Childhood cancer - Knowledge

50: 675: 1359:). Alex's Lemonade Stand Foundation allows people across the US to raise money for pediatric cancer research by organizing lemonade stands. The National Pediatric Cancer Foundation focuses on finding less toxic and more effective treatments for pediatric cancers. This foundation works with 24 different hospitals across the US in search of treatments effective in practice. Childhood Cancer International is the largest global pediatric cancer foundation. It focuses on early access to care for childhood cancers, focusing on patient support and patient advocacy. 1296: 880:, often defined as those aged 13–30. Studies have continuously shown that while pediatric cancer survival rates have gone up, the survival rate for adolescents and young adults has remained stagnant. Additionally, AYA helps patients with college concerns, fertility, and sense of aloneness. Studies have often shown that treating young adults with the same protocols used in pediatrics is more effective than adult-oriented treatments. 1384:

groups within hospitals and online for parents and families to aid in the coping process. Targeted support for siblings of children with cancer is also warranted. Resources that account for family context, age, and gender can help siblings process cancer-related emotional reactions. These targeted resources help promote family activities and normal family functioning, while enhancing family adjustment over time.

1240: 4529: 522:(PCCI) or "chemo brain." This term is commonly use by cancer survivors who describe having thinking and memory problems after cancer treatment. Researchers are unsure what exactly causes chemo brain, however, they say it is likely to be linked to either the cancer itself, the cancer treatment, or be an emotional reaction to both. 929:

Psychosocial care of children with cancer is also important during the cancer journey, but the implementation of evidence-based interventions need to be further spread across pediatric cancer centers. In general, psychosocial care can include therapy with a psychologist or psychiatrist, referral to a

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In 2005, 2.9 of every 100,000 people 0–19 years of age were found to have cancer of the brain or central nervous system, and 0.7 per 100,000 died from it. These cancers were found most often in children between 1 and 4 years of age, but the most deaths occurred among those aged 5–9. The main subtypes

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with unique biological characteristics and research and treatment is yet very challenging and limited. For this reason, childhood cancer is often ignored in control planning, contributing to the burden of missed opportunities for its diagnoses and management in countries that are low- and mid-income.

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According to estimates by experts in the field of pediatric cancer, by 2020, cancer will cost $ 158 million annually for both research and treatment which marks a 27% increase since 2010. Ways in which the foundations are helped by people include writing checks, collecting spare coins, bake/lemonade

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Childhood cancer survivors are also at risk of sustaining adverse effects on the kidneys and the liver. Specific cancer treatments such as cisplatin, carboplatin, and radiotherapy are known to cause kidney damage. The risk of liver damage is increased in those who have had radiotherapy to the liver

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Since adult survivors of childhood cancer are living longer, these individuals may experience long-term complications that are associated with their cancer treatment. This can include problems with organ function, growth and development, neurocognitive function and academic achievement, and risk for

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Advanced parental age has been associated with increased risk of childhood cancer in the offspring. There are preventable causes of childhood malignancy, such as delivery overuse and misuse of ionizing radiation through computed tomography scans when the test is not indicated or when adult protocols

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This cognitive impairment is commonly noticed a few years after a child endures cancer treatment. When a childhood cancer survivor goes back to school, they might experience lower test scores, problems with memory, attention, and behavior, as well as poor hand-eye coordination and slowed development

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Cancer in children is rare in the UK, with an average of 1,800 diagnoses every year but contributing to less than 1% of all cancer-related deaths. Age is not a confounding factor in mortality from the disease in the UK. From 2014 to 2016, approximately 230 children died from cancer, with brain/CNS

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To help monitor for these long-term consequences, a set of guidelines have been created to facilitate long term follow up for childhood, adolescent, and young adult cancer survivors. This provides guidance for healthcare professionals on how to provide high quality follow-up care and appropriate

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With the advancement of new treatments for childhood cancer, 85% of individuals who had childhood cancer now survive 5 years or more. This is an increase from the mid-1970s where only 58% of children with childhood cancer survived 5 years or more. However, this survival rate is dependent on many

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The emotional challenges that a parent may encounter can disrupt their child's treatment, parenting and support for the child who is ill and their siblings, and impact overall family stability. Therefore, having a support network during this time is important. Different foundations fund support

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of 12,000 new cases, and 1,300 deaths, from cancer among children 0 to 14 years of age. Cancer is the second leading cause of death in males and fourth in women under the age of 20 in the United States. The survival rate of children with cancer has improved since the late 1960s which is due to

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Usually, Quality of Life improves with time since diagnosis, especially for children with solid tumors and hematological malignancies. Children with a CNS tumors, on the other hand, show little or no improvement over time. Quality of Life is often measured both during and after treatment, but

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can be successfully treated via modern medical treatments and optimal patient care. However, only about 10% of children diagnosed with cancer reside in high-income countries where the necessary treatments and care is available. Childhood cancer represents only about 1% of all types of cancers

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is one example of a major long-term consequence seen in adult survivors of childhood cancer. These individuals are eight times more likely to die of heart disease than other people, and up to one quarter of the children treated for cancer develop some type of cardiac abnormality, mainly left

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over time. Children with cancer should be monitored and assessed for these neuropsychological deficits during and after treatment. Patients with brain tumors can have cognitive impairments before treatment and radiation therapy is associated with increased risk of cognitive impairment.

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international comparisons of both outcomes and predictors are hindered by the use of a large number of different measurements. Recently, a first step for a joint international consensus statement for measuring Quality of Life in survivors of childhood cancer has been established.

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In the United States, an arbitrarily adopted standard of the ages used are 0–14 years inclusive, that is, up to 14 years 11.9 months of age. However, the definition of childhood cancer sometimes includes adolescents between 15 and 19 years old. Pediatric oncology is the branch of

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In addition to advancing research focusing on cancer, the foundations also offer support to families whose children are affected by the disease. The estimated total cost for one child with cancer (medical costs and lost parental wages) is $ 833,000. Organizations such as the

706:(11%). In 2005, 4.1 of every 100,000 young people under 20 years of age in the U.S. were diagnosed with leukemia, and 0.8 per 100,000 died from it. The number of new cases was highest among the 1–4 age group, but the number of deaths was highest among the 10–14 age group. 1197:, at 4.8%. Kids with cancer are disadvantaged compared to kids in developed countries; therefore their statistic for childhood cancer is higher. In sub-Saharan Africa, 10% of children die before their 5th birthday, yet it is not due to cancer; 930:

social worker, or referral to a pastoral counselor. Family-centered psychosocial care is one approach that can be used to not only support the patient's psychosocial well-being but also support the parents and any caregivers of the patient.

