Carcinoma

What is a carcinoma?

Carcinomas are cancers that form in the skin and the tissues lining or covering organs such as the heart, kidneys and lungs.

The main types of carcinomas seen in children and adolescents include:

• Adrenocortical carcinoma (See adrenocortical tumors):
  • Occurs in the adrenal cortex, the outer layer of the adrenal gland (located at the top of each kidney), which produces hormones needed for the body to work properly
  • Causes the adrenal gland to make too much or too little of one or more hormones, with symptoms related to the cancer’s location
• Thyroid carcinoma (See endocrine tumors):
  • Occurs in the thyroid gland, located in the neck
  • A healthy thyroid gland helps control heart rate, body temperature, energy level, body weight and calcium levels in the blood
• Nasopharyngeal (nose and throat) carcinomas
  • Start in the upper part of the throat (pharynx) behind the nose

How common are carcinomas?

• The most common cancer in adults, carcinomas are rare in children. In the United States, fewer than 1,000 children and adolescents are diagnosed with carcinoma each year, most of them adolescents.
• The most common pediatric carcinomas are thyroid carcinomas. Of those, the differentiated thyroid carcinomas are most common.

What are the symptoms of carcinoma?

• Adrenocortical carcinoma symptoms differ depending on whether the cancer has spread, and on the amount and type of hormones made by the tumor. Symptoms may include the following:
  • A lump in the abdomen (belly)
  • Pain in the abdomen or back
  • A feeling of fullness
  • Learn more about adrenocortical tumors.
• Thyroid carcinoma symptoms include the following:
  • A lump on the neck that can be felt beneath the skin
  • Increasing hoarseness and other voice changes
  • Problems swallowing
  • Pain in the neck and throat
  • Swollen nodes in the neck
  • Learn more about thyroid carcinomas
• With nasopharyngeal carcinoma, most children have a lump in the neck caused by cancer spreading to nearby lymph nodes. Other symptoms include the following:
  • Hearing loss, ringing in the ears and/or a feeling of fullness in one or both ears
  • Frequent ear or sinus infections
  • Nosebleeds
  • “Stuffy” nose
  • Headaches
  • Pain or numbness in the face
  • Problems opening the mouth to talk or eat

How is carcinoma treated?

Carcinoma treatment varies widely based on the tumor’s type, location, spread (if any) outside the original site and its effect on body functions. Treatment may include the following:

• Surgery - is used to both diagnose and treat carcinomas:
  • A biopsy (removing a tissue sample to test for disease) is done to determine the tumor’s type and grade.
  • If the biopsy finds cancer cells and the patient is still in surgery, the surgeon may take out as much tumor as can be removed safely. In addition to surgery, chemotherapy and radiation therapy may be used to kill remaining cells.
• Chemotherapy (“chemo”) - uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells:
  • Chemo may be injected into the bloodstream, so that it can travel throughout the body.
  • Some chemo may be given by mouth.
  • Combination therapy uses more than one type of chemo at a time.
• Radiation therapy - uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing:
  • External radiation uses machines outside the body to deliver the X-ray dose.
  • Internal radiation uses needles, seeds, wires or catheters to deliver the radiation directly into or close to the cancer.
  • Some types of thyroid cancer use radioactive iodine to find where the cancer may have spread, and to help treat cancer that is left after surgery.
• Chemoradiotherapy - a combination of chemo and radiation has also been used for nasopharyngeal carcinoma.

What are the survival rates for carcinomas?

Survival rates vary depending on the type of carcinoma, its location and the length of time before it is found and treated. Five-year survival rates for common carcinomas include:

• Adrenocortical tumor: greater than 85 percent if caught early and removed completely
• Thyroid carcinomas: around 98 percent
• Nasopharyngeal carcinomas: around 70 percent

Why choose St. Jude for your child’s carcinoma treatment?

• St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
• St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
• The nurse-to-patient ratio at St. Jude is unmatched— averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
• St. Jude offers a dedicated team of specialists to meet the needs of children with carcinomas, including: surgeons (specialists for the ear/nose/throat and for plastic surgery/reconstruction); doctors and nurses who treat this cancer; doctors who specialize in radiation therapy, in hormones (endocrinologists), and in diagnosis (pathologists); experts in diagnostic imaging and nuclear medicine; genetic counselors; dietitians; speech therapists; rehabilitation specialists (physiotherapists, occupational therapists); child life specialists; psychologists; Quality of Life team members; experts who help manage and minimize the long-term or late effects of treatment; researchers; scientists; and many others.
• Complete, quality surgery is an important part of treating carcinomas. Cancer surgery in children requires expertise because of the risks of not completely removing the tumor, not completely assessing disease spread, and injuring blood vessels or nerves. For example, adrenal glands can be fragile, and tumors may have clots in the large veins. Cancer neck surgery in children needs an expert to avoid damage to important nerves that may lead to weakness, numbness, or problems with speech or swallowing. To manage hormone changes that may be seen as some types of tumors or glands are removed, expert care before, during and after surgery is also key.
• The expert skills and experience of St. Jude specialty surgeons can help improve patients’ chances for best outcomes.
• St. Jude brings the minds and efforts of doctors and scientists interested in treating childhood cancers together. For example, St. Jude scientists created an adrenal tumor model in the lab that scientists use to test drugs for adrenocortical tumors. St. Jude doctors and scientists from the clinic and the lab regularly meet together, in person and online with partners elsewhere, to discuss the best new ideas for treating this cancer.
• Researchers at St. Jude found specific mutations (changes) in the TP53 gene that increase the likelihood that a person will develop adrenocortical tumors.
• In 1990, St. Jude developed the International Pediatric Adrenocortical Tumor Registry to provide a central place for data and tumor samples to be stored and shared. Investigators use information from this registry to better understand the disease, its risks and outcomes. Clinicians also use data from this registry to design studies and to decide the best treatments.
• St. Jude takes part in international studies, including work with the Children’s Oncology Group to study how to provide the safest and most effective treatments for patients with both small tumors and tumors that have spread.
• St. Jude is actively studying the gene changes in the tumor and in patients, which may help scientists find new and better ways to treat patients with rare tumors.