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Types of children’s cancers

Bone tumours

Bone tumours are cancers that start in a bone. It is sometimes called a bone sarcoma. 

There are two main types of bone tumours in children.

Osteosarcoma

Osteosarcoma starts in cells called osteoblasts, which are cells that form new bone. Osteosarcoma usually develops at the ends of the long bones, such as the arms or legs.

This type of tumour often starts in bones that are growing quickly, making it more common in teenagers during their growth spurt than in young children. Osteosarcoma is very rare in children under five years old.1

Ewing sarcoma

Ewing sarcoma (also called Ewing family of tumours) forms from a type of stem cell in the bone marrow. Ewing tumours can form in the bones of the:

  • arms
  • legs
  • hands
  • feet
  • spine
  • skull
  • ribs
  • shoulder blades 
  • hips.

Ewing sarcomas can also form in soft tissues near bones. These are called extraosseous or extraskeletal Ewing tumours. The Soft tissue sarcoma section has some information about these types of tumours.

Ewing tumours are also more common in teenagers than in young children.

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917386/

 

Chance of a cure

One of your biggest concerns on learning your child has cancer may be about their chance of being cured.

Due to major advances in treatment, many children treated for cancer now survive into adulthood. Children diagnosed with cancer between 2004 and 2012 have a 5-year survival rate of 85%. In the 1980s, the 5-year survival rate for all cancers was about 73%.1

Talk to your child’s doctor about your child’s diagnosis, treatments and long-term survival. Long-term survival is also called the outlook or prognosis. It on depends several things, including:

  • age of your child at diagnosis
  • extent or stage of the cancer
  • how the cancer cells look under a microscope (the shape, function and structure of the cells)
  • how the cancer responds to treatment
  • cancer or tumour biology, which includes
    • the patterns of the cancer cells
    • how different the cancer cells are from normal cells
    • how fast the cancer cells are growing.

To learn more about survival for bone tumours in children, visit Australian Cancer Childhood Statistics Online

References

[1] https://cancerqld.blob.core.windows.net/content/docs/Childhood-Cancer-in-Australia-1983-2015.pdf

 

Clinical trials

It’s possible that your child may be able to be part of a clinical trial. Clinical trials are research investigations to test new treatments, interventions or tests, or as a way to prevent, detect, treat, or manage various diseases or medical conditions. The patients involved in clinical trials are volunteers.1

With regard to cancer, researchers run clinical trials to test new ways to:

  • treat cancer
  • find and diagnose cancer
  • manage cancer symptoms and treatment side effects.

If a trial is available, taking part in one will be entirely the family’s decision.

It’s important to note that any new treatments are strictly regulated. They have to be approved before they can be used in a clinical trial. Your child’s doctor will explain everything about the trial and give you detailed written information. You will need to give permission for your child to be part of the trial.

Participating in a clinical trial may or may not directly benefit your child. But the results of clinical trials today help children with cancer in the future. If you’re interested in participating in a clinical trial, ask your child’s doctor if there are any suitable for your child.

You can find further information on our Clinical trials and research page.

References

[1] https://www.australianclinicaltrials.gov.au/what-clinical-trial

 

Diagnosis

When your child is diagnosed with cancer, it can feel overwhelming. This phase involves finding out if your child has cancer, and determining the type of cancer they have. Children’s cancer can be difficult to diagnose, as many symptoms are similar to those caused by less serious conditions, or injuries. This means that your child may need several tests and medical appointments before you receive confirmation that your child has cancer.

If your doctor thinks your child has a bone tumour, your child will have several tests, which may include:

  • medical history and physical exam
  • medical imaging, such as
    • X-ray
    • computed tomography (CT) scan
    • magnetic resonance imaging (MRI)
    • bone scan
    • positron emission tomography (PET) scan
  • biopsy, with tests for genetic changes to help find how best to treat your child.

To diagnose Ewing tumours, doctors may also ask for:

  • blood tests
  • bone marrow aspiration and biopsy.

Our section, How is cancer diagnosed? explains these tests in more detail.

