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Cancer in Children, Adolescents, and Young Adults

Cancer in children is rare when compared to cancer occurring in adults. About 15,000 children younger than 20 are diagnosed with cancer each year in the United States. Pediatric cancer death rates have dropped by nearly 70% over the past 40 years. Cancer is still the leading cause of death from disease among children from birth to age 14.

No exact definition exists to differentiate childhood cancers from adolescent and young adult cancers. Cancers in young adults are those that start between the ages of 20 to 39 years of age. Eighty thousand young adults ages 20-39 are diagnosed with cancer each year.

The most common types of cancer in children aged 0 to 14 years are:

  • Bone
  • Brain and spinal cord tumors
  • Leukemia
  • Lymphoma (Hodgkin and non-Hodgkin)
  • Neuroblastoma
  • Retinoblastoma
  • Rhabdomyosarcoma
  • Wilms tumor

The most common types of cancer in adolescents aged 15 to 19 years are:

  • Brain and spinal cord tumors
  • Leukemia
  • Lymphoma
  • Melanoma
  • Ovarian
  • Sarcoma
  • Testicular
  • Thyroid

The most common types of cancer in young adults aged 20 to 39 are:

  • Breast
  • Brain and spinal cord tumors
  • Colorectal
  • Gynecological
  • Lymphoma
  • Melanoma
  • Sarcoma
  • Testicular
  • Thyroid

Risk Factors

Risk factors influence a person’s chance of getting cancer, but this occurs over a longer duration of time. Risk factors are not thought to increase children’s , adolescents, or young adults risk for cancer as in older adults with lifestyle behaviors, such as smoking, alcohol use, etc.

Other risk factors that could be associated with cancer in children are radiation exposure or other environmental exposures and acquired or inherited gene mutations.

Other risk factors that could increase the chance of an adolescent or young adult getting cancer are environmental exposures, acquired or inherited gene mutations, ultraviolet (UV) radiation from tanning beds, and treatment from a childhood cancer, HPV infection, and human immunodeficiency virus (HIV) infection.

Prevention and Early Detection

Lifestyle risk factors, such as smoking, being overweight, not exercising, and eating unhealthy foods, play a role in many types of adult cancers. However, most lifestyle risk factors do not play a role in childhood cancers. Since cancer in children is rare, it is hard to detect if no symptoms are present.

Some children inherit DNA changes (mutations) from a parent that increase their risk of certain types of cancer. These changes are present in every cell of the child’s body, and they can often be tested for in the DNA of blood cells or other body cells. Some of these DNA changes are linked only with an increased risk of cancer, while others can cause syndromes that also include other health or developmental problems.

However, most childhood cancers are not caused by inherited DNA changes. They are the result of DNA changes that happen early in the child’s life, sometimes even before birth. Every time a cell divides into two new cells, it must copy its DNA. This process isn’t perfect, and errors sometimes occur, especially when the cells are growing quickly. This kind of gene mutation can happen at any time in life and is called an acquired mutation.

Some risk factors that can be reduced in adolescents are limiting exposure to environmental risk factors, such as radiation exposure and UV radiation, and receiving the HPV vaccine. No cancer screening tests for children and adolescents are recommended, as cancer is not common for this age group. Cancer is not usually screened for if there are no signs or symptoms.

For young adults, reasons why cancer may not be detected early on include infrequent visits to the doctor or not having a primary care doctor. Financial issues and insurance coverage may impact whether or not a person goes to the doctor. Cancers are not common between ages 20 and 39. Many screening tests to look for cancer in people in this age group are not recommended unless they have an increased risk.

Incidence: Cancer in Children, Adolescents, and Young Adults

Figure 13 below summarizes the incidence rate for all childhood invasive cancers combined for 2017 in Illinois.

All Childhood Invasive Cancers Combined by Age Group per 1,000,000 for 2017 in Illinois

Figure 14, Figure 15, and Figure 16 shows the incidence by cancer types for childhood, adolescent, and young adults for 2017 in Illinois.

2017 Incidence for Ages 0-14 per 1,000,000 Population in Illinois

Cancer Type Incidence (per 1,000,000)

I Leukemia

127

I(a) Lymphoid leukemias

88

I(b) Acute myeloid leukemias

24

II Lymphoma and reticuloendothelial neoplasms

57

II(b) Non-Hodgkin lymphomas (except Burkitt lymphoma)

23

II(d) Miscellaneous lymphoreticular neoplasms

16

III CNS and misc intracranial and intraspinal neoplasms

64

III(b) Astrocytomas

32

III(c) Intracranial and intraspinal embryonal tumors

19

IV Sympathetic nervous system tumors

22

IV(a) Neuroblastoma and ganglioneuroblastoma

22

VI Renal tumors

34

VI(a) Nephroblastoma and other nonepithelial renal tumors

31

IX Soft-tissue sarcomas

26

X Germ-cell, trophoblastic and other gonadal neoplasms

21

XI Carcinomas and other malignant epithelial neoplasms

23

2017 Incidence for Ages 15-19 per 1,000,000 Population in Illinois

Cancer Type Incidence (per 1,000,000)

