The diagnosis and treatment of cancer are a stressful and threatening experience, which can be

emotionally devastating to children. Despite the improved prognosis, the course of cancer
treatment has tremendous impact on children. This article aims to examine the impact of cancer
on physical, emotional, and psychosocial well-being of Hong Kong Chinese children, an area of
research that has been underrepresented in the literature. Ninety-eight Hong Kong Chinese
children aged 7 to 15 years, admitted for treatment of cancer in 2 pediatric oncology units of 2
different hospitals, were invited to participate in the study. Findings from this study indicated
that the children scored considerably high state anxiety on admission, and more than half of the
participants presented some depressive symptoms during their stay in the hospital. Moreover,
semistructured interviews indicated that nearly all children expressed different degrees of
sadness and worry. The findings suggested that there is a room for improvement in existing
nursing intervention regarding preparing children for hospitalization and treatment of cancer.
There is an imperative need for nurses to evaluate appropriate nursing interventions that can help
children resume their normal growth and development, in particular, to help them ease the
physical, emotional, and psychological burden of life-threatening disease.

Coping
with the

physical

impact of

cancer
This page covers some of the more common side effects of different treatments and of cancer itself.
These symptoms will depend on the type of cancer. Not all or necessarily any will be experienced by
everyone. It is important that you tell your doctor or nurse if you have any side effects that worry
you.
It is also important to know that some side effects are temporary and will disappear when treatment
ends, others may be more long lasting and require specialist management from the treating team.

 Will cancer treatment make me tired?

 What is fatigue and how might it affect me?

 What causes fatigue?

 Are there ways to manage my fatigue?

 Will I experience nausea and vomiting?

 Is there information on nausea and vomiting?

 Will I experience pain?

 Is there information on managing pain?

 Will I lose my hair?

 How do I access the Wig Service?

 Where can I purchase Wigs?

 Does having cancer affect my sexuality?

 Is there information on sexuality and cancer?

 What is lymphoedema?

 Where can I get help to manage lymphoedema?

 Are there programs that could help give me confidence in my appearance whilst having

treatment?

 Will relaxation help me to cope with the side effects of cancer treatment?

 Why am I so worried about every little change in my body?

Will cancer treatment make me tired?

Fatigue is the most common side effect of cancer treatment. Fatigue due to cancer treatment is
different from everyday tiredness. It can occur suddenly. Unlike everyday tiredness, it is not
necessarily brought on by exercise or a long day’s activity. Resting does not always help relieve the
fatigue.
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What is fatigue and how might it affect me?

 Fatigue can affect how you think as well as how you feel.

 You may need more sleep.

 You may experience physical, emotional and/or mental exhaustion.

 Your body, especially your arms and legs, may feel heavy.

 You may have less desire to do normal activities, like eating or shopping.

 You may find it hard to concentrate or think clearly.

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What causes fatigue?
Cancer treatment-related fatigue is due to a range of causes.
It is common for chemotherapy to cause anaemia. This means there are fewer red blood cells to carry
oxygen through your body. Anaemia can also be caused by radiotherapy and sometimes through loss
of blood during surgery.
Other things related to your illness can make you feel tired such as not sleeping well, feeling stressed,
feeling depressed, coping with infections, some drugs, not exercising, and not eating properly.
Treatments are available for some of these causes of fatigue, so it is important to talk to your doctor.
[return to top]
Are there ways to manage my fatigue?
Over the last few years emerging evidence supports that fatigue can be best managed by participating
in an exercise program. You may like to participate in a Cancer Council WA Life Now exercise program
that is designed specially for cancer patients. This program is provided by a qualified exercise
physiologist or physiotherapist who carefully monitors your condition and recommends adjustments to
the intensity and volume of your exercise program. If there is not a Cancer Council Life Now Exercise
Program in your community then talk with your doctor or a nurse on the Cancer Council Helpline about
other options.
For further information on how to manage fatigue you can download the booklet Exercise for people
living with cancer (pdf 783kb). This is a 40 page booklet that aims to help people understand the
importance of exercise and also provides information about the benefits exercise may have during and
after cancer treatments. It provides information on getting started, training, overcoming common side
effects with exercise and sample exercises.
It may also be helpful to listen to the Life Now CD called Living with Cancer. This CD has some
information about living with the after effects of cancer and is available for you to download.
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Will I experience nausea and vomiting?
Some people experience nausea and vomiting while having their treatments. There are many ways to
reduce nausea and vomiting and also helpful medications that can be prescribed by your doctor. Don’t
wait for these symptoms to become severe. It is easier to control nausea and vomiting if relief
medications are prescribed early.
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Is there information on nausea and vomiting?
If you would like to read more tips about controlling nausea and vomiting the following booklets
contain information on this topic.
Understanding radiation therapy booklet (pdf 1977kb)

Understanding chemotherapy booklet (pdf 3.95mb)

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Will I experience pain?
Many people believe that cancer is always painful. This is not true. Some patients with cancer do not
experience cancer-related pain.
Some patients do experience pain associated with their cancer and its treatment. If cancer does cause
pain at some stage it is usually possible to control it.
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Is there information on managing pain?
It may be necessary for your doctor to prescribe pain medications as an option during or after
treatment so you don't experience too much discomfort. Pain relief medication helps patients stay as
comfortable as possible. It is easier to control pain if relief medications are prescribed early. If you
have any side effects from the medication tell your doctor promptly so they can be controlled or
prevented.
There are a few tips that can assist you to manage pain:

 Keep a diary of pain levels and other symptoms so that you can tell the doctor and the

healthcare team if there are any changes.

 Use a pain scale to help you communicate the amount of pain. A scale from 1 to 10 is used.

With 10 being the worst pain you have experienced.

 It can be important to take prescribed medication regularly.

 You may try relieving pain and discomfort with physical therapies such as hotwater bottles, ice

packs and/or massage, check with you doctor or specialist nurse.

If you would like more information about controlling pain you may want to look at the 16 page booklet
called Pain Medication, a guide for people with cancer, their carers family and friends (pdf 678kb). It
can also be ordered through the Cancer Council Helpline on 13 11 20.
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Will I lose my hair?
You may lose part or all of your hair whilst having treatment for cancer. Chemotherapy and
radiotherapy can cause hair to be lost from the head and other parts of the body. Hair loss due to
cancer treatment is usually temporary; it’s a significant event nevertheless.
If you are receiving chemotherapy and/or radiotherapy and are worried about hair loss, you may find
thebooklet Hair loss - what can I do? (pdf 4.97mb) helpful and reassuring. Topics include
chemotherapy, radiotherapy and hair loss, care of hair and scalp during treatment, coping with hair
loss, and choosing a wig or hairpiece. This is a 16 page booklet designed as a guide for people with
cancer, their families and friends. It can also be ordered through the Cancer Council Helpline on 13 11
20.
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How do I access the Wig Service?
Hair loss is usually only temporary. You may like to wear a wig, hat, scarf or turbans.
The Cancer Council WA offers a free wig service. You can borrow wigs, turbans and scarves at no cost
and for as long as required during cancer treatment.
The Wig Service also has a mail order service for country patients. For more information on the Cancer
Council Wig Service go to the Wig Service page.

Download a printable version of the Cancer Council Wig Service brochure (pdf 830kb).
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Where can I purchase Wigs?
The Cancer Council Wig Service brochure (pdf 830kb) and the Cancer Council Helpline have a list of
the various retail outlets that sell wigs suitable for cancer patients.
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Does having cancer affect my sexuality?
When you are first diagnosed with cancer, it’s natural to focus on getting well. You may not think
about or be interested in sexual contact or intimacy for a while. During or after treatment you may
start to think about the impact of cancer on your sexuality.
Having cancer doesn’t mean you are no longer a sexual person. However, treatment for cancer such
as surgery, chemotherapy, radiotherapy and hormone therapy can affect your sexuality. This includes
your interest in sex, your ability to give or receive sexual pleasure, how you see yourself and how you
think others see you. Some of these effects are temporary while others are long lasting. All can be
managed or controlled.
Sometimes a counsellor can help you find ways to help each other. You or your partner can also call
the Cancer Council Helpline on 13 11 20 for information about appropriate counselling services.
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Is there information on sexuality and cancer?
The following booklets can help you to understand and deal with the emotional and physical impact
that your cancer and its treatment may have on your sexuality. If you find the booklet helpful, pass it
on to your partner who may also find it useful.

 Sexuality: A guide for women with cancer, their families and friends (pdf 795kb).

 Sexuality: A guide for men with cancer, their families and friends. (pdf 1.62mb)

Copies of these booklets can be ordered from the Cancer Council Helpline on 13 11 20.
It may also be helpful to listen to the Life Now CD called Sexuality and Cancer. This CD has
information about the possible impact of cancer on your sexuality and some coping strategies. It is
available for you to download,
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What is lymphoedema?
Lymphoedema is swelling caused by a build-up of lymph fluid, usually in a limb extremity. This
happens when there is insufficient drainage in lymphatic vessels or lymph nodes. Lymphoedema can
occur following some cancer treatments especially where lymph nodes have been removed or
damaged by cancer treatment. The aim of lymphoedema treatment is to improve the drainage of fluid
and reduce swelling, pain and discomfort.
You may also find the information booklet called 'Lymphoedema - What you need to know' helpful.
This booklet is produced by the National Breast and Ovarian Cancer Centre and is developed to help
you understand the signs and symptoms of lymphoedema following treatment for cancer and what
you can do to help manage the condition if you develop it.
Regular Understanding Lymphoedema workshops are provided by the Cancer Council. Ring Cancer
Council Helpline to register for the workshops on 13 11 20.
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Where can I get help to manage lymphoedema?
The Cancer Council WA provides a comprehensive Lymphoedema Management Service, as well as
lymphoedema management workshops for clients with, or at risk of, developing lymphoedema after
cancer.
Some regional hospitals offer a lymphoedema management service that cancer patients can access
free of charge. You may need to ask you general practitioner or local cancer support service for their
details.
The Cancer Council Helpline also keep a list of accredited lymphoedema therapists that operate in
metropolitan and regional areas 13 11 20.
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Are there programs that could help give me confidence in my appearance whilst having
treatment?
Look Good Feel Better offer workshops for men, women and teenagers that can assist you to face
cancer with more confidence. These workshops teach you how to apply makeup, wigs, hats, scarves
and turbans. They are a lot of fun and help boost your self esteem , making you feel confident and
positive during treatment.
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Will relaxation help me to cope with the side effects of cancer treatment?
Reducing stress and finding a way to relax will often reduce side effects of cancer treatment.
Diversional activities such as listening to music, watching TV and regular exercise can be beneficial for
some people. For others attending a yoga relaxation and meditation group provided by the Cancer
Council can have added benefit of joining with other people who understand your needs.
For further information on coping with cancer and strategies to deal with symptoms you may like to
listen to the Life Now CDs that contain various relaxation and other strategies for people living with
cancer or call the helpline 13 11 20 to find your nearest group program.
[return to top]
Why am I so worried about every little change in my body?
A patient who has had cancer is likely to be more aware of his or her body and any symptoms
experienced can be frightening. You might find that a tummy upset, sore throat or cough worries you
more than it used to because it could mean the cancer has returned or is more active. This is a natural
reaction shared by many. When this happens to you speak to your doctor about your concerns.
The normal balance between you mind, body, emotions and spirit can become a significant challenge
following a cancer diagnosis and it can be helpful to speak to a professional counsellor.

How common is childhood cancer in the United States?

Childhood cancer is relatively rare -- only about 2 percent of all cancer cases occur in children. Each year,
about one out of every 15,000 children gets cancer. In 1998, the most recent year for which we have
data, about 12,400 U.S. children under 20 were found to have cancer. That same year, 2,500 children
died from the disease.

Rates of childhood cancer have risen over the past few decades, so the disease is more common now
than it once was. Cancer kills more children than any other disease, and is the second most common
cause of death in children, behind injuries. But while the number of new cases of childhood cancer has
risen, the death rate has decreased for most forms since 1970, largely because of improved treatments.

Is childhood cancer increasing?

It is clear that childhood cancer increased significantly from the early 1970s to the early 1990s, rising
about 1 percent each year during those two decades. Since the 1990s, rates of childhood cancer seem to
have leveled off, but there is no evidence of a decline back to pre-1980 rates. The reason for the dramatic
increase in childhood cancers during the seventies and eighties is still unclear. But many researchers feel
that genetic factors and improved diagnosis fail to explain it, making environmental factors the most likely
cause.

How do childhood and adult cancers differ?

Children's cancer is not only less frequent than adult cancer, it is also different. None of the most common
adult cancers -- prostate, breast, lung, colon -- are found in children. Instead, children tend to get
leukemias, brain tumors and other cancers of the blood and connective tissues. Adult cancers are thought
to occur because of years of cumulative damage to the cells. In children, this kind of long-term damage
has not had a chance to take place. Their cancers are thought to occur, instead, during periods of
vulnerability during early development, when the organs are still forming.

At what age does childhood cancer most often occur?

