Childhood cancer survival rates have increased dramatically over the past 40 years.
Despite the survival rate increase, cancer continues to be the No. 1 disease killer and second-leading cause of death in children.
Every day, City of Hope’s team of physicians and researchers aggressively study the science behind childhood cancers and provide comprehensive, family-centered care for children with cancer and blood disorders.
Clarke Anderson, MD is here to discuss childhood cancer, some of the possible causes and what parents with children who have cancer need to know.
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Childhood Cancer: What Families Need To Know
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Learn more about Clarke Anderson, M.D
Clarke Anderson, MD
Clarke Anderson, M.D. is an assistant clinical professor in the department of pediatrics. He specialized in pediatric hematology/oncology.Learn more about Clarke Anderson, M.D
Transcription:
Childhood Cancer: What Families Need To Know
Melanie Cole (Host): Everyday, City of Hope’s team of physicians and researchers aggressively study the science behind childhood cancers and provide comprehensive family-centered care for children with cancer and blood disorders. My guest today is Dr. Clarke Anderson. He’s an assistant clinical professor in the Department of Pediatrics, specializing in pediatric hematology/oncology at City of Hope. Welcome to the show, Dr. Anderson. Tell us how common is cancer in children? It seems to be every parent’s biggest worry. Leukemia, brain tumors, any of these things, how common is it really?
Dr. Clarke Anderson (Guest): First of all, thank you, Melanie, for having me. Pediatric cancer is actually really rare. I don’t think people realize how rare it is. It’s really only about one in 10,000 children who develop cancer. If you compare that to adults, for example, with breast cancer, there’s over 250,000 women a year that are diagnosed. Whereas—I am a specialist in a disease called neuroblastoma, which is a nerve tumor near the kidney—only about 800 children a year are diagnosed in the United States. That shows you the difference of how rare the pediatric cancers are.
Melanie: Which cancers tend to affect children the most and what are some causes that you can think of, maybe even risk factors?
Dr. Anderson: The number one cancer in children is, more often than not, leukemia. It’s usually the one that’s diagnosed between the age of two and 10 years of age. Brain tumors are also quite common, the pediatric tumor. The risk factors, I get asked that all the time. When I first see a family, they ask me, “Why did it happen to my child?” I think all of us are brought up thinking that there has to be a cause and effect for cancers. You smoke for many, many years, you develop lung cancer. Well, that does not appear to be the case with children. There are probably different factors, different biology that leads to cancer in children. Some children, they were born with a tendency to have the cancer. I’ll use the classic example. There’s an eye cancer called retinoblastoma. This is where your body is born without a gene that helps to protect against the mutations of your DNA. By second year of life, many times these children will have cancer in the eye just because of exposure to ultraviolet light. Those kinds of things, that’s a risk. In general, there’s no known risk for the majority of pediatric cancers.
Melanie: As we’re talking about pediatric cancers, Dr. Anderson, we want to give hope to parents. However, this is a very scary topic and can be a very depressing topic. We talk about all kinds of cancers on this show, but this one in particular seems to really hit a nerve for parents, for anybody with children or loved ones. Tell us a little bit about childhood cancers. Should we be so concerned and worried all the time about our children?
Dr. Anderson: Clearly, it’s a huge fear. I think every parent fears that the child will develop cancer. But as an oncologist, I’ve seen a lot over my 25 years of practice. Many of the cancers, including neuroblastoma as the example, had maybe a 20 percent survival when I started. Now, the survival is close to 70 percent of beating and cure rate of the cancer. That gives me a lot of hope. It gives me a lot of optimism when I first see a family. Even though that’s optimistic and hopeful, that still means that we’re not successful with all kids. Regardless, the statistics are still much better, and so I always have hope when I first see a family.
Melanie: If parents have a child with cancer, should they have their other children tested? Are there certain genetic predispositions that would lend themselves to run in families?
Dr. Anderson: That’s an excellent, excellent question. In general, no. The risk for other children is very, very, very small. There are few genetic conditions where they may have an abnormal gene or something like that, but in general, it happens sporadically and the other children are not at risk.
Melanie: Is there anything, Dr. Anderson, that parents can do to prevent some of these cancers? Obviously, with adult cancers, we know there are certain behavioral modifications that we can make, but what about with children? Is there anything we can do?