I Leukemia

31

I(a) Lymphoid leukemias

17

II Lymphoma and reticuloendothelial neoplasms

47

II(a) Hodgkin lymphomas

29

III CNS and misc intracranial and intraspinal neoplasms

20

VIII Malignant bone tumors

16

IX Soft-tissue sarcomas

22

X Germ-cell, trophoblastic and other gonadal neoplasms

27

X(c) Malignant gonadal germ cell tumors

24

XI Carcinomas and other malignant epithelial neoplasms

59

XI(b) Thyroid carcinomas

27

XI(f) Other and unspecified carcinomas

24

2017 Incidence for Ages 20-39 per 100,000 Population in Illinois

Cancer Type Incidence (per 100,000)

Brain and Other Nervous System

98

Breast

506

Cervix Uteri

112

Colon and Rectum

194

Corpus Uteri

64

Kidney and Renal Pelvis

90

Leukemias

118

Lung and Bronchus

37

Melanoma of the Skin

314

Non-Hodgkin Lymphoma

126

Oral Cavity and Pharynx

59

Ovary

65

Pancreas

25

Stomach

31

Thyroid

392

Urinary Bladder, invasive and in situ

26

Mortality: Cancer in Children, Adolescents, and Young Adults

Figure 17, Figure 18, and Figure 19 shows the mortality rate for childhood, adolescent, and young adults for 2013-2017 in Illinois.

2013-2017 Mortality for Ages 0-14 per 100,000 Population in Illinois

Cancer Type Mortality (per 100,000)

Acute Lymphocytic Leukemia

25

Acute Myeloid Leukemia

23

Brain and Other Nervous System

74

Endocrine System

26

Leukemias

62

Other Endocrine including Thymus

26

Soft Tissue including Heart

20

2013-2017 Mortality for Ages 15-19 per 100,000 Population in Illinois

Cancer Type Mortality (per 100,000)

Bones and Joints

20

Brain and Other Nervous System

32

Leukemias

42

2013-2017 Mortality for Ages 20-39 per 100,000 Population in Illinois

Cancer Type Mortality (per 100,000)

Brain and Other Nervous System

187

Breast

236

Cervix Uteri

65

Colon and Rectum

160

Esophagus

19

Kidney and Renal Pelvis

39

Leukemias

140

Liver

19

Lung and Bronchus

73

Melanoma of the Skin

67

Non-Hodgkin Lymphoma

76

Oral Cavity and Pharynx

31

Ovary

46

Pancreas

39

Stomach

68

Strategies

The American Childhood Cancer Organization has identified action items specifically for childhood cancers.

  • Research new, less toxic therapies for treating childhood cancer
  • Ensure children diagnosed with cancer (and their families) have equitable access to quality health care and psychosocial programs
  • Ensure equitable access to educational opportunities for children with cancer
  • Ensure children (and their families) have knowledge of the long-term effects of childhood cancer treatment and have equitable access to high quality follow-up care
  • Increase awareness of childhood cancer among families, health care professionals, schools, and society as a whole

In addition to the strategies listed elsewhere in this plan, the following lists strategies by topic area.

Research

  • Work with state and national partners to support funding for pediatric cancer research
  • Support research leading to new therapies targeted specifically for children with cancer that are effective and less toxic
  • Promote basic/molecular research leading to an improved understanding of the causes of childhood cancers

Equitable Access to Quality Health Care and Psychosocial Programs

  • Work with childhood cancer advocacy organizations to support efforts aimed at improving pediatric cancer patients’ quality of life from diagnosis onward
  • Identify and address family medical education needs (diagnosis, treatment, late-effects, support programs, sibling support, and respite care)
  • Educate human resource professionals as to the full extent of resources available to pediatric cancer caregivers through the Family Medical Leave Act
  • Provide strong recommendation for parents and caregivers to receive early and ongoing assessment of their mental health needs
  • Provide bereavement follow-up for parents/caretakers

Health Care Providers/Insurers

  • Expand workforce training in pediatric palliative care
  • Increase awareness of clinical trial in the pediatric/adolescent population

Equitable Access to Education

  • Educate patients, parents, and educators on academic challenges faced by childhood cancer patients
  • Work with school intervention specialists to raise awareness among patients, families, educators, and administrators of the support that should be available through the school system

Long-term Effects

  • Increase education about long-term consequences of cancer treatment for pediatric, adolescent, and young adult patients
  • Educate families about the need for long-term follow-up care to monitor the late effects of childhood cancer treatment and to promote healthy survivorship
  • Promote utilization of recommendations/standards for follow-up care (COG Passport for Care, Psychosocial Standards of Care Project for Childhood Cancer)

Awareness

  • Increase general awareness of the incidence and impact of pediatric cancer on children in Illinois
  • Increase awareness of the need for novel pediatric cancer therapies
  • Increase awareness of the impact of pediatric cancer on survivors and their families