Childhood cancer most often strikes very young children. For that reason, even though it causes a
relatively small number of deaths, childhood cancer leads to many years of lost life -- about 70 per child
who does die. Forty percent of cases occur in children under five, with most occurring in children less
than a year old. The frequency of cancer then decreases, but rises again when children reach
adolescence.

Which cancers affect children most often?

Leukemia is the most common childhood cancer, representing 31.5 percent of cases in children under 15.
Next most common are central nervous system cancers including brain cancer (20.2 percent),
lymphomas including Hodgkin's disease and non-Hodgkin's lymphoma (10.7 percent), neuroblastoma and
other cancers of the nerves (7.8 percent), soft tissue sarcomas (7 percent), kidney cancers (6.3 percent)
and cancer of the bones (4.5 percent).
The patterns of these cancers vary by age. For infants, neuroblastoma is the most common form,
accounting for 28 percent of cases. Leukemia (17 percent), central nervous system cancers (13 percent),
retinoblastoma (12 percent) and Wilms tumor (9 percent) are the next most common. For children up to
15 years, the most common cancers are leukemia, brain and central nervous system cancers, lymphoma,
soft tissue sarcomas, kidney tumors and cancer of the bones.

What is the survival rate for childhood cancer?

For most forms of childhood cancer, the survival rate is high. Mortality (death) rates have decreased
dramatically since the 1970s as a result of improved treatment. An important exception is brain cancer.
Death rates for this form have actually climbed in recent years.

What are the effects of cancer treatment?

Today, the most important effect of cancer treatment is that children are likely to be cured. But treatments
for childhood cancer may lead to other health effects later in life, including developmental effects, other
cancers, organ damage, hormonal problems, infertility and premature death. And, of course, there is
another effect, much harder to measure: the anguish and disruption cancer treatment causes not only for
children, but also for their families.

Is childhood cancer caused by genetic or environmental factors?

Childhood cancer doesn't usually run in families, and there is little evidence for a strong genetic
predisposition. Evidence does exist, however, for environmental links with childhood cancer. But it will
most likely turn out that both genetic and environmental factors are involved. For example, some children
may have genetic predispositions toward cancer that are triggered by environmental exposures, or they
may be less able to tolerate exposure to a toxic or cancer-causing chemical. This may explain why some
children who are exposed to hazardous substances develop cancer, while many others do not.

What are the links between pesticides and childhood cancer?

Numerous research studies have uncovered links between pesticide exposure and childhood cancer.
Most of the research has focused on leukemia and brain tumors, and the majority of the studies have
found connections with pesticides. However, there are many uncertainties. For example, not all studies
identified a link with pesticides, and the studies that did find a link were usually unable to identify the
particular chemical that might have been responsible; instead, they found links with insecticide use
generally, or with working on a farm. It also remains unclear if there are certain people who are more
susceptible, and if there are certain times of life during which children are most vulnerable. Because of
these uncertainties, it is difficult to be sure what to protect children from. The best course is to decrease
or eliminate any unnecessary pesticide exposures.

What other environmental exposures may cause childhood cancer?

Research has linked childhood cancer to numerous environmental factors. Some of these may occur
before the child is even born. For example, parents who were exposed to solvents (such as paint
thinners, degreasers, glues or gasoline) on the job are more likely to have children who develop leukemia
or brain tumors. A few studies have found possible links between exposure to electromagnetic fields and
childhood leukemia, although these results are contradicted by several good studies that found no such
link. Ionizing radiation (such as that produced by nuclear bombs, nuclear power plants, and X-rays) is a
known cause of childhood cancer. Other likely links include cigarette smoke and radon gas.

Children With Cancer; Effects and Educational Implications

Sarah McDougal

Indiana University

December 11, 1997

 Introduction
 Types of Cancer and Their Treatments
 Effects of Cancer and Its Treatment
o Physical and Medical
o Psychological Effects Resulting from Appearance-Related Effects of Treatment
o Other Psychological Effects
o Cognitive and Neuropsychological Effects
o Educational Implications
 The Role of the Family
 The Role of the Teacher
 The Role of Peers
 The Role of the School Psychologist
 A Successful Reintegration Program
 Conclusion
 References

Introduction

Before the age of 19, one in every 330 children in the United States will develop some form of
cancer. Cancer is the number one cause of death due to disease in children aged one through
adolescence (National Children's Cancer Foundation, 1997). In 1997, approximately 8800 new
cases will be diagnosed, and approximately 1700 children will die (American Cancer Society,
1997).

However, cancer is no longer equated with death, as it was in the past (Glazer, 1991). As new
medical treatments and technologies are developed, more and more children each year are
survivors of cancer; over 60% of children with cancer survive the disease (Bleyer, 1990). These
children are able to continue normal lives during and after treatment. Thus, research relating to
the effects of cancer and cancer treatment and how they affect the child's ability to carry on a
normal life has become increasingly more important. More specifically, research regarding the
educational implications of the child's illness has become vital to those who aid in the transition
process from medical center to classroom. Children with cancer may experience medical and
physical effects, psychological effects, and cognitive and neuropsychological effects, all of
which may impact a child's experience upon reentry into the classroom.

The present paper examines the effects of various types of childhood cancer and their treatments,
as well as the educational issues that may result from the illness and its treatments. It also
examines the roles of the family, the teacher, peers, and the school psychologist in the hospital-
to-school transition; each plays an important part in helping the child to adjust successfully to the
school environment.

Types of Cancer and Their Treatments

Leukemia

Leukemia is the most common pediatric malignancy; it accounts for 39% of all childhood
cancers (National Children's Cancer Foundation, 1997). Leukemia is cancer of the bone marrow,
characterized by an abundance of abnormal white blood cells. Children with leukemia tend to
show symptoms such as anemia, bleeding, fever, an increased susceptibility to infection, easy
bleeding and bruising, enlarged lymph nodes, liver, and spleen, and bone pain.

There are two types of leukemia: acute lymphoblastic leukemia (ALL) and acute
nonlymphoblastic leukemia (ANLL). Both involve a proliferation of abnormal blood cells in the
bone marrow, which prevents it from producing normal blood cells. ALL is the most common
type of leukemia, and occurs in the lymphoblasts, which is a type of white blood cells. Four out
of every 100,000 children in the United States have ALL, with peak occurrence from ages three
to six. ANLL, in contrast, is less common, occurring in one out of every 100,000 children in the
United States; its incidence increases throughout adolescence. It targets the white blood cells in
the marrow that are not lymphoblasts, and produces symptoms similar to the symptoms of ALL
(Granowetter, 1994).

Treatment for leukemia consists of different procedures, one of which is bone marrow
transplantation (BMT). During this treatment, high doses of chemotherapy and sometimes
radiation are administered to the patient to kill the existing bone marrow and its functioning.
Then, the patient receives the infusion of the replacement bone marrow. After this transfusion,
the bone marrow does not function normally, putting the patient at risk for infection, so the
patient is required to stay in protective isolation until normal bone marrow function begins,
which can take two to four weeks (Phipps, 1994). The patient is at-risk for serious complications
or death due to the lack of bone marrow functioning for an extended period of time, the high-
intensity therapy, or donor rejection or mismatch (Granowetter, 1994).

An additional risk for patients with ALL is that the cancer is prone to entering the central
nervous system (CNS), which requires further treatment for the patient. This treatment may
include additional chemotherapy or cranial radiation therapy (CRT). However, CRT is becoming
decreasingly common due to its linkage with significant neuropsychological problems post-
treatment (Brown & Madan-Swain, 1993; Mulhern, 1994). This issue will be addressed later in
the present paper. Treatment procedures for ALL result in a cure for 50-70% of patients
(Niemayer, Hitchcock-Bryan, & Sallan, 1985), while treatment procedures for ANLL result in
survival rates of 35% when chemotherapy is the only treatment (Gaynon, 1992) and 50-70%
when BMT is employed (Granowetter, 1994).

Brain Tumors

Brain tumors are the second-leading cause of childhood cancer, accounting for 15% of all
childhood malignancies. Brain tumors occur mainly in children between the ages of five and 10
(National Children's Cancer Foundation, 1997). Symptoms depend on the location of the tumor,
but may include headache, vision problems, vomiting, balance and coordination problems, and
cognitive and/or neurological deficits.

Most often, treatment of brain tumors requires surgical removal of the tumor, which includes
laser surgery and microsurgery. Some tumors, however, may not be completely removed, due to
their precarious location (for example, the brain stem); these tumors, in addition to recurring
tumors, may require chemotherapy and CRT (Granowetter, 1994). For treatment of brain cancer,
the 5-year survival rate can range from 15-20% for a more serious tumor to 70% for a less
serious tumor (Duffner, Cohen, & Freeman, 1985).

Lymphomas

Lymphomas account for ten percent of all childhood cancers (National Children's Cancer
Foundation, 1997). Lymphoma is cancer of the lymph nodes of which there are two types: non-
Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma.

NHL is most common in preadolescents and adolescents. Its most common symptoms "include
enlarged lymph nodes, difficulty breathing because of enlarged lymph nodes in the chest, an
abdominal tumor from enlarged lymph nodes, fevers, weight loss, and lethargy" (Granowetter,
1994, p. 25). This cancer tends to metastasize to other areas rapidly, most commonly to the
bones, CNS, and the bone marrow. Due to the link between the lymph node system and the
immune system, Horowitz and Pizzo (1990) predict that the incidence of NHL may increase as
the number of children with the AIDS virus increases.

Hodgkin's lymphoma "differs from NHL in that it usually demonstrates a slower onset and an
orderly progression, involving contiguous lymph node areas" (Granowetter, 1994, p. 26). Its
peak incidence occurs in late adolescence, early adulthood, and middle age.

Treatments for lymphomas may include chemotherapy, medication, radiation therapy, and
possibly CRT (if the cancer has spread to the CNS). Treatment may be inpatient or outpatient,
and although the survival rate depends on the type of lymphoma, the prognosis is excellent in
general (Granowetter, 1994); the American Cancer Society (1997) reports that the five-year
survival rate is 92% for patients with Hodgkin's lymphoma.

Wilms' Tumor
Wilms' Tumor, or cancer of the kidney, accounts for 6% of childhood cancers (National
Children's Cancer Foundation, 1997). Its peak incidence is in children ages two to three. There
may be no obvious symptoms, although the parent or child might notice a lump or swelling in the
abdominal area.

Treatment usually consists of surgical removal of the tumor and chemotherapy. If the cancer has
spread to the chest or other areas, the patient may receive radiation therapy. Treatment is
normally done on an outpatient basis (Granowetter, 1994). Prognosis for Wilms' Tumor is
excellent; the National Children's Cancer Foundation (1997) reports the five-year survival rate as
93%.

Neuroblastoma

Neuroblastomas account for seven percent of childhood cancers, occurring mainly in very young
children. This cancer is characterized by tumors that start in the adrenal glands, chest and
abdomen. These tumors are highly malignant, and spread quickly. Symptoms may include fever,
bone pain, and abdominal swelling (American Cancer Society, 1997; Granowetter, 1994). If
caught early, treatment may only consist of surgical removal of the tumor (National Children's
Cancer Foundation, 1997). However, if the cancer has spread, the patient may require
chemotherapy, radiation therapy, and/or bone marrow transplantation. The sooner the cancer is
identified, the better the prognosis will be for the child, and the younger the child is, the better
his/her outlook seems to be (Granowetter, 1994). The overall survival rate for neuroblastoma is
61% (American Cancer Society, 1997).

Bone Tumors

Six percent of childhood malignancies are bone tumors (National Children's Cancer Foundation,
1997). Two common types of bone cancer are osteosarcoma and Ewing's sarcoma. Osteosarcoma
occurs mainly in children ages ten to 20. Its symptoms include a rapid growth spurt and swelling
at the tumor site (American Cancer Society, 1997; Granowetter, 1994). Treatment for
osteosarcoma is usually intensive and may interfere with normal functioning. It may include
tumor removal, chemotherapy, and possibly amputation. Ewing's sarcoma consists of tumors that
are found in the marrow spaces between the bones (National Children's Cancer Foundation,
1997). Like osteosarcoma, its peak incidence is from ages ten to 20. Ewing's sarcoma also
requires intensive treatment; the patient may receive aggressive chemotherapy for approximately
one year, then the tumors are surgically removed, and then the patient receives radiation therapy
with continued chemotherapy (Granowetter, 1994). For all bone cancers, the five-year survival
rate is estimated at 65% (American Cancer Society, 1997).

Retinoblastoma

Retinoblastoma is cancer of the eye. It is often present at birth, and 40% of the cases are
hereditary. It occurs in one out of every 18,000 births, and is usually identified by age three.
Symptoms include squinting and other vision problems. Retinoblastoma has various treatments;
the most severe cases may require chemotherapy and/or radiation therapy. If treated early, a
complete cure is possible (Granowetter, 1994).
 Effects of Cancer and Its Treatment

Physical and Medical

There are numerous physical and medical conditions that may arise as a result of cancer and its
various treatments. Chemotherapy, radiation therapy, BMT, and surgeries have different effects
on each child; these effects depend on the methods employed and the aggressiveness of the
treatment. Children who have undergone BMT and total body irradiation (TBI) often experience
thyroid dysfunction, growth delay, problems with sexual maturation and fertility, and cataract
development (Phipps, 1994). Meadows and Silber (1985) name several other long-term
conditions that can occur as a result of cancer treatments, including scoliosis, dental and facial
problems, cardiac abnormalities, pulmonary abnormalities, liver damage, urinary tract problems,
and amputation. Mulhern, Wasserman, Friedman, and Fairclough (1989) add scars (due to
surgical removal of tumors), immature development of organs, and hearing loss to this list.
Kazak (1994) acknowledges that various short-term problems may result as well, including
weight gain or weight loss and hair loss.