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Toretsky JA, Jenson J, Sun CC, Eskenazi AE, Campbell A, Hunger SP, et al. (June 2003). "Translocation (11;15;19): a highly specific chromosome rearrangement associated with poorly differentiated thymic carcinoma in young patients".

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sales, donating portions of purchases from stores or restaurants, or Paid Time Off donations as well as auctions, bike rides, dance-a-thons. Additionally, many of the major foundations have donation buttons on their respective websites.

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occurs when comparing high-income countries to low-income ones. This may result from differences in being able to diagnose cancer, differences in risk among different ethnic or racial population subgroups, as well as differences in

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Botta L, Gatta G, Capocaccia R, Stiller C, Cañete A, Dal Maso L, et al. (December 2022). "Long-term survival and cure fraction estimates for childhood cancer in Europe (EUROCARE-6): results from a population-based study".

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Risk factors are any genetic or environmental exposure that increase the chances of developing a pathological condition. Some examples are age, family history, environmental factors, genetics, and economic status among others.

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The foundations for pediatric cancer all fall under the 501(c)3 designation which means that they are non-profit organizations that are tax-exempt. The "International Childhood Cancer Day" occurs annually on February 15.

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improved treatment and public health measures. The estimated proportion surviving 5 years from diagnosis increased from 77.8 percent to 82.7 percent to 85.4 percent for those diagnosed in the 1990s, 2000s, and 2010–2016.

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and in those with other risk factors, such as a higher body mass index or chronic viral hepatitis. Certain treatments and liver surgery may also increase the risk of adverse liver effects in childhood cancer survivors.

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Overall, treating childhood cancer requires a multidisciplinary team of doctors, nurses, social workers, therapists, and other members of the community. Here is a brief list of doctors that can treat childhood cancer:

1058:. More than 16 out of every 100,000 children and teens in the U.S. were diagnosed with cancer, and nearly 3 of every 100,000 died from the disease. In the United States in 2012, it was estimated that there was an 1922: 2231:

Pui CH, Ribeiro RC, Hancock ML, Rivera GK, Evans WE, Raimondi SC, et al. (December 1991). "Acute myeloid leukemia in children treated with epipodophyllotoxins for acute lymphoblastic leukemia".

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is the study of the distribution and determinants of disease frequency in the human population and the study of how to control health problems. Internationally, the greatest variation in childhood

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Stovall M, Weathers R, Kasper C, Smith SA, Travis L, Ron E, et al. (July 2006). "Dose reconstruction for therapeutic and diagnostic radiation exposures: use in epidemiological studies".

138:(ALL) is most common in children. ALL usually develops in children between the ages of 1 and 10 (it could occur at any age). This type of cancer is more prevalent in males and in whites. 1213:. Children with cancer are often exposed to these preventable infections and diseases. Tumor registries only cover 11% of the African population, and there is a significant absence in 492:

Children with cancer are at risk for developing various cognitive or learning problems. These difficulties may be related to brain injury stemming from the cancer itself, such as a

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Note: Incidence and mortality rates are per 1,000,000 and age-adjusted to the 2000 US standard population. Observed survival percentage is based on data from 2003 to 2009.

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monitoring. These guidelines also help healthcare providers collaborate with oncology specialists, in order to create recommendations specific to an individual patient.

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are identified in 5-15% of childhood cancer cases. In <5-10% of cases, there are known environmental exposures and exogenous factors, such as prenatal exposure to

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Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, et al. (March 2013). "Paediatric cancer in low-income and middle-income countries".

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Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, et al. (March 2013). "Paediatric cancer in low-income and middle-income countries".

4005: 17: 1930: 2753: 4450: 2849: 1979: 949:, and if there is any genetic component to the cancer. Survival rate is also impacted by socioeconomic status and access to resources during treatment. 639:

Different, and sometimes unique, exposures to environmental hazards. Children must often rely on adults to protect them from toxic environmental agents.

3739: 926:. For children undergoing treatment for high-risk cancer, more than 80% experience life-threatening or fatal toxicity as a result of their treatment. 4251: 1887:

Nichols KE, Li FP, Haber DA, Diller L (March 1998). "Childhood cancer predisposition: applications of molecular testing and future implications".

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U.S. Environmental Protection Agency. (2017). NIEHS/EPA Children's Environmental Health and Disease Prevention Research Centers Impact Report:

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Other specialties that can assist in the treatment process include radiology, neurosurgery, orthopedic surgery, psychiatry, and endocrinology.

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can provide financial assistance for the costs associated with childhood cancer like medical care, home care, child care, and transportation.

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can apply their children for special educational services at school if their cognitive learning disability affects their educational success.

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Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database: Incidence - SEER 18 Regs Research Data - Total U.S., 1969-2017

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Currently, there are various organizations whose main focus is fighting childhood cancer. Organizations focused on childhood cancer through

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children often have a better chance of survival compared to other racial and ethnic groups. Where an individual lives is one of the biggest

2428:"Critical windows of exposure for children's health: cancer in human epidemiological studies and neoplasms in experimental animal models" 1604: 3840: 911:

Recent medical advances have improved our understanding of the genetic basis of childhood cancers. Treatment options are expanding, and

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The growth and development of children in phases known as "developmental windows" result in certain "critical windows of vulnerability".

4537: 2695: 2690: 4352:"Support for families at home during childhood cancer treatment: a pilot study with Mr.V the Spaceman, a family-based activities tool" 892:

Childhood cancer treatment is individualized and varies based on the severity & type of cancer. In general, treatment can include

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ventricular systolic dysfunction although this may be asymptomatic or too mild to qualify for a clinical diagnosis of heart disease.

4401:"Family Adjustment When Facing Pediatric Cancer: The Role of Parental Psychological Flexibility, Dyadic Coping, and Network Support" 4200: 2137: 2053:

Irestorm E, Perrin S, Tonning Olsson I (February 2018). "Pretreatment Cognition in Patients Diagnosed With Pediatric Brain Tumors".

