bruises or feel sick. Parents should ensure kids get regular medical checkups and seek attention for a symptom that doesn’t go away.

While the incidence of pediatric cancers has risen slightly over the past decades, the number of children who survive their disease increased significantly.

In this segment, Kara Kelly, MD, Chair, Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, discusses what symptoms took look for and what achievements have been made to help children survive a diagnoses of childhood cancer.
What are the Warning Signs of Pediatric Cancer?
Featured Speaker:
Kara Kelly, MD
Kara Kelly, MD is a pediatric oncologist with special expertise in the care of children and adolescents with leukemia and lymphoma.

Learn more about Kara Kelly, MD

Bill Klaproth (Host): Cancers in children are sometimes hard to recognize because common illnesses or everyday bumps and bruises can mask the early warning signs. As a parent, what should you look out for? Here to tell us more is Dr. Kara Kelly, Chair of Pediatric Oncology at Roswell Park Comprehensive Cancer Center. Dr. Kelly, thank you for your time. Are the types of cancer that develop in children different from those that develop in adults?

Dr. Kara Kelly (Guest): Yes, they are. The types that we see in children tend to be more related to abnormal development that occurs in different parts of the body as opposed to the types of cancers that develop from environmental exposures and other such things. They are very different. Fortunately, they’re very rare in children. We estimate that there are only about 10,000 cases of childhood cancer diagnosed each year in the US in children under the age of 15. Although cancer is very serious, and something parents worry about, but fortunately, it’s very rare.

Bill: Okay, so lifestyle or environmental risk factors don’t play a role in children's’ cancer, so then what are the cancers that are most prevalent in children, today?

Dr. Kelly: If you look at the top five, they include the leukemias, which are cancer of the blood, which occur in about 30%. The next most common are brain tumors, which occur in just over a quarter of cases. The next would be the lymphomas, which are cancers of the lymph glands or lymph nodes. Next, is a tumor of the nervous system called neuroblastoma, which occurs in about 5 or 6% of cases. And then rounding out would be tumors of the kidneys called Wilms’ Tumor, which is really specific to the pediatric population.

Bill: Okay, so leukemias, brain tumors, lymphoma, neuroblastoma, and the Wilms’ Tumor. Can you go through the warning signs of each for us?

Dr. Kelly: Sure. The leukemias – this is a cancer of the bone marrow, which is where blood cells are #cell development. The type of warning signs that we see is a result of that process. If you’re not making enough red blood cells, children will look pale; they’ll be very tired, won’t have much energy. There’s an impact on the production of platelets. Those are cells that help the blood to clot, so we will see increased bruising or bleeding, particularly in places that you don’t normally see – on the upper back or on the arms or places that kids don’t usually bruise from routine play and sports activities.

And then the third is there’s an impact on the white blood cells, which are the cells that are important in fighting infection. Here we’ll see fevers or illnesses that just really won’t go away. I think it’s most important to point out is that these are also symptoms that we see in the setting of many routine illnesses – the common cold and other infections -- which are much, much more common than the development of leukemia. It’s really when these signs are more pronounced or aren’t going away that a parent should think about taking the child to the pediatrician. Not that it means it’s leukemia, but just that there can be testing that can be done to explore further whether it’s related to the more common things or whether further workup for leukemia is necessary.

Bill: Right. Always better to know and be safe. So then, next would be brain tumors.

Dr. Kelly: Sure. Brain tumors, present by causing pressure within the brain. One of the most common signs of that is very frequent headaches, particularly if they’re severe or if they’re associated with vomiting. Especially in the morning, when a child first arises, that can be a sign. Sometimes you can see a limp, or you can see weakness on one side, but overall, headaches are probably the most common cause. But again, like leukemia, there are other causes of headaches. Brain tumors are relatively rare, so it’s really when it’s out of proportion, persistent, and associated with the other symptoms that it needs work up. And again, the pediatrician would be the best place to start to do some additional testing.

Bill: Okay, and then you mentioned lymphoma?

Dr. Kelly: Um-hum. Lymphoma is a cancer of the lymph nodes, which are collections of white blood cells in the body. They are kind of like the first defense in an infection. There are lymph nodes in the neck so that if there’s a sore throat or a throat infection, those cells are available and rarely, cancer can develop within those cells.

We see two different types. The non-Hodgkin type, which typically occurs in younger children, and then the Hodgkin Lymphoma type, which is actually the most common type of cancer we see in teenagers and young adults. With this type of cancer, the most common presenting sign is a big lump. These lymph nodes get very large in size, and so there may be swelling of the neck or the groin or the belly depending on which lymph nodes are involved. And again, here, these lymph nodes can be enlarged in the setting of infection, which is much more common than lymphoma. It’s when it’s asymmetric – bigger on one side than the other if it’s not getting better over a week or two weeks of time, or it seems to be out of proportion – bigger than one would expect with a regular infection then it needs to have an additional work up by the pediatrician.

Bill: Right, okay. And then – I hear about this one a lot – neuroblastoma.