Psychological Effects Resulting from Appearance-Related Effects of Treatment

Undoubtedly, changes in physical appearance have psychological implications for youths that
have undergone cancer treatment. In general, a poor body image is associated with self-rankings
of academic, social, and psychological impairment, low self-esteem, and symptoms of
depression (Hesse-Biber, Clayton-Matthews, & Downey, 1987; Noles, Cash, & Winstead, 1985;
Silberstein, Striegel-Moore, Timko, & Rodin, 1988). A study by Varni, Katz, Colegrove, and
Dolgin (1995) showed these associations to be true as well in children with cancer. In this study,
30 children ages 8-13 with varying types of cancer showed that a more positive perception of
one's physical appearance was significantly correlated with fewer depressive symptoms, less
social anxiety, and a higher self-esteem. Bolstering these results are results from a study of 21
cancer survivors ages 11-21 conducted by Pendley, Dahlquist, and Dreyer (1997). This study
showed that the more the subject perceived that his or her appearance was affected by cancer, the
worse he or she tended to rate social adjustment, which included feelings of loneliness and social
anxiety.

Other Psychological Effects

Psychological issues related to physical appearance are not the only issues that a child with
cancer or a cancer survivor may experience. Kazak (1994) acknowledges that "the data are clear
in stating that most childhood cancer survivors do not have clinically significant psychological
difficulties and most function well. However, a troubling subset of survivors do have significant
difficulties, which we do not presently understand very well" (p. 179). Researchers have found a
variety of these psychological difficulties in children affected by cancer. These reactions and
conditions include anxiety and panic (both chronic and acute) (Kazak et. al, 1997); inhibited and
withdrawn behavior; fear of trying new things; low emotional expressiveness (Stehbens, Kisker,
& Wilson, 1983); behavior problems (Carpentieri, Mulhern, Douglas, Hanna, & Fairclough,
1993); an excessive number of unfounded somatic complaints (Mulhern et al., 1989); intense
stress (Kazak & Christakis, 1996); post-traumatic stress disorder (PTSD) (Stuber, Nader,
Yasuda, Pynoos, & Cohen, 1991); frustration and discouragement related to school difficulties
(Kazak, Christakis, Alderfer, & Coiro, 1994); peer relationship difficulties (La Greca, 1990); loss
of independence (especially during adolescence); concern about ability to attract the opposite
sex; and worries about the future in relation to career and relationships (Stevens & Dunsmore,
1996). Varni, Katz, Colegrove and Dolgin (1994) offer a reason for these psychological
difficulties; they state that "the chronic strains of childhood cancer, such as treatment-related
pain; nausea and vomiting; visible side effects such as hair loss, weight gain or loss, and physical
disfigurement; and repeated absences from school and peers, interact to negatively impact social
and psychological adjustment""(p. 20).

There are numerous factors, however, which seem to predict better psychological adjustment for
children with cancer. As mentioned earlier, the less they believe their physical appearance is
affected by cancer, the better their adjustment seems to be (Pendley et al., 1997). Furthermore,
having high levels of support from the family, classmates, the school, and the hospital predicts
better adjustment (Kazak, 1994; Varni et al., 1994). Furthermore, social skills training has been
shown to improve adjustment; "social skills training is hypothesized to facilitate adaptation by
teaching the child a set of social skills that are particularly relevant to cancer and its treatment"
(Varni, Katz, Colegrove, & Dolgin, 1993, p. 753). Additional factors that are related to positive
adjustment are the use of successful coping strategies; the absence of learning difficulties; the
absence of functional and physical limitations; and not coming from a single-parent home
(Kazak, 1994; Kazak, Christakis, Alderfer, & Coiro, 1994; Mulhern et al., 1989).

Cognitive and Neuropsychological Effects

Currently, data are mixed regarding the long-term effects of various cancer treatments on
cognitive abilities. However, studies show that certain treatments may have an adverse effect on
IQ. In a review of the literature regarding this area, Mulhern (1994) reports that research on
children with ALL and brain tumors shows that having CRT may be related to a decrease in IQ
scores. He reports that these effects seem to be increased if the child received CRT at a young
age and if the child is female. In addition, the more time that passes since treatment, the more
impaired intellectual functioning seems to become. Furthermore, having a brain tumor in certain
vulnerable parts of the brain may cause neurological impairments as well. Mulhern (1994)
reports specific neuropsychological difficulties in children who have received these treatments,
which include difficulties with higher conceptual abilities, memory functioning, visual-motor
functioning, visuographic abilities, and fine motor skills. Brown and Madan-Swain (1993) report
these difficulties in their review of literature on the topic, as well as various signs of attention
deficit hyperactivity disorder (ADHD), such as distractibility, impulsivity, and concentration
problems.

Not only does CRT seem to have an effect on learning ability, but certain chemotherapeutic
agents may cause side effects that impact learning as well. Children with brain tumors, ALL, and
solid tumors who have received chemotherapy reported fatigue, decreased energy, motor
weakness, hearing impairment, and irritability (Armstrong & Horn, 1995). However, the side
effects of the chemotherapy may not be all that affects learning; the chemotherapy itself may
also negatively affect cognitive abilities. Brown et al. (1996) compared children who had
received chemotherapy that affected the CNS to children who had received chemotherapy that
did not affect the CNS. Their results showed that those who had received the CNS chemotherapy
had poorer academic achievement, as measured by tests in reading, spelling, and arithmetic.

Educational Implications

Under P.L. 94-142, children with identified disabilities are entitled to a free and appropriate
public education. Students with cancer may fall under the category of "orthopedically impaired"
or "other health impaired", since children with cancer may have "limited strength, vitality, or
alertness due to chronic or acute health problems_which adversely affect educational
performance" (P.L. 94-142, 1975). In addition, children with cancer may be eligible to receive
related services that will help them to benefit fully from their educational experience, such as
audiology and speech pathology, counseling and psychological services, medical services,
occupational and physical therapy, and school health services (e.g., services provided by the
school nurse).

Students with academic difficulties may be eligible to receive assistance in a special education
program. Kazak et al. (1994) report that 25% of their sample of long-term cancer survivors
received special school services related to learning problems. The need for the availability of
special education for this population becomes clear when one considers that almost 30% of adult
cancer survivors report having academic difficulties (Lansky, List, & Ritter-Sterr, 1986).

Contributing to the learning problems which many students with cancer face is the high rate of
absenteeism that may result from hospitalizations, treatments, and treatment side effects.
Children with leukemia report missing up to 10-20 weeks of school in one year, and as a result,
many children repeat grades (Deasy-Spinetta, 1981; Mulhern et al., 1989).

Given the documented psychosocial problems and academic difficulties, thorough attention must
be given to all aspects of the difficulties that face children with cancer. It is beneficial to look at
the issues surrounding childhood cancer in light of the systems in which the child exists, namely
the family and the school.

School reentry is one issue in which both the family and the school play important roles.
Returning to a normal routine as soon after diagnosis as possible is crucial for the child with
cancer, as this normalcy has a significant effect on a child's general adjustment and self-esteem.
School to a child is like work to an adult, and when a child is out of school for a long period of
time, he or she may experience reactions such as depression, apathy, and poor self-concept, as if
he or she was "unemployed" (Katz, 1980).

The Role of the Family

Family members of a child with cancer may suffer various forms of distress in regards to the
child's illness. Parents report feelings of uncertainty, loneliness, low self-esteem, symptoms of
PTSD, and distress related to the adjustment of the child's siblings (Kazak et al., 1997; Van
Dongen-Melman et al., 1995). These problems may be exacerbated if the parents are of low SES,
have no religious affiliation, have chronic illness in another family member, and have other
concurrent stresses in their life (Van Dongen-Melman et al., 1995).
Parents' attitudes about school reentry may reflect this distress, and they may delay or discourage
school reentry based on their feelings of uncertainty about the child's future. In addition, parents
may feel that the emotional and physical effort of returning to school will be "too much" for the
child (Lansky et al., 1983). In addition, research has shown that both parent and child may
display separation anxiety which manifests itself as school phobia; the child may express somatic
complaints, which the parent responds to by allowing the child to stay home from school, and
this pattern of absenteeism becomes a cycle in which the child ultimately refuses to attend school
at all (Lansky et al., 1975).

Researchers have provided guidelines for parents to follow in order to facilitate a successful
school reentry after cancer diagnosis and treatment. First, parents should provide the school with
accurate and up-to-date medical information, and they should communicate effectively and
regularly with school personnel regarding the child's condition. Also, parents should encourage
and facilitate continued interactions with classmates and peers. Parents should ensure that the
child keeps up with his or her school assignments. Finally, parents should encourage the child to
participate in ordinary tasks, responsibilities, and school activities (Sexson & Madan-Swain,
1993; Spinetta & Deasy-Spinetta, 1986). By following such guidelines, parents not only facilitate
a return to the normal routine, but they also show the child that they have an optimistic
expectation that the child will survive (Deasy-Spinetta & Spinetta, 1980).

The Role of the Teacher

The teacher plays a crucial role in facilitating a smooth transition back into the classroom for the
child with cancer. There are several aspects to this role, one of which is knowledge of all
relevant information about the child and his or her illness. The teacher should be aware of the
type of cancer that the child has, its symptoms, the prognosis, and the treatments and their side
effects. Also, the teacher should be aware of the wishes of the parents and the child regarding
what they want the classmates and other school personnel to know about the child's illness.
Additionally, the teacher should be knowledgeable regarding the effects of the disease and
treatments, and how these effects can affect certain skills needed for learning, such as attention,
memory, nonverbal skills, language skills, and motor skills. The teacher should be aware of the
psychological effects of cancer and be prepared to deal with issues such as anxiety, behavior
problems, emotional difficulties, peer relationship difficulties, and frustration related to school
difficulties. Finally, the teacher should receive a schedule of upcoming medical appointments, so
that they can help the child prepare ahead for absences (Nessim & Katz, 1995).

The teacher also is instrumental in preparing the class for the child's return. The teacher should
have a classroom presentation given by a hospital/school liaison regarding the child's disease, the
purpose of which is to explain what is going on, answer questions, and clarify stereotypes about
cancer (Goodell, 1984; Katz, 1985; Nessim & Katz, 1995). If the child is currently unable to
attend school, the teacher can facilitate classmate support by encouraging contact with the child
(Chekryn, Deegan, & Reid, 1986).

The teacher should use the knowledge that he or she has about the effects of treatments in his or
her teaching methods and disciplinary practices. The child may show academic and behavioral
problems that are a result of treatment, and thus the teacher will need to adjust to the needs of the
individual student. However, the teacher should maintain appropriate expectations regarding the
child's schoolwork (Henning & Fritz, 1983).

The Role of Peers

Peer support is extremely important to the child with cancer during school reintegration. As
mentioned previously, higher perceived social support from classmates is correlated with higher
psychosocial adjustment for children with cancer. LaGreca (1989) agrees with this assertion; i.e.,
the more the disease interferes with the social functioning of the child, the more it may
compromise the general psychosocial adaptation of the child. Furthermore, peers are likely to
influence treatment and medication compliance; i.e., a child is more likely to ignore treatment
and medication rules if they interfere with social situations (LaGreca, 1989).

Thus, dissemination of information to peers is crucial. If peers are knowledgeable and informed
about the disease, they seem to be more likely to accept and interact with children with cancer
(Mabe, Riley, & Treiber, 1987). Children's knowledge about the disease varies according to
individuals and developmental level; elementary school students are likely to ask questions such
as "What is cancer?" "Can he/she die from it?" "Can I get cancer?" "Can he/she still play?" "Can
we talk about it or should we ignore it?" Middle school and high school students tend to ask
harder, more theoretical questions (Peckham, 1993; Sexson & Madan-Swain, 1993). Children
tend to have many misconceptions about the disease, and these conversations are crucial to
dispelling myths that may affect the way in which peers treat the child.

The Role of the School Psychologist

Nessim and Katz (1995) delineate the role of the school psychologist during school reintegration
as follows: a) to educate parents, medical personnel and school personnel about the special needs
of the child; b) to teach parents how to gain access to services within the educational system; c)
to help teachers provide an effective learning environment based on the child's individual needs;
d) to educate peers about the child's situation so that they can be accepting and supportive; and e)
to work directly with the child or adolescent to ensure adjustment, both academically and
socially.