1820: 4505: 2813: 1694: 623:, or certain medications. For the remaining 75-90% of cases, however, the individual causes remain unknown. In most cases, as in 2371:"Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland" 1802: 1344: 877: 519: 2831: 3874: 1368: 487: 2795: 1405: 1190: 1954: 873: 3419:

Kooijmans EC, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen-den Broeder E, van der Pal HJ, et al. (March 2019).

3204:"The cumulative burden of surviving childhood cancer: an initial report from the St Jude Lifetime Cohort Study (SJLIFE)" 4483: 1524:"Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge" 1282: 1264: 4012: 1011: 833: 739: 3359:"Automated Global Longitudinal Strain Assessment in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia" 1522:

Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L, et al. (September 2015).

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radiation and prior chemotherapy are accepted causes of childhood cancer, each raising risk several fold (4-7).

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is not yet well understood. Several chromosomal disorders and constitutional syndromes are associated with it.

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van Gorp M, Irestorm E, Twisk JW, Dors N, Mavinkurve-Groothuis A, Meeteren AY, et al. (September 2023).

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Bakker A, Streefkerk N, Bakker A, van Gorp M, van Litsenburg R, Grootenhuis M, et al. (December 2023).

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This rate decreases to 128 cases per million from 5–9 years of age, and it rises again to 220 cases/million.

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Aiuppa L, Cartaxo T, Spicer CM (9 December 2020). "Epidemiology of Childhood Cancer in the United States".

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Gonzalez-Manzanares R, Castillo JC, Molina JR, Ruiz-Ortiz M, Mesa D, Ojeda S, et al. (15 March 2022).

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Also, a longer life expectancy in children avails for a longer time to manifest cancer processes with long

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Aspects that make the risk factors of childhood cancer different from those seen in adult cancers include:

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van Kalsbeek RJ, Hudson MM, Mulder RL, Ehrhardt M, Green DM, Mulrooney DA, et al. (June 2023).

1572:"Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1995" 3421:"Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer" 2668:. National Cancer Institute, DCCPS, Surveillance Research Program. April 2019 – via UpToDate. 1185:

where there is limited access to prevention or treatment of cancer. The under-five mortality rate (

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Erdmann F, Frederiksen LE, Bonaventure A, Mader L, Hasle H, Robison LL, et al. (April 2021).

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Lichtenstein P, Holm NV, Verkasalo PK, Iliadou A, Kaprio J, Koskenvuo M, et al. (July 2000).

1475:"Late mortality among 5-year survivors of childhood cancer: A systematic review and meta-analysis" 1193:, is at 109 per 1,000 live births. The proportion of childhood cancer is higher in Africa than in 3848: 3473:

Mulder RL, Bresters D, Van den Hof M, Koot BG, Castellino SM, Loke YK, et al. (April 2019).

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Swensen SJ, Duncan JR, Gibson R, Muething SE, LeBuhn R, Rexford J, et al. (September 2014).

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Howard SC, Metzger ML, Wilimas JA, Quintana Y, Pui CH, Robison LL, et al. (February 2008).

2661: 1210: 1051: 1043: 1027: 497: 2700: 1320: 1198: 2942: 674: 3154:"Childhood cancer: Survival, treatment modalities, late effects and improvements over time" 2880: 2784:. U.S. Department of Health and Human Services, National Institutes of Health. 13 May 2015. 2189: 2090:"Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours" 1003: 905: 769: 643: 612: 254: 206: 4399:

Van Schoors M, De Paepe AL, Lemiere J, Morez A, Norga K, Lambrecht K, et al. (2019).

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Johnson KJ, Carozza SE, Chow EJ, Fox EE, Horel S, McLaughlin CC, et al. (July 2009).

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Moskalewicz A, Martinez B, Uleryk EM, Pechlivanoglou P, Gupta S, Nathan PC (2024-01-25).

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Johnston WT, Erdmann F, Newton R, Steliarova-Foucher E, Schüz J, Roman E (April 2021).

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often presents as a mass, a painful extremity or, occasionally, a pathologic fracture.

299: 271: 198: 141: 3982: 3947: 3325: 3258:"Long-term Follow-up Care for Childhood, Adolescent, and Young Adult Cancer Survivors" 3219: 2869:"The genomic landscape of pediatric cancers: Implications for diagnosis and treatment" 2725: 1900: 1702: 1652:"Age definitions, childhood and adolescent cancers in relation to reproductive issues" 1443: 4432: 4381: 4350:

van Bindsbergen KL, D'Olivo P, Rozendaal MC, Merks JH, Grootenhuis MA (August 2021).

4336: 4324: 4226: 3986: 3951: 3916: 3870: 3796: 3713: 3637: 3596: 3555: 3504: 3450: 3398: 3380: 3339: 3287: 3233: 3185: 3173: 3107: 3055: 3006: 2957: 2906: 2640: 2597: 2530: 2457: 2392: 2357: 2289: 2248: 2244: 2205: 2119: 2070: 2039: 2027: 1904: 1845: 1784: 1749: 1745: 1673: 1636: 1624: 1553: 1504: 1496: 1459: 1447: 1352: 1250: 901: 862: 719: 715: 508: 69: 4264: 3725: 2977:"Improving the outcome for children with cancer: Development of targeted new agents" 2609: 2284: 2267: 876:

is a branch of medicine that deals with the prevention, diagnosis, and treatment of

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Bhakta N, Liu Q, Ness KK, Baassiri M, Eissa H, Yeo F, et al. (December 2017).

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Children's Health and the Environment, a WHO Training Package for the Health Sector

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This cancer is an extracranial solid tumor commonly diagnosed in childhood.

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is more common in older children, and it is less prevalent than Hodgkin's disease.

3475:"Hepatic late adverse effects after antineoplastic treatment for childhood cancer" 4295:"Siblings Dealing with Pediatric Cancer: A Family- and Context-oriented Approach" 3782: 3591: 3574: 3041: 2592: 2575: 2516: 1312: 1295: 1047: 939: 803: 735: 416: 193: 62: 3864: 3169: 2387: 2370: 1839: 1780: 1620: 4367: 3632: 3615: 3540: 2636: 2268:"Concise handbook of familial cancer susceptibility syndromes - second edition" 1328: 946: 819: 813: 781: 753: 654: 624: 4294: 3678: 2856:. U.S. Department of Health and Human Services, National Institutes of Health. 2838:. U.S. Department of Health and Human Services, National Institutes of Health. 2820:. U.S. Department of Health and Human Services, National Institutes of Health. 2802:. U.S. Department of Health and Human Services, National Institutes of Health. 2478: 2412: 2310: 2169:. National Institutes of Health, U.S. Department of Health and Human Services. 2105: 1668: 1651: 4546: 4417: 4310: 3600: 3384: 3273: 1838:

Seligson MT, Surowiec SM (26 September 2022). "Superior Vena Cava Syndrome".