Dr. Anderson: Well, since there are really many cases that have no known cause, it is actually quite hard to consider prevention. However, there are probably some lifestyle choices that can be looked into, for example, obesity. Definitely, an adult obesity is potential risk factor for development of cancers. For children, it’s not as clear if that is the case, but definitely in children, we have seen that if they are diagnosed with cancer and they are obese, they don’t do as well with chemotherapy. They potentially have a higher relapse rate and it probably has to do with the change in how they deal with the drug when they are also obese. The other risk factor that I don’t know if it’s necessarily a risk factor but something that should be, I think, looked at over the next few years is vitamin D deficiency. It is a surprise how many times we check our patient’s vitamin D level and they’re essentially zero. That probably wasn’t the case 30 years ago. My best guess is it’s our lifestyle. We sit indoors. We are on our cellphones, on the computer. We wear long-sleeved shirts. We wear sunscreens. We’re not getting the vitamin D that we naturally would make through our skin. Vitamin D is such an important vitamin. Not only does it help our bones to become stronger and less brittle when we get older, but it also could contribute to cancer and also arthritis.
Melanie: I understand, Dr. Anderson, that there are many different types of cancers with many different types of symptoms. If parents are overly concerned, keeping an eye on their kids all the time, looking for things, we’ve heard with leukemia you look for bruising, I know every parent looks over their child when they’re little for these bruises that don’t go away. Give us some red flags that you, as a doctor, would say, “You know what? Keep your eyes out for these kinds of things, and that’s when you really need to see a doctor.”
Dr. Anderson: Well, the symptoms of cancer, whether it’s leukemia or other types of cancer, are generic symptoms, things like fever, being tired, pain in a certain area, sweating, any of those things, like bruises. I think the best rule of thumb is things that don’t go away: Bruising that lasts several days that you can’t explain, fevers that just are not explainable—you’ve not had an exposure, no one else has been sick—something that just does not get better over a period of time. I’ll use an example for a teenager. Bone cancer is very common in teenagers during their growth spurt. So, pain, you can have one or two days of pain and that’s probably something that’s not cancerous and something that’s not to really worry too much about. But pain that lasts several days, several weeks, exactly in the same place, probably needs to have medical attention. So I think if there’s any advice that I give parents is not to worry for the symptom itself, but does it persist and it’s not getting better and you can’t explain.
Melanie: If parents are asking you advice, they’re cornering you somewhere and asking you for your best advice on pediatric cancers, what do you tell them? What is your best advice and why should they consider coming to City of Hope for their care?
Dr. Anderson: That’s kind of a two-part question.
Melanie: Yes, it is.
Dr. Anderson: I think my first advice, I’m going to actually answer it more like a child is diagnosed with cancer and what advice would I give parents. I think that’s how I’d answer it. First of all, when your child is diagnosed with cancer, it’s a very, very scary period of time, a lot of anxiety. Everyone will try and give you advice. My probably biggest point I tell most new families is don’t look at the Internet for at least the first two weeks. It’s a big scary place. If you search the name of your child’s cancer, you’re going to see a lot of really bad, scary things that may not apply to your child. Wait a couple of weeks, get more information, and then I tell the families the Internet is a completely fair game. There’s no website that I’m afraid of, you know, but have some time, get some answers. The other thing is people outside of the medical community are going to tell them a lot of advices, like you have this particular diet, do this particular thing. All of that may be good and well, but take some time. Learn about your child’s disease and then make your own informed decision. The second part of your question was why they should come to City of Hope. Our environment is, I think, clearly in my mind, is at the standard for families in our care. When I first came here 10 years ago, when I first came to City of Hope 10 years ago, one of the things that impressed me the most was how involved all of the subspecialties besides medicine and nursing, meaning, the child life specialists who have master’s degrees and help educate the children through very scary procedures, those kinds of things, they do a wonderful job at that; the psychologist and social workers. It was a very, very close team approach that I think really helps the family in very difficult times. The other thing about City of Hope is something that I’m quite excited about over the next few years. Dr. Karen Aboody is one of the research scientists here at City of Hope and she is working very hard on developing a technique that uses nerve stem cell that when injected will go directly to the tumor, and in this case, neuroblastoma which is a nerve tumor near the kidney, and make it possible for chemotherapy to work 80 times better. It basically increases the concentration of the chemotherapy 80 times right where it needs to be, where the tumor is. As a smart target, it goes exactly where it’s supposed to go. Hopefully, this will limit toxicities to liver, lungs, and other parts of the body. This is still in development and the first child will probably be treated no earlier than 2017. I give this as an example of some of the amazing stuff that we do here at City of Hope.