Nessim and Katz also suggest some more specific functions that the school psychologist should
perform before the child's return to school. If possible, the school psychologist should conduct a
pre-treatment baseline assessment of cognitive and academic functioning and then a post-
treatment assessment. In addition, periodic assessments should be done as well in the years
following treatment. The purpose of the continuous testing is to assess the possible effects of the
treatment, as well as to determine if treatments negatively affect abilities that emerge at different
developmental periods (Armstrong & Horn, 1995; Nessim & Katz, 1995). Not only should the
school psychologist assess cognitive abilities, but he or she should also assess psychosocial
functioning. It is important to identify children and teens that are at-risk for poor psychosocial
adjustment, so that they can receive prompt and appropriate intervention.

In addition to assessment, Nessim and Katz recommend that the school psychologist act as a
liaison between the regular classroom teacher and home or hospital teachers in order to ensure
that educational services are adequately received during absences. It is important that the student
stay as current as possible in his or her studies; Lansky, Lowman, and Vats (1975) found that
daily inpatient teaching in hospitals improved school performance, decreased anxiety about
school return, and positively influenced the overall experience of children with cancer. In
addition, encouraging the child to keep up with his or her studies may "assure him that health
professionals believe treatment might be successful and that it is appropriate to plan for the
future" (Battista, 1986).

At the time of the child's return, the school psychologist has additional functions to perform
(Nessim & Katz, 1995). First, the school psychologist should arrange conferences with relevant
individuals to ensure a smooth transition back to the school. He or she should meet first with the
family, to prepare them for the child's return and inquire about their wishes and needs. Then he
or she should meet with medical personnel and school personnel, so that this information can be
communicated as well as specific information regarding medical and educational issues. This
step is important to establish the school psychologist's role as the liaison during the reentry
process. Teachers want to know specific medical information about the student's illness, side
effects the child has experienced, learning difficulties that may occur, psychological effects of
the illness on the child, and how to talk with the student about cancer (Fryer, Finch, Saylor, &
Smith, 1989). Thus, the school psychologist should obtain this information from the parents and
medical personnel so that they can disseminate it to the teachers and other relevant school
personnel.

Second, the school psychologist should function as an aid to parents during this process. He or
she should help them gain access to available school services, as well as aid them in going
through the IEP process, if necessary. Additionally, he or she can discuss other possible
interventions that may become necessary as the child progresses through school, such as social
skills training or additional tutoring.

Third, the school psychologist should set up the classroom presentation, the purpose of which, as
stated earlier, is to provide information to classmates, dispel stereotypes about cancer, and to
help the peers to be less anxious and more supportive of their classmate with cancer. During the
presentation, the school psychologist should describe the patient's hospital experiences, provide
the class with information about the child's specific illness and treatments, discuss social support
and teasing, and establish the patient as the expert on his or her disease and treatment. It is
important to keep in mind developmental issues when conducting a classroom presentation
(Katz, Rubinstein, Hubert, & Blew, 1988).

Finally, due to the vast amount of psychological issues that the child with cancer and his or her
family may experience, the school psychologist should either provide counseling or refer the
child and family to counseling. This counseling may consist of support groups, individual
counseling, or social skills training. In addition to providing support to the child and family, the
school psychologist may need to offer support to school personnel as well. Chekryn, Deegan,
and Reid (1987) found that teachers expressed feelings of shock, worry, uncertainty and
frustration regarding having a child with cancer in their classroom. Some teachers sought out the
school nurse for support and information; however, teachers reported that a lack of visibility, a
lack of accessibility, and a lack of rapport prevented them from receiving support from the
school nurse. Thus, the school psychologist should establish him or herself as a source of support
and information for teachers.

A Successful Reintegration Program

Nessim and Katz (1995) have developed The Cancervive Teacher's Guide for Kids with Cancer,
which goes along with the School Reintegration Program developed by Ernest Katz. This
program is research-based and extremely comprehensive, and consists of the school psychologist
functioning in the capacities suggested above by Nessim and Katz. The accompanying guide acts
as a resource for teachers who have a student with cancer. It addresses a variety of relevant
topics, such as medical information about cancer, cancer treatment, emotional impact of cancer,
role of school personnel in school transition, possible academic effects of treatment, how to deal
with classmate reactions, coping with medical crises, and follow-up for cured youths. In
addition, the guide provides a sample classroom presentation and a list of resources for
information on cancer.

Studies evaluating the program showed that it was highly effective. Children with cancer who
were a part of this project showed fewer behavior problems; less internalizing behavior; fewer
symptoms of depression; greater perceived social, academic, and physical competence; less
anxiety; and greater levels of developmentally appropriate behavior (Nessim and Katz, 1995).
Furthermore, evaluations of the program by teachers, parents, and children have been very
positive (Katz, Varni, Rubenstein, Blew, and Hubert, 1992).

Conclusion

More and more children survive cancer each year due to improvements in medical technology
and treatments. These cancer survivors face not only the issues that surround the illness and its
treatments, but also medical and physical, psychological, cognitive and neuropsychological, and
social issues. As the child returns to school, he or she must face these issues that inevitably
impact school adjustment and performance. Without intervention, these issues may have
negative, long-lasting effects. Thus, it is crucial that a comprehensive plan involving the family,
peers, the teacher, and the school psychologist be implemented for the school reintegration
process of a child with cancer.

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Children With Cancer; Effects and Educational Implications

Sarah McDougal

Indiana University

December 11, 1997

 Introduction
 Types of Cancer and Their Treatments
 Effects of Cancer and Its Treatment
o Physical and Medical
o Psychological Effects Resulting from Appearance-Related Effects of Treatment
o Other Psychological Effects
o Cognitive and Neuropsychological Effects
o Educational Implications
 The Role of the Family
 The Role of the Teacher
 The Role of Peers
 The Role of the School Psychologist
 A Successful Reintegration Program
 Conclusion
 References

Introduction

Before the age of 19, one in every 330 children in the United States will develop some form of
cancer. Cancer is the number one cause of death due to disease in children aged one through
adolescence (National Children's Cancer Foundation, 1997). In 1997, approximately 8800 new
cases will be diagnosed, and approximately 1700 children will die (American Cancer Society,
1997).

However, cancer is no longer equated with death, as it was in the past (Glazer, 1991). As new
medical treatments and technologies are developed, more and more children each year are
survivors of cancer; over 60% of children with cancer survive the disease (Bleyer, 1990). These
children are able to continue normal lives during and after treatment. Thus, research relating to
the effects of cancer and cancer treatment and how they affect the child's ability to carry on a
normal life has become increasingly more important. More specifically, research regarding the
educational implications of the child's illness has become vital to those who aid in the transition
process from medical center to classroom. Children with cancer may experience medical and
physical effects, psychological effects, and cognitive and neuropsychological effects, all of
which may impact a child's experience upon reentry into the classroom.
The present paper examines the effects of various types of childhood cancer and their treatments,
as well as the educational issues that may result from the illness and its treatments. It also
examines the roles of the family, the teacher, peers, and the school psychologist in the hospital-
to-school transition; each plays an important part in helping the child to adjust successfully to the
school environment.

Types of Cancer and Their Treatments

Leukemia

Leukemia is the most common pediatric malignancy; it accounts for 39% of all childhood
cancers (National Children's Cancer Foundation, 1997). Leukemia is cancer of the bone marrow,
characterized by an abundance of abnormal white blood cells. Children with leukemia tend to
show symptoms such as anemia, bleeding, fever, an increased susceptibility to infection, easy
bleeding and bruising, enlarged lymph nodes, liver, and spleen, and bone pain.

There are two types of leukemia: acute lymphoblastic leukemia (ALL) and acute
nonlymphoblastic leukemia (ANLL). Both involve a proliferation of abnormal blood cells in the
bone marrow, which prevents it from producing normal blood cells. ALL is the most common
type of leukemia, and occurs in the lymphoblasts, which is a type of white blood cells. Four out
of every 100,000 children in the United States have ALL, with peak occurrence from ages three
to six. ANLL, in contrast, is less common, occurring in one out of every 100,000 children in the
United States; its incidence increases throughout adolescence. It targets the white blood cells in
the marrow that are not lymphoblasts, and produces symptoms similar to the symptoms of ALL
(Granowetter, 1994).

Treatment for leukemia consists of different procedures, one of which is bone marrow
transplantation (BMT). During this treatment, high doses of chemotherapy and sometimes
radiation are administered to the patient to kill the existing bone marrow and its functioning.
Then, the patient receives the infusion of the replacement bone marrow. After this transfusion,
the bone marrow does not function normally, putting the patient at risk for infection, so the
patient is required to stay in protective isolation until normal bone marrow function begins,
which can take two to four weeks (Phipps, 1994). The patient is at-risk for serious complications
or death due to the lack of bone marrow functioning for an extended period of time, the high-
intensity therapy, or donor rejection or mismatch (Granowetter, 1994).

An additional risk for patients with ALL is that the cancer is prone to entering the central
nervous system (CNS), which requires further treatment for the patient. This treatment may
include additional chemotherapy or cranial radiation therapy (CRT). However, CRT is becoming
decreasingly common due to its linkage with significant neuropsychological problems post-
treatment (Brown & Madan-Swain, 1993; Mulhern, 1994). This issue will be addressed later in
the present paper. Treatment procedures for ALL result in a cure for 50-70% of patients
(Niemayer, Hitchcock-Bryan, & Sallan, 1985), while treatment procedures for ANLL result in
survival rates of 35% when chemotherapy is the only treatment (Gaynon, 1992) and 50-70%
when BMT is employed (Granowetter, 1994).
Brain Tumors

Brain tumors are the second-leading cause of childhood cancer, accounting for 15% of all
childhood malignancies. Brain tumors occur mainly in children between the ages of five and 10
(National Children's Cancer Foundation, 1997). Symptoms depend on the location of the tumor,
but may include headache, vision problems, vomiting, balance and coordination problems, and
cognitive and/or neurological deficits.

Most often, treatment of brain tumors requires surgical removal of the tumor, which includes
laser surgery and microsurgery. Some tumors, however, may not be completely removed, due to
their precarious location (for example, the brain stem); these tumors, in addition to recurring
tumors, may require chemotherapy and CRT (Granowetter, 1994). For treatment of brain cancer,
the 5-year survival rate can range from 15-20% for a more serious tumor to 70% for a less
serious tumor (Duffner, Cohen, & Freeman, 1985).

Lymphomas

Lymphomas account for ten percent of all childhood cancers (National Children's Cancer
Foundation, 1997). Lymphoma is cancer of the lymph nodes of which there are two types: non-
Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma.

NHL is most common in preadolescents and adolescents. Its most common symptoms "include
enlarged lymph nodes, difficulty breathing because of enlarged lymph nodes in the chest, an
abdominal tumor from enlarged lymph nodes, fevers, weight loss, and lethargy" (Granowetter,
1994, p. 25). This cancer tends to metastasize to other areas rapidly, most commonly to the
bones, CNS, and the bone marrow. Due to the link between the lymph node system and the
immune system, Horowitz and Pizzo (1990) predict that the incidence of NHL may increase as
the number of children with the AIDS virus increases.

Hodgkin's lymphoma "differs from NHL in that it usually demonstrates a slower onset and an
orderly progression, involving contiguous lymph node areas" (Granowetter, 1994, p. 26). Its
peak incidence occurs in late adolescence, early adulthood, and middle age.

Treatments for lymphomas may include chemotherapy, medication, radiation therapy, and
possibly CRT (if the cancer has spread to the CNS). Treatment may be inpatient or outpatient,
and although the survival rate depends on the type of lymphoma, the prognosis is excellent in
general (Granowetter, 1994); the American Cancer Society (1997) reports that the five-year
survival rate is 92% for patients with Hodgkin's lymphoma.

Wilms' Tumor

Wilms' Tumor, or cancer of the kidney, accounts for 6% of childhood cancers (National
Children's Cancer Foundation, 1997). Its peak incidence is in children ages two to three. There
may be no obvious symptoms, although the parent or child might notice a lump or swelling in the
abdominal area.
Treatment usually consists of surgical removal of the tumor and chemotherapy. If the cancer has
spread to the chest or other areas, the patient may receive radiation therapy. Treatment is
normally done on an outpatient basis (Granowetter, 1994). Prognosis for Wilms' Tumor is
excellent; the National Children's Cancer Foundation (1997) reports the five-year survival rate as
93%.

Neuroblastoma

Neuroblastomas account for seven percent of childhood cancers, occurring mainly in very young
children. This cancer is characterized by tumors that start in the adrenal glands, chest and
abdomen. These tumors are highly malignant, and spread quickly. Symptoms may include fever,
bone pain, and abdominal swelling (American Cancer Society, 1997; Granowetter, 1994). If
caught early, treatment may only consist of surgical removal of the tumor (National Children's
Cancer Foundation, 1997). However, if the cancer has spread, the patient may require
chemotherapy, radiation therapy, and/or bone marrow transplantation. The sooner the cancer is
identified, the better the prognosis will be for the child, and the younger the child is, the better
his/her outlook seems to be (Granowetter, 1994). The overall survival rate for neuroblastoma is
61% (American Cancer Society, 1997).

