Cancer & Tumors

Hodgkin lymphoma is a type of cancer that affects the lymphatic system. This highly sophisticated filtering system helps the body’s immune system remove bacteria, viruses, and other unwanted substances.

The lymphatic system includes the lymph nodes (glands), thymus, spleen, tonsils, adenoids, and bone marrow, as well as the channels (called lymphatics or lymph vessels) that connect them. When lymphoma happens, cancer cells develop in a person’s lymphatic system and start to grow uncontrollably.

The different types of lymphomas are grouped into two broad categories: Hodgkin lymphoma and non-Hodgkin lymphoma. Lymphomas that involve a type of cell known as a Reed-Sternberg cell are classified as Hodgkin lymphoma. The different subtypes of Hodgkin lymphoma are classified based on how the cancerous tissue looks under a microscope.

Lymphomas without Reed-Sternberg cells are usually classified as non-Hodgkin lymphomas.

Risk Factors

Age is a risk fact for Hodgkin lymphoma — it tends to mostly affect teens and people older than 55. It also can happen in people with severe immune deficiencies from things such as inherited immune defects, human immunodeficiency virus (HIV) infection, treatment with immunosuppressive drugs after organ transplants, or Epstein-Barr virus.

Usually, the causes of lymphoma are unknown and no lifestyle factors have been definitely linked to childhood lymphomas.

So, neither parents nor kids have control over the things that cause the disease. Most lymphomas come from noninherited mutations (errors) in the genes of growing blood cells. However, there is a very slightly increased risk of Hodgkin lymphoma if other family members have had the disease. Regular pediatric checkups can sometimes spot early symptoms of lymphoma.

Signs and Symptoms

The most common first symptom of Hodgkin lymphoma is a painless enlargement of the lymph nodes (often called “swollen glands”) in the neck, the underarm area, or the groin.

If cancer involves the lymph nodes in the chest, pressure may trigger an unexplained cough, shortness of breath, or problems in blood flow to and from the heart.

About a third of patients have other nonspecific symptoms, including fatigue (tiredness), poor appetite, itching, or a rash. Unexplained fever, night sweats, and weight loss are also common. Many patients have no other symptoms at all.

Diagnosis

One of the things doctors might look for if they suspect lymphoma is enlargement of the lymph nodes. They may first try to treat swollen lymph nodes with antibiotics, because infections are the most common cause of this.

But if the lymph nodes stay swollen, a child may be referred to an oncologist (cancer doctor), who might recommend imaging studies and a biopsy (tissue sample) of the lymph nodes.

During a biopsy, a tiny bit of tissue is removed from the body and sent out to a laboratory for analysis. If Hodgkin lymphoma is suspected, one of these biopsies may be done:

• Core biopsy: the doctor uses a hollow needle to remove a small amount of tissue from the lymph node.
• Excisional biopsy or incisional biopsy: the doctor opens the skin to remove the entire enlarged lymph node (excisional) or only part of it (incisional).

Depending on the type of biopsy ordered, the doctor might use local anesthesia (where only a part of the body is numbed) or, most commonly, general anesthesia (in which a patient is asleep) to ensure there is no pain.

If the doctor suspects Hodgkin lymphoma, more tests will be done to see if the cancer has spread. These can include:

• blood tests
• a chest X-ray
• a computed tomography (CT or CAT) scan, a type of X-ray that rotates around the patient and creates a picture of the inside of the body from different angles
• a bone marrow biopsy to check for cancer in the bone marrow
• a positron emission tomography (PET) scan, which can tell the difference between normal and abnormal cells

Treatment

Treatment for Hodgkin lymphoma is very effective for most kids. The choice of treatment is largely determined by staging. Staging is a way to categorize or classify patients according to how extensive the disease is at the time of diagnosis.

There are four stages of lymphoma, ranging from Stage I (cancer involving only one area of lymph nodes or only one organ outside the lymph nodes) to Stage IV (cancer has spread, or metastasized, to one or more tissues or organs outside the lymphatic system). The stage at diagnosis can help medical professionals choose the best therapy and predict how someone with lymphoma will do in the long term.

Treatment may involve radiation (the use of high-energy rays to shrink tumors and keep cancer cells from growing), chemotherapy (the use of highly potent medical drugs to kill cancer cells), or both, depending on the type and stage of the cancer as well as the age and overall health of the child.

For children whose cancer comes back after treatment or who do not respond well to treatment, doctors may do stem cell transplants (also called bone marrow transplants) to replace cells damaged by chemotherapy or radiation. These transplants involve taking the cells from bone marrow or blood (either taken from the patient or donated by another person) and transplanting them to the patient after chemo. There are also some very effective drugs that have helped improve the chances of a cure.

Researchers are constantly working on new treatments for cancer. Some parents enroll their child in clinical trials, which are ways to test new cancer treatments or compare their effectiveness with existing treatments. If your child has Hodgkin lymphoma, the doctor can tell you whether this is a good idea for the particular type he or she has.

Short-Term and Long-Term Side Effects

Treatment for Hodgkin lymphoma is powerful. It destroys good cells along with bad, which can create certain side effects.

Intensive lymphoma treatment affects the bone marrow, causing anemia and easy bleeding, and increasing the risk for serious infections. Chemotherapy treatments have side effects — some short-term (such as hair loss, increased infection risk, and nausea and vomiting) and some long-term (such as heart, thyroid, and kidney damage, reproductive problems, or the development of another cancer later in life) — that parents should discuss with the doctor.

Prognosis

The majority of kids with Hodgkin lymphoma are cured, meaning they will have long-term cancer-free survival. However, those with higher-stage disease are at risk for more long-term side effects as a result of more intensive treatment.

After treatment is finished, it’s important for anyone who has had Hodgkin lymphoma to have regular checkups throughout life to watch for recurrence of the lymphoma and for late side effects of treatment.

About Leukemia

Leukemia is a type of cancer that affects the body’s white blood cells (WBCs).

Normally, WBCs help fight infection and protect the body against disease. But in leukemia, WBCs turn cancerous and multiply when they shouldn’t, resulting in too many abnormal WBCs. These cells then interfere with the body’s ability to function normally.

Juvenile myelomonocytic leukemia (JMML) is a rare childhood cancer that usually happens in children younger than 2 years old. In JMML, too many myelocytes and monocytes (two types of WBCs) are produced from immature blood stem cells called blasts. These myelocytes, monocytes, and blasts overwhelm the normal cells in the bone marrow and other organs, causing the symptoms of JMML.

Causes

The cause of JMML is unknown, but doctors do know that certain medical conditions — such as neurofibromatosis type 1 and Noonan syndrome — can make a child more likely to develop it.

Signs and Symptoms

JMML tends to progress slowly, so at first a child may have few if any symptoms. In fact, symptoms can take months or even years to develop.