Melanie: Thank you so much, Dr. Anderson. It’s absolutely fascinating and you’re giving hope to so many parents worldwide. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks for listening.
Childhood Cancer: What Families Need To Know
Melanie Cole (Host): Everyday, City of Hope’s team of physicians and researchers aggressively study the science behind childhood cancers and provide comprehensive family-centered care for children with cancer and blood disorders. My guest today is Dr. Clarke Anderson. He’s an assistant clinical professor in the Department of Pediatrics, specializing in pediatric hematology/oncology at City of Hope. Welcome to the show, Dr. Anderson. Tell us how common is cancer in children? It seems to be every parent’s biggest worry. Leukemia, brain tumors, any of these things, how common is it really?
Dr. Clarke Anderson (Guest): First of all, thank you, Melanie, for having me. Pediatric cancer is actually really rare. I don’t think people realize how rare it is. It’s really only about one in 10,000 children who develop cancer. If you compare that to adults, for example, with breast cancer, there’s over 250,000 women a year that are diagnosed. Whereas—I am a specialist in a disease called neuroblastoma, which is a nerve tumor near the kidney—only about 800 children a year are diagnosed in the United States. That shows you the difference of how rare the pediatric cancers are.
Melanie: Which cancers tend to affect children the most and what are some causes that you can think of, maybe even risk factors?
Dr. Anderson: The number one cancer in children is, more often than not, leukemia. It’s usually the one that’s diagnosed between the age of two and 10 years of age. Brain tumors are also quite common, the pediatric tumor. The risk factors, I get asked that all the time. When I first see a family, they ask me, “Why did it happen to my child?” I think all of us are brought up thinking that there has to be a cause and effect for cancers. You smoke for many, many years, you develop lung cancer. Well, that does not appear to be the case with children. There are probably different factors, different biology that leads to cancer in children. Some children, they were born with a tendency to have the cancer. I’ll use the classic example. There’s an eye cancer called retinoblastoma. This is where your body is born without a gene that helps to protect against the mutations of your DNA. By second year of life, many times these children will have cancer in the eye just because of exposure to ultraviolet light. Those kinds of things, that’s a risk. In general, there’s no known risk for the majority of pediatric cancers.
Melanie: As we’re talking about pediatric cancers, Dr. Anderson, we want to give hope to parents. However, this is a very scary topic and can be a very depressing topic. We talk about all kinds of cancers on this show, but this one in particular seems to really hit a nerve for parents, for anybody with children or loved ones. Tell us a little bit about childhood cancers. Should we be so concerned and worried all the time about our children?
Dr. Anderson: Clearly, it’s a huge fear. I think every parent fears that the child will develop cancer. But as an oncologist, I’ve seen a lot over my 25 years of practice. Many of the cancers, including neuroblastoma as the example, had maybe a 20 percent survival when I started. Now, the survival is close to 70 percent of beating and cure rate of the cancer. That gives me a lot of hope. It gives me a lot of optimism when I first see a family. Even though that’s optimistic and hopeful, that still means that we’re not successful with all kids. Regardless, the statistics are still much better, and so I always have hope when I first see a family.
Melanie: If parents have a child with cancer, should they have their other children tested? Are there certain genetic predispositions that would lend themselves to run in families?
Dr. Anderson: That’s an excellent, excellent question. In general, no. The risk for other children is very, very, very small. There are few genetic conditions where they may have an abnormal gene or something like that, but in general, it happens sporadically and the other children are not at risk.
Melanie: Is there anything, Dr. Anderson, that parents can do to prevent some of these cancers? Obviously, with adult cancers, we know there are certain behavioral modifications that we can make, but what about with children? Is there anything we can do?