Staging

Doctors use staging to describe how much the cancer has grown. Some of the tests will also help to stage the tumour. Staging measures:

  • where the tumour is
  • how big the tumour is
  • what nearby organs it affects
  • if it has spread to other parts of the body.

Your doctor will use this information to determine the best way to treat the disease. Staging will also give your doctor an idea of how well these treatments are likely to work (prognosis).

How doctors assess the stage or extent of disease varies. They often stage osteosarcoma and Ewing tumours in one of two ways. The disease can be localised or metastatic. Localised means the cancer has not spread beyond the bone it started in. Metastatic means the cancer has spread to other parts of the body, usually to other bones or the lungs.

The American Cancer Society has more information about staging for osteosarcoma and Ewing tumours.

 

Risk factors

A risk factor is anything that increases a person’s chance of getting a certain condition or disease. Researchers know about some risk factors that increase the chance of developing cancer. However, for most children with cancer, the cause is unknown.

What we do know is that if a child develops cancer, it’s not because of something they, or their parents did to cause it. No one is to blame if a child develops cancer.

Even if your child has a risk factor, it doesn’t mean they will develop cancer. Many children with a risk factor will never develop cancer, most children with cancer have no known risk factors. Even if a child with a risk factor develops cancer, the risk factor may not have directly caused the cancer.

Researchers don’t completely understand what causes bone tumours. However, some things are linked to a higher chance of getting bone tumours.

Genetic conditions

Some bone conditions can increase your child’s chance of getting osteosarcoma, including:

  • Paget disease
  • hereditary multiple osteochondromas.

Genetic conditions that increase the likelihood of getting cancer can also increase your child’s risk of getting osteosarcoma. These include:

  • hereditary retinoblastoma
  • Diamond–Blackfan anaemia
  • Li–Fraumeni syndrome
  • Rothmund–Thomson syndrome
  • Bloom syndrome
  • Werner syndrome.

If your child has one of these genetic conditions, they will need specific care to monitor for the development of cancer. Your health care team will talk to you about which ongoing tests your child will need.

Childhood cancers with links to genetic conditions may also affect the risk for other family members. You can ask your child’s treatment team if you or your family should get genetic counselling.

To learn more about genetic conditions, see the children’s cancer glossary or the Centre for Genetics Education.

Exposure to radiation

Children who have had radiation therapy in the past may have a higher chance of getting osteosarcoma.

 

Support and more information

A diagnosis of cancer in a child is difficult for your family. It’s normal for you and your family to feel overwhelmed, scared, anxious or angry.

If you or others around you are having trouble coping, make sure you speak to your child’s treatment team. They have helped and supported many other families who have been through what you’re currently going through. Sometimes just letting other people know how you’re feeling helps you feel less alone. If you feel supported, then you will feel more able to support your child.

Most children’s hospitals will allocate a social worker to each family to provide support throughout treatment. If you need support, contact your hospital-based social worker to let them know how you’re feeling and to see what support can be made available to you and your family, including music therapists, play therapists or education support staff.

The following webpages and organisations also offer support and/or extra information for children with cancer and their families:

  • Living with children’s cancer has information about physical, emotional and practical issues during and after diagnosis and treatment.
  • Organisations that can provide support and information.
  • Redkite is a national organisation that provides emotional support, financial assistance, information and resources to families who have a child with cancer. You can reach them through their support line 1800 733 548 (1800 REDKITE), which is open (9am-7pm AEST), email support@redkite.org.au or live chat on www.redkite.org.au
  • Canteen provides a service called Canteen Connect, an online community for young people aged 12-25 dealing with their own or a close family member’s cancer, and Parent Connect, an online community with resources, information and peer support on parenting through cancer. Online counselling is available seven days a week, including evenings. Visit https://canteenconnect.org/ or call 1800 835 932.
  • The Cancer Council in your state or territory can give you
  • general information about cancer
  • information on resources and support groups in your area.
  • You can call the Cancer Council Helpline from anywhere in Australia on 13 11 20.
  • Any of the major children’s hospitals and networks in your state or territory can provide information about childhood cancer.

For more information about types of bone tumours, see:

Note that information from international organisations may not always apply to children in Australia.

