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Cancer

Our Expertise

The Herbert Irving Division of Child & Adolescent Oncology:

• provides unprecedented medical, surgical, psychosocial, and complementary care to children with cancer and their families
• eases the pain and suffering of children afflicted with cancer and helps make their lives as "normal" as possible during treatments
• offers a family-centered environment for the care of children with cancer and their families, and
• pursues basic science and clinical research to increase our understanding of pediatric cancer and develop methods for cure and prevention.

The Division's clinical services are comprised of three disease-oriented teams that address hematological cancers (leukemia and lymphomas), solid tumors, and cancers of the brain and central nervous system. This structure helps to ensure that our patients are cared for by oncologists with expertise in their specific cancer type. With a shared and dedicated purpose, each team's physicians, nurse practitioners, and social workers collaborate to provide continuity of care, ensure our patients' access to appropriate clinical trials, and help with referrals for outside resources, such as home tutoring, transportation, and home care. Each team is supported by a range of resources that include psychosocial services, child life programs, and a comprehensive integrative therapies program.

At the core of our clinical services is a focus on research aimed at developing the right combination of targeted therapies to treat a specific cancer and to minimize any toxicities of treatment. Clinical research is conducted under the auspices of consortiums such as the Children's Oncology Group and the Dana Farber Cancer Institute as well as Hospital-based studies and protocols. Every member of the Division is dedicated to enhancing our understanding of pediatric oncological diseases, their treatment and side effects, and issues associated with survival. Each of the three treatment teams-leukemia /lymphoma, solid tumors, and neuro-oncology-conduct clinical studies to help achieve this goal.

Leukemia/Lymphoma

Leukemia is a cancer of the bone marrow, the organ in the body that produces blood cells. It is the most common type of childhood cancer representing approximately 25 percent of all cancers diagnosed in children and adolescents. Signs and symptoms of the disease are persistent fever, easy bruising, swollen glands, and pain in the extremities.

Through a number of research projects and clinical trial initiatives, our physicians are making strides in the development of treatments for children with leukemia. In addition to taking part in an experimental therapeutics consortium focusing on childhood leukemia, we are involved with the Dana-Farber Cancer Institute's Acute Lymphoblastic Leukemia Consortium-another important trial initiative in which both children and adults can enroll. Our physicians are also developing collaborative relationships with colleagues who treat adults to share therapeutic information that can be mutually beneficial for both pediatric and adult patients.

Among the conditions we treat are:

• Acute lymphoblastic leukemia - a fast-growing cancer of the white blood cells. Lymphocytes is a type of white blood cell that fights infections in the body. In acute lymphoblastic leukemia, the bone marrow creates unformed cells (blasts) that normally would develop into lymphocytes. However, these blasts are abnormal and do not develop to fight infections. The number of abnormal cells (leukemia cells) grows quickly, crowding out the normal red blood cells, white blood cells and platelets.
• Acute myelogenous leukemia-a cancer of the myeloid line of white blood cells in which the infection-fighting white blood cells do not mature fast enough, leaving the body susceptible to anemia and infection. The most commonly diagnosed type of adult leukemia, acute myelogenous leukemia is rare among children.
• Chronic myelogenous leukemia-a type of blood cancer that involves the accumulation of granulocytes (a type of white blood cell) in the bone marrow and bloodstream, leaving the body susceptible to anemia, infection, and bleeding.
• Hodgkin's disease-a cancer of the lymphatic system that usually presents with a painless and generally slow-growing swelling of lymph glands in the neck. Patients sometimes experience fever, night sweats, and weight loss.
• Our physicians are experts in the treatment of Hodgkin's disease and have chaired national studies that report the best results ever achieved in children and adolescents. Treatment, which consists of chemotherapy and perhaps radiation therapy, lasts less than a year with cure rates that exceed 90 percent.