Dr. Anderson: Well, since there are really many cases that have no known cause, it is actually quite hard to consider prevention. However, there are probably some lifestyle choices that can be looked into, for example, obesity. Definitely, an adult obesity is potential risk factor for development of cancers. For children, it’s not as clear if that is the case, but definitely in children, we have seen that if they are diagnosed with cancer and they are obese, they don’t do as well with chemotherapy. They potentially have a higher relapse rate and it probably has to do with the change in how they deal with the drug when they are also obese. The other risk factor that I don’t know if it’s necessarily a risk factor but something that should be, I think, looked at over the next few years is vitamin D deficiency. It is a surprise how many times we check our patient’s vitamin D level and they’re essentially zero. That probably wasn’t the case 30 years ago. My best guess is it’s our lifestyle. We sit indoors. We are on our cellphones, on the computer. We wear long-sleeved shirts. We wear sunscreens. We’re not getting the vitamin D that we naturally would make through our skin. Vitamin D is such an important vitamin. Not only does it help our bones to become stronger and less brittle when we get older, but it also could contribute to cancer and also arthritis.
Melanie: I understand, Dr. Anderson, that there are many different types of cancers with many different types of symptoms. If parents are overly concerned, keeping an eye on their kids all the time, looking for things, we’ve heard with leukemia you look for bruising, I know every parent looks over their child when they’re little for these bruises that don’t go away. Give us some red flags that you, as a doctor, would say, “You know what? Keep your eyes out for these kinds of things, and that’s when you really need to see a doctor.”
Dr. Anderson: Well, the symptoms of cancer, whether it’s leukemia or other types of cancer, are generic symptoms, things like fever, being tired, pain in a certain area, sweating, any of those things, like bruises. I think the best rule of thumb is things that don’t go away: Bruising that lasts several days that you can’t explain, fevers that just are not explainable—you’ve not had an exposure, no one else has been sick—something that just does not get better over a period of time. I’ll use an example for a teenager. Bone cancer is very common in teenagers during their growth spurt. So, pain, you can have one or two days of pain and that’s probably something that’s not cancerous and something that’s not to really worry too much about. But pain that lasts several days, several weeks, exactly in the same place, probably needs to have medical attention. So I think if there’s any advice that I give parents is not to worry for the symptom itself, but does it persist and it’s not getting better and you can’t explain.
Melanie: If parents are asking you advice, they’re cornering you somewhere and asking you for your best advice on pediatric cancers, what do you tell them? What is your best advice and why should they consider coming to City of Hope for their care?
Dr. Anderson: That’s kind of a two-part question.
Melanie: Yes, it is.
Dr. Anderson: I think my first advice, I’m going to actually answer it more like a child is diagnosed with cancer and what advice would I give parents. I think that’s how I’d answer it. First of all, when your child is diagnosed with cancer, it’s a very, very scary period of time, a lot of anxiety. Everyone will try and give you advice. My probably biggest point I tell most new families is don’t look at the Internet for at least the first two weeks. It’s a big scary place. If you search the name of your child’s cancer, you’re going to see a lot of really bad, scary things that may not apply to your child. Wait a couple of weeks, get more information, and then I tell the families the Internet is a completely fair game. There’s no website that I’m afraid of, you know, but have some time, get some answers. The other thing is people outside of the medical community are going to tell them a lot of advices, like you have this particular diet, do this particular thing. All of that may be good and well, but take some time. Learn about your child’s disease and then make your own informed decision. The second part of your question was why they should come to City of Hope. Our environment is, I think, clearly in my mind, is at the standard for families in our care. When I first came here 10 years ago, when I first came to City of Hope 10 years ago, one of the things that impressed me the most was how involved all of the subspecialties besides medicine and nursing, meaning, the child life specialists who have master’s degrees and help educate the children through very scary procedures, those kinds of things, they do a wonderful job at that; the psychologist and social workers. It was a very, very close team approach that I think really helps the family in very difficult times. The other thing about City of Hope is something that I’m quite excited about over the next few years. Dr. Karen Aboody is one of the research scientists here at City of Hope and she is working very hard on developing a technique that uses nerve stem cell that when injected will go directly to the tumor, and in this case, neuroblastoma which is a nerve tumor near the kidney, and make it possible for chemotherapy to work 80 times better. It basically increases the concentration of the chemotherapy 80 times right where it needs to be, where the tumor is. As a smart target, it goes exactly where it’s supposed to go. Hopefully, this will limit toxicities to liver, lungs, and other parts of the body. This is still in development and the first child will probably be treated no earlier than 2017. I give this as an example of some of the amazing stuff that we do here at City of Hope.
Melanie: Thank you so much, Dr. Anderson. It’s absolutely fascinating and you’re giving hope to so many parents worldwide. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks for listening.