Bone Tumors

Six percent of childhood malignancies are bone tumors (National Children's Cancer Foundation,
1997). Two common types of bone cancer are osteosarcoma and Ewing's sarcoma. Osteosarcoma
occurs mainly in children ages ten to 20. Its symptoms include a rapid growth spurt and swelling
at the tumor site (American Cancer Society, 1997; Granowetter, 1994). Treatment for
osteosarcoma is usually intensive and may interfere with normal functioning. It may include
tumor removal, chemotherapy, and possibly amputation. Ewing's sarcoma consists of tumors that
are found in the marrow spaces between the bones (National Children's Cancer Foundation,
1997). Like osteosarcoma, its peak incidence is from ages ten to 20. Ewing's sarcoma also
requires intensive treatment; the patient may receive aggressive chemotherapy for approximately
one year, then the tumors are surgically removed, and then the patient receives radiation therapy
with continued chemotherapy (Granowetter, 1994). For all bone cancers, the five-year survival
rate is estimated at 65% (American Cancer Society, 1997).

Retinoblastoma

Retinoblastoma is cancer of the eye. It is often present at birth, and 40% of the cases are
hereditary. It occurs in one out of every 18,000 births, and is usually identified by age three.
Symptoms include squinting and other vision problems. Retinoblastoma has various treatments;
the most severe cases may require chemotherapy and/or radiation therapy. If treated early, a
complete cure is possible (Granowetter, 1994).

Effects of Cancer and Its Treatment

Physical and Medical

There are numerous physical and medical conditions that may arise as a result of cancer and its
various treatments. Chemotherapy, radiation therapy, BMT, and surgeries have different effects
on each child; these effects depend on the methods employed and the aggressiveness of the
treatment. Children who have undergone BMT and total body irradiation (TBI) often experience
thyroid dysfunction, growth delay, problems with sexual maturation and fertility, and cataract
development (Phipps, 1994). Meadows and Silber (1985) name several other long-term
conditions that can occur as a result of cancer treatments, including scoliosis, dental and facial
problems, cardiac abnormalities, pulmonary abnormalities, liver damage, urinary tract problems,
and amputation. Mulhern, Wasserman, Friedman, and Fairclough (1989) add scars (due to
surgical removal of tumors), immature development of organs, and hearing loss to this list.
Kazak (1994) acknowledges that various short-term problems may result as well, including
weight gain or weight loss and hair loss.

Psychological Effects Resulting from Appearance-Related Effects of Treatment

Undoubtedly, changes in physical appearance have psychological implications for youths that
have undergone cancer treatment. In general, a poor body image is associated with self-rankings
of academic, social, and psychological impairment, low self-esteem, and symptoms of
depression (Hesse-Biber, Clayton-Matthews, & Downey, 1987; Noles, Cash, & Winstead, 1985;
Silberstein, Striegel-Moore, Timko, & Rodin, 1988). A study by Varni, Katz, Colegrove, and
Dolgin (1995) showed these associations to be true as well in children with cancer. In this study,
30 children ages 8-13 with varying types of cancer showed that a more positive perception of
one's physical appearance was significantly correlated with fewer depressive symptoms, less
social anxiety, and a higher self-esteem. Bolstering these results are results from a study of 21
cancer survivors ages 11-21 conducted by Pendley, Dahlquist, and Dreyer (1997). This study
showed that the more the subject perceived that his or her appearance was affected by cancer, the
worse he or she tended to rate social adjustment, which included feelings of loneliness and social
anxiety.

Other Psychological Effects

Psychological issues related to physical appearance are not the only issues that a child with
cancer or a cancer survivor may experience. Kazak (1994) acknowledges that "the data are clear
in stating that most childhood cancer survivors do not have clinically significant psychological
difficulties and most function well. However, a troubling subset of survivors do have significant
difficulties, which we do not presently understand very well" (p. 179). Researchers have found a
variety of these psychological difficulties in children affected by cancer. These reactions and
conditions include anxiety and panic (both chronic and acute) (Kazak et. al, 1997); inhibited and
withdrawn behavior; fear of trying new things; low emotional expressiveness (Stehbens, Kisker,
& Wilson, 1983); behavior problems (Carpentieri, Mulhern, Douglas, Hanna, & Fairclough,
1993); an excessive number of unfounded somatic complaints (Mulhern et al., 1989); intense
stress (Kazak & Christakis, 1996); post-traumatic stress disorder (PTSD) (Stuber, Nader,
Yasuda, Pynoos, & Cohen, 1991); frustration and discouragement related to school difficulties
(Kazak, Christakis, Alderfer, & Coiro, 1994); peer relationship difficulties (La Greca, 1990); loss
of independence (especially during adolescence); concern about ability to attract the opposite
sex; and worries about the future in relation to career and relationships (Stevens & Dunsmore,
1996). Varni, Katz, Colegrove and Dolgin (1994) offer a reason for these psychological
difficulties; they state that "the chronic strains of childhood cancer, such as treatment-related
pain; nausea and vomiting; visible side effects such as hair loss, weight gain or loss, and physical
disfigurement; and repeated absences from school and peers, interact to negatively impact social
and psychological adjustment""(p. 20).

There are numerous factors, however, which seem to predict better psychological adjustment for
children with cancer. As mentioned earlier, the less they believe their physical appearance is
affected by cancer, the better their adjustment seems to be (Pendley et al., 1997). Furthermore,
having high levels of support from the family, classmates, the school, and the hospital predicts
better adjustment (Kazak, 1994; Varni et al., 1994). Furthermore, social skills training has been
shown to improve adjustment; "social skills training is hypothesized to facilitate adaptation by
teaching the child a set of social skills that are particularly relevant to cancer and its treatment"
(Varni, Katz, Colegrove, & Dolgin, 1993, p. 753). Additional factors that are related to positive
adjustment are the use of successful coping strategies; the absence of learning difficulties; the
absence of functional and physical limitations; and not coming from a single-parent home
(Kazak, 1994; Kazak, Christakis, Alderfer, & Coiro, 1994; Mulhern et al., 1989).

Cognitive and Neuropsychological Effects

Currently, data are mixed regarding the long-term effects of various cancer treatments on
cognitive abilities. However, studies show that certain treatments may have an adverse effect on
IQ. In a review of the literature regarding this area, Mulhern (1994) reports that research on
children with ALL and brain tumors shows that having CRT may be related to a decrease in IQ
scores. He reports that these effects seem to be increased if the child received CRT at a young
age and if the child is female. In addition, the more time that passes since treatment, the more
impaired intellectual functioning seems to become. Furthermore, having a brain tumor in certain
vulnerable parts of the brain may cause neurological impairments as well. Mulhern (1994)
reports specific neuropsychological difficulties in children who have received these treatments,
which include difficulties with higher conceptual abilities, memory functioning, visual-motor
functioning, visuographic abilities, and fine motor skills. Brown and Madan-Swain (1993) report
these difficulties in their review of literature on the topic, as well as various signs of attention
deficit hyperactivity disorder (ADHD), such as distractibility, impulsivity, and concentration
problems.

Not only does CRT seem to have an effect on learning ability, but certain chemotherapeutic
agents may cause side effects that impact learning as well. Children with brain tumors, ALL, and
solid tumors who have received chemotherapy reported fatigue, decreased energy, motor
weakness, hearing impairment, and irritability (Armstrong & Horn, 1995). However, the side
effects of the chemotherapy may not be all that affects learning; the chemotherapy itself may
also negatively affect cognitive abilities. Brown et al. (1996) compared children who had
received chemotherapy that affected the CNS to children who had received chemotherapy that
did not affect the CNS. Their results showed that those who had received the CNS chemotherapy
had poorer academic achievement, as measured by tests in reading, spelling, and arithmetic.

Educational Implications
Under P.L. 94-142, children with identified disabilities are entitled to a free and appropriate
public education. Students with cancer may fall under the category of "orthopedically impaired"
or "other health impaired", since children with cancer may have "limited strength, vitality, or
alertness due to chronic or acute health problems_which adversely affect educational
performance" (P.L. 94-142, 1975). In addition, children with cancer may be eligible to receive
related services that will help them to benefit fully from their educational experience, such as
audiology and speech pathology, counseling and psychological services, medical services,
occupational and physical therapy, and school health services (e.g., services provided by the
school nurse).

Students with academic difficulties may be eligible to receive assistance in a special education
program. Kazak et al. (1994) report that 25% of their sample of long-term cancer survivors
received special school services related to learning problems. The need for the availability of
special education for this population becomes clear when one considers that almost 30% of adult
cancer survivors report having academic difficulties (Lansky, List, & Ritter-Sterr, 1986).

Contributing to the learning problems which many students with cancer face is the high rate of
absenteeism that may result from hospitalizations, treatments, and treatment side effects.
Children with leukemia report missing up to 10-20 weeks of school in one year, and as a result,
many children repeat grades (Deasy-Spinetta, 1981; Mulhern et al., 1989).

Given the documented psychosocial problems and academic difficulties, thorough attention must
be given to all aspects of the difficulties that face children with cancer. It is beneficial to look at
the issues surrounding childhood cancer in light of the systems in which the child exists, namely
the family and the school.

School reentry is one issue in which both the family and the school play important roles.
Returning to a normal routine as soon after diagnosis as possible is crucial for the child with
cancer, as this normalcy has a significant effect on a child's general adjustment and self-esteem.
School to a child is like work to an adult, and when a child is out of school for a long period of
time, he or she may experience reactions such as depression, apathy, and poor self-concept, as if
he or she was "unemployed" (Katz, 1980).

The Role of the Family

Family members of a child with cancer may suffer various forms of distress in regards to the
child's illness. Parents report feelings of uncertainty, loneliness, low self-esteem, symptoms of
PTSD, and distress related to the adjustment of the child's siblings (Kazak et al., 1997; Van
Dongen-Melman et al., 1995). These problems may be exacerbated if the parents are of low SES,
have no religious affiliation, have chronic illness in another family member, and have other
concurrent stresses in their life (Van Dongen-Melman et al., 1995).

Parents' attitudes about school reentry may reflect this distress, and they may delay or discourage
school reentry based on their feelings of uncertainty about the child's future. In addition, parents
may feel that the emotional and physical effort of returning to school will be "too much" for the
child (Lansky et al., 1983). In addition, research has shown that both parent and child may
display separation anxiety which manifests itself as school phobia; the child may express somatic
complaints, which the parent responds to by allowing the child to stay home from school, and
this pattern of absenteeism becomes a cycle in which the child ultimately refuses to attend school
at all (Lansky et al., 1975).

Researchers have provided guidelines for parents to follow in order to facilitate a successful
school reentry after cancer diagnosis and treatment. First, parents should provide the school with
accurate and up-to-date medical information, and they should communicate effectively and
regularly with school personnel regarding the child's condition. Also, parents should encourage
and facilitate continued interactions with classmates and peers. Parents should ensure that the
child keeps up with his or her school assignments. Finally, parents should encourage the child to
participate in ordinary tasks, responsibilities, and school activities (Sexson & Madan-Swain,
1993; Spinetta & Deasy-Spinetta, 1986). By following such guidelines, parents not only facilitate
a return to the normal routine, but they also show the child that they have an optimistic
expectation that the child will survive (Deasy-Spinetta & Spinetta, 1980).

The Role of the Teacher

The teacher plays a crucial role in facilitating a smooth transition back into the classroom for the
child with cancer. There are several aspects to this role, one of which is knowledge of all
relevant information about the child and his or her illness. The teacher should be aware of the
type of cancer that the child has, its symptoms, the prognosis, and the treatments and their side
effects. Also, the teacher should be aware of the wishes of the parents and the child regarding
what they want the classmates and other school personnel to know about the child's illness.
Additionally, the teacher should be knowledgeable regarding the effects of the disease and
treatments, and how these effects can affect certain skills needed for learning, such as attention,
memory, nonverbal skills, language skills, and motor skills. The teacher should be aware of the
psychological effects of cancer and be prepared to deal with issues such as anxiety, behavior
problems, emotional difficulties, peer relationship difficulties, and frustration related to school
difficulties. Finally, the teacher should receive a schedule of upcoming medical appointments, so
that they can help the child prepare ahead for absences (Nessim & Katz, 1995).

The teacher also is instrumental in preparing the class for the child's return. The teacher should
have a classroom presentation given by a hospital/school liaison regarding the child's disease, the
purpose of which is to explain what is going on, answer questions, and clarify stereotypes about
cancer (Goodell, 1984; Katz, 1985; Nessim & Katz, 1995). If the child is currently unable to
attend school, the teacher can facilitate classmate support by encouraging contact with the child
(Chekryn, Deegan, & Reid, 1986).

The teacher should use the knowledge that he or she has about the effects of treatments in his or
her teaching methods and disciplinary practices. The child may show academic and behavioral
problems that are a result of treatment, and thus the teacher will need to adjust to the needs of the
individual student. However, the teacher should maintain appropriate expectations regarding the
child's schoolwork (Henning & Fritz, 1983).