The symptoms of all types of leukemia are generally the same and include:

• fatigue (tiredness) and weakness
• swollen lymph nodes
• recurrent infections (such as bronchitis or tonsillitis)
• fever
• easy bruising
• bone and joint pain
• abdominal pain (caused by abnormal blood cells building up in organs like the kidneys, liver, and spleen)
• swelling of the spleen and abdomen

Diagnosis

A doctor who suspects a child has leukemia may order tests that include:

• Blood tests. Tests such as a complete blood count, liver and kidney function panels, and blood chemistries can give important information about the number of normal blood cells in the body and how well the organs are functioning. The blood cells are viewed under a microscope to check for abnormal shapes or sizes.
• Bone marrow aspiration. In this procedure, the doctor inserts a needle into a large bone, usually the hip, and removes a small amount of bone marrow to examine it for abnormal cells.
• Imaging studies. These may include an X-ray, CT scan, MRI, or ultrasound to check for an enlarged spleen or liver, and also to rule out any other possible causes of a child’s symptoms.
• Lumbar puncture. Also called a spinal tap, this procedure uses a hollow needle to remove a small amount of cerebrospinal fluid (CSF), the fluid surrounding the brain and spinal cord, for examination in a lab.
• Flow cytometry tests. Using markers on leukemia cells collected from the blood, bone marrow, and/or CSF, doctors can determine the type of leukemia a child has. This is important because treatments may vary according to the type of leukemia.
• Chromosomal tests. Analyzing DNA from the blood or bone marrow is another way that doctors can learn which type of leukemia a child has.
• Tissue typing or HLA (human leukocyte antigen) typing. If a child needs a stem cell transplant (also called a bone marrow transplant), this test helps doctors find a suitable stem cell donor. It works by comparing the proteins on the surface of a child’s blood cells with the proteins on a potential donor’s cells. The more HLA (human leukocyte antigen) markers a child and donor share, the greater the chance that a transplant will be successful.

Treatment

Chemotherapy (the use of drugs to kill cancer cells) may be used to temporarily control JMML. However, effective treatment of JMML usually requires a stem cell (bone marrow) transplant.

This procedure involves destroying cancer cells and normal bone marrow and immune system cells with high-dose chemotherapy and then re-introducing healthy donor stem cells into the body. The new stem cells can rebuild a healthy blood supply and immune system.

Even though these therapies are the treatment of choice for kids with JMML, the disease remains difficult to cure. Researchers are looking into the use of alternative treatments, like molecular-targeted therapies (medicines that slow the growth of cancer cells by blocking certain molecules or proteins that help cancer cells grow) and immunotherapies (medicines that mark cancer cells so that the body’s immune system can find the cells and remove them from the body).

Coping

Being told that your child has cancer can be very frightening, and the stress of treating the disease can be overwhelming for any family.

Although you might feel like it at times, you’re not alone. To find support for you or your child, talk to your doctor or a hospital social worker. Many resources can help you get through this difficult time.

The liver is the body’s largest solid organ. Lying next to the stomach on the right side of the abdomen, it has many jobs — like cleansing the blood of toxins, producing bile (which helps break down food during digestion), and storing energy in the form of a sugar called glycogen.

Tumors happen when abnormal cells form a mass or growth. If a tumor develops in the liver, the liver can’t work as it should.

Types of Tumors

Tumors can be benign (not cancerous) or malignant (cancerous).

Most benign liver tumors are present at birth. They’re usually the result of abnormal tissue growth while the fetus was developing. Types of benign liver tumors include mesenchymal hamartomas, adenomas, and hemangiomas. These tumors can be watched by a doctor or removed through surgery with no other treatment needed.

Malignant liver tumors happen less frequently. These usually require more aggressive treatment, like chemotherapy and surgery.

Malignant (Cancerous) Tumors

Hepatoblastoma is most common in very young children (usually younger than 3). When found early, this type of cancer typically responds well to treatment with chemotherapy and surgery.

Hepatocellular carcinoma is more common in adults but can affect older children. Because it can be hard to remove surgically and might not respond to chemotherapy, hepatocellular carcinoma can be difficult to treat.

The cause of malignant liver tumors is unknown. But risk factors for hepatoblastoma include Beckwith-Wiedemann syndrome (a disorder that can cause too much growth in the body, including in the internal organs), familial adenomatous polyposis (a condition that causes polyps to form in the large intestine), being male, and having a very low birth weight.

Medical conditions connected with an increased risk of hepatocellular carcinoma include infection with hepatitis B or C, or conditions connected with cirrhosis (long-term damage) of the liver, like hereditary hemochromatosis and autoimmune hepatitis.

Symptoms

Early on, a child with a liver tumor might have few symptoms — or none at all. As the mass grows, however, these symptoms may develop:

• a lump that can be felt in the abdomen, or a swollen abdomen
• pain on the right side of the abdomen, where the liver is (if the tumor is pressing on nerves or muscles, pain may extend upward and back)
• early puberty
• decreased appetite and weight loss
• vomiting
• jaundice (yellowing of the eyes and skin)

Diagnosis

A doctor who thinks a child might have a liver tumor will do a thorough physical exam and order these tests:

• Imaging studies. Imaging studies can include an ultrasound, CT scan, or MRI. These tests can help find the size and location of the tumor and also help show if cancer has spread (metastasized) to other parts of the body.
• Biopsy. A biopsy is when a piece of tissue is removed from the body for study in a lab. This closer look helps doctors make a diagnosis (such as cancer) and choose the right treatment.
• Blood tests. Tests such as a complete blood count, liver function panel, and blood chemistries can show how well the liver and other organs are working. If the doctor thinks the tumor is related to a genetic condition, certain genetic tests might be done, too.

Treatment

Treatment of malignant liver tumors depends on staging. Staging is a way to classify the extent of the disease. It takes into account the size of the tumor (or tumors), how easily the tumor can be removed by surgery, and whether the tumor has spread to nearby or distant organs.

This information, in addition to a child’s age and overall heath, helps doctors develop a treatment plan. The plan might include the following options, in combination or alone:

• Surgery. Benign masses are usually removed. Malignant tumors also may require surgery to remove as many of the cancerous cells as possible. The amazing thing about the liver is that even if a large portion is removed, the remaining part usually can regenerate (“re-grow”). The liver is the only organ that can grow back in this way.
• Chemotherapy. Chemotherapy works to treat cancer throughout the body. Often, chemo drugs are combined to attack the cancer cells in different ways, which is effective in diseases such as hepatoblastoma. Side effects can happen, but will ease once treatment ends.
• Radiation therapy. Radiation therapy uses high-energy radiation to target and destroy cancer cells in a specific area. It’s not a common treatment for hepatoblastoma.
• Liver transplant. If a tumor can’t be removed without a loss of liver function, a liver transplant may be necessary. Many kids who have liver transplants go on to live normal, healthy lives. They’ll need to take medicine to help prevent complications and have regular checkups to make sure the liver is working correctly.

Coping

The stress of having a child who is being treated for a tumor can be overwhelming for any parent. Talk with your child’s medical team, who can answer any questions and will support you during this challenging time.

The body’s lymphatic system helps the immune system filter out bacteria, viruses, and other unwanted or harmful substances. The lymphatic system includes:

• the lymph nodes (also called lymph glands)
• thymus
• spleen
• tonsils
• adenoids
• bone marrow

Channels — called lymphatics or lymph vessels — connect the parts of the lymphatic system.

