cal examination and laboratory studies and later involve pediatric oncologists, radiologists, surgeons, and pathologists who may conduct surgical biopsies, laboratory and pathological studies, imaging tests (e.g., computed tomographic scans, magnetic resonance imaging scans), and assessments of family history.

Primary and Adjuvant Treatment

The treatment of childhood cancers is complex, involving the consideration of many factors, including characteristics of the cancer (e.g., its type, site, stage, and histology) and of the child (e.g., his or her age, presence of symptoms, and general health). In general, most children with cancer are treated using chemotherapy, surgery, radiation therapy, or a combination of two or more of these modalities. Although there are exceptions, childhood cancers tend to respond well to chemotherapy because they involve fast-growing cells, the target of most forms of chemotherapy. Many of the gains in childhood cancer survival have come through the development of combination chemotherapies (use of multiple agents) and multimodality therapy (the application of different types of treatment). While there are some accepted standard forms of therapy, an estimated 60 percent of children treated for cancer participate in clinical trials, which may involve variations in standard treatment, new combinations of agents, variations in doses of chemotherapy or radiation, use of alternate methods of administration, or entirely new approaches to therapy (e.g., immunotherapy). As information regarding late effects of treatment has emerged, therapies for childhood cancer have been informed and modified. There has, for example, been a reduction of dose or an elimination of the craniospinal radiation used to treat children with leukemia in an effort to reduce the risk of treatment-related adverse events such as growth and cognitive deficits. Since the introduction of more aggressive chemotherapies in the 1980s, however, other late effects such as damage to the heart, kidney, and hearing have been noted.

Primary Care

Children treated for cancer generally maintain their relationship with their primary care pediatrician for preventive care, health maintenance, and acute care. Following primary treatment for cancer, children resume care with their pediatrician, family practitioner, or internist. Their primary care provider must acquire information from the cancer care team on cancer treatment exposures, possible late effects, and guidance on appropriate follow-up care.

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