The Role of Peers

Peer support is extremely important to the child with cancer during school reintegration. As
mentioned previously, higher perceived social support from classmates is correlated with higher
psychosocial adjustment for children with cancer. LaGreca (1989) agrees with this assertion; i.e.,
the more the disease interferes with the social functioning of the child, the more it may
compromise the general psychosocial adaptation of the child. Furthermore, peers are likely to
influence treatment and medication compliance; i.e., a child is more likely to ignore treatment
and medication rules if they interfere with social situations (LaGreca, 1989).

Thus, dissemination of information to peers is crucial. If peers are knowledgeable and informed
about the disease, they seem to be more likely to accept and interact with children with cancer
(Mabe, Riley, & Treiber, 1987). Children's knowledge about the disease varies according to
individuals and developmental level; elementary school students are likely to ask questions such
as "What is cancer?" "Can he/she die from it?" "Can I get cancer?" "Can he/she still play?" "Can
we talk about it or should we ignore it?" Middle school and high school students tend to ask
harder, more theoretical questions (Peckham, 1993; Sexson & Madan-Swain, 1993). Children
tend to have many misconceptions about the disease, and these conversations are crucial to
dispelling myths that may affect the way in which peers treat the child.

The Role of the School Psychologist

Nessim and Katz (1995) delineate the role of the school psychologist during school reintegration
as follows: a) to educate parents, medical personnel and school personnel about the special needs
of the child; b) to teach parents how to gain access to services within the educational system; c)
to help teachers provide an effective learning environment based on the child's individual needs;
d) to educate peers about the child's situation so that they can be accepting and supportive; and e)
to work directly with the child or adolescent to ensure adjustment, both academically and
socially.

Nessim and Katz also suggest some more specific functions that the school psychologist should
perform before the child's return to school. If possible, the school psychologist should conduct a
pre-treatment baseline assessment of cognitive and academic functioning and then a post-
treatment assessment. In addition, periodic assessments should be done as well in the years
following treatment. The purpose of the continuous testing is to assess the possible effects of the
treatment, as well as to determine if treatments negatively affect abilities that emerge at different
developmental periods (Armstrong & Horn, 1995; Nessim & Katz, 1995). Not only should the
school psychologist assess cognitive abilities, but he or she should also assess psychosocial
functioning. It is important to identify children and teens that are at-risk for poor psychosocial
adjustment, so that they can receive prompt and appropriate intervention.

In addition to assessment, Nessim and Katz recommend that the school psychologist act as a
liaison between the regular classroom teacher and home or hospital teachers in order to ensure
that educational services are adequately received during absences. It is important that the student
stay as current as possible in his or her studies; Lansky, Lowman, and Vats (1975) found that
daily inpatient teaching in hospitals improved school performance, decreased anxiety about
school return, and positively influenced the overall experience of children with cancer. In
addition, encouraging the child to keep up with his or her studies may "assure him that health
professionals believe treatment might be successful and that it is appropriate to plan for the
future" (Battista, 1986).

At the time of the child's return, the school psychologist has additional functions to perform
(Nessim & Katz, 1995). First, the school psychologist should arrange conferences with relevant
individuals to ensure a smooth transition back to the school. He or she should meet first with the
family, to prepare them for the child's return and inquire about their wishes and needs. Then he
or she should meet with medical personnel and school personnel, so that this information can be
communicated as well as specific information regarding medical and educational issues. This
step is important to establish the school psychologist's role as the liaison during the reentry
process. Teachers want to know specific medical information about the student's illness, side
effects the child has experienced, learning difficulties that may occur, psychological effects of
the illness on the child, and how to talk with the student about cancer (Fryer, Finch, Saylor, &
Smith, 1989). Thus, the school psychologist should obtain this information from the parents and
medical personnel so that they can disseminate it to the teachers and other relevant school
personnel.

Second, the school psychologist should function as an aid to parents during this process. He or
she should help them gain access to available school services, as well as aid them in going
through the IEP process, if necessary. Additionally, he or she can discuss other possible
interventions that may become necessary as the child progresses through school, such as social
skills training or additional tutoring.

Third, the school psychologist should set up the classroom presentation, the purpose of which, as
stated earlier, is to provide information to classmates, dispel stereotypes about cancer, and to
help the peers to be less anxious and more supportive of their classmate with cancer. During the
presentation, the school psychologist should describe the patient's hospital experiences, provide
the class with information about the child's specific illness and treatments, discuss social support
and teasing, and establish the patient as the expert on his or her disease and treatment. It is
important to keep in mind developmental issues when conducting a classroom presentation
(Katz, Rubinstein, Hubert, & Blew, 1988).

Finally, due to the vast amount of psychological issues that the child with cancer and his or her
family may experience, the school psychologist should either provide counseling or refer the
child and family to counseling. This counseling may consist of support groups, individual
counseling, or social skills training. In addition to providing support to the child and family, the
school psychologist may need to offer support to school personnel as well. Chekryn, Deegan,
and Reid (1987) found that teachers expressed feelings of shock, worry, uncertainty and
frustration regarding having a child with cancer in their classroom. Some teachers sought out the
school nurse for support and information; however, teachers reported that a lack of visibility, a
lack of accessibility, and a lack of rapport prevented them from receiving support from the
school nurse. Thus, the school psychologist should establish him or herself as a source of support
and information for teachers.

A Successful Reintegration Program

Nessim and Katz (1995) have developed The Cancervive Teacher's Guide for Kids with Cancer,
which goes along with the School Reintegration Program developed by Ernest Katz. This
program is research-based and extremely comprehensive, and consists of the school psychologist
functioning in the capacities suggested above by Nessim and Katz. The accompanying guide acts
as a resource for teachers who have a student with cancer. It addresses a variety of relevant
topics, such as medical information about cancer, cancer treatment, emotional impact of cancer,
role of school personnel in school transition, possible academic effects of treatment, how to deal
with classmate reactions, coping with medical crises, and follow-up for cured youths. In
addition, the guide provides a sample classroom presentation and a list of resources for
information on cancer.

Studies evaluating the program showed that it was highly effective. Children with cancer who
were a part of this project showed fewer behavior problems; less internalizing behavior; fewer
symptoms of depression; greater perceived social, academic, and physical competence; less
anxiety; and greater levels of developmentally appropriate behavior (Nessim and Katz, 1995).
Furthermore, evaluations of the program by teachers, parents, and children have been very
positive (Katz, Varni, Rubenstein, Blew, and Hubert, 1992).

Conclusion

More and more children survive cancer each year due to improvements in medical technology
and treatments. These cancer survivors face not only the issues that surround the illness and its
treatments, but also medical and physical, psychological, cognitive and neuropsychological, and
social issues. As the child returns to school, he or she must face these issues that inevitably
impact school adjustment and performance. Without intervention, these issues may have
negative, long-lasting effects. Thus, it is crucial that a comprehensive plan involving the family,
peers, the teacher, and the school psychologist be implemented for the school reintegration
process of a child with cancer.

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Hesse-Biber, S., Clayton-Matthews, A., & Downey, J.A. (1987). The differential importance of
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Horowitz, M.E., & Pizzo, P.A. (1990). Cancer in the child infected with human
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Living with and after cancer
A diagnosis of cancer can have an impact on many areas of your life, both during
and after treatment.  Get information and practical advice to help you cope with
issues ranging from side effects of treatment and talking about cancer to managing
your finances.  

Symptoms & side effects

Cancer and cancer treatments can cause a range of symptoms and side effects. These can often be effectively
managed or controlled.

Financial issues
A cancer diagnosis can have an effect on your income – but you may be able to get help with NHS costs, grants, and
certain benefits.

Emotional effects
A cancer experience can trigger a range of emotional responses for you, your family and friends, but there are a
number of ways to manage them and get support.

Life after cancer

When your treatment is over, it's important to give yourself time to adjust to any physical or emotional changes.

Eating well
Cancer and its treatment can sometimes cause problems with eating. There are tips to help you manage different
eating problems and maintain a healthy diet.

Practical issues
It can help to think ahead when planning a holiday, getting travel insurance, going to work or arranging care for your
pets.

Relationships & communication

Cancer can have an emotional and physical impact on your relationships, but there's help available for you, your
family and friends.

Advanced cancer
It's usually a shock if a cancer comes back. There may be decisions and plans you want or need to make to if this
happens.

D. Lakshmi Ranganayakamma : Donate Online (Type patient name in 'Projects ' while filling the online
donation form)

Lakshmi Ranganayakamma (42 yrs), from Visakhapatnam, India is the wife of a farmer and has two sons
aged 6 yrs and 14 yrs. She has been diagnosed with Philadelphia positive acute lymphoblastic
leukaemia. She requires 4 cycles of hyperCVAD chemotherapy followed by allogenic Stem Cell
transplantation. Her brother is HLA match and can serve as a peripheral blood stem cell donor. The
estimated total cost of the treatment will be approximately Rs. 18 – Rs. 20 Lakhs.

She is unable to take any treatment due to their dismal financial condition. Please donate generously to
help her and her family in this crisis.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Jigyasa Pannicker : Donate Online (Type patient name in 'Projects ' while filling the online donation
form)

Jigyasa aged 14 years has been suffering from AML M 4 since October 2007.
Jigyasa is a bright girl and excelled in her studies and always stood top in the
school. She was very active in all extra-curricular activities and won many
awards and merit certificates. She was undergoing treatment at Apollo Hospital
Delhi on various regimens and was last discharged in November 2008. The
disease has relapsed again in May 09 and she has now been taken to Apollo
Chennai for further treatment where she has been recommended Cord Blood
transplant after attaining remission. The family has already spent about Rs. 22
lacs in Delhi Apollo and further sum of Rs. 12 lacs at Chennai where the total
cost will be in the region of 40 to 50 lacs. They also have to make a payment of
USD 44,000 to NMDP, US for a suitable cord Blood. The family seeks help for
the same. I look forward to your positive response to help the Pannicker family fight and save this bright
child.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Mr. Waseem Chaudhary: Donate Online (Type patient name in 'Projects ' while filling the online
donation form)

Waseem Chaudhary is a 20 year old patient suffering from Acute Myeloid

Leukemia. He is undergoing treatment at Tata Memorial Hospital under the care
of Dr. Sripad D. Banavali. Waseem is a second year Commerce student. He
was initially diagnosed with Aplastic Anemia in December 2008. In June, 2009
the condition turned into AML.  He has been advised Chemotherapy at a cost of
Rs. 6 Lakhs (Rs. 80,000 per month) and possibly, Bone Marrow Transplant
thereafter which will cost Rs. 12 lakhs. Waseem has three sisters and a brother
who works in a BPO. His siblings are putting in every effort to raise these funds.
Please donate generously to help him and his family to overcome this tragedy.
Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

P K Mathur : Donate Online (Type patient name in 'Projects ' while filling the online donation form)

Pradeep Kumar Mathur, aged 50 years is a patient of multiple myeloma

(cancer). He has been undergoing treatment (chemotherapy) at P.D. Hinduja
Hospital, Mumbai for over 3 months and spent over Rs. 4 lacs. The doctors
have now advised a Bone Marrow Transplant (BMT) the cost of which is
estimated to be over Rs. 8 lacs. He works at a cement company and is the only
earning member of his family. He has 2 sons, one pursuing an Engineering
degree and the other one is in 11th grade. He has an added responsibility of
bearing the high cost of their education too.

Please donate generously to help him and his family in this crisis.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Umesh Karkera: Donate Online (Type patient name in 'Projects ' while filling
the online donation form)

Mr. Umesh Karkera is a 48 year old patient suffering from Multiple Myeloma
since October, 1999. He is under going treatment at Prince Ali Khan Hospital
under the care of Dr. Tapan Saikia.

Mr. Umesh stays at Kandivali with his wife and two school going children. He
comes from a middle class family and is jobless for the last seven years. His
wife gives tuition from the home and that is the only source of income of the
family. Beside this, he is totally dependent on his elder brother’s income who
works in a private company.

In August 2005 he had undergone Bone Marrow Transplantation and thereafter hip replacement surgeries
in 2007 and 2008. However his disease has now resurfaced. He has been advised treatment with a new
line drug Inj Velcade from Johnson & Johnson. The cost of the injection is being given at a concessional
rate of
Rs. 45,000/- per vial. He will need 24 vials. The total expenditure for the treatment would be
approximately
Rs. 10,00,000/- (Ten lakh rupees) for next four months.
He has spent Rs. 35 lakhs already, from his pockets and borrowing money from relatives, friends and
trusts. Unfortunately the family’s financial resources cannot bear the brunt of this prolonged treatment.

Please help this patient and his family be donating generously to give him a chance to lead a normal life.

You can also send cheques in favour of ‘Vardhman Bio-Pharma & Genetic Private Ltd’ which will go
directly to the drug manufacturer to get Velcade at a concessional rate.

Please donate generously to help him and his family in this crisis.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Abhishek Sinha : Donate Online (Type patient name in 'Projects ' while filling the online donation form)

30 year old Abhishek Sinha was diagnosed with BAL -Bi-phenotypic Acute
Leukemia on 24th March 2009 and is currently undergoing his second round of
chemotherapy at the Manipal Hospital, Bangalore under Dr. Ashish Dixit.
Abhishek is an alumni of Symbiosis Institue of Business Management, Pune
and is currently working as a Product Manager at Britannia Industries Limited in
Bangalore.

