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 Possible signs and symptoms of cancer in children

The American Cancer Society compiled the following list of potential indicators that a child might be developing cancer. The majority of these symptoms are more likely to be caused by an injury or infection other than cancer. However, the organization recommended bringing your child to see a doctor if they exhibit any of these symptoms.
An unusual lump or swelling
Unexplained paleness and loss of energy
Easy bruising
An ongoing pain in one area of the body
Limping
Unexplained fever or illness that doesn’t go away
Frequent headaches, often with vomiting
Sudden eye or vision changes
Sudden unexplained weight loss




Troubling trends
A look at the state’s pediatric cancer rates

08/30/18



 By Scott Murphy

smurphy@hippopress.com 
 
A recent report from the Centers for Disease Control raised concerns about pediatric cancer in the Granite State. Cancer rates among people under age 20 were higher in New Hampshire than in any other state between 2003 and 2014, with about 206 cases for every one million residents.  
 
The hard truth
Between 2003 and 2014, the CDC reported 816 cases of pediatric cancer in New Hampshire, ranking it sixth among states in the Northeast. New Hampshire had the largest portion of its youth population develop cancer — 205.5 cases for every million residents — in this time frame. The remaining rates in the Northeast ranged from 164.2 in Vermont up to 192.3 in New Jersey. 
These numbers may not represent the entire picture, though. How these numbers break down according to race is an important piece of context according to Julie Kim, program leader for Dartmouth-Hitchcock’s Pediatric Cancer Program. Though not all states reported pediatric cancer cases by race, the data made available to the CDC indicates that cases of cancer among white, Hispanic and Asian young people were similar to other states in the Northeast and the country. Kim said that the high pediatric cancer rate in New Hampshire is likely due to the state’s higher population of white people, who are generally more prone to developing cancer.
“In general, Caucasians have more inherited genetic syndromes and more instances of cancer than all other populations put together,” said Kim. “If you break the numbers down by race, we’re not any worse than other states.” 
Additionally, instances of pediatric cancer are relatively rare across the nation. The National Cancer Institute estimated that 15,270 children and adolescents ages 0 to 19 years would be diagnosed with cancer in the U.S. in 2017. By comparison, the institute estimated a total of 1.7 million new cases of cancer would be diagnosed in 2018. 
The survival rate has also increased dramatically over the last few decades. According to the Institute, the chance of pediatric cancer patients living for at least five years after their diagnosis has grown from just over 50 percent in 1975 to as high as 83 percent in 2013. 
“Things are improving greatly all the time, especially since I started my career 20 years ago,” Kim said. “We can expect the vast majority of kids to do quite well and go on to grow up, go to college and do everything parents want to see their kids do.”
Still, pediatric cancer remains the leading cause of death among children in the U.S. The Institute estimated that 1,790 children would die of cancer in 2017. And for parents and families of children with cancer, statistics about the rarity of pediatric cancer are the least of their concerns.
“As a parent who had two kids diagnosed with cancer, it certainly doesn’t feel rare,” said Sylvia Pelletier, president of Childhood Cancer Lifeline in Hillsborough. The nonprofit provides various support services to families of children with cancer. 
 
Finding a cause
The cause of pediatric cancer has remained elusive despite decades of research. Whitney Hammond, chronic disease director for the state’s Bureau of Population Health & Community Services, said the rareness of pediatric cancer in relation to all cancer cases makes it difficult to conduct research with a large enough sample size.
“About 15,000 children are diagnosed with cancer in the entire country, and that’s with all different kinds of pediatric cancers,” said Hammond. “When you really start to get down to children with leukemia or brain cancer or lymphoma, those numbers get relatively small.”
Pelletier said another roadblock to finding a cure is the disproportionate amount of funding for adult cancer compared to pediatric cancer. Because pediatric cancer makes up a smaller portion of overall cancer cases, she said that might affect the funding and donations directed toward research.   
According to data released by the National Institutes of Health, the federal government budgeted $6.6 billion for cancer research in Fiscal Year 2018. Only about $486 million was allocated specifically for pediatric cancer. 
“Child research can be used toward adult cancers, but that doesn’t always work the other way around,” said Pelletier. “We need to do whatever we can to find out what causes this so we can prevent future cases. It’s frustrating that we haven’t found the answer, but I hope we never stop asking why it happens.”
In New Hampshire specifically, the Department of Health and Human Services started an investigation in 2014 that examined a concentration of cancer cases among children in Greenland, New Castle, North Hampton, Portsmouth and Rye. A 2016 report from the department found a “small but higher than expected number” of children diagnosed with a type of sarcoma and a specific pediatric lung cancer when compared to the rest of Rockingham County. However, the department couldn’t find a cause, reporting that current research “does not currently link either cancer to a specific behavioral or environmental factor. Inherited or genetic predispositions to development of these cancers are possible.”
Nationally, the National Cancer Institute reported that about 5 percent of all cancers in children are caused by genetic mutations. Beyond that, it’s often difficult to pinpoint a direct cause due to the rarity of pediatric cancer and young people’s lack of exposure to common harmful habits and behaviors.
“Unlike for most adult cancers, kids usually aren’t exposed to things like smoking, tanning and drinking which can definitely increase cancer rates,” said Kim. “In most cases, kids have an acute onset. They may be fine one day and two weeks later they don’t feel so well.”
Kim said there might be some benefit to avoiding unnecessary radiations like X-rays, and Hammond added that exposure to radiation from chemotherapy is a risk factor for childhood cancer survivors. But in general, there isn’t much parents can do other than monitor their child’s health and behavior. Kim added that there’s rarely a delay in making a diagnosis when parents bring their children in for testing.
 
Long-term support
Hammond said the Department of Health and Human Services is providing information on various warning signs of pediatric cancer to primary care providers across the state, and working with these providers and oncologists at local hospitals to help build a more connected network for childhood cancer patients and survivors. Kim added that Dartmouth-Hitchcock and the general field of pediatric oncology has continued to improve its focus on long-term care for children in remission. 
“Because of the pediatric age range, we worry about what’s going to happen years down the road,” said Kim. “We have a long-term follow-up clinic to make sure children understand the side effects and long-term risks of their specific cancer.”
Beyond medical treatment, Pelletier of Childhood Cancer Lifeline said emotional and financial support are significant needs for families with children diagnosed with cancer. Pelletier and her family were part of a group of four families who formed the nonprofit in 1995, all of whom had children with cancer. The goal of the organization was to bring together parents and children who know the struggles of pediatric cancer so they could provide this kind of support to other local families.
“We were all treated at different times and centers, but we all felt a sense of isolation when we came home every day,” said Pelletier. “We remember what it was like to struggle to find child care for siblings and how to afford putting gas in the car and dealing with insurance, and then still worrying at the end of the day if your child would be well.”
The nonprofit has raised over $473,000 in direct assistance to families across the state as well as Vermont families who are treated in New Hampshire at Dartmouth-Hitchcock. Last year alone the organization raised $83,000 to pay for groceries, bills, gas and more. 
Every Labor Day weekend, the nonprofit holds its Camp Winning Spirit event at YMCA Camp Coniston in Croydon. Families with children at any stage of their cancer diagnosis are invited for a free weekend of cabin camping, food and activities. About 30 to 35 families attend every year, and Pelletier said they have some parents who continue to attend after their child had died. 
“We recognize it’s important to build a network of support,” she said. “As long as you feel the need to come, you’re welcome.” 





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