International Experts in Treating Pediatric Cancer

Families come from around the world to Cincinnati Children’s for treatment from our expert team. Some patients are newly diagnosed and others seek care for recurrent or treatment-resistant tumors. We treat all forms of pediatric cancers in patients up to 39 years old. Conditions we treat include:

Blood Cancers (Leukemia and Lymphoma)

• Acute lymphoblastic leukemia (ALL), also called lymphocytic or lymphoid leukemia, is the most common form of leukemia in children. In this form of leukemia, the bone marrow makes too many lymphocytes (a type of white blood cell that help fight infection). These lymphocyte cancer cells, also called blasts, are not normal and do not fight infection well.
• Acute myeloid leukemia (AML), also called myelogenous, granulocytic, myelocytic or myeloblastic leukemia, is the second most common blood cancer in children. AML affects certain cells in the bone marrow (myeloid cells). These cells ordinarily develop into normal, mature blood cells, but with AML, these immature cells do not develop properly and become cancerous.
• Chronic myeloid leukemia (CML), also called chronic myelogenous leukemia, is a type of cancer affecting the blood and bone marrow. In CML, the bone marrow—the soft, spongy center of the bone where blood cells form—produces too many white blood cells. White blood cells normally help fight infection and disease. But in CML, the white blood cells become abnormal. They begin to grow too fast and crowd out normal, healthy cells.
• Hodgkin lymphoma is a cancer that starts in a white blood cell called a B lymphocyte. Healthy B lymphocytes are part of the immune system. In Hodgkin lymphoma, some of the B lymphocytes are no longer healthy and do not fight infection. Instead, the abnormal (cancerous) lymphocytes begin to grow out of control, causing the lymph nodes to get bigger.
• Non-Hodgkin lymphoma (NHL), including both B- and T-cell subtypes, starts in a cell called a lymphocyte. With NHL, abnormal (cancerous) lymphocytes divide rapidly, crowding out the normal cells. NHL may spread to the bone marrow, central nervous system, liver, spleen and reproductive organs.
• B-cell lymphoma is a form of cancer that starts in a white B cell called a lymphocyte. Mixed phenotype acute leukemia (MPAL) is a very rare type of leukemia where more than one type of leukemia occurs at the same time.
• Post-transplant lymphoma and lymphoproliferative disorders (PTLD) are a group of potentially life-threatening conditions that affect patients who have had an organ or bone marrow transplant. PTLD occurs because the immune system of these patients is weakened with medication to allow them to accept the newly transplanted organ or bone marrow.
• Myelodysplasic disorders (MDS) are bone marrow disorders that can lead to acute myeloid leukemia. MDS occurs when young blood cells in the bone marrow do not develop properly into healthy white cells, red blood cells or platelets. This leads to a shortage of healthy white cells (which fight infection), red blood cells (which carry oxygen), or platelets (which help your blood clot).
• Leukemia and lymphoma that occur in people who have an increased risk of developing these cancers, including people with Down syndrome and Fanconi anemia.