Dr. Dixit has stressed the need for a bone marrow transplant at the earliest and
has decided to shift Abhishek to either Apollo Chennai or CMC Vellore for a non
related bone marrow transplant. The HLA type matching of his siblings was
negative. His  10/10 HLA typing results are awaited this week and as soon as
the same is received the search process for a non-related donor will start.

The estimated expenses for the entire treatment and related expenses ranges from Rs. 80 lakhs to
Rs.110 lakhs. While the family has been able to mobilize Rs. 27 lakhs through Abhishek's and Shubdha's
insurance covers, personal contributions from family, friends and colleagues, they still need help for the
balance funding.

Please donate generously to help him and his family in this crisis.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Dinesh K. Parmar : Donate Online (Type patient name in 'Projects ' while filling the online donation
form)
 Dinesh K. Parmar is a 43 year old patient suffering from enhancing focal lesion
involving the left tongue and extending into sublingual space-squamous cell
carcinoma cancer of the tongue. The doctors at Bhagwan Mahavir Cancer
Hospital and Research Centre, Jaipur have diagnosed his case as being Stage
II but fast advancing to Stage III. His best chance of long term survival is for
surgery to be performed within 30 days. Dinesh has a 15 year old daughter and
7 year old son. He is a peon with an annual income of Rs. 54,000 only.

He now needs Rs. 1,50,000 (1.5 Lakh rupees) )for the treatment. Please donate
generously to help him and his family in this crisis.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Venkat Ramani : Donate Online (Type patient name in 'Projects ' while filling the online donation form)

Venkat Ramani is 40, an architect, employed with a Project Management firm.

He was diagnosed with Acute Lymphoblastic Leukaemia (ALL) with Philadelphia
positive (PH+) chromosome, a type of blood cancer. He has undergone 4 out of
the total 8 rounds of chemotherapy and the consulting doctors have advised
Bone Marrow Transplant (BMT).

Unfortunately, his bone marrow type has not matched with either of his two
siblings and we have initiated a global search for a matched unrelated donor
(MUD). The minimum estimated cost for this procedure ranges from Rs 1.5
crores to Rs 2 crores (US $400,000). Since pooling in all his savings and
liquidating his assets is not going to cover the entire above mentioned cost, this
is an appeal for voluntary financial help. Ramani has an eight year old daughter, Tanaya, who wishes to
see her father fighting fit again.

Ramani looks forward to the day when he is no longer considered just a cancer survivor, but an activist
for cancer awareness. Help make his dreams come true.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Deepak Kumar Gupta : Donate Online (Type patient name in 'Projects ' while filling the online donation
form)

23 year old Deepak Gupta has been diagnosed with Acute Myeloid Leukemia.
He needs intensive chemotheraphy for 4 months. It will approximately cost Rs.
25 Lakhs (Rs. 25,00,000/-). he is currently undergoing treatment at the Apollo Speciality Hospital in
Chennai, India.

Donations can be made to "Cancer Patients Aid Association" with the name of the patient on the
back. Donations to CPAA are tax exempt under section 80G (50% exemption). You will be sent a
certificate of exemption along with receipt and letter of acknowledgement.

[Top]  

Gaurav Tandon : Donate Online (Type patient name in 'Projects ' while filling the online donation form)

Gaurav Tandon is a 34 year old professional working with a private IT firm 

(Datacraft). His small family comprises wife, a 6 year old son. He has two elder
sisters both are happily married and a brother who is serving as Captain in the
Indian Army. Gaurav was detected with AML in November. He has responded
well to chemotherapy, but must get a Bone Marrow Transplant as the only
possibility for a cure. Unfortunately the HLA typing test of his siblings is
negative. Doctors have therefore strongly recommended a Non-Related
Allogenic transplant for which the family needs financial aid.

Definition of cancer

Tumors are abnormal growth of cells in an uncontrolled manner and are of two types viz. benign tumors
and malignant tumors.

Benign tumors increase in size but are often harmless until they are near any vital organ.

Malignant tumor is termed as Cancer (or a neoplasm meaning a new growth) which proliferates in an
uncontrolled way causing in some cases, to metastasize (spread).

Cancer is not one disease. It is a group of diseases. Cancer is NOT contagious.

Cancer can involve any tissue of the body and have many different forms in each body area. Most
cancers are named for the type of cell or organ in which they start. If a cancer spreads (metastasizes),
the new tumor bears the same name as the original tumor.

The frequency of a particular cancer may depend on gender.

In India oral cancers are most common type of malignancy in men & breast cancer and cervix cancer in
women.

Cancer is the Latin word for crab. The ancients used the word to mean a malignancy, doubtless
because of the crab-like tenacity a malignant tumor sometimes seems to show in grasping the tissues it
invades.
 
Classification and Nomenclature of Tumours

We may conveniently distinguish tumours of:-

1) Epithelial tissues
2) Connective tissues including muscles
3) Blood Vessels and lymphatics
4) Nervous system
5) Lymphoid and Lymphopoietic tissues
6) Others

Of these, the epithelial are the overwhelmingly commonest and responsible for 90% of all the Cancer deaths.

Teaching the masses about early signs & symptoms

Negligence may cost your life so act fast and consult an Expert if the symptoms persists beyond 15
days.

Cancer of Brain:- Partial paralysis / numbness of any part of the body with head ache / fits / transitory
blindness etc.
Cancer of Eye:- Conjunctivitis, Hemorrhage & protruding eye.
Cancer of Mouth:- Partial opening of mouth, white / red patches within Oral Cavity / Ulcers.
Cancer of Larynx:- Hoarseness of voice. Oesophagus: - Difficulty / pain in swallowing.
Cancer of Lungs:- Unexplained cough, presence of Blood in Sputum.
Cancer of Breast:- any swelling or lump in breast. (Breast Self Examination needed).
Cancer of Abdominal Region:- Loss of appetite, nausea, vomiting, persisting unexplained pain.
Cancer of Intestine:- Changing bowel habits, bouts of loose motion and constipation.
Cancer of Cervix:- Irregular Menses or bleeding after menopause.
Cancer of Local:- Swelling, lump, tumor, ulcer, sore, wound, change in size / color / weeping wart or
mole.
Cancer of Blood:- Pale appearance frequent fatigue, breathlessness, low fever.

Early detection is possible through self-examination followed by Clinical Examination by the expert.
 

Diagnosis

Early detection is possible through self-examination followed by Clinical Examination by the expert
who may ask for one or more of the following examinations:

- Computerized Axial Tomography (CAT) Scan

- Magnetic Resonance Imaging (MRI) Scan
- Ultrasound
- Mammography
- X-ray
- Endoscopy
- Nuclear Medicine

Cytological Examinations for confirmation.

- Exfoliative Cytology
- Fine Needle Aspiration Cytology (FNAC)
- Biopsy examination

Treatment

Method of treatment depends upon the site and type of cancer. Normally three methods are used:

- Surgery
- Chemotherapy
- Radiotherapy

Some times alone or in combination are advocated for treatment.

 
Leukemia or Blood cancer is amongst the ten most common cancers of humans seen in India. This is the only
cancer which is not a tumour.

Blood is made up of plasma and three types of blood cells.

Red Blood Cells (RBC) which carry oxygen from the lung to the body tissues. White Blood Cells (WBC) which help in
defending the body against infections. Platelets help in blood clotting and control bleeding. White Blood Cells are of
five types - Lymphocytes, Granulocytes, Monocytes, Eosinophils & Basophils. Blood cells are produced in the bone
marrow in an orderly fashion and only mature cells are released in circulation.

What is Leukemia?

Leukemia or Blood Cancer is a cancer of the White Blood Cells (WBC). In Leukemia a large number of White Blood
Cells are produced in the bone marrow. These immature cells are incapable of normal functions. Cancer starts in the
bone marrow but spreads to the Blood, Lymph Nodes, the Spleen, Liver, Central Nervous System (the Brain and
Spinal Cord), Testes (Testicles), and other organs.

Leukemia can be acute (rapidly growing) or chronic (slowly growing). It can further be classified as Myelocytic or
Lymphocytic, depending on which White Blood Cell type is affected. Thus, the four major types of Leukemia are:

 Acute Lymphocytic Leukemia (ALL) - the most common type of leukemia in young children. It also affects
adults, especially those older than 55 years.
 Chronic Lymphocytic Leukemia (CLL) - most often affects adults over the age of 55. It sometimes occurs
in young adults, but it almost never affects children.
 Acute Myeloeytic Leukemia (AML) - occurs in both adults and children. This type of leukemia is
sometimes called Acute Nonlymphocytic Leukemia (ANLL).
 Chronic Myeloeytic Leukemia (CML) - occurs mainly in adults. Very rarely children may develop this
disease.

Children born to pregnant women having undergone X-ray's during pregnancy are more prone to develop acute
Leukemia at the age of 2-4 yrs.

What are the signs and symptoms of Leukemia?

In Leukemia the Bone Marrow is busy producing abnormal White Blood Cells and not enough Red Blood Cells are
produced resulting in anemia. Patients look pale, feel weak and tired frequently. Reduction in number of healthy
platelets causes patients even with bruises to bleed easily. In Leukemia WBC's are functionally immature, hence the
body cannot fight infections and thus patients often suffer from infections and fever.

Like all blood cells, Leukemia cell travel throughout the body. Depending on the number of abnormal cells and where
these cells collect, patients with Leukemia may have a number of symptoms. In acute Leukemia syptoms appear and
get worse quickly. People with this disease visit their doctor because they feel sick.

In acute Leukemia, the abnormal cells may collect in the brain or spinal cord (also called the central nervous system
or CNS). The result may be headache, vomiting, confusion, loss of muscle control and seizures. Leukemia cells also
can collect in the Testicles and cause swelling. Also, some patients develop swelling in the eyes or on the skin.
Leukemia affects the digestive tract, kidneys, lungs or other parts of the body.

Common symptoms seen in Leukemia are:

 Tiredness, lethargy and breathlessness (as a result of anemia).

 Pale complexion.
 Frequent, prolonged or severe infection (as a result of impaired white cell function).
 Frequent bruising and bleeding (as a result of platelet deficiency).
 Tiny red spots (called petechae) under the skin.
 Swollen or bleeding gums.
 Sweating, especially at night.
 Bone or joint pain.
 Loss of appetite and/or weight.
 Swollen or tender lymph nodes, liver, or spleen.
  Persistent low grade lever.

Some of the symptoms mentioned above are quite common in everyday illnesses and do not necessarily indicate
cancer. Nevertheless, it is wise to pay heed to these symptoms and seek advise from your doctor. If symptoms
persist consult a specialist and get a full check up. Early detection gives the best chance of cure.

How is Leukemia diagnosed?

When we visit with a problem, the doctor first listens to our complaints in detail and then examines us. In some cases
it may be very easy to rule out cancer, using this simple measure but at other times, the doctor recommends tests to
be carried out to enable him confirm or disprove his suspicion. After history taking and clinical examination, routine
examination of the blood, urine and stool is often the starting point. Depending on circumstances of the case, the d
octor may then also recommend other special tests.

The only way to make diagnosis of cancer is to examine cells or tissues from the suspected lesion under a
microscope. Merely establishing the diagnosis of cancer is not enough to select appropriate treatment.

Although a simple blood smear examination may reveal that a patient has leukemia, it may not show what type of
leukemia it is. To check further for Leukemia cells or to decide the type of Leukemia, the doctor examines a sample of
bone marrow under a microscope. The doctor withdraws the sample by inserting a needle into a large bone (usually
the hip) and removing a small amount of liquid bone marrow. This procedure is called bone morrow aspiration. A
bone marrow biopsy is performed with a larger needle and removes a small piece of bone and bone marrow.

If leukemia cells are found in the bone marrow sample, the doctor orders other tests to find out the extent of the
disease. A spinal tap (lumbar puncture) checks for leukemia cell in the fluid that fills the spaces in and around the
brain and spinal cord (cerebrospinal fluid). Chest X-rays can reveal signs of disease in the chest.

How is Leukemia Treated?

Treatment for leukemia is complex. The treatment depends not only on the type of leukemia, but also on certain
features of the leukemia cells, the extent of the disease, and whether the leukemia has been treated before. It also
depends on the patient's age, symptoms and general health.

The aim of treatment for acute leukemia is cure. Complete remission means no evidence of cancer. The primary
treatment for acute leukemia is chemotherapy. Radiation therapy may be used in certain cases. Presently in some
cases bone morrow transplantation is also done.

Chronic Leukemia patients who do not have symptoms may not require immediate treatment. However, they should
have frequent checkups to see how the disease is progressing. Treatment can often control the disease and its
symptoms. However, chronic leukemia can seldom be cured.