Lymphoma is a type of cancer that begins in lymphatic tissue. There are several different types of lymphomas. Some involve lymphoid cells and are grouped under the heading of Hodgkin lymphoma. All other forms of lymphoma fall into the non-Hodgkin lymphoma grouping.

Hodgkin Lymphoma

Lymphomas that involve a type of cell called a Reed-Sternberg cell are classified as Hodgkin lymphoma. Different types of Hodgkin lymphoma are classified based on how the cancerous tissue looks under a microscope. Hodgkin lymphoma affects about 3 out of every 100,000 Americans, most commonly during early and late adulthood (between ages 15 and 40 and after age 55).

The most common first symptom of Hodgkin lymphoma is a painless enlargement of the lymph nodes (a condition known as swollen glands) in the neck, above the collarbone, in the underarm area, or in the groin.

If Hodgkin lymphoma involves the lymph nodes in the center of the chest, pressure from this swelling may cause an unexplained cough, shortness of breath, or problems in blood flow to and from the heart.

Some people have other symptoms including fatigue (tiredness), poor appetite, itching, or hives. Unexplained fever, night sweats, and weight loss are also common.

Non-Hodgkin Lymphoma (NHL)

Non-Hodgkin lymphoma (NHL) can happen at any age during childhood, but is rare before age 3. NHL is slightly more common than Hodgkin disease in kids younger than 15 years old.

In non-Hodgkin lymphoma, there is malignant (cancerous) growth of specific types of lymphocytes (a kind of white blood cell that collects in the lymph nodes).

Risk for Childhood Lymphoma

Both Hodgkin lymphoma and non-Hodgkin lymphoma tend to happen more often in people with certain severe immune deficiencies, including:

• those with inherited immune defects (defects passed down by parents)
• adults with human immunodeficiency virus (HIV) infection
• those treated with immunosuppressive drugs after organ transplants (these strong drugs help hold back the activity of the immune system)

Kids who have had either radiation therapy or chemotherapy for other types of cancer seem to have a higher risk of developing lymphoma later in life.

Regular pediatric checkups can sometimes spot early symptoms when lymphoma is linked to an inherited immune problem, HIV infection, treatment with immunosuppressive drugs, or prior cancer treatment.

No lifestyle factors have been definitely linked to childhood lymphomas. Usually, neither parents nor kids have control over what causes lymphomas. Most cases are due to noninherited mutations (errors) in the genes of growing blood cells.

Diagnosis

Doctors will check a child’s weight and do a physical examination to look for enlarged lymph nodes and signs of infection. Using a stethoscope, they’ll examine the chest and feel the abdomen to check for pain, organ enlargement, or fluid build-up.

In addition to the physical exam, doctors take a medical history by asking about the child’s past health, his or her family’s health, and other issues.

Sometimes, when a child has an enlarged lymph node for no apparent reason, the doctor will watch the node closely to see if it continues to grow. The doctor may prescribe antibiotics if the gland is thought to be infected by bacteria, or do blood tests for certain types of infection.

If the lymph node stays enlarged, the next step is a biopsy (removing and examining tissue, cells, or fluids from the body). Biopsies are also necessary for lymphomas that involve the bone marrow or structures in the chest or abdomen.

The biopsy may be done using a thin hollow needle (this is known as needle aspiration). Or, a small surgical incision might be made while the patient is under general anesthesia. Sometimes, a biopsy may require a surgical excision under anesthesia. This means a piece of the lymph node or the entire lymph node is removed.

In the laboratory, tissue samples from the biopsy are examined to determine the specific type of lymphoma. Besides these basic lab tests, more sophisticated tests are usually done, including genetic studies, to distinguish between specific types of lymphoma.

To identify which areas of the body are affected by lymphoma, these tests are also used:

• blood tests, including complete blood count (CBC)
• blood chemistry, including tests of liver and kidney function
• bone marrow biopsy or aspiration
• lumbar puncture (spinal tap) to check for cancer spread to the central nervous system (brain and spinal cord)
• ultrasound
• computed tomography (CT) of the chest and abdomen, and sometimes X-rays
• magnetic resonance imaging (MRI)
• bone scan, gallium scan, and/or positron emisson tomography (PET) scan (when a radioactive material is injected into the bloodstream to look for evidence of tumors throughout the body)

These tests help doctors decide which type of treatment to use.

Treatment

Treatment of childhood lymphoma is largely determined by staging. Staging is a way to categorize or classify patients according to how extensive the disease is at the time of diagnosis.

Chemotherapy (the use of highly potent medical drugs to kill cancer cells) is the main form of treatment for all types of lymphoma. In certain cases, radiation (using high-energy rays  to kill cancer cells and keep them from growing and multiplying) may also be used.

Short-Term and Long-Term Side Effects

Chemotherapy for lymphoma affects the bone marrow, causing anemia and bleeding problems, and increases a person’s risk for serious infections.

Chemotherapy and radiation treatments have many other side effects — some short-term (such as hair loss, changes in skin color, increased infection risk, and nausea and vomiting) and some long-term (such heart and kidney damage, reproductive problems, thyroid problems, or the development of another cancer later in life).

Parents should discuss all potential side effects with their child’s care team.

Relapses

Although most kids recover from lymphoma, some with severe lymphoma will have a relapse (reappearance of the cancer). For these children, bone marrow transplants and stem cell transplants are often among the treatment options.

During a bone marrow/stem cell transplant, chemotherapy with or without radiation therapy is given to kill cancerous cells. Then, healthy bone marrow/stem cells are introduced into the body. These healthy cells can produce white blood cells that will help the child fight infections.

New Treatments

New treatments for childhood lymphomas include several different types of immune therapy, specifically using antibodies to deliver chemotherapy medicines or radioactive chemicals directly to lymphoma cells. (Antibodies are proteins made by the immune system to fight bacteria, viruses, and toxins.) This direct targeting of lymphoma cells can help a person avoid the side effects that happen when chemotherapy and radiation treatments damage normal, noncancerous body tissues.

Although there are several different types of skin cancer, most don’t become life-threatening because they aren’t likely to spread to other parts of the body. Unfortunately, melanoma is different. If not caught early, melanoma can spread from the skin to other organs — often with deadly results.

And this serious skin cancer is no longer considered just an older person’s disease. Rates are on the rise — especially among people in their teens and 20s — and research shows that the increase may be partly related to ultraviolet (UV) sun exposure during childhood. In the United States alone, the percentage of people who develop melanoma has more than doubled in the past four decades.

If there’s any good news about melanoma, it’s this: You have the power to greatly lower your family’s risk of getting it by protecting kids from the sun, paying attention to the moles on their skin, and making sure they know from an early age that it’s important to take sun safety seriously.

About Melanoma

Melanoma is a type of cancer that begins in the melanocytes — the cells deep within the epidermis (the outermost layer of the skin) whose function is to produce melanin, the pigment that gives skin its color. Dark-skinned people have cells that naturally produce a lot of melanin, while fair-skinned people produce much less.