Brain Tumors

• Gliomas are the most common type of brain tumor. These tumors begin from “glial” cells, which support functions of the nervous system. There are two major groups of glioma, high-grade gliomas and Low-grade gliomas. Examples of gliomas include:
  • Astrocytomas, which typically occur in the cerebellum, the area of the brain that plays a role in almost all of the body’s physical movement.
  • Ependymomas, which usually begin in the lining of the ventricles (large open structures deep in the brain) or in the spinal cord, near the cerebellum.
  • Optic nerve gliomas, which usually start in the optic nerve. They can cause vision issues and other problems.
  • Diffuse Intrinsic Pontine Glioma (DIPG) is a type of brain tumor that comes from glial cells. This is also known as Diffuse Midline Glioma (DMG). Normally glial cells surround, protect, and support other cells in the brain. But in a tumor, they continue to grow without stopping and eventually compress and hurt other parts of the brain.
• Embryonal tumors. These can include:
  • Atypical teratoid rhabdoid tumor (ATRT) is a rare and aggressive type of cancer that can appear in the brain or spinal cord.
  • Medulloblastoma, which commonly occurs in the cerebellum and blocks cerebrospinal fluid from draining, causing increased pressure in the brain. Medulloblastoma to be considered a type of Primitive Neuroectodermal Tumors (PNET), but that term isn’t used anymore.
• Craniopharyngiomas, which arise above the pituitary gland, a pea-sized structure attached to the base of the brain that helps control the body’s growth, development and regulation.
• Germ cell tumors of the brain including germinoma, teratoma, embryonal carcinoma and yolk-sac tumors. These typically occur in the first two years of life but can occur later.
• Choroid plexus tumors, which arise from cells lining the ventricles of the brain.
• Meningeal tumors, such as meningioma, which arise from the membranes (meninges) surrounding the brain and spinal cord.
• Mixed neuronal-glial tumors, which have abnormal neuron cells and abnormal glial cells. Examples include those listed below.
  • Ganglioglioma are usually small and noncancerous and develop slowly.
  • Subependymal giant cell tumors may occur in children and adults who have a condition called tuberous sclerosis.
  • Pleomorphic xanthoastrocytoma often occur between 10 and 20 years of age. They can be cancerous or noncancerous and may spread to other parts of the brain and spine.

Kidney Tumors

• Wilms tumor, also called nephroblastoma, is a malignant (cancerous) tumor that originates in the cells of the kidney. It is the most common type of kidney cancer in childhood.
• Renal cell carcinoma (RCC), is a rare type of kidney cancer. Renal cell carcinoma is the second most common type of kidney cancer in children. There are many different types of pediatric RCC. About half of children with renal cell carcinoma have translocation renal cell carcinoma.
• Rhabdoid tumors
• Clear cell sarcoma is rare, typically affecting young adults between 20 and 40 years old. These tumors tend to grow in the deep tissues of the upper and lower limbs, including in the feet and hands. Clear cell sarcoma typically spreads to surrounding tissues, tendons, muscles and organs.
• Renal angiomyolipoma
• Other rare renal tumors

Liver Tumors

• Hepatoblastoma is a rare, malignant (cancerous) tumor of the liver. It is found 90 percent of the time before 3 years of age. The cause of hepatoblastoma is most often not known. It is often first suspected when there is a large mass in the belly. The initial diagnosis can be made using imaging and blood tests.
• Hepatocellular carcinoma (HCC) is a very rare disease in which cancer cells develop in the tissues of the liver and form a tumor. The cause of HCC is not known. It is not clear what causes the tumor to develop.
• Hemangioendothelioma
• Hepatic sarcoma
• Other forms of liver cancer

Neuroblastoma

Neuroblastoma is the most common malignant (cancerous) extracranial solid tumor of childhood. The tumor usually begins in the nerve tissues of the adrenal gland (above the kidney), but may also begin in nerve tissues of the neck, chest or pelvis. Although neuroblastoma often is present at birth, it generally is not detected until the tumor begins to grow and compress the surrounding organs.

Neurofibromatosis

• Neurofibromatosis (NF) is a group of genetic disorders that can affect the body in many ways, including causing the growth of tumors on nerve tissue. There are four types of neurofibromatosis. Each type of neurofibromatosis is caused by a unique, separate genetic change (mutation). Children who have one type of neurofibromatosis are not at increased risk of getting another type.
  • Neurofibromatosis 1 (NF1) is the most common type of neurofibromatosis, affecting 1 in 3,000 people. NF1 is characterized by tumors, changes in skin pigment, bone abnormalities, learning disabilities. A genetic change on chromosome 17 causes neurofibromatosis 1. NF1 can affect every person differently, even among family members who have the condition.
  • Neurofibromatosis 2 (NF2) is a genetic disorder that causes slow-growing tumors on the eighth cranial nerves and other nerves located in the brain and spine. It can result in hearing loss, vision loss and other concerns. Neurofibromatosis 2 is rare, affecting about 1 in every 25,000 people. A genetic change on chromosome 22 causes NF2.
  • Schwannomatosis is a rare form of neurofibromatosis that usually affects people after age 20. Patients with schwannomatosis develop multiple schwannomas (Schwann cell tumors) on different parts of their bodies, such as their cranial, spinal and peripheral nerves, arms, legs, chest, and abdomen. These tumors are not cancerous, but they often are painful. In the large majority of cases, schwannomatosis is not a life-threatening disorder.
  • Segmental NF is when NF1 or NF2 occurs in just one area of the body.