1539: 1500: 1348: 1340: 1018:. In industrialized countries, Burkitt lymphoma is not associated with these 957: 923: 797: 749: 723: 238: 3375: 2892: 1571: 1030:

in the world, as illness and healthcare options can vary by an individual's

4436: 4385: 4328: 4319: 4174: 3990: 3955: 3920: 3800: 3742:. World Health Organization Initiative for Vaccine Research. Archived from 3717: 3641: 3559: 3508: 3454: 3402: 3356: 3343: 3291: 3237: 3177: 3111: 3059: 3010: 2961: 2910: 2644: 2601: 2534: 2461: 2443: 2396: 2361: 2293: 2209: 2123: 2074: 2031: 1849: 1753: 1677: 1628: 1583: 1557: 1521: 1508: 1451: 986: 919: 897: 827: 787: 687: 512: 504: 437: 281: 234: 58: 3686:. A WHO Training Package for the Health Sector, World Health Organization. 2488:. A WHO Training Package for the Health Sector. World Health Organization. 2320:. A WHO Training Package for the Health Sector. World Health Organization. 2252: 1908: 1788: 945:

factors such as the type of cancer, age of onset, location of the cancer,

511:. Studies have shown that chemo and radiation therapies may damage brain 1336: 791: 759: 711: 699: 628: 493: 4349: 3814: 3308:

Lipshultz SE, Franco VI, Miller TL, Colan SD, Sallan SE (January 2015).

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of chemotherapy can result in immediate and long-term treatment-related

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that sickens 6 to 7 children out of every 100,000 annually in parts of

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Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S (January 2017).

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diagnosed in children and adults, It is often more complex than adult

2926:"Immune-Based Approaches for the Treatment of Pediatric Malignancies" 2201: 1055: 657:, increasing the risk of developing some cancer types later in life. 432: 94: 4006:

Committing to childhood survival: A promise renewed. Progress Report

3078:"Standards of Psychosocial Care for Parents of Children With Cancer" 2662:"The most common malignancies in infants, children, and adolescents" 2087: 703: 343: 339: 170: 157: 129: 112: 78: 4506:"February 15th is International Childhood Cancer Awareness Day!!!" 3659:. Burlington, MA: Jones & Bartlett Learning. pp. 237–266. 3151: 115:

concerned with the diagnosis and treatment of cancer in children.

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Ward E, DeSantis C, Robbins A, Kohler B, Jemal A (Mar–Apr 2014).

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Childhood Cancer and Functional Impacts Across the Care Continuum

3418: 3153: 1304: 1206: 1202: 1015: 616: 527: 376: 304: 151: 4201:"Cancer costs projected to reach at least $ 158 billion in 2020" 3613: 2368: 998:. An example of differing risk factors is in cases of pediatric 858:

These doctors specialize in treating blood diseases in children.

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Cranial nerve abnormalities as a result of brainstem compression

4398: 3310:"Cardiovascular disease in adult survivors of childhood cancer" 1356: 1300: 763: 731: 553: 475: 465:

Significant extremity dysfunction (when trauma is not involved)

228: 176: 165: 103: 90: 3572: 2501:"Parental age and risk of childhood cancer: a pooled analysis" 548:

Childhood cancer varies by age, sex, ethnicity, and race. Its

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Van Schoors M, Sels L, Goubert L, Verhofstadt LL (May 2021).

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Protecting children's health where they live, learn, and play

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Hudson MM, Bhatia S, Casillas J, Landier W (September 2021).

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for childhood cancers is a rapidly growing area of research.

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This is the most common type of cancer during childhood, and

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of brain and central nervous system tumors in children are:

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Frequent delayed diagnosis (early symptoms are nonspecific)

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Kaatsch P (June 2010). "Epidemiology of childhood cancer".

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Lindor NM, McMaster ML, Lindor CJ, Greene MH (2008-06-01).

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This malignancy presents as an abdominal mass in a child.

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Bosse KR, Majzner RG, Mackall CL, Maris JM (March 2020).

2305: 2303: 1730: 852:: These doctors specialize in treating childhood cancers. 4104: 2923: 2576:"An appeal for safe and appropriate imaging of children" 1767:

Pollack IF (December 1994). "Brain tumors in children".

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in general, the cancers are assumed to involve multiple

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increases during childhood and it peaks in adolescence.

4086: 3692:"Childhood cancer epidemiology in low-income countries" 2230: 2425: 2300: 3764: 3201: 2498: 2426:

Anderson LM, Diwan BA, Fear NT, Roman E (June 2000).

1923:"Children Diagnosed With Cancer: Returning to School" 1050:

between the ages of 1 and 14 years, exceeded only by

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Loss of greater than 10 percent of total body weight.

3023: 2555:. Alliance for Radiation Safety in Pediatric Imaging 2272:

