CHILDHOOD CANCER FACTS & FIGURES 2023

From American Cancer Society’s Cancer Facts & Figures 2023 (you can find the entire document HERE)

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Cancer in Children and Adolescents

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New cases and deaths:

In 2023, an estimated 9,910 children (ages 0 to 14 years) and 5,280 adolescents (ages 15-19 years) will be diagnosed with cancer and 1,040 children and 550 adolescents will die from the disease. Cancer is the leading disease-related cause of death among both children and adolescents. The most commonly diagnosed cancers in children and adolescents are leukemia (28% and 13%, respectively); brain, including benign and borderline malignant tumors (26% and 21%); and lymphoma (12% and 19%).

 

Incidence trends:

Overall, incidence rates from 2010 through 2019 stabilized in children after increasing since at least 1975, but continued to rise in adolescents by 1% per year, although trends vary by cancer type.

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Mortality trends:

The death rate for cancer has declined by more than half from 1970 to 2020 in both children (from 6.3 per 100,000 to 1.9) and adolescents (from 7.2 to 2.6), largely due to improvements in treatment and high participation in clinical trials for the most common cancers (e.g., leukemia), especially among children. However, progress lags for some rare cancer types, such as diffuse midline glioma, a type of Cancer Facts & Figures 2023 13 brain cancer. Recent reclassification of brain and other central nervous system tumors according to genetic and molecular characteristics has increased biologic understanding and is hoped to facilitate precision treatment and better outcomes.

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Risk factors:

Cancers that occur during childhood or adolescence have few established risk factors, and most are thought to be due to random cell mutations without an external cause. Exposure to ionizing radiation, such as that from prior radiation therapy, increases the risk of leukemia, brain tumors, and possibly other neoplasms. Prior chemotherapy also increases the risk of leukemia. Solid organ transplant recipients are at increased risk for non-Hodgkin lymphoma, largely due to drugs that suppress the immune system to prevent organ rejection. Infection with Epstein-Barr virus (EBV) is associated with some types of non-Hodgkin lymphoma, such as Burkitt lymphoma. Cancer risk is also increased in children and adolescents with certain genetic syndromes (e.g., Down syndrome, Li-Fraumeni syndrome, and Beckwith-Wiedemann syndrome) or a family history of certain childhood cancers (e.g., hereditary retinoblastoma).

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Signs and symptoms:

Many early signs and symptoms of childhood and adolescent cancer include nonspecific symptoms shared by common childhood conditions, which can challenge timely diagnosis. Parents or other caregivers should ensure regular medical checkups and be alert to unusual, persistent symptoms, including an unusual mass or swelling; unexplained paleness or loss of energy; a sudden increase in the tendency to bruise or bleed; persistent, localized pain or limping; prolonged, unexplained fever or illness; frequent headaches, often with vomiting; sudden eye or vision changes; and excessive, rapid weight loss. Following are more specific symptoms for the major categories of pediatric cancer according to the International Classification of Childhood Cancer (ICCC): • Leukemia may cause bone and joint pain, fatigue, weakness, pale skin, bleeding or bruising easily, fever, or infection.

 

• Brain and other central nervous system tumors may cause headaches, nausea, vomiting, blurred or double vision, seizures, dizziness, and difficulty walking or handling objects.

• Lymphoma often causes lymph nodes to swell, which can appear as a lump in the neck, armpit, or groin; other symptoms can include fatigue, swelling or pain in the abdomen, weight loss, sweating (especially at night), and fever.

• Neuroblastoma, a cancer of immature nerve cells that is most common in children under 5 years of age, often appears as a swelling in the abdomen, sometimes accompanied by loss of appetite. However, neuroblastoma can develop anywhere in the body where groups of nerve cells are found.

• Wilms tumor, also called nephroblastoma, is a kidney cancer that may appear as swelling or a lump in the abdomen, sometimes with blood in the urine.

• Rhabdomyosarcoma is a soft tissue sarcoma that occurs in muscle tissue, most often in the head or neck, genitourinary area, or extremities, and may cause pain and/or a mass or swelling at the tumor site.

• Retinoblastoma, an eye cancer that usually occurs in children under 5 years of age, may cause vision problems and is often recognized because the pupil appears white or pink instead of the normal red color in flash photographs or during an eye examination.

• Osteosarcoma, a bone cancer that most often occurs in adolescents, commonly appears as sporadic pain in the affected bone that may worsen at night or with activity and eventually progresses to local swelling.

• Ewing sarcoma, another cancer usually arising in the bone in adolescents, typically appears as pain or swelling at the tumor site.

• Gonadal germ cell tumors occur in the ovaries in girls and can be difficult to detect because symptoms, such as abdominal pain, often do not present until the tumor is advanced; in boys, these tumors occur in the testes and are often visible and may cause pain at an early stage.

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Treatment:

Treatment is based on type and stage of cancer and is typically coordinated by a team of experts, including pediatric oncologists and nurses, social workers, psychologists, and others trained to assist young patients and their families. Outcomes are generally most successful when treatment is managed by specialists at a children’s cancer center. Adolescents may be treated in the pediatric or adult oncology setting depending on cancer type and preference, although superior outcomes in the pediatric setting have been reported for some cancers (e.g., acute lymphocytic leukemia). If the child or adolescent is eligible, participation in a clinical trial, which usually compares a new treatment with the best available standard treatment, should be considered.

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Survival:

Excluding benign and borderline malignant brain tumors, for which 5-year relative survival is >97% in children and adolescents, the 5-year relative survival rate during 2012 to 2018 for all cancers combined classified by the ICCC was 85% among children and 86% among adolescents. However, rates vary considerably depending on cancer type, patient age, and other factors. The overall survival rate among adolescents is heavily influenced by high survival for thyroid cancer (>99%) and Hodgkin lymphoma (98%), masking lower survival than children for several other cancers, including acute lymphocytic leukemia (77% versus 92%) and Ewing sarcoma (64% versus 78%). (See the Cancer Statistics Center for more childhood and adolescent survival rates.) Some treatment-related side effects may persist, or even begin, long after treatment ends, including impaired organ function (e.g., memory or heart problems) and new cancers at the same or different sites. The burden of these and other chronic health conditions among childhood cancer survivors is nearly double that of the general population by age 50. The Children’s Oncology Group (COG) has developed guidelines for screening for and managing late effects in survivors of childhood cancer. See the COG website at survivorshipguidelines.org for more information. For more information on cancer in children and adolescents, see the Cancer Facts & Figures 2014 Special Section: Cancer in Children & Adolescents and Cancer Facts & Figures 2020 Special Section: Cancer in Adolescents & Young Adults at cancer.org/statistics, and visit cancer.org to see the Childhood Cancer Research Landscape Report.

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