Melanocytes commonly cluster together to form skin growths called moles (or nevi, in medical terms). Most people have several moles — maybe even dozens — and in most cases they don’t cause any problems. They may be flat or raised, large or small, light or dark, and can appear anywhere on the body.

Sometimes, though, melanocytes can stop working normally. Because of a genetic change (mutation), they can begin growing out of control, sticking together to form lesions or tumors, crowding out healthy cells, and damaging surrounding tissue. This condition is known as cancer.

Melanoma that’s caught early, when it’s still on the surface of the skin, can be cured. But if melanoma is not treated, it can grow downward into the skin until it reaches the blood vessels and lymphatic system. These two systems can act like a highway for the cancer cells, allowing them easy access to distant organs like the lungs or the brain. That’s why early detection is so important.

How People Get It

How does a normal melanocyte turn cancerous? Researchers believe it’s probably a combination of genetic and behavioral factors. But one of the most important common contributors is UV sun damage. Cells that have been damaged by UV rays are more likely to become cancerous over time.

And though you might think that ongoing exposure — being in the sun because you work outside, for example — would increase someone’s risk of melanoma, it’s actually occasional exposure that has the potential to do the most damage. So short bouts of bad, blistering sunburn that a child may get during a day at the beach or the park or even on the family vacation may be more harmful than lower-level, everyday exposure.

Among teens and young adults who are diagnosed with melanoma, most are tanning bed users who are exposed to “concentrated” doses of UV rays. Just one tanning session can make someone more likely to develop skin cancer.

Of course, there may be other reasons for the increase in overexposure to harmful rays. The thinning of the ozone layer or clothing styles that expose more skin also may have contributed to the risk. And it’s thought that as people live longer and become more are aware of the disease, more cases of skin cancer will be diagnosed.

But today’s melanoma rates also have a lot to do with false beliefs about tanning from years ago. Most people — including some doctors — once thought it was safe and even healthy for people to lather up with oil and tan as much as they wanted. In the 1960s and ’70s, metallic reflectors and baby oil were all the rage. Then, in the 1980s, tanning beds and sun lamps became popular, and many people began believing it was actually safer to get a “base tan” indoors before heading out into the summer sun or going on a tropical vacation.

Risk Factors for Melanoma

Today we know better. Still, certain risk factors can increase a person’s chance of developing melanoma, including:

• a fair complexion (light skin that freckles or burns easily, blue eyes, or blond or red hair)
• having many moles (usually, more than 25)
• UV exposure (whether from the sun or a tanning bed)
• having a history of frequent or severe sunburns
• having a relative with melanoma or a family history of irregular moles
• age (older people are still at greater risk)
• having a previous melanoma (moles typically don’t grow back after being removed, but a person who’s had melanoma once is more likely to have a recurrence somewhere else)

But melanoma doesn’t discriminate. Though less likely, people can still get it even if they’re young, have no family history of cancer, or have dark skin. People of African heritage are more likely to get melanoma under the nails, or on the palms and soles. This condition, called acral lentiginous melanoma, is not related to sun exposure.

Signs and Symptoms

Many melanomas start out as a mole or a bump on the skin. Of course, not every mole is cancerous — far from it. What’s more telling is whether a mole has undergone any kind of recent change, whether in size, shape, or color.

That’s why it’s important to look at your child’s skin (and, of course, your own) and take a mental snapshot — kind of like a mole roadmap — so you’ll know what’s normal. With that as a baseline, you’ll be able to spot any changes early.

The ABCDE Rule

Keep the ABCDE rule in mind when checking moles:

• A for asymmetry: If you were to cut the mole down the middle, would the left and the right sides look different?
• B for border: Are the edges blurry and undefined? Does it appear to be spreading sideways?
• C for color: Does the mole look darker or lighter than usual, or does it have an area of new color — perhaps black, blue, purple, red, or white?
• D for diameter: Is the mole larger than the eraser on a pencil top?
• E for elevation: Does it have a raised or bumpy surface?

If you answered yes to any of these questions about an existing mole — or if you notice a new mole, or one that’s started to itch or bleed — see your doctor right away. Melanoma most commonly appears on the trunk, head, and neck for boys, and the lower legs for girls.

If melanoma is suspected, the doctor will do a biopsy by removing all or part of the mole and examining its cells under a microscope. A biopsy not only shows if the cells are cancerous, but also shows how deeply they’ve penetrated the skin and can predict the risk of spreading. Knowing these details will help the doctor map out a treatment plan.

Treatment

Once a doctor confirms melanoma, treatment depends on how big and deep the lesion is, what part of the body it’s on, and whether the cancer has spread to other parts of the body. This process is called staging. Although staging is a complicated procedure that involves both physical exams and lab tests, the basic idea is that the lower the stage, the better the chance of recovery.

Treatment for melanoma usually includes surgery to remove the lesion and, possibly, radiation (high-energy X-rays that are directed at tumors) or chemotherapy (cancer-fighting drugs) if the doctor suspects that cancerous cells may have traveled to other areas of the body.

Immunotherapy (also known as biologic therapy) — in which doctors stimulate the body’s own immune system to fight cancer cells — also may be used along with these other treatments.

Prevention

Although you can’t control how fair their skin is or whether they have a relative with cancerous moles, you can lower your kids’ risk of developing melanoma. The most important way is to limit sun exposure.

Keep kids younger than 6 months out of the sun entirely, because their skin is extremely sensitive. If any body parts of a child under 6 months must be exposed to the sun, use a small amount of sunscreen on those parts, such as the face and hands. For kids 6 months and older, use sunscreen with an SPF of at least 30 every day.

Other ways to help prevent skin cancer include:

• avoiding the strongest sun of the day — between 10 a.m. and 4 p.m.
• encouraging kids to wear wide-brimmed hats and long, loose cotton clothing, especially if they tend to burn easily
• making sure your teen understands the dangers of tanning salons
• being a good role model yourself

Also, encourage kids to check their moles often (they may need some help with those hard-to-reach areas, like the back and scalp). Help kids keep dated records of each mole’s location, size, shape, and color. Remind them to bring anything suspicious to your attention so you can have it checked out.

Just as important, encourage them from an early age to think about and take responsibility for their own sun safety. For very young kids, it helps to keep it fun. Make a game out of applying sunscreen, whether it’s racing each other to lather up or making up a silly song about slathering on the lotion. For older kids, keep some sunscreen by the front door and make putting it on a requirement for playing outside (you may even consider rewarding them every time they remember without being told).

For teens, seeing some pictures of normal vs. sun-damaged or cancerous skin can really drive the message home that the choices they make today can absolutely have an effect on their health tomorrow.

Not all skin cancer is melanoma, but every case of melanoma is serious. Do what you can to lower your kids’ risk and empower them to make smart choices about sun safety. After all, the best defense is a good offense.

Most people have never heard of neuroblastoma, but it’s actually the most common type of cancer in infants.