Retinoblastoma 

Retinoblastoma is a malignant (cancerous) tumor that occurs in the eye. It arises in the part of the eye known as the retina, which is located along the back wall of the inside of the eye. It more commonly occurs in only one eye (unilateral intra-ocular retinoblastoma) but can also occur in both eyes (bilateral intra-ocular retinoblastoma). Extra-ocular retinoblastoma occurs when tumors that spread beyond the eye. Retinoblastoma is relatively rare, occurring in one in 15,000 to 16,000 births and often is diagnosed in children who are less than 2 years of age.

Sarcomas

Bone Sarcomas

• Osteosarcoma is the most common type of bone cancer in children and young adults. Usually, it begins in long bones, such as the thighbone, shin bone, or the humerus (upper arm bone). It also can begin in the bones of the pelvis and skull. Osteosarcoma usually occurs in children age 10 and older. Learn more.
• Ewing Sarcoma occurs in bones or in the tissue around bones, and is typically found in the legs, pelvis, ribs, arms or spine. Ewing sarcoma is one of the most common forms of bone cancer in children. About 250 children are diagnosed with Ewing sarcoma each year in the United States. Ewing sarcoma may also present as a soft-tissue tumor; this is especially common in young adults. Learn more.
• Chondrosarcoma is a rare, cancerous type of tumor that begins in cartilage cells. These tumors can appear in the body wherever cartilage is present. They usually begin in the bones of the limbs and pelvis, particularly the hipbone and thighbone.
• Chordoma occur in the bones of the skull and spine. They usually grow slowly, but can be difficult to treat, in part because they are located near critical structures, such as the spinal cord and brainstem. Chordomas are rare, especially in children.

Soft-Tissue Sarcomas

• Alveolar soft part sarcoma is one of the most rare types of sarcoma. It typically occurs in the thigh or buttock, but can appear in the head and neck as well. Alveolar soft part sarcoma grows slowly, but it is likely to spread and recur.
• Angiosarcoma is a type of cancer that develops in the blood vessels or the lining of the blood vessels. Angiosarcoma affects both children and adults, although it is very rare in young patients. Overall, angiosarcoma accounts for 2 percent of sarcomas, affecting approximately 600 people per year in the United States. Learn more.
• Clear cell sarcoma is rare, typically affecting young adults between 20 and 40 years old. These tumors tend to grow in the deep tissues of the upper and lower limbs, including in the feet and hands. Clear cell sarcoma typically spreads to surrounding tissues, tendons, muscles and organs.
• Epithelioid sarcoma typically appears in the extremities (especially in the arms and hands). It also can develop in the torso. Epithelioid sarcoma can affect both children and adults, but is most common in young adulthood. In most cases, epithelioid sarcoma does not spread. If it does spread, lymph nodes, the lungs and bones are the most common sites. Learn more.
• Desmoplastic small round cell tumors (DSRCT) are rare. This type of cancer usually begins in the abdomen or pelvis, and does not respond well to treatment. The majority of patients (90 percent) are Caucasian males between the ages of 10 and 30. Learn more.
• Gastrointestinal stromal tumor (GISTs) are uncommon tumors of the digestive system. They can form anywhere along the GI tract, but most commonly begin in the stomach or small intestine. GIST tumors arising in children and young adults are often distinct from those more commonly encountered in adult patients, requiring specialized therapies and surgical management.
• Infantile fibrosarcoma is rare, occurring most commonly in infants and young children under 5 years of age. This type of sarcoma most commonly affects the limbs and the torso, but it can occur anywhere. Learn more.
• Malignant peripheral nerve sheath tumors (MPNST) occur in the protective lining of the nerves that extend from the spinal cord into the body. These tumors can occur anywhere in the body, but are usually found in the deep tissue of the extremities or torso. They occur more commonly in people who have an inherited condition called neurofibromatosis but may also arise in otherwise healthy people.
• Rhabdomyosarcoma is the most common soft tissue sarcoma in children. It typically occurs in locations where muscle is present and is most common in children who are younger than 10. Rhabdomyosarcoma can occur throughout childhood and young adulthood, and can even be present at birth. Learn more.
• Synovial sarcoma usually arises in the legs or arms but may be found virtually anywhere in the body. Despite the name, it does not necessarily occur in the synovial tissue found in the joints. About one to three people in a million are diagnosed with the disease each year. Synovial sarcoma can occur at any age, but is most common in young adults. Learn more.
• Undifferentiated sarcoma is a diagnosis given when a sarcoma lacks distinctive features and cannot be classified more specifically. Learn more.