Chemotherapy is treatment of cancer by drugs. Cancer chemotherapy employs cytotoxic drugs capable of arresting
fast cellular growth. Chemotherapy also affects other fast growing normal cells in the body. Anti cancer drugs are
normally given by injection into a vein. Chemotherapy is also given into the muscle, under the skin, cerebrospinal fluid
(CSF), or taken by mouth. The treatment is given in cyclic form once in 3 to 4 weeks or weekly regimens to allow for
adequate recovery of normal tissues and to ensure that cancer cells are killed at the same time. In general, AML
treatment will use higher doses of chemotherapy over a shorter period of time, and ALL will take chemotherapy over
a longer period of time.

Bone-Marrow Transplantation

Bone-Marrow Transplantation is a newer type of treatment. First high dose of chemotherapy with or without radiation
therapy are given to destroy all of the Bone-Marrow in the body. Healthy marrow is then taken from another person (a
donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a
brother or sister, or another person not related. The healthy marrow from the donor is given to the patient through a
needle in a vein, and the marrow replaces the marrow that was destroyed. This procedure is reserved for relapsed
cases or very aggressive cases.

There are generally four phases of treatment for acute Leukemia. The first phase, uses chemotherapy to kill as many
of the Leukemia cells as possible to cause the cancer to go into remission. Once a patient goes into remission and
there are no signs of Leukemia, a second phase of high-dose chemotherapy is given in attempt to kill any remaining
Leukemia cells. The third phase is preventive therapy, here high-dose systemic chemotherapy is given to the Central
Nervous System (CNS) to kill any Leukemia cell present there, or to prevent the spread of cancer cells to the brain
and spinal cord, even if no cancer has been detected there. Radiation therapy to the brain may also be given, in
addition to chemotherapy, for this purpose. The fourth phase of treatment uses chemotherapy for 2 years to maintain
the remission.

Leukemia and its treatment can cause a number of complications and side effects. Patients need supportive care to
prevent or control these problems and to improve their quality of life during treatment. Because leukemia patients get
infection very easily, they may receive antibiotics and other drugs to help protect them from infections.

Anemia and bleeding are other problems that often require supportive care. Transfusions of red blood cells may be
given to help reduce the shortness of breath and fatigue that anemia can cause. Platelet transfusions can help
reduce the risk of serious bleeding. Leukemia and chemotherapy can make the mouth sensitive, easily infected and
likely to bleed. Doctors often advise patients to have a complete dental exam before treatment begins.

What will happen after treatment for Leukemia?

Every leukemia cancer patient needs close monitoring following cancer treatment. This is referred to as "follow-up".
Follow-up is an integral part of cancer treatment and is usually done by physical examination, blood examination, X-
ray tests. Cancer patients need life long follow-up. Cancer treatment is never complete theoretically because cancer
can occur at the primary site or anywhere else within the body at a later date. For several years after treatment,
regular follow-up examination is very important, as the doctors continue to watch for the signs of the disease as well
as for short-term and long-term side effects of the treatment.

Can Leukemia be prevented?

 
Although many cancers of adults can be prevented by lifestyle changes which reduce certain risk factors, there is
currently no known way to prevent childhood cancers, particularly leukemia.

Are there any tests for detection of Leukemia?

At present, there are no special tests recommended for the early detection of leukemia. The best policy for early
diagnosis is prompt attention to the signs and symptoms of this disease. Close follow-up is important for children with
a known genetic abnormality which might increase their risk of leukemia, children who have and another cancer
treated with chemotherapy or combined chemotherapy and radiation therapy and children who have received organ
transplants and are taking immune system-suppressing drugs.

What are the chances of cure in acute Leukemia?

In ALL of children, the long term survival (cure) is almost in the range of 70-80% (in western countries). In our country
it is in the range of 50-55%.

 Adult ALL - Adults do not fare as well as children. The long term survival is in the range of 40-45%.
 AML - the outcome is very dismal for both children and adults, the long term survival is in the range of 20%.
With high dose chemotherapy & BMT, the maximum long term survival achieved is around 35-40%.
 CML - The only curative treatment is allogenic BMT. Other treatments only increase the survival.
 CLL - There is no curative treatment, but it is a disease of elderly people, who can maintain good quality of
life up to 10 years with proper treatment.

Many parents describe feeling totally shattered and unable to

believe what has happened.

They describe it as

 Shock

Download The Information Book

(PDF 4.5MB)
 Disbelief
 Sadness
 Guilt
 Sense of loss
 Helplessness
 Stress
 They refer to it as a terrible ROLLER COASTER RIDE

This section may assist you in balancing hospital, home, siblings, work, relationships, and parenting
issues. Some of the items in this section include:

 Helping your child cope with tests

 What to do if your child is sick
 Mouthcare, eating well and good food hygiene
 Taking care of your relationships

What Are the Types of Childhood

Cancers?

Leukemia

Leukemias are the most common childhood cancers. They account for about 33% of all childhood
cancers. Acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML) are the most
common types of leukemia in children. Leukemia may be cause bone and joint pain, weakness, bleeding,
fever, weight loss, and other symptoms. For more information see our document Childhood Leukemia.

Brain and nervous system cancers

Brain and other nervous system cancers are the second most common cancers in children, making up
about 21% of childhood cancers. Most brain cancers of children involve the cerebellum or brain stem. In
early stages they can cause headaches, nausea, vomiting, blurred or double vision, dizziness, and
trouble walking or handling objects. Adults are more likely to develop cancers in different parts of the
brain--usually the cerebral hemispheres. Spinal cord tumors are less common than brain tumors in both
children and adults. For more information see our document Brain and Spinal Cord Tumors in Children.

Neuroblastoma

Neuroblastoma is a form of cancer that starts in certain types of nerve cells found in a developing embryo
or fetus. This type of cancer occurs in infants and young children. It is most often found during the first
year of life. It is rarely found in children older than 10. This tumor can start anywhere but usually occurs in
the belly (abdomen) and is noticed as swelling. It can also cause bone pain and fever. It accounts for
about 7% of childhood cancers. For more information see our document Neuroblastoma.

Wilms tumor

Wilms tumor is a cancer that starts in one, or rarely, both kidneys. It is most often found in children about
3 years old, and is uncommon in children older than age 6. It can show up as a swelling or lump in the
belly (abdomen). Sometimes the child may have other symptoms, such as fever, pain, or poor appetite.
Wilms tumor accounts for about 5% of childhood cancers. For more information see our document Wilms
Tumor.

Lymphoma

Non-Hodgkin lymphoma and Hodgkin lymphoma (sometimes called Hodgkin disease, Hodgkin's disease,
or Hodgkin's lymphoma), are cancers that start in lymph tissues, such as the tonsils, lymph nodes, and
thymus. These cancers may spread to bone marrow and other organs, which can cause different
symptoms depending on where it is growing. They also can cause fever, sweats, weakness, and swollen
lymph nodes in the neck, armpit, or groin.

Hodgkin lymphoma can occur in both children and adults, and accounts for about 4% of childhood
cancers. It is more common, though, in 2 age groups: early adulthood (age 15 to 40, usually people in
their 20s) and late adulthood (after age 55). Hodgkin lymphoma is rare in children younger than 5 years of
age. About 10% to 15% of cases are diagnosed in children and teenagers.

Non-Hodgkin lymphoma makes up a little more than 4% of childhood cancers, and can cause symptoms
much like those of Hodgkin lymphoma. It can also cause other symptoms depending on where it starts in
the body. For more information see our document Childhood Non-Hodgkin Lymphoma.

Rhabdomyosarcoma

Rhabdomyosarcoma is the most common soft tissue sarcoma in children. It makes up a little more than
3% of childhood cancers. This tumor starts in the same embryonic cells that develop into striated
(voluntary) muscles. It can happen in the head and neck, groin, abdomen, pelvis, arms and legs. It may
cause pain, swelling (a lump), or both. For more information see our document Rhabdomyosarcoma.

Retinoblastoma

Retinoblastoma is a cancer of the eye. It is rare, accounting for just under 3% of childhood cancers. It
usually occurs in children under the age of 4, and is seldom found in children older than 6. For more
information see our document Retinoblastoma.

Bone cancers

Primary bone cancers (cancers that start in the bones) occur most often in children and adolescents.
Primary bone cancer is different from metastatic bone cancer, which is cancer that has spread from
another site to the bone. Metastatic bone cancer is named for the place the cancer came from. For
instance, it might be described as prostate cancer that has spread (metastasized) to the bone, or prostate
cancer with bone metastasis.

Metastatic bone cancer is more common than primary bone cancer because many types of cancer can
spread to the bone. Two types of primary bone cancers occur in children:

Osteosarcoma is uncommon, accounting for almost 3% of all new childhood cancer cases in the
United States. It often causes no pain or symptoms until swelling starts, but sometimes there is
bone pain that keeps getting worse. For more information see our document Osteosarcoma.

Ewing sarcoma is a less common primary bone cancer which can cause bone pain. It is mostly
found in adolescents. It accounts for a little more than 1% of childhood cancers. For more
information see our document Ewing Family of Tumors
What Are the Types of Childhood
Cancers?

Leukemia

Leukemias are the most common childhood cancers. They account for about 33% of all childhood
cancers. Acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML) are the most
common types of leukemia in children. Leukemia may be cause bone and joint pain, weakness, bleeding,
fever, weight loss, and other symptoms. For more information see our document Childhood Leukemia.

Brain and nervous system cancers

Brain and other nervous system cancers are the second most common cancers in children, making up
about 21% of childhood cancers. Most brain cancers of children involve the cerebellum or brain stem. In
early stages they can cause headaches, nausea, vomiting, blurred or double vision, dizziness, and
trouble walking or handling objects. Adults are more likely to develop cancers in different parts of the
brain--usually the cerebral hemispheres. Spinal cord tumors are less common than brain tumors in both
children and adults. For more information see our document Brain and Spinal Cord Tumors in Children.

Neuroblastoma

Neuroblastoma is a form of cancer that starts in certain types of nerve cells found in a developing embryo
or fetus. This type of cancer occurs in infants and young children. It is most often found during the first
year of life. It is rarely found in children older than 10. This tumor can start anywhere but usually occurs in
the belly (abdomen) and is noticed as swelling. It can also cause bone pain and fever. It accounts for
about 7% of childhood cancers. For more information see our document Neuroblastoma.

Wilms tumor

Wilms tumor is a cancer that starts in one, or rarely, both kidneys. It is most often found in children about
3 years old, and is uncommon in children older than age 6. It can show up as a swelling or lump in the
belly (abdomen). Sometimes the child may have other symptoms, such as fever, pain, or poor appetite.
Wilms tumor accounts for about 5% of childhood cancers. For more information see our document Wilms
Tumor.

Lymphoma

Non-Hodgkin lymphoma and Hodgkin lymphoma (sometimes called Hodgkin disease, Hodgkin's disease,
or Hodgkin's lymphoma), are cancers that start in lymph tissues, such as the tonsils, lymph nodes, and
thymus. These cancers may spread to bone marrow and other organs, which can cause different
symptoms depending on where it is growing. They also can cause fever, sweats, weakness, and swollen
lymph nodes in the neck, armpit, or groin.

Hodgkin lymphoma can occur in both children and adults, and accounts for about 4% of childhood
cancers. It is more common, though, in 2 age groups: early adulthood (age 15 to 40, usually people in
their 20s) and late adulthood (after age 55). Hodgkin lymphoma is rare in children younger than 5 years of
age. About 10% to 15% of cases are diagnosed in children and teenagers.

Non-Hodgkin lymphoma makes up a little more than 4% of childhood cancers, and can cause symptoms
much like those of Hodgkin lymphoma. It can also cause other symptoms depending on where it starts in
the body. For more information see our document Childhood Non-Hodgkin Lymphoma.

Rhabdomyosarcoma

Rhabdomyosarcoma is the most common soft tissue sarcoma in children. It makes up a little more than
3% of childhood cancers. This tumor starts in the same embryonic cells that develop into striated
(voluntary) muscles. It can happen in the head and neck, groin, abdomen, pelvis, arms and legs. It may
cause pain, swelling (a lump), or both. For more information see our document Rhabdomyosarcoma.

Retinoblastoma

Retinoblastoma is a cancer of the eye. It is rare, accounting for just under 3% of childhood cancers. It
usually occurs in children under the age of 4, and is seldom found in children older than 6. For more
information see our document Retinoblastoma.

Bone cancers

Primary bone cancers (cancers that start in the bones) occur most often in children and adolescents.
Primary bone cancer is different from metastatic bone cancer, which is cancer that has spread from
another site to the bone. Metastatic bone cancer is named for the place the cancer came from. For
instance, it might be described as prostate cancer that has spread (metastasized) to the bone, or prostate
cancer with bone metastasis.

Metastatic bone cancer is more common than primary bone cancer because many types of cancer can
spread to the bone. Two types of primary bone cancers occur in children:

Osteosarcoma is uncommon, accounting for almost 3% of all new childhood cancer cases in the
United States. It often causes no pain or symptoms until swelling starts, but sometimes there is
bone pain that keeps getting worse. For more information see our document Osteosarcoma.

Ewing sarcoma is a less common primary bone cancer which can cause bone pain. It is mostly
found in adolescents. It accounts for a little more than 1% of childhood cancers. For more
information see our document Ewing Family of Tumors
v