In this rare disease, a solid tumor (a lump or mass caused by uncontrolled or abnormal cell growth) is formed by special nerve cells called neuroblasts. Normally, these immature cells grow into functioning nerve cells. But in neuroblastoma, they become cancer cells instead.

Although neuroblastoma sometimes forms before a child is born, it usually isn’t found until later, when the tumor begins to grow and affect the body. When neuroblastoma is found and treated in infancy, the chance of recovery is good.

About Neuroblastoma

Neuroblastoma most commonly starts in the tissue of the adrenal glands, the triangular glands on top of the kidneys that make hormones that control heart rate, blood pressure, and other important functions. Like other cancers, neuroblastoma can spread (metastasize) to other parts of the body, such as the lymph nodes, skin, liver, and bones.

In a few cases, the tendency to get this type of cancer can be passed down from a parent to a child (called the familial type). But most cases of neuroblastoma (98%) are not inherited (called the sporadic type). It happens almost exclusively in infants and children, and is slightly more common in boys than in girls.

Children diagnosed with neuroblastoma are usually younger than 5 years old, and most new cases happen in children younger than 2. About 700 new cases of neuroblastoma are diagnosed each year in the United States.

Causes

Neuroblastoma happens when neuroblasts grow and divide out of control instead of developing into nerve cells. The exact cause of this abnormal growth is not known, but scientists believe a defect in the genes of a neuroblast allows it to divide uncontrollably.

Signs and Symptoms

The effects of neuroblastoma can be different depending on where the disease first started, how much the cancer has grown, and how much it has spread to other parts of the body.

The first symptoms are often vague and may include irritability, being very tired, loss of appetite, and fever. But because these early signs can develop slowly and be similar to symptoms of other common childhood illnesses, neuroblastoma can be difficult to diagnose.

In young children, neuroblastoma often is discovered when a parent or doctor feels an unusual lump or mass somewhere in the child’s body — most often in the abdomen, though tumors also can appear in the neck, chest, and elsewhere.

The most common signs of neuroblastoma happen when the growing tumor presses on nearby tissues or when the cancer spreads to other areas. For example, a child may have:

• a swollen stomach, abdominal pain, and decreased appetite (if the tumor is in the abdomen)
• bone pain or soreness, black eyes, bruises, and pale skin (if the cancer has spread to the bones or bone marrow)
• weakness, numbness, inability to move a body part, or difficulty walking (if the cancer presses on the spinal cord)
• drooping eyelid, unequal pupils, sweating, and red skin, which are signs of nerve damage in the neck known as Horner’s syndrome (if the tumor is in the neck)
• difficulty breathing (if the cancer is in the chest)
• fever and irritability

Diagnosis

If a doctor suspects neuroblastoma, your child may undergo tests to confirm the diagnosis and rule out other causes of symptoms. These tests may include simple urine tests and blood tests, imaging studies (such as X-rays, a CT scan, an MRI, an ultrasound, and a bone scan), and a biopsy (removal and examination of a tissue sample).

These tests help to find the location and size of the original (primary) tumor and see whether it has spread to other areas of the body, a process called staging. Other tests, such as a bone marrow aspiration and biopsy, also might be done.

The doctor might order an MIBG scan. In this imaging test, MIBG (iodine-meta-iodobenzyl-guanidine, a type of radioactive material) is injected into the blood and attaches to neuroblastoma cells. This lets the doctor see if the neuroblastoma has spread to other parts of the body. MIBG is also used at higher doses to treat neuroblastoma, and can be used for scanning after treatment to see if any cancer cells remain.

In rare cases, neuroblastoma may be detected by ultrasound before birth.

Treatment

How neuroblastoma is treated depends on factors that determine risk, such as the child’s age, the characteristics of the tumor, and whether the cancer has spread.

The three risk groups are: low risk, intermediate risk, and high risk. Children with low-risk or intermediate-risk neuroblastoma have a good chance of being cured. However, more than half of all children with neuroblastoma have the high-risk type, which can be difficult to cure.

Because some cases of neuroblastoma disappear on their own without treatment, doctors also sometimes use “watchful waiting” before trying other treatments.

Typical treatments for neuroblastoma include surgery to remove the tumor, radiation therapy, and chemotherapy. If the tumor hasn’t spread to other parts of the body, surgery is usually enough.

Unfortunately, in most cases the neuroblastoma has spread by the time it’s diagnosed. In these cases, chemotherapy and surgery are usually the primary treatments and may be done along with radiation therapy and stem cell transplants.

Another treatment the doctor might suggest is retinoid therapy. (Retinoids are substances that work in the body much like vitamin A.) Scientists believe that retinoids can help cure neuroblastoma by encouraging cancer cells to turn into mature nerve cells. Retinoids are often used after other treatments to help prevent the cancer from growing back.

Other treatment options include tumor vaccines and immunotherapy using monoclonal antibodies. Monoclonal antibodies are special substances that can be injected into the body to seek out and attach to cancer cells. They’re sometimes used to stimulate the immune system to attack the neuroblastoma cancer cells.

Outlook

With treatment, many children with neuroblastoma have a good chance of surviving. In general, neuroblastoma has a better outcome if the cancer hasn’t spread or if the child is younger than 1 year old when diagnosed.

High-risk neuroblastoma is harder to cure and is more likely to become resistant to standard therapies or come back (recur) after initially successful treatment.

Late Effects

“Late effects” are problems that patients can develop after cancer treatments have ended. Late effects of neuroblastoma include growth and developmental delays and loss of function in involved organs. Hearing loss is common. The risk of developing late effects depends on things like the specific treatments used and the child’s age during treatment.

Although rare, some kids with neuroblastoma develop opsoclonus-myoclonus syndrome, a condition where the immune system attacks normal nerve tissue. As a result, some might have learning disabilities, delays in muscle and movement development, language problems, and behavioral problems.

Children treated for neuroblastoma also may be at higher risk for other cancers.

Caring for Your Child

Being told your child has neuroblastoma can be overwhelming, and cancer treatment can take a huge toll on your child and family. At times, you might feel helpless.

But you play a vital role in your child’s treatment. During this difficult time, it’s important to learn as much as you can about neuroblastoma and its treatment. Being knowledgeable will help you make informed decisions and better help your child cope with the tests and treatments. Don’t be afraid to ask the doctors questions.

Although you might feel like it at times, you’re not alone. It can help to find a support group for parents whose kids are coping with cancer (there are groups specifically for parents of children with neuroblastoma).

Parents often struggle with how much to tell a child who’s diagnosed with cancer. While there’s no perfect answer, experts agree that it’s best to be honest — but to tailor the details to your child’s degree of understanding and emotional maturity. Give as much information as your child needs, but not more.

And when explaining treatment, try to break it down into steps. Addressing each part as it comes — visiting various doctors, having a special machine take pictures of the body, needing an operation — can make the big picture less scary. Be sure to explain to your child that the disease is not the result of anything he or she did.

Also remember that it’s common for siblings to feel neglected, jealous, and angry when a child is seriously ill. Explain as much as they can understand, and involve family members, teachers, and friends to help keep some sense of normalcy for them.