Journal of the National Cancer Institute. Monographs

1961:. Mayo Foundation for Medical Education and Research 1886: 4288: 4286: 3862: 3075: 2866: 209:is obtained (CBC) if any suspicious finding arise. 4451:"Exemption Requirements - 501(c)(3) Organizations" 3895:"Childhood and adolescent cancer statistics, 2014" 3765:Moormann AM, Snider CJ, Chelimo K (October 2011). 3076:Kearney JA, Salley CG, Muriel AC (December 2015). 3024:Wiener L, Devine KA, Thompson AL (February 2020). 503:or from side effects of cancer treatments such as 4468: 3888: 3886: 3869:. Washington, DC: National Academies Press (US). 3414: 3412: 3303: 3301: 2003: 562:Slight male dominance for most childhood cancers. 4544: 4283: 1837: 1649: 1351:), Childhood Cancer Support (Australia) and the 1042:In the United States, cancer is the second most 397:Dysfunction of the location of the primary tumor 212: 3654: 3147: 3145: 3071: 3069: 2656: 2654: 2004:Annett RD, Patel SK, Phipps S (December 2015). 1844:. Treasure Island (FL): StatPearls Publishing. 1726: 1724: 1722: 1720: 1378: 972: 745:Other, less common childhood cancer types are: 184:Significant, unintended, and sudden weight loss 3883: 3468: 3466: 3464: 3409: 3298: 3251: 3249: 3247: 3197: 3195: 1949: 1947: 1695:"Childhood Cancers: Basic Facts & Figures" 1229: 4510:The Foundation for Children with Cancer (FCC) 3820:US Centers for Disease Control and Prevention 2748: 2746: 1339:), Children's Cancer Recovery Foundation (in 1303:wrappings goes to childhood cancer research, 1299:Part of the proceeds from the sale of yellow 1181:A large number of children in Africa live in 3672: 3670: 3668: 3666: 3142: 3066: 2730:American Society of Clinical Oncology (ASCO) 2651: 2473: 2471: 2405: 1980:"Late Effects of Childhood Cancer Treatment" 1717: 1226:cancers being the most commonly fatal type. 3657:Essentials of Epidemiology in Public Health 3479:The Cochrane Database of Systematic Reviews 3461: 3425:The Cochrane Database of Systematic Reviews 3244: 3192: 2850:"How Immunotherapy Is Used to Treat Cancer" 2567: 1944: 1689: 1687: 585:Identified Cancer Predisposition Syndromes 542: 4538:Centers for Disease Control and Prevention 3160:. Childhood Cancer: A Global Perspective. 2867:Sweet-Cordero EA, Biegel JA (March 2019). 2743: 2696:Centers for Disease Control and Prevention 2685: 2683: 2681: 2679: 2677: 2675: 1611:. Childhood Cancer: A Global Perspective. 592:Hereditary breast or ovarian cancer (BRCA 447:Malignancies of the musculoskeletal system 48: 4426: 4416: 4375: 4318: 3910: 3815:"WISQARS Leading Causes of Death Reports" 3790: 3707: 3663: 3631: 3590: 3549: 3539: 3498: 3444: 3392: 3374: 3333: 3281: 3227: 3101: 3049: 3000: 2951: 2941: 2900: 2591: 2524: 2468: 2451: 2386: 2351: 2283: 2113: 2021: 1667: 1547: 1490: 1283:Learn how and when to remove this message 870:Adolescent and young adult oncology (AYA) 318: 1684: 1294: 694:The most common cancers in children are 673: 566: 470:Genetic syndromes associated with cancer 4254:. EPA Publication No. EPA/600/R-17/407. 4062:"Children's Cancer Recovery Foundation" 2974: 2943:10.1146/annurev-cancerbio-030419-033436 2720: 2718: 2672: 2622: 1766: 1650:Bahadur G, Hindmarsh P (January 2000). 14: 4545: 4269:American Childhood Cancer Organization 4091:American Childhood Cancer Organization 4003: 3771:Current Opinion in Infectious Diseases 3126:"Key Statistics for Childhood Cancers" 3026:"Advances in pediatric psychooncology" 2616: 1345:American Childhood Cancer Organization 878:cancer in adolescents and young adults 839: 646:or metabolize environmental substances 520:post-chemotherapy cognitive impairment 18:American Childhood Cancer Organization 4299:Journal of Pediatric Oncology Nursing 4265:"PSYCHOLOGICAL AND EMOTIONAL SUPPORT" 4066:Children's Cancer Recovery Foundation 3680:Children's Health and the Environment 2917: 2486:Children's Health and the Environment 2325: 2318:Children's Health and the Environment 1734:American Journal of Clinical Oncology 1325:Children's Cancer and Leukaemia Group 1176: 605:Colorectal cancer/polyposis syndromes 488:Learning problems in childhood cancer 368:If head and neck masses are affected 118: 57:A girl trying out hats to wear after 4476:"International Childhood Cancer Day" 4154:National Pediatric Cancer Foundation 2715: 1233: 481: 248: 205:Important: It is recommended that a 201:should raise suspicion for leukemia. 3740:"Viral Cancers: Epstein-Barr virus" 2549:"Radiology Safety - What can I do?" 2375:The New England Journal of Medicine 2233:The New England Journal of Medicine 2067:10.1016/j.pediatrneurol.2017.11.008 1864:"Wilms tumor: MedlinePlus Genetics" 1769:The New England Journal of Medicine 518:This cognitive problem is known as 24: 4536:from websites or documents of the 4482:. 15 February 2013. Archived from 2754:"Who Treats Children with Cancer?" 