 

Symptoms

Symptoms of osteosarcoma may include:

  • pain or swelling over a bone or joint
  • bone or joint pain that:
    • lasts for weeks
    • wakes you from sleep
    • stops you from doing activities you usually enjoy like sports or work
  • a bone that breaks for no reason.

Symptoms of Ewing tumours in bone may include:

  • pain or swelling, usually in the arms, legs, chest, back or hips; pain may be worse at night
  • a lump that might feel soft and warm, often in the arms, legs, chest or hips
  • a bone that breaks for no reason
  • fever
  • tiredness
  • weight loss.

Many conditions can cause the symptoms above, not just cancer. If your child has any of these symptoms and you are worried, talk to your child’s doctor. The earlier cancer is found, the better.

 

Treatment

Your team of doctors, called a multidisciplinary team (MDT), will care for and treat your child, and will ensure that all your child’s needs are considered while they have cancer treatment. The section called The treatment team has further information about this.

Treatment for bone tumours depends on:

  • the age of your child
  • the stage of the cancer
  • the type of bone tumour
  • other factors.

Doctors will suggest treatments based on your child’s situation. Treatment may involve one or more of the following:

  • surgery
  • chemotherapy
  • radiation therapy
  • targeted therapy.

Surgery

If your child has a bone tumour, they are likely to have surgery at some point during their treatment.

For bone tumours in the arms or legs, doctors can usually remove the tumour and some of the surrounding healthy tissue. Missing tissue is replaced with a graft or an implant. This procedure is called limb-sparing surgery. Most implants can be made longer as your child grows, without needing more surgery.

After limb-sparing surgery, your child will have intensive rehabilitation and physical therapy to make sure their limb continues to work normally. If the surgery was on a leg, it can take many months for your child to learn to walk again. Your MDT will be able to provide you with further details about what’s involved in rehabilitation.

In some cases, your doctors may need to remove (amputate) all or part of the arm or leg. This type of surgery can seem drastic and you may feel shocked, angry and upset about your child undergoing amputation. These feelings are very normal. However, your child will be able to be fitted with an artificial limb (prosthesis) which will allow them to perform many of the things they would have been able to do prior to amputation. Your child will need to have intensive rehabilitation therapy to help them learn to use their new limb. However modern technology has made artificial limbs very effective, with many people able to walk, run and even play sports using their prosthetic limbs.

Tumours in other bones where surgery might not be possible are usually treated with a combination of chemotherapy and radiation therapy. Such areas include the spine, skull, chest or hips.

See How is cancer treated - surgery for more detail about cancer surgery.

Chemotherapy

Chemotherapy uses anti-cancer medicines to destroy cancer cells. It’s often given as a combination of medicines to try to stop the cancer cells from becoming resistant to just one or two medicines.

Chemotherapy to treat bone tumours is usually given both before and after surgery:

  • before the surgery, it shrinks the tumour to make it easier to remove
  • after surgery, it destroys any remaining cancer cells.

Chemotherapy is usually part of treatment for all children with Ewing tumours. Your child may get chemotherapy combined with surgery and radiation therapy.

More detail about chemotherapy treatments can be found on our page How is cancer treated - chemotherapy.

Radiation therapy

Radiation therapy is also called radiotherapy. It uses high-energy X-rays or other types of radiation to destroy cancer cells or stop them from growing.

For bone tumours, radiation therapy might be used to:

  • treat the tumour, combined with other treatments such as chemotherapy
  • get rid of any cancer cells that might be left after surgery
  • relieve symptoms of bone tumours (such as pain and swelling) if surgery is not a good option, or if the cancer has come back.

Osteosarcoma cells are not easily destroyed by radiation, so this treatment is not used in all cases of osteosarcoma.

Ewing tumours can be treated with radiation therapy either alone or with surgery, and usually with chemotherapy.

Radiation therapy can have long-term side effects in children. If radiation therapy is included in your child’s treatment, special care will be taken to reduce these risks. Be sure to speak to your doctor if you have concerns about radiation therapy.

You can find more detail about radiation therapy on our page How is cancer treated - radiation therapy.