And finally, as hard as it may be, try to take care of yourself. Parents who get the support they need are better able to support their children.

About Neurocutaneous Syndromes

Neurocutaneous syndromes are disorders that lead to growth of tumors in various parts of the body. They’re caused by the abnormal development of cells in an embryo and characterized by the tumors in various parts of the body (including the nervous system) and by certain differences in the skin.

While some can be diagnosed at birth, others don’t produce symptoms until later in life. Although neurocutaneous syndromes can’t be cured, treatments can help manage symptoms and any health problems that occur.

Recently, important advances have been made in using DNA testing to confirm these syndromes in some people.

Types of Neurocutaneous Syndromes

Common neurocutaneous syndromes that affect kids include:

• neurofibromatosis, types 1 and 2 (NF1 and NF2)
• Sturge-Weber syndrome
• tuberous sclerosis (TS)
• ataxia-telangiectasia (A-T)
• von Hippel-Lindau disease (VHL)

Symptoms vary widely from condition to condition, and they affect different kids in different ways. Often, the full effects of these diseases — even if detected at birth — don’t emerge until a child grows up. The educational, social, and physical problems that the conditions cause must be managed throughout a child’s life.

Neurofibromatosis

Neurofibromatosis is one of the most common neurocutaneous syndromes. It can cause tumors involving the nerves, brain, and other organs.

Neurofibromatosis is usually inherited, but up to half of cases happen because of spontaneous changes (mutations) in a person’s genes. Once a mutation occurs, the changed (mutant) gene can be passed on to children. The child of a parent with neurofibromatosis has a 50% chance of inheriting the disorder.

The three forms of this disorder are neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and Schwannomatosis. NF1 is the most common, accounting for about 90% of all cases.

Neurofibromatosis Type 1

NF1 (also known as von Recklinghausen disease) occurs in about 1 in 2,500 babies born worldwide. To diagnose NF1, doctors take a thorough medical and family history because children with NF1 often have a parent with the disease.

The classic sign of NF1 are skin pigmentary findings known as “café-au-lait” spots. These light brown or coffee-colored birthmarks may be present at birth. They typically increase in size and number during the first two years of life. A child diagnosed with NF1 must have at least six café-au-lait spots of a certain size. The spots are flat, don’t itch or hurt, and don’t turn into anything more serious.

Other common signs are freckling in the armpits and groin, as well as Lisch nodules, which are small noncancerous (benign) bumps on the iris, the colored part of the eye. In some cases, tumors can develop along the optic pathway and affect vision. During puberty, noncancerous tumors called neurofibromas may develop on or under the skin or along the nerves. Bone deformities also may develop.

A child with complications involving the eye, nervous system, spine, or bones will be referred to a specialist for treatment. In cases where these neurofibromas are causing pain or infections, or growing into vital body organs, the growths can be removed through surgery.

Children with NF1 can also have a high prevalence of seizures, learning disabilities, attention deficit disorder (ADHD), autism, and speech problems. Therapy and specialists can help manage those symptoms.

Neurofibromatosis Type 2

Neurofibromatosis type 2 is less common, occurring in about 1 in 25,000 births. Young adults with NF2 are typically diagnosed when they develop tumors on the vestibular nerves (the nerves leading to the ear). In contrast, young kids with NF typically have retinal abnormalities and spinal tumors.

NF2 symptoms, which appear in the teen years or early 20s, can include hearing loss, ringing in the ears, and balance problems balance. Surgery and chemotherapy can help manage these problems.

Schwannomatosis

Schwannomatosis is an even rarer type of neurofibromatosis, in which people develop multiple non-cancerous tumors involving the nerves in many areas of the body, most often the arms or legs. But unlikeNF2, they don’t get vestibular nerve tumors.

In their mid-20s, people with this disorder may experience numbness, weakness, muscle atrophy, and severe pain in parts of their bodies. Treatments, such as pain medications and surgery, are available to manage these symptoms.

Tuberous Sclerosis

Tuberous sclerosis, or TS, causes non-cancerous growths called tubers  to form on organs, including the brain, eyes, kidneys, heart, lungs, bones, and skin. It occurs in about 1 in 6,000 births, and the child of a parent with TS has a 50% chance of having it.

TS is often first recognized when a child has seizures or shows developmental delays. The severity of TS symptoms varies greatly among kids, ranging from mild skin changes to learning disabilities, mental retardation, or kidney failure.

Treatment usually includes medication to control seizures, treatments to address skin problems, surgery to remove tumors, and management of high blood pressure caused by kidney disease.

Sturge-Weber Syndrome

Sturge-Weber syndrome is a rare condition caused by a spontaneous genetic mutation that affects the skin and brain. What causes the mutation is unknown. So far, no genetic factors have been found. It isn’t passed to children by parents who carry the disease. Because it frequently goes undiagnosed, it’s difficult to estimate how many people are affected.

Each case of Sturge-Weber is unique and symptoms vary widely. The most visible sign is a facial birthmark or “port-wine stain” at birth that usually covers at least one upper eyelid and the forehead.

Sturge-Weber syndrome can lead to neurological problems, including unusual blood vessel growths on the brain. These often cause seizures that begin before the first birthday and can worsen with age. A child also may experience seizures that affect the side of the body that’s opposite from the port-wine stain.

About half of patients also develop glaucoma (increased pressure inside the eye that impairs vision), typically in the eye that is affected by the port-wine stain. That eye also might be enlarged (a condition called buphthalmos). Some kids who have this condition also experience strokes.

Treatments, medications, and surgery can help a child cope with the health problems associated with the disease.

Children as young as 1 month old who have Sturge-Weber can undergo laser treatment to reduce or remove port-wine stains. Anticonvulsant medication may be used to control seizures, and surgery can control glaucoma and vision problems.

Ataxia Telangiectasia

Ataxia telangiectasia (A-T) is a gradually worsening disease involving many major body systems. It’s a recessive genetic disease, meaning that two healthy parents who carry the gene could have a child with A-T. Two parents who carry the mutated gene have a 1 in 4 chance of having a child affected by A-T.

A-T is usually noticed in the second year of life, as a child develops problems with balance and slurred speech caused by ataxia (lack of muscle control). The ataxia occurs because the cerebellum, the part of the brain that controls muscle movement, is degenerating. Eventually, lack of muscle control becomes severe enough for the child to require a wheelchair.

Another symptom of A-T is the appearance of tiny, red, spiderlike veins in the corners of the eyes or on the ears and cheeks when exposed to sunlight. These veins, known as telangiectasias, are harmless.

About 70% of children with A-T also have immune system problems that make them more susceptible to lung disease. These children often have chronic upper respiratory infections, lung infections, and pneumonia. They’re also very susceptible to developing certain cancers, such as leukemia and lymphoma.

Currently, there’s no cure for A-T and no way to stop its progression. But treatment can help kids manage symptoms. Physical therapy and occupational therapy may help maintain flexibility, and speech therapy can help address slurring and other speech problems. Special medications may be given to help enhance weakened immune systems.