2138:"Learning Problem After Treatment" 1369:National Children's Cancer Society 642:Immature physiological systems to 580: 556:with about 240 cases/million/year. 25: 4564: 3326:10.1146/annurev-med-070213-054849 2432:Environmental Health Perspectives 1315:and/or support programs include: 1220: 348:Palpable mass and intussusception 284:or enlarged axillary or inguinal 4532: This article incorporates 4527: 4129:Alex's Lemonade Stand Foundation 2332:Archives of Disease in Childhood 1746:10.1097/00000421-200306000-00019 1238: 1183:low- and middle-income countries 1054:such as injuries sustained in a 1037: 856:Pediatric hematology-oncologist: 834:Juvenile myelomonocytic leukemia 740:atypical teratoid rhabdoid tumor 385: 270:Persistent cough secondary to a 4498: 4443: 4392: 4343: 4257: 4244: 4219: 4193: 4167: 4142: 4117: 4097: 4079: 4054: 4029: 3997: 3962: 3927: 3856: 3833: 3807: 3758: 3732: 3655:Aschengrau A, Seage GR (2020). 3648: 3607: 3566: 3515: 3350: 3118: 3017: 2968: 2930:Annual Review of Cancer Biology 2860: 2842: 2824: 2806: 2788: 2770: 2541: 2492: 2259: 2224: 2173: 2155: 2144:. The Children's Oncology Group 2130: 2081: 2046: 1997: 1972: 1915: 1880: 1856: 1831: 1813: 1795: 1760: 1209:, and other infections are the 981: 533: 410: 217:This is the second most common 4179:Childhood Cancer International 3491:10.1002/14651858.cd008205.pub3 3437:10.1002/14651858.cd008944.pub3 2699:. 30 July 2009. Archived from 1699:Minnesota Department of Health 1643: 1596: 1564: 1515: 1466: 1422: 1416:Mount Sinai Hospital, New York 1398: 13: 1: 4037:"Childhood cancer statistics" 3983:10.1016/S1470-2045(13)70008-1 3948:10.1016/s1470-2045(13)70008-1 3220:10.1016/S0140-6736(17)31610-0 3030:Current Opinion in Pediatrics 2285:10.1093/jncimonographs/lgn001 1986:. American Cancer Society Inc 1901:10.1016/s0022-3476(98)70007-1 1841:StatPearls [Internet] 1444:10.1016/s1470-2045(22)00637-4 1391: 1373:Leukemia and Lymphoma Society 608:Familial retinoblastoma (RB1) 462:Pain awakens a child at night 253:The likelihood of developing 213:Central nervous system tumors 4205:National Institute of Health 3841:"Cancer Facts & Figures" 3783:10.1097/QCO.0b013e328349ac4f 3592:10.1016/j.ejcped.2023.100134 3082:Pediatric Blood & Cancer 3042:10.1097/MOP.0000000000000851 2593:10.1097/PTS.0000000000000116 2517:10.1097/EDE.0b013e3181a5a332 2422:. World Health Organization. 2245:10.1016/0753-3322(92)90056-d 2010:Pediatric Blood & Cancer 1528:Journal of Clinical Oncology 1379:Importance of family support 973:Quality of Life in survivors 933: 887: 664: 515:and disrupt brain activity. 241:due to aqueduct compression) 221:diagnosed during childhood. 136:acute lymphoblastic leukemia 7: 3170:10.1016/j.canep.2020.101733 2778:"Treating Childhood Cancer" 2726:"Childhood Cancer overview" 2388:10.1056/NEJM200007133430201 1781:10.1056/nejm199412013312207 1621:10.1016/j.canep.2019.101662 1258:. The specific problem is: 1230:Foundations and fundraising 589:Li-Fraumeni syndrome (TP53) 451:A tumor that arises in the 363:Superior vena cava syndrome 352:If mediastinum is affected 123: 10: 4569: 4368:10.1007/s00520-021-05995-3 3633:10.1038/s41591-023-02339-y 3541:10.1186/s12885-023-11379-z 2637:10.1016/j.ctrv.2010.02.003 937: 776:Childhood rhabdomyosarcoma 680:acute lymphocytic leukemia 485: 414: 127: 4356:Supportive Care in Cancer 3314:Annual Review of Medicine 2854:National Cancer Institute 2836:National Cancer Institute 2818:National Cancer Institute 2800:National Cancer Institute 2782:National Cancer Institute 2580:Journal of Patient Safety 2326:Birch JM (January 1999). 2167:National Cancer Institute 2142:Children's Oncology Group 2106:10.1038/nrneurol.2016.185 2094:Nature Reviews. Neurology 1889:The Journal of Pediatrics 1189:), a robust indicator of 1137:Observed Survival % 1088:Observed Survival % 1066:Statistics from the 2014 722:, desmoplastic infantile 267:Painless mass in the neck 93:in a child. About 80% of 68: 56: 47: 39: 34: 4480:educationscotland.gov.uk 4418:10.3389/fpsyg.2019.02740 4311:10.1177/1043454221992303 4011:(Report). Archived from 3274:10.1542/peds.2021-053127 2625:Cancer Treatment Reviews 1821:"Non-Hodgkin's lymphoma" 1540:10.1200/JCO.2014.60.6376 824:hepatocellular carcinoma 810:Pleuropulmonary blastoma 669: 543:Demographic risk factors 314:Persistent painless mass 4405:Frontiers in Psychology 3849:American Cancer Society 3677:"Children and Cancer". 3579:EJC Paediatric Oncology 3376:10.3390/cancers14061513 2893:10.1126/science.aaw3535 1984:American Cancer Society 1927:American Cancer Society 1669:10.1093/humrep/15.1.227 1333:Child Cancer Foundation 1317:Childhood Cancer Canada 1260:needs editing for tone. 1068:American Cancer Society 332:If abdomen is affected 4534:public domain material 2444:10.1289/ehp.00108s3573 2016:(Suppl 5): S460–S513. 