Treatment for Childhood Cancer

The Sassy Carmen Foundation celebrates the lives of courageous women who faced cancer with unwavering bravery and courage. In witnessing their journeys, we commit to supporting children and families affected by childhood cancer through comprehensive support programs. These programs provide essential support for cancer patients with information to help them and families like yours with their educational needs during treatment.

More than 15,000 children aged birth to 19 years are diagnosed with cancer every year. According to the National Cancer Institute, the most common types of pediatric cancer (children aged 0-14 years) are leukemias, brain and other central nervous system cancer.

Pediatric leukemia refers to leukemia that occurs in patients who are 18 years old or younger and can affect children differently than adults. According to Yale Medicine, with advances in the treatment of leukemia, children with the disease have up to a 90% survival rate. ¹

Initial treatment for childhood leukemia, ALL and AML, involves chemotherapy and is planned in three phases. Before beginning treatment, the treatment team evaluates the risk for the patient, which can have important implications for clinical management. ¹

Acute Lymphoblastic Leukemia (ALL)/lymphoblastic lymphoma (LBL) is the most common childhood cancer, occurring in 3.4 per 100,000 cases and peaks between ages two to five years, and is higher in boys than girls. ²

Acute Myeloid Leukemia (AML) is characterized by uncontrolled clonal (from a single cell) expansion of myeloid progenitors. Progenitors are descendants of stem cells that become specialized cell types. ³

Initial evaluation

The risk of disease relapse is an essential consideration for treatment planning for ALL/LBL. Evaluation of risk, or risk stratification, categorizes patients according to health status at the beginning of treatment. This helps guide therapy, enables providers to prescribe lower treatment intensity and less toxicity for most children with ALL/LBL, and affects all stages of therapy. High-risk children receive intensified therapy that may cause more adverse effects. ¹². Treatment for ALL is based on whether ALL is untreated, in remission, or recurrent.

Risk is categorized or stratified below.

Standard risk includes children aged 1-10 whose white blood cell (WBC) count has fallen below 50,000 WBCs per microliter of blood at the time of diagnosis. ⁶

High risk includes children 10 years or older with a WBC count of 50,000 WBCs or more at the time of diagnosis. ⁷

Very high risk includes children who are younger than 1 year of age, children who have certain changes in genes, and children with signs of leukemia after 4 weeks of treatment. ⁸

Stratification also includes the evaluation of chromosomes and genetic features.

Risk Factors for ALL

Exposure to HIGH levels of radiation, as in survivors of atomic bombs, has increased the risk of developing ALL or AML. Radiation therapy can cause an increased risk of leukemia, although it is greater for AML. There is a greater potential risk if chemotherapy and radiation are used together in treatment. ⁴

Exposure to radiation from medical imaging tests at very young ages may increase the risk of leukemia, but this is not clear. ⁵

Treatment Phases

The first treatment phase:

Remission induction: The goal is to kill leukemia cells in the blood and bone marrow. This puts the leukemia into remission. ⁹

The second treatment phase:

Consolidation or intensification begins once the leukemia is in remission.

In this phase, the goal is to kill any remaining leukemia cells that could lead to relapse. ¹⁰

The third phase:

Maintenance kills remaining cells that may regrow and cause relapse. Usually given in lower doses than for remission induction and consolidation phases. This is also known as the continuation therapy phase. ¹¹

Treatment Types for Leukemias

Many cancer drugs are broadly grouped as chemotherapy, targeted therapy, and immunotherapy. They each have varied actions (how they work) and side effects.

Chemotherapy

Chemotherapy, also called “chemo,” is given to stop the growth of cancer cells. It can either kill the cells or prevent them from dividing (reproducing) to amplify the elimination of cancer cells while reducing the adverse effects on normal health cells. Commonly administered intravenously, usually at an infusion center, it can require hours to complete the infusion.

Your child may need a central venous access device (CVAD). A CVAD is necessary for the safe delivery of chemotherapy. It can also serve as venous access for blood draws or allow for administering other intravenous medications while limiting repeated needle punctures whenever venous access is needed. CVADs are temporary and remain in place for the duration of chemotherapy.

The treatment goals of chemotherapy are to eradicate the cancer, prevent recurrence, and achieve long-term disease control. ¹³

Systemic chemotherapy can be given by mouth or injected into a vein or muscle. When drugs enter the bloodstream, they can reach the cancer cells throughout the body.
Intrathecal chemotherapy introduces chemotherapy directly into the cerebrospinal space and into the fluid surrounding the brain and spinal cord). The intrathecal route is for treating or preventing brain and spinal cord cancers.

Radiation Therapy

Radiation Therapy is the delivery of high-energy X-rays or other radiation to kill cancer cells or keep them from growing.

External radiation is delivered from outside the body, targeting the area with cancer. Radiation Therapy can treat ALL that has already spread or may spread to the brain and spinal cord.

Doctors treat certain cancers by implanting radioactive substances sealed within materials directly into or near the tumor site. This method delivers a high dose of radiation to the tumor while minimizing damage to healthy tissues.¹⁴ They often use it to treat tumors in the head and neck, breast, cervix, prostate, and eye.