Von Hippel-Lindau Disease

Von Hippel-Lindau disease (VHL) is a rare genetic disorder involving the abnormal growth of blood vessels, leading to tumors. It usually affects certain areas, such as the brain and other parts of the central nervous system, the retina in the back of the eye, the adrenal glands, the kidneys, or the pancreas. Although few people have this disease, the child of a parent who carries the gene that causes VHL has a 50% chance of having the disorder.

Blood vessels usually grow like branches on a tree, but in kids with VHL, they form small tumors called angiomas. Doctors carefully monitor angiomas because, depending on their location, they can cause other medical problems. For example, angiomas on the retina may lead to vision loss.

Symptoms usually appear when someone is between 10 and 30 years old. VHL is diagnosed through an MRI or CT scan, a physical examination, and blood tests.

Symptoms depend on the size and location of the angiomas, and can include headaches, balance problems, dizziness, weakness, vision problems, and high blood pressure. Fluid-filled cysts or tumors (cancerous or non-cancerous) may develop around the angiomas, worsening these symptoms. People with this disorder have a higher risk of developing cancer, especially kidney cancer.

VHL treatment depends on the size and location of the angiomas. The goal is to treat the tumors while they’re small and before they put pressure on any major organs. Surgery may be required to remove tumors before they create severe problems.

The outlook for VHL patients depends where the tumor is located and whether it’s causing a problem to the patient. Fortunately, early detection and treatment can improve treatment outcome.

Caring for Your Child

The illnesses associated with neurocutaneous syndromes can place enormous stress and emotional burdens on you and your child, and it’s easy to feel overwhelmed. Early intervention is important to help your child achieve the best quality of life possible.

It’s important that your child is cared for by a team of medical experts. Treatment should prevent or minimize complications and maximize a child’s strengths. Keep these tips in mind:

• Positive reinforcement can strengthen your child’s self-esteem and foster a sense of independence. Let your child find out what he or she is capable of, especially regarding daily living skills.
• Support groups can be help, so seek out local chapters that address your child’s particular illness. They provide a supportive social environment, and are a great way to share knowledge and resources.
• Psychotherapy or other supportive treatments can boost your child’s self-esteem and coping skills, so ask the treatment team for referrals. Therapy also can help other family members deal with the stress involved in caring for a child with a chronic illness or disability.
• Physical, occupational, or speech therapy can help your child improve some of the developmental delays caused by the specific illness.
• Check with your local hospital or university for seminars about neurocutaneous syndromes.

Many medical professionals might care for your child during diagnosis and treatment. These professionals can include a family practitioner, pediatrician, neurologist, neurosurgeon, orthopedic surgeon, oncologist, geneticist, and ophthalmologist. A genetic counselor also can provide information about genetic testing and the risk of passing the disease on to another child.

Remember that although each of these conditions is challenging, supportive therapies and treatments can help both you and your child.

About Neurofibromatosis

Neurofibromatosis (NF) is a neurocutaneous syndrome that can affect many parts of the body, including the brain, spinal cord, nerves, skin, and other body systems. NF can cause growth of non-cancerous (benign) tumors involving the nerves and brain.

NF can range from mild to severe. Some children live almost unaffected by their NF, while others can be severely disabled.

Types of NF

Of the three types of neurofibromatosis — NF1, NF2, and schwannomatosis — NF1 is most common. NF1, also known as von Recklinghausen disease, occurs in 1 of every 2,500 births and affects about 100,000 Americans.

NF2 is much rarer, found in about 1 in 25,000 births. A person with NF2 almost always has bilateral vestibular schwannomas, which are non-cancerous tumors affecting the nerves that carry hearing and balance information to the brain.

Schwannomatosis is the third and rarest type of NF. People with schwannomatosis have many noncancerous tumors (schwannomas) affecting the nerves throughout the body. In contrast to NF2, they don’t develop tumors on the vestibular nerves of the ear and lose their hearing. This disorder isn’t usually identified until people reach their mid-20s and begin to get symptoms of chronic pain.

Even in a family in which more than one person has NF, the disease may cause slightly different problems in each person who has it.

Causes of NF

Both neurofibromatosis 1 and 2 are kind of inherited disorder. People with NF have 1 in 2 chance of passing it on to each of their babies. About half of cases of NF are inherited in this way. In the other half of cases, the mutation that causes neurofibromatosis happens spontaneously. In these families where nobody has had NF before, the genetic material gets changed when the sperm meets the egg.

Blood testing helps confirm whether a person has NF, and helps check for mutations.

Signs and Symptoms

In younger kids or in those with mild cases, NF1 can be found early when café-au-lait spots (birthmarks) appear on the skin.

Many people without NF1 have one café-au-lait spot. But if a young child has more than five of these birthmarks, at least ½ inch in diameter (roughly the size of a dime), a doctor will look for other clues that may indicate NF1. Other signs of NF1 include freckling in the armpits and groin areas, as well as neurofibromas — tumors on, under, or hanging off the skin — and Lisch nodules, tiny, noncancerous bumps on the iris (the colored part of the eye). Although Lisch nodules help identify a person with NF1, they don’t cause any vision problems.

Neurofibromas can be on various parts of the body, often right before puberty starts.

People with NF1 may also have bone problems, such as the thinning or overgrowth of the bones in the arms or lower leg, or scoliosis, an abnormal curving of the spine.

NF2 isn’t usually diagnosed until a child is older. Hearing loss in the late teens and early 20s, is often the first symptom of the disorder, and is caused by tumors growing on the vestibular nerves. The vestibular nerves carry electrical impulses from the ear to the brain, allowing us to hear, and these tumors can occur on one or both sides.

Other symptoms of NF2 include continuous ringing in the ears, headache, facial pain, or weakness, and feeling unsteady or off-balance.

Other tumors may involved the lining of the brain (meningiomas) and spinal cord (ependymomas). Young children also may have problems with the retina in the back of the eye.

Diagnosis

Neurofibromatosis is usually diagnosed based a child having at least two of these seven signs:

• café-au-lait spots of a certain number, size, and location
• the appearance of two or more neurofibromas (often resembling pea-sized bumps on the skin)
• two or more Lisch nodules
• an optic glioma (tumor along the main nerve from the eye responsible for sight)
• certain skeletal defects
• a close family member with NF1
• freckling under the arms or in the groin

This list helps diagnose patients with NF1 in all but the youngest children, and by age 8, most children with NF1 will meet the criteria. By the age of 20, all patients meet the criteria.  If the diagnosis isn’t certain based on these factors, genetic testing is available, but the result can’t help a person tell which signs of NF they will develop.

If a doctor suspects your child has NF1, he or she may refer you to NF1 specialists.

Other tests help identify medical problems associated with the NF. Tests like magnetic resonance imaging (MRI) help screen for changes in the brain called “bright spots,” brain enlargement, and tumors. X-rays may help identify skeletal problems.

To diagnose NF2, doctors will check for any evidence of hearing loss or balance problems. They’ll order audiometry (hearing tests) as well as brain and spine imaging studies to look for tumors in the nerves of the ears, spinal cord, or brain. They’ll also ask about family members who may have NF2. Individuals will also be sent to an eye doctor to check for cataracts and retinal problems.