Sarcomas (Benign) of Skin and Bone

• Aneurysmal bone cyst is a blood-filled cyst that can expand the bone, causing pain, swelling and fractures. They are not cancerous, but they can be destructive.
• Chondroblastoma is a rare, benign (non-cancerous) bone tumor that occurs when a single chondroblast (cell that produces cartilage) divides out of control. It is usually found in the ends of long bones, typically in the lower extremities. Chondroblastoma is mostly likely to strike people between age 10 and 20, before bone growth is complete.
• Desmoids, also called aggressive fibromatosis, can occur anywhere in the body, but are often found in the extremities, torso, head and neck. Desmoid tumors arise from cells called fibroblasts, whose main function is to support and protect vital organs such as the liver and lungs. They do not spread, but they may grow and cause life-threatening problems if they compress vital organs.
• Giant cell tumor of the bone is a rare, benign (non-cancerous) tumor. It usually begins near a joint at the end of the bone. This type of sarcoma is most common in young adults between the ages of 20 and 40, occurring after a person’s bone growth is complete. Giant cell tumor of the bone is typically managed by orthopedic surgery but medical management may be utilized when not amenable to surgical resection. Giant cell tumor of the bone may rarely spread to the lungs.
• Pigmented villonodular synovitis (PVNS) causes the synovium (a thin layer of tissue that lines the joints and tendons) to thicken and overgrow. The tumor that results from this overgrowth is not cancerous and does not spread (metastasize) to other areas of the body. But PVNS can lead to bone damage and arthritis. It typically affects the knee, although it can affect other joints as well.
• Osteoid osteoma is a small, benign (non-cancerous) tumor that usually grows in the long bones of person’s lower extremities, usually the thighbone. It can occur in the hand or in the lower part of the spine as well. These tumors do not spread, but they may grow and cause problems such as a fracture or damage to the growth plate. This type of soft tissue sarcoma is most common in teens and young adults.
• Unicameral bone cysts are simple, benign (non-cancerous) lesions that consist of a fluid-filled cavity in the bone. They usually occur in long bones, especially in the upper part of the humerus (upper arm) or thighbones. These cysts tend to occur in children ages 5 to 15. They do not spread but they may grow, causing problems such as a fracture or damage to the growth plate.

Small cell carcinoma of the ovary hypercalcemic type (SCCOHT)

Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is a very rare type of cancer. It most commonly affects people in their early 20s. Infants and people in their 40s may develop the disease. SCCOHT begins in one ovary and may spread to other parts of the body. In a small subgroup of patients, this cancer type is related with hypercalcemia (high calcium levels). Each year, about 40 to 50 people in the United States are diagnosed with SCCOHT.