Solid Tumors

Among the solid tumors treated by our physicians are:

• Retinoblastoma-a malignant intraocular tumor that develops from retinal cells, usually occurring in children under the age of five. The tumors may involve just one eye or, if inherited, can occur in both eyes. They usually present with a painless abnormal appearance or glare to the eye. Treatment usually consists of surgery and/or radiation therapy; if the tumor has spread beyond the orbit of the eye, chemotherapy is recommended. The Reese-Ellsworth staging system for this disease was developed at Columbia University in the 1960s. Members of the Herbert Irving Division of Child & Adolescent Oncology are national experts in the epidemiology and treatment of retinoblastoma.
• Neuroblastoma-a malignant tumor that arises from nerve tissue in the neck, chest, abdomen (adrenal gland), or pelvis. Neuroblastoma most commonly starts in the abdomen, either in the adrenal glands or around the spinal cord. Treatment depends on the tumor's biologic features, site of the primary tumor, the age of the patient at diagnosis, and the extent of the disease. Indications of the tumor upon diagnosis include an abdominal mass, pain, neurological symptoms, such as weakness or the inability to walk, and loss of appetite and weight loss.
• Our multidisciplinary team of pediatric surgeons, oncologists, and radiation therapists provide a targeted treatment approach that incorporates surgery, chemotherapy, immunotherapy, stem cell transplants and radiation therapy, as needed. We also have developed novel treatments for neuroblastoma that involve antibodies and anti-angiogenic agents such as antivascular endothelial growth factor.
• Germ Cell Tumors-a diverse group of benign or malignant tumors that usually arise in gonadal tissue, such as the ovaries or testis, and in extragonadal tissue, found in the brain or chest. Treatment consists of surgery and a short course of chemotherapy. Patients treated with these protocols at our Division achieve an 80 to 90 percent cure rate.
• Hepatic Tumors-tumors of the liver-occur infrequently in children and adolescents. Patients present with an abdominal mass and usually appear quite ill. Treatment consists of surgery and chemotherapy. Our physicians are uniquely qualified to care for patients with liver tumors. Our hepatic surgeons are internationally recognized as pioneers in liver surgery and liver transplantation. In addition, our oncologists are members of the Children's Oncology Group hepatic tumor committee and have been instrumental in developing a clinical trial utilizing radiosensitive antibodies to treat these tumors.
• Wilms' Tumor-arises from the kidney and is the most common abdominal tumor in school-age children, usually presenting with a painless abdominal mass. Treatment consists of surgery, chemotherapy, and perhaps radiation therapy. Our physicians are national leaders of the National Wilms' Tumor Study Committee and have been instrumental in developing novel therapies for patients for whom standard treatment has not been successful. More than 90 percent of children with Wilms' tumor are cured of this disease.

Neuro-oncology

Brain tumors are the second most common cancer in children and treatment involves the interaction of multiple clinical subspecialties. Our comprehensive Alfano Family Foundation Pediatric Neuro-oncology Program offers the experience of seasoned medical and radiation oncologists, who can offer the latest therapeutic regimens; highly trained pediatric neurosurgeons, who perform specialized procedures that incorporate advanced imaging methods, such at PET scans, and gamma knife stereotactic radiosurgery-a safe, non-invasive, technologically advanced device for treating deep-seated brain tumors; a neurologist and a neuro-pathologist. We offer innovative protocols that can defer radiotherapy-sometimes indefinitely. This is especially important for infants and children whose brains are not fully mature. We also call on the diagnostic, treatment, and scientific resources of the Neurological Institute of Columbia University Medical Center-an internationally renowned center for the study and treatment of brain tumors.

Central nervous system tumors include tumors of the brain and spine. Brain tumors, the most common solid tumors in children, can be benign and slow growing or highly malignant. They can occur in infants, children, adolescents, and young adults. Symptoms include headache, excessive vomiting, unsteady gait, and visual disturbances.

Our program's nurse practitioner ensures that a child's care is coordinated and optimally managed. Following a diagnosis, our epidemiology specialist addresses questions of causation, helping parents to understand the "why" of their child's cancer. Our social worker, who works specifically with pediatric neuro-oncology patients, is an integral member of the team and is readily available to all family members to provide support, help them access Hospital services, and guide them to external resources that may be of assistance. The team conducts a weekly case conference at which each patient's progress is discussed. Through the conference, we are able to bring together experts who can advise on the latest therapeutic and investigational protocols that might benefit the patient.

All members of our team, no matter what their role, come to know the families of our patients. Each of our staff members understands the emotional and physical toll that a cancer diagnosis can bring and is equipped with the sensitivity and kindness to help families through the process of diagnosis, treatment and recovery.