Genetic testing is now available for NF2. For women with NF2 who are pregnant, amniocentesis or chorionic villus sampling can also sometimes determine if an unborn child has the condition.

Treatment

Treatment for NF requires multi-disciplinary team management.

Research over the past decade has resulted in the discovery of new treatments for people with NF. These new therapies are currently being offered as part of ongoing clinical trials to provide better options for affected individuals.

Caring for Your Child

The first noticeable sign of neurofibromatosis usually is the presence of multiple café-au-lait spots. If your child has several of these birthmarks, ask your doctor to refer you to a clinical program with expertise in NF.

If your child is diagnosed with cancer, it may feel as though you went to bed one night and woke up in an alternate universe. Suddenly there are all these new words — oncology, chemotherapy, radiation — not to mention a slew of new fears and emotions.

Now the doctor is saying your child’s immune system isn’t strong enough for him or her to go to school or even visit family.

If that’s the case, chances are it’s because your child has developed a condition called neutropenia. Neutropenia is when the body has very low levels of certain white blood cells (called neutrophils), the body’s main defense against infection.

Cancer and its treatment also may cause other problems with the immune system, making it important to avoid crowds of people who could expose your child to viruses.

A Weakened Immune System

When a germ enters the body, a healthy immune system springs into action, sending an army of neutrophils to the area to attack. The next time those same germs enter the body, the immune system will “remember” them and try to head them off before they can cause any serious trouble.

Someone with cancer, though, often has fewer neutrophils patrolling the body. In some cases, that’s because the cancer itself damages the bone marrow, the spongy material inside the bones where all new blood cells — including neutrophils — are made. (This is especially common with cancers like leukemia and lymphoma.)

Other times it may be the cancer treatments themselves that are doing the damage. Both chemotherapy (powerful cancer-fighting drugs) and radiation (high-energy X-rays) work by killing the fastest-growing cells in the body — both bad and good. That means that while cancer cells are destroyed, so too are healthy blood cells, like neutrophils.

Risk of Illness

With fewer neutrophils, a person is more prone to infection. Even things the body would normally be able to fight off without much trouble, like skin infections or ear infections, become much more serious and long-lasting when someone is in a “neutropenic state.”

That’s why it’s important to call the doctor right away if your child has a fever, shaking or chills, or any mouth or skin sores, which can be signs of infection.

Fortunately, doctors can use a blood test called an absolute neutrophil count (ANC) to judge how cautious someone needs to be about avoiding germs:

• When the neutrophil count is below 1,000 cells per microliter of blood, the risk of infection increases somewhat.
• When it falls below 500 cells per microliter, the risk increases quite a bit more.
• If it stays below 100 for many days, the risk of serious infection becomes very high.

Sometimes, medicines called growth factors can be given to encourage the body to produce more neutrophils. But often it’s safest for a child to remain home for a length of time determined by the doctor. Places like schools, locker rooms, malls, and even churches — where people are close together and germs spread easily — are just too risky. To a child’s weakened immune system, it would feel like standing at the edge of a forest fire with only a water gun for defense.

Making the Best of It

Being stuck at home can be tough on anyone. When things feel out of control, most people — and especially kids — count on the routines of daily life to help maintain some sense of normalcy. It’s only natural that losing that, even temporarily, can leave your child feeling angry, frustrated, left out, depressed, punished, and even jealous of siblings and friends.

So what can you do to help your child make the best of the time at home?

Plenty — though it may depend on how your child feels. Some days the cancer treatments will wipe your child out, and all he or she will want to do is sleep. Other days your child will have more energy.

Follow your child’s lead, and when he or she seems up for it, here are some ideas for beating the boredom:

Help Your Child Stay Connected

Even if you cracked down on screen time before your child got sick, now’s a good time to consider easing up. Allowing access to the Internet, texting, online messaging, photo sharing, Skype, and online games with friends is more than just a perk — it’s a valuable way for your child to stay within his or her social network.

Ask the doctor or nurse if a friend can come over. In some cases, if the doctor says it’s OK, your child might be able to have a friend over for a brief visit or a movie night. If so, a little prep work on both sides can make the evening go smoothly.

First, make sure the friend knows that your child’s cancer, and related neutropenia, isn’t contagious — otherwise he or she may be reluctant to come. More important for your child’s safety, reschedule get-togethers if there’s any question about whether the visitor is sick, even if it’s just a cold. And finally, always have everyone who comes in contact with your child wash their hands.

Even though it may hurt to talk about this, let your child know that some friends may deal with his or her illness better than others. Remind your child to try not to take it personally if some friends don’t know what to say, or if they talk about things that your child missed out on. The good news is that there will usually be a few true friends who will know how to treat your child like the same person he or she has always been.

Get Creative

What are some things your child never gets a chance to do? Maybe your daughter is an athlete who’s always wondered if she has an artistic side; or your son is a computer whiz who’s always enjoyed creative writing.

Now’s the time to explore those other sides of your child’s personality. Painting, drawing, building models, designing clothes or jewelry, learning an instrument, or making a scrapbook or collage of favorite photos are all great ways to get those creative juices flowing. Writing poetry or keeping journals or a blog can help your child deal with difficult emotions — and rereading them when your child feels better will be a reminder of how far he or she has come.

Approve a Room Makeover

With a little help from you, your child’s bedroom can become the coolest and comfiest space ever. Maybe you can turn a corner into a lounge, or the bed into a funky sofa with fluffy pillows or a reading pillow with arms. Choose colors that make your child feel good and be sure to keep favorite music, books, and photos nearby to really make it special.

Get Outside

Even when public places are off limits, fresh air usually isn’t. So encourage your child to sit on the porch or in the yard and read, talk on the phone, or listen to music.

Help Your Child Feel Empowered

One of the best ways for anyone to feel stronger is to do something good — maybe your child can coordinate a fundraiser for a favorite charity, whether it has to do with cancer or another special cause, like animals or the environment. Maybe he or she could start a blog about dealing with cancer that can help other kids in the same position.

Or maybe your child can make a list of things to look forward to when this experience is over. Getting your child to think beyond the here and now can make the time go faster and help everyone stay positive.

Talk It Out

Feelings and worries can become overwhelming when they’re held in, so find a way to help your child let them out. A good place to start is with your hospital’s social worker, who can put your family in touch with others who’ve been where you are now.

Or check out some of the many cancer support websites, most with chat areas or message boards, that make it easy to share what your family is going through with others who understand.

Try to Keep Up With Schoolwork

And last but not least, encourage your child to stay on top of schoolwork as much as possible. Keep in touch with teachers to find ways to stay involved in classroom life and modify assignments, when necessary.

Staying home may be hard on kids at first, especially if a child was always on the go. The good news for many kids with cancer is that having to stay home is only a temporary setback. Once the immune system recovers, your child should be able to get back in the swing of things.

In the meantime, keep your child’s spirits up, look toward the future, and have confidence that, even though things seem difficult now, your child will get through it with help from loved ones.