1584:10.1037/e407432005-001 1308: 1211:leading cause of death 1052:unintentional injuries 1028:determinants of health 691: 498:central nervous system 453:musculoskeletal system 324:Non-Hodgkin's lymphoma 319:Non-Hodgkin's lymphoma 293:Drenching night sweats 188:Physical examination: 4231:Cure Childhood Cancer 2479:"Children and Cancer" 2413:"Children and Cancer" 2311:"Children and Cancer" 1321:Young Lives vs Cancer 1298: 1199:communicable diseases 677: 567:Environmental factors 142:Signs & Symptoms: 99:high-income countries 3971:The Lancet. Oncology 3936:The Lancet. Oncology 3214:(10112): 2569–2582. 2691:"Cancer in Children" 2438:(Suppl 3): 573–594. 2424:In turn citing: > 1705:on 20 September 2017 1432:The Lancet. Oncology 1265:improve this section 1254:to meet Knowledge's 1048:death among children 1004:non-Hodgkin lymphoma 953:additional cancers. 850:Pediatric oncologist 770:Non-Hodgkin lymphoma 696:(childhood) leukemia 207:complete blood count 4486:on 20 November 2016 4227:"Fundraising Ideas" 4105:"Hayim Association" 3158:Cancer Epidemiology 2975:Adamson PC (2015). 2885:2019Sci...363.1170S 2879:(6432): 1170–1175. 2832:"Radiation Therapy" 2194:2006RadR..166..141S 2188:(1 Pt 2): 141–157. 2055:Pediatric Neurology 1895:(3 Pt 1): 389–397. 1803:"Hodgkin's disease" 1609:Cancer Epidemiology 1195:developed countries 1124: 1075: 1020:infectious diseases 840:Medical specialties 458:Signs and Symptoms 424:Signs and Symptoms 393:Signs and Symptoms 329:Signs and Symptoms 263:Signs and Symptoms 224:Signs and Symptoms 4041:Cancer Research UK 3912:10.3322/caac.21219 3709:10.1002/cncr.23205 3268:(3): e2021053127. 2993:10.3322/caac.21273 2344:10.1136/adc.80.1.1 2328:"Genes and cancer" 2182:Radiation Research 1656:Human Reproduction 1492:10.1002/cncr.35213 1309: 1215:death registration 1177:Sub-Saharan Africa 1122: 1073: 1024:Non-Hispanic white 1012:Epstein-Barr virus 1008:sub-Saharan Africa 913:precision medicine 692: 684:intravenous access 290:Intermittent fever 260:Hodgkin's disease 199:Hepatosplenomegaly 119:Signs and symptoms 4553:Pediatric cancers 3876:978-0-309-68352-4 3746:on March 24, 2006 3094:10.1002/pbc.25761 3088:(S5): S632–S683. 2239:(24): 1682–1687. 2023:10.1002/pbc.25749 1775:(22): 1500–1507. 1576:PsycEXTRA Dataset 1534:(27): 3065–3073. 1485:(10): 1844–1857. 1438:(12): 1525–1536. 1353:Hayim Association 1293: 1292: 1285: 1256:quality standards 1247:This section may 1169: 1168: 1120: 1119: 1074:Ages birth to 14 863:Pediatric surgeon 720:craniopharyngioma 716:brain stem glioma 509:radiation therapy 482:Learning problems 381:Nasal obstruction 255:Hodgkin's disease 249:Hodgkin's disease 84: 83: 29:Medical condition 16:(Redirected from 4560: 4531: 4530: 4521: 4520: 4518: 4516: 4502: 4496: 4495: 4493: 4491: 4472: 4466: 4465: 4463: 4461: 4447: 4441: 4440: 4430: 4420: 4396: 4390: 4389: 4379: 4362:(8): 4875–4884. 4347: 4341: 4340: 4322: 4290: 4281: 4280: 4278: 4276: 4261: 4255: 4248: 4242: 4241: 4239: 4237: 4223: 4217: 4216: 4214: 4212: 4197: 4191: 4190: 4188: 4186: 4171: 4165: 4164: 4162: 4160: 4146: 4140: 4139: 4137: 4135: 4121: 4115: 4114: 4112: 4111: 4101: 4095: 4094: 4083: 4077: 4076: 4074: 4072: 4058: 4052: 4051: 4049: 4047: 4033: 4027: 4026: 4024: 4023: 4017: 4010: 4001: 3995: 3994: 3977:(3): e104–e116. 3966: 3960: 3959: 3942:(3): e104–e116. 3931: 3925: 3924: 3914: 3890: 3881: 3880: 3860: 3854: 3853: 3845: 3837: 3831: 3830: 3828: 3827: 3811: 3805: 3804: 3794: 3762: 3756: 3755: 3753: 3751: 3736: 3730: 3729: 3711: 3688:In turn citing: 3687: 3685: 3674: 3661: 3660: 3652: 3646: 3645: 3635: 3626:(6): 1340–1348. 3611: 3605: 3604: 3594: 3570: 3564: 3563: 3553: 3543: 3519: 3513: 3512: 3502: 3470: 3459: 3458: 3448: 3416: 3407: 3406: 3396: 3378: 3354: 3348: 3347: 3337: 3305: 3296: 3295: 3285: 3253: 3242: 3241: 3231: 3199: 3190: 3189: 3164:(Pt B): 101733. 3149: 3140: 3139: 3137: 3136: 3122: 3116: 3115: 3105: 3073: 3064: 3063: 3053: 3021: 3015: 3014: 3004: 2972: 2966: 2965: 2955: 2945: 2921: 2915: 2914: 2904: 2864: 2858: 2857: 2846: 2840: 2839: 2828: 2822: 2821: 2810: 2804: 2803: 2796:"Cancer Surgery" 2792: 2786: 2785: 2774: 2768: 2767: 2765: 2764: 2750: 2741: 2740: 2738: 2736: 2722: 2713: 2712: 2710: 2708: 2687: 2670: 2669: 2658: 2649: 2648: 2620: 2614: 2613: 2595: 2571: 2565: 2564: 2562: 2560: 2545: 2539: 2538: 2528: 2496: 2490: 2489: 2483: 2475: 2466: 2465: 2455: 2423: 2417: 2409: 2403: 2400: 2390: 2365: 2355: 2322:In turn citing: 2321: 2315: 2307: 2298: 2297: 2287: 2263: 2257: 2256: 2228: 2222: 2221: 2202:10.1667/rr3525.1 2177: 2171: 2170: 2159: 2153: 2152: 2150: 2149: 2134: 2128: 2127: 2117: 2085: 2079: 2078: 2050: 2044: 2043: 2025: 2001: 1995: 1994: 1992: 1991: 1976: 1970: 1969: 1967: 1966: 1951: 1942: 1941: 1939: 1938: 1929:. Archived from 1919: 1913: 1912: 1884: 1878: 1877: 1875: 1874: 1860: 1854: 1853: 1835: 1829: 1828: 1817: 1811: 1810: 1799: 1793: 1792: 1764: 1758: 1757: 1728: 1715: 1714: 1712: 1710: 1701:. Archived from 1691: 1682: 1681: 1671: 1647: 1641: 1640: 1615:(Pt B): 101662. 