EUGENIE S. KLEINERMAN, MD: My name is Eugenie Kleinerman. I'm head of the Division of Pediatrics in the Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center. I'm here today to share some information about childhood cancer. The majority of the time, we really don't know what the etiology is of childhood cancer. That being said, there is an alarming increase in the number of melanomas that we are seeing in children and this is probably most definitely linked to sun exposure. The most common childhood cancers are:
1. Leukemia-lymphoma.
2. Brain tumors.
3. Neuroblastoma.
Childhood cancers are often picked up as an incidental finding. For leukemia, a typical presentation is in the pediatrician's office during a normal routine physical when an abnormal blood count is picked up, either a very high white count or a low red cell count that triggers the pediatrician to get further tests. For solid tumors, such as a bone tumor, often what happens is during an athletic event, a child falls or kicks a ball or something, and that triggers a break in the bone which initiates an x-ray and then the tumor is diagnosed on the x-ray. So it's really usually a very silent disease and that emphasizes the importance of getting a routine physical at the pediatrician's office. Clearly, the treatment of childhood cancer depends on the tumor. In cancers that are labeled the same for example, leukemia - there are adults with leukemia and there are children with leukemia, the drugs that we use are totally different and the reason is probably because the biology of the two diseases is not the same. So we in Pediatric Oncology have found a group of drugs that we used for children with leukemia and these are totally different from what the adults use. In terms of solid tumors, again, the type of brain tumor that we commonly see in children is medulloblastoma rather than glioblastoma so it's a different subtype. Very few adults are diagnosed with medulloblastoma and again, the agents that are used to treat these two
different types of brain tumor are different. So it's very important when a diagnosis of cancer is made that the particular type of cancer is identified. The subtype is identified by an expert pathologist who has had a lot of experience in reading these types of tumors. While we are curing 70% to 75% of children with cancer and our cure rates are increasing every day, there are approximately 300,000 childhood cancer survivors that are adults, two-thirds of which have late effects. That's 200,000 adult survivors of childhood cancer that have late effects. Because we are not sure of the etiology of the majority types of childhood cancer, there really is no one prevention. That being said, sunscreen is very important because we know there is a link to melanoma and skin cancer and exposure to sun, and there is an alarming increase in the incidence of melanoma in teenagers and young adults. So that's particularly one area that we need to pay attention to. It's also probably important that a child have an annual physical so that blood work can be done, the skin can be examined for abnormal lesions, so that if there is something, it can be picked up early because we know early diagnosis leads to an increase in cure.
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