Transplants (Stem Cells)

Stem cell transplantation is a procedure that replaces lost blood-forming cells destroyed by chemotherapy and radiation. This transplant occurs in hospitals with a specialized transplant center certified by the Foundation for the Accreditation of Cellular Therapy.

Stem cells primarily live in the bone marrow. However, they also exist in small amounts in adult peripheral and umbilical cord blood. Stem cells are able to renew themselves and differentiate (able to develop into a different cell type). Your treatment team will collect the stem cells from peripheral blood or by bone marrow aspiration and, later, infuse the stem cells (the new blood-forming cells) by intravenous infusion. The entire treatment protocol may take up to several weeks to complete. Full recovery of the immune system after transplantation may take much longer. ¹⁵

Surgery

Surgery: Surgical removal of a cancerous tumor and surrounding tissues is often the primary treatment for localized cancers.

Effects of Treatment

Chemotherapy is most likely to affect blood cells forming in the bone marrow, cells in the digestive tract, hair follicles, and cells in the reproductive system. Chemotherapy can cause side effects of decreased blood counts, fatigue, nausea and vomiting, diarrhea, mouth sores, hair loss, and infertility. ¹⁵ Decreased RBCs, which carry oxygen, result in anemia and fatigue. Reduced WBCs can increase the risk of infection and fever. A reduction in the number of platelets (platelets help blood clot) can cause bruising and bleeding.

Radiation Therapy for brain cancer can cause short-term and long-term side effects. Short-term side effects include swelling, fatigue, and nausea. Long-term side effects include memory loss, vision changes, and hearing loss.

CNS Tumors

Central Nervous System tumors are the most common solid tumors in children ¹⁶

And they are the leading cause of cancer mortality in children. ¹⁷

The most common types of CNS tumors in children are:

Astrocytoma- the most abundant cell type in the brain
Medulloblastoma – invasive and rapidly growing
Ependymomas – slow-growing and involving the ventricular system

Diagnosis requires a biopsy of the mass after an MRI detects the tumor. Staging and risk assessment follow.

Treatment of CNS Tumors

Treatment can consist of surgical resection (an operation to remove the tumor), chemotherapy, targeted therapy, or radiation therapy. Targeted therapy helps treat cancer by interfering with certain proteins that help tumors grow and spread throughout the body.

After initial surgical resection, radiation therapy and chemotherapy are likely to follow.

Lymphoma

Childhood Hodgkin’s Lymphoma is a cancer that starts in the lymph system. The lymph system helps protect the body from infection and disease.

Risk factors in the development of childhood Hodgkin’s lymphoma include:

Exposure to the Epstein-Barr virus
Exposure to HIV infection
Having certain diseases of the immune system like autoimmune lymphoproliferative syndrome
Having a weakened immune system after an organ transplant or from medicines given to prevent rejection of the transplanted organ
Having a close family member with a personal history of Hodgkin’s Lymphoma

Inherited genes may increase the risk of childhood lymphoma. Exposure to common infections in early childhood may decrease the risk of Hodgkin’s lymphoma in children.

Treatments:

Chemotherapy
Radiation therapy
Targeted therapy
Surgery
High-dose chemotherapy with stem cell transplant
Clinical trials: A clinical trial is a research study that evaluates new treatment approaches. Patients can begin clinical trials before, during, or after starting treatment.

Founded in 2020, the Sassy Carmen Foundation strives to bring hope and light into the lives of families battling pediatric cancer. For information regarding the diagnosis and treatment of childhood cancer, follow the Sassy Carmen blog at https://www.sassycarmen.org/about/

References

1 https://www.yalemedicine.org/conditions/leukemia-in-children#:~:text

2 https://sso.uptodate.com/contents/treatment-of-acute-lymphoblastic-leukemia-lymphoma-in-children-and-adolescents?search=

3 https://www.uptodate.com/contents/overview-of-the-clinical-presentation-and- diagnosis-of-acute-lymphoblastic-leukemia-lymphoma-in-children?search

4 https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/causes-risks-prevention/risk-factors.html

5 https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/causes-risks-prevention/risk-factors.html

6-9 https://www.cancer.gov/types/leukemia/patient/child-all

9-11 https://www.cancer.gov/types/leukemia/patient/child-all-treatment-blood

12 Horton, Terzah MD, PhD; McNeer, Jennifer L. MD, MS; Treatment of Acute Lymphoblastic leukemia/lymphoma in Children and adolescents. In Up to Date, retrieved 2/17/25

13 https://www.ncbi.nlm.nih.gov/books/NBK569416/

14 https://www.cancer.gov/publications/dictionaries/cancer-

15 https://www.cancer.gov/publications/dictionaries/cancer-

16 Brain Sci. 2023 Jul 21;13(7):1106. doi:

17 Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024 [published correction appears in CA Cancer J Clin. 2024 Mar-Apr;74(2):203]. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820

Treatment for Childhood Cancer