Dr. Kelly: Right, neuroblastoma is a cancer that develops in specific types of nerves that run along the spine and down into the belly. This type of cancer is seen especially in young children under the age of five and occasionally can be seen in kids a bit older. This type can be very aggressive especially in these younger children and will present with enlargement of the belly. The belly gets much bigger in size, and that’s due to enlargement of these tumors within the belly. It also can present with involvement of the bone, and that can cause a limp or can cause a lot of pain or discomfort. Sometimes we can see bruising, particularly under the eyes, and that again is related to some of the involvement of the bone that occurs.

Like all of the other types of childhood cancer, many of these symptoms overlap with much more common conditions in children, so again, if the symptoms are pronounced, if they’re not getting better, if they seem to be worsening over a week or two, that would warrant further investigation and a checkup by the child’s primary doctor.

Bill: Right, and then lastly, Wilms’ tumor?

Dr. Kelly: Wilms’ tumor is a tumor of the kidneys, and it’s very different than types of cancers that occur in adults. Here, like neuroblastoma, the usual presenting sign is a lump in the belly, but usually, it’s on one side. Usually, the children don’t have any additional symptoms, unlikely neuroblastoma where there’s often bone involvement and a lot of pain. Usually, with Wilms’ tumor, the child is otherwise well, except that there is an enlargement on one side of the abdomen. Often times, it’s noted by a parent while they’re changing the child’s diaper because this also tends to occur in younger children or it can sometimes be picked up by the pediatrician during a regular well-child checkup. Occasionally, probably about 10% of the time, it may present with some blood in the urine. If there’s bright red blood in the urine, that would also warrant a further check up and testing.

Bill: All right, and Dr. Kelly, can you tell us about the advancements made in pediatric cancer treatment and outcomes over the past few years?

Dr. Kelly: Sure. Fortunately, childhood cancer is very responsive to treatment. We now estimate that over three-quarters of all children are cured. That’s some of the more common types, particularly leukemias and lymphomas, the success rate is over 90% today. It’s really quite significant, and much better than many of the types of cancer that occur in adults. When we say cure, we do mean long-term cure, not just putting a child into remission, but really going onto live a long, full life. These advances have really been a result of collaborative research. Pediatric cancer field is considered the poster child for different hospitals working together to develop and test new types of treatments. That collaboration has resulted in these extremely high outcomes that we are fortunately able to offer today.

Bill: Well, that is really good news and good to hear. Dr. Kelly, can you tell us about your own areas of expertise, including complementary therapies?

Dr. Kelly: Sure. My research is focused in two main areas. One is in clinical trials for children with leukemia and lymphoma, particularly Hodgkin lymphoma. I oversee the development and conduct of very large international trials treating children and teenagers with Hodgkin lymphoma, including some of the new, exciting therapies such as the checkpoint inhibitors and other immune therapies that are under development.

My second main area of focus is on supportive care, developing and testing new strategies that can help support children through the side-effects of cancer treatment including the use of complementary therapies. We -- as I mentioned a moment ago -- we’ve made significant strides. We’re curing over three-quarters – over 90% of children with leukemia and lymphoma, but the treatments we have today are still unfortunately quite toxic. They’re associated with pain, with nausea, reduced appetite, so we see these complementary therapies as a way to help children tolerate the therapy better so that we can deliver these treatments and deliver the high cure rates that we’re seeing.

Some of my work includes acupuncture for managing particularly the pain, nausea, some of the other side-effects of treatment. As a result of the research I’ve done, we’re now offering that treatment to our children and teenagers at Roswell Park. I’ve also tested other things such as aromatherapy and different herbal supplements, again with the focus on managing the side-effects of the cancer treatment.

Bill: Well, you’re very accomplished, and thank you so much for sharing that with us. If you could just quickly wrap this up for us – you kind of touched on this a couple of times, but just one more time – how should a parent distinguish which symptoms are potentially serious and which may be something common like the flu or just a fever or a cold? If you could just quickly reiterate that for us one more time, I would appreciate it.

Dr. Kelly: Sure. The main take-home point is that childhood cancer is rare, so parents shouldn’t jump to that first – to that being cancer. It’s really in a situation where the symptoms are persistent, unexplained, just not getting better over the usual time period of an illness. That’s really where a parent should seek additional treatment. If they’re concerned, pediatricians welcome the calls. It’s better to call earlier and have the child evaluated if there’s any concern. Most times, it turns out not to be cancer, but in the rare event that it does, seeking treatment and getting tests done will help to improve the outcome and to minimize the impact on the child and the family .

Bill: Better to know early than late, so that’s great advice.

Dr. Kelly: But not to panic [LAUGHING].

Bill: Right.

Dr. Kelly: Just keep in mind, 10,000 cases in the US, so what we’re talking about here in our region, it’s a limited number, but if there’s any question, go to the pediatrician and have things checked out. They can help to alleviate any concerns.

Bill: That’s right. It’s very important to remember that it is very rare. Dr. Kelly, thank you so much for your time today. For more information, you can visit, that’s You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.