1600: 1594: 1593: 1591: 1590: 1568: 1562: 1561: 1551: 1519: 1513: 1512: 1494: 1470: 1464: 1463: 1426: 1420: 1419: 1406:"EBSCO database" 1402: 1288: 1281: 1277: 1274: 1268: 1242: 1241: 1234: 1125: 1121: 1076: 1072: 1000:Burkitt lymphoma 991:cancer incidence 806:(5%, many sites) 804:Germ cell tumors 800:(1%, many sites) 778:(3%, many sites) 601: 600: 596: 97:cancer cases in 87:Childhood cancer 52: 43:Pediatric cancer 35:Childhood cancer 32: 31: 21: 4568: 4567: 4563: 4562: 4561: 4559: 4558: 4557: 4543: 4542: 4528: 4525: 4524: 4514: 4512: 4504: 4503: 4499: 4489: 4487: 4474: 4473: 4469: 4459: 4457: 4449: 4448: 4444: 4397: 4393: 4348: 4344: 4320:1854/LU-8680415 4291: 4284: 4274: 4272: 4263: 4262: 4258: 4249: 4245: 4235: 4233: 4225: 4224: 4220: 4210: 4208: 4199: 4198: 4194: 4184: 4182: 4173: 4172: 4168: 4158: 4156: 4148: 4147: 4143: 4133: 4131: 4123: 4122: 4118: 4109: 4107: 4103: 4102: 4098: 4085: 4084: 4080: 4070: 4068: 4060: 4059: 4055: 4045: 4043: 4035: 4034: 4030: 4021: 4019: 4015: 4008: 4004:UNICEF (2013). 4002: 3998: 3967: 3963: 3932: 3928: 3891: 3884: 3877: 3861: 3857: 3843: 3839: 3838: 3834: 3825: 3823: 3813: 3812: 3808: 3763: 3759: 3749: 3747: 3738: 3737: 3733: 3683: 3676: 3675: 3664: 3653: 3649: 3620:Nature Medicine 3612: 3608: 3571: 3567: 3520: 3516: 3485:(4): CD008205. 3471: 3462: 3431:(3): CD008944. 3417: 3410: 3355: 3351: 3306: 3299: 3254: 3245: 3200: 3193: 3150: 3143: 3134: 3132: 3124: 3123: 3119: 3074: 3067: 3022: 3018: 2973: 2969: 2922: 2918: 2865: 2861: 2848: 2847: 2843: 2830: 2829: 2825: 2812: 2811: 2807: 2794: 2793: 2789: 2776: 2775: 2771: 2762: 2760: 2752: 2751: 2744: 2734: 2732: 2724: 2723: 2716: 2706: 2704: 2703:on 4 March 2016 2689: 2688: 2673: 2660: 2659: 2652: 2621: 2617: 2572: 2568: 2558: 2556: 2547: 2546: 2542: 2497: 2493: 2481: 2477: 2476: 2469: 2415: 2411: 2410: 2406: 2313: 2309: 2308: 2301: 2264: 2260: 2229: 2225: 2178: 2174: 2161: 2160: 2156: 2147: 2145: 2136: 2135: 2131: 2086: 2082: 2051: 2047: 2002: 1998: 1989: 1987: 1978: 1977: 1973: 1964: 1962: 1953: 1952: 1945: 1936: 1934: 1921: 1920: 1916: 1885: 1881: 1872: 1870: 1868:medlineplus.gov 1862: 1861: 1857: 1836: 1832: 1819: 1818: 1814: 1801: 1800: 1796: 1765: 1761: 1729: 1718: 1708: 1706: 1693: 1692: 1685: 1648: 1644: 1601: 1597: 1588: 1586: 1570: 1569: 1565: 1520: 1516: 1471: 1467: 1427: 1423: 1404: 1403: 1399: 1394: 1381: 1313:cancer research 1289: 1278: 1272: 1269: 1262: 1243: 1239: 1232: 1223: 1179: 1040: 984: 975: 942: 940:Cancer survivor 936: 890: 842: 736:medulloblastoma 678:Two girls with 672: 667: 655:latency periods 613:genetic factors 598: 594: 593: 583: 581:Genetic factors 569: 545: 536: 490: 484: 472: 449: 419: 413: 388: 321: 251: 215: 194:lymphadenopathy 162:Low-grade fever 132: 126: 121: 30: 23: 22: 15: 12: 11: 5: 4566: 4556: 4555: 4523: 4522: 4497: 4467: 4442: 4391: 4342: 4305:(3): 166–175. 4282: 4256: 4243: 4218: 4192: 4166: 4141: 4116: 4096: 4078: 4053: 4028: 3996: 3961: 3926: 3882: 3875: 3855: 3832: 3806: 3777:(5): 435–441. 3757: 3731: 3662: 3647: 3606: 3565: 3514: 3460: 3408: 3349: 3320:(1): 161–176. 3297: 3243: 3191: 3141: 3130:www.cancer.org 3117: 3065: 3016: 2987:(3): 212–220. 2967: 2936:(1): 353–370. 2916: 2859: 2841: 2823: 2814:"Chemotherapy" 2805: 2787: 2769: 2758:www.cancer.org 2742: 2714: 2671: 2650: 2631:(4): 277–285. 2615: 2586:(3): 121–124. 2566: 2540: 2511:(4): 475–483. 2491: 2467: 2404: 2402: 2401: 2366: 2299: 2258: 2223: 2172: 2154: 2129: 2080: 2045: 1996: 1971: 1943: 1914: 1879: 1855: 1830: 1812: 1794: 1759: 1740:(3): 300–306. 1716: 1683: 1642: 1595: 1563: 1514: 1465: 1421: 1396: 1395: 1393: 1390: 1380: 1377: 1329:United Kingdom 1291: 1290: 1246: 1244: 1237: 1231: 1228: 1222: 1221:United Kingdom 1219: 1178: 1175: 1167: 1166: 1163: 1160: 1157: 1153: 1152: 1149: 1146: 1143: 1139: 1138: 1135: 1132: 1129: 1123:Ages 15 to 19 1118: 1117: 1114: 1111: 1108: 1104: 1103: 1100: 1097: 1094: 1090: 1089: 1086: 1083: 1080: 1039: 1036: 983: 980: 974: 971: 938:Main article: 935: 932: 889: 886: 882: 881: 867: 859: 853: 841: 838: 837: 836: 831: 820:Hepatoblastoma 817: 814:pleural cavity 807: 801: 795: 785: 782:Retinoblastoma 779: 773: 767: 757: 754:nervous system 682:demonstrating 671: 668: 666: 663: 651: 650: 647: 640: 633: 632: 631:and variables. 625:carcinogenesis 609: 606: 603: 590: 582: 579: 578: 577: 568: 565: 564: 563: 560: 557: 544: 541: 535: 532: 486:Main article: 483: 480: 471: 468: 467: 466: 463: 448: 445: 444: 443: 440: 435: 429: 428:Abdominal pain 415:Main article: 412: 409: 408: 407: 404: 403:Abdominal pain 401: 398: 387: 384: 383: 382: 379: 375:Cranial nerve 373: 366: 365: 360: 350: 349: 346: 337: 336:Abdominal pain 320: 317: 316: 315: 312: 307: 302: 297: 294: 291: 288: 280:ess commonly: 275: 268: 250: 247: 246: 245: 242: 237:disturbances ( 231: 214: 211: 203: 202: 196: 186: 185: 182: 179: 174: 168: 163: 160: 154: 125: 122: 120: 117: 82: 81: 72: 66: 65: 54: 53: 45: 44: 41: 37: 36: 28: 9: 6: 4: 3: 2: 4565: 4554: 4551: 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