The Big Truth About Small Patients: Why Childhood Cancer Is Different

When most people hear the word “cancer,” their minds jump to adult experiences – a loved one’s chemotherapy, a neighbor’s surgery, a friend’s remission story. So when they hear about childhood cancer, it’s easy to assume it’s just the same disease in a smaller patient. But that’s not necessarily true. In fact, pediatric cancer plays by a very different set of rules.

From the way it develops at the cellular level to how it responds to treatment, childhood cancer is its own unique challenge. Understanding these differences isn’t just a matter of scientific curiosity – it’s essential to saving lives.

At LSU LCMC Health Cancer Center, and in partnership with Manning Family Children’s Hospital, we’re dedicated to improving diagnosis and treatment for our littlest cancer patients to give them the best possible chance at not just surviving, but thriving.

The Biological Differences Between Childhood and Adult Cancers

Most of the well-known and common risk factors for adult cancers take many years to increase a person’s risk of developing the disease. These include tobacco and alcohol use, eating unhealthy foods, not exercising, and having a high body fat percentage.

But children haven’t had enough time for these risk factors to play a role in cancer development. Instead, childhood cancers are usually due to gene changes (or changes to the DNA sequence during cell division). These are also called random acquired mutations.

Other potential causes include:

• Exposure to radiation
• Secondhand smoke
• Inherited syndromes, like Cowden syndrome and Lynch syndrome  

Cancer in children usually affects the blood cells (called acute lymphoblastic leukemia). It can also affect the lymph system, brain, adrenal glands, and bones.

Unique Challenges in Diagnosing Childhood Cancer

Screening for adult cancer is not just common, it’s a key part of most adult health maintenance plans. From breast cancer screenings (such as mammograms) to colon cancer screenings (such as colonoscopies), adults go through any number of screenings for cancer, especially as they get older. For children, screenings aren’t routine, and diagnosing cancer can be more challenging.

For starters, some symptoms can seem like childhood illnesses, which any parent can attest to being a common and normal part of childhood. Extreme fatigue for no reason can be a sign of cancer, but many children seem tired from missed naps, early wakings, and long days at school. Easy bruising or bleeding is another symptom, but children are also often covered in scrapes and bruises due to trips and falls. It can be difficult for parents and caregivers to know when there’s cause for concern.

Children are also just learning to articulate their feelings, including physical ones. It can be hard for them to explain what hurts and for how long it’s been hurting.

But perhaps the most challenging part of diagnosing childhood cancer is how rare it is. Because cancer is not always the first illness to test for, it can go undiagnosed for longer.

Key Differences in Treating Childhood Cancer

When it comes to treatment, the same approaches for adult cancer are used for childhood cancer, including chemotherapy (the most common), radiation, immunotherapy, stem cell transplants, and surgery.

The good news is that children often respond better to many treatments compared to adults. This may be because of the cancer itself or the fact that children can typically handle higher doses of chemotherapy. It may also be because children don’t have as many other underlying health issues, which can get worse during treatment, that adults sometimes do.

Treating childhood cancer can still come with challenges. Some treatments can impact organ and tissue function. Others can delay growth or increase the child’s risk for another cancer as they get older. These are called late effects and may be noticed weeks or even years after treatment. Children who were treated for cancer will visit their care teams for many years to monitor for these changes.

The Role of Clinical Trials and Pediatric-Specific Studies

Cancer treatment moves quickly, including for childhood cancer. One of the best ways children can access the latest and most effective treatments is through clinical trials. During a clinical trial, children will get either the most effective current treatment or a treatment that researchers believe will work even better. They’ll also have extra monitoring and a more extensive care team during the trial.

Clinical trials also help healthcare providers learn better ways to treat childhood cancer, so participation can help save the lives of other children with cancer.

As with any treatment, it’s important to make sure a trial is right for each patient. Not only do children have to qualify, but parents – and sometimes children if they’re old enough – must agree to participate.

While clinical trials offer many benefits, there are some risks. For instance, newer treatments might have unknown or more serious side effects than current treatments. Side effects may also be less predictable. Children in clinical trials may also need to go to additional appointments and undergo extra tests so their care team can watch them more carefully, which can be time-consuming.

Turning Knowledge Into Hope for Pediatric Cancer Care

Childhood cancer isn’t a smaller version of adult cancer. It’s a completely different disease that demands unique science, tailored treatments, and specialized care teams. By recognizing and addressing these differences, we open the door to more effective therapies, fewer long-term side effects, and brighter futures for children and families facing a diagnosis.

Every step forward in pediatric oncology is made possible because communities, caregivers, researchers, and healthcare professionals continue to push for research, awareness, and support for these young patients. Through this, we can honor the fact that children aren’t just small adults – they’re strong fighters who deserve care designed just for them.