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What’s the deal with Childhood Cancers? with Dr. Ermoian

What’s the deal with Childhood Cancers? with Dr. Ermoian

What’s the deal with Childhood Cancers?

We sat down with our resident childhood cancer expert, Dr. Ralph Ermoian. Dr. Ermoian is board certified in radiation oncology and also completed residency training in pediatrics. He sees patients at Seattle Children’s Hospital, the University of Washington Medical Center and SCCA Proton Therapy Center. Before the center opened, Dr. Ermoian routinely sent children to other proton therapy facilities to get treated.

How rare is it that a child’s ailment turns out to be cancer?

Really rare. One hundred adults are diagnosed for every one child. Nationally, only 15,000 children are diagnosed each year, and that includes leukemia. In comparison, 220,000 people are diagnosed each year with breast cancer. When I studied to be a pediatrician we were told that we might see two or three kids with cancer over our entire careers.

When might a doctor suspect it’s cancer? Would a regular pediatrician make a diagnosis?

There is no one way to diagnose cancer because the diseases present in so many different ways. If something doesn’t get better the way it should or doesn’t seem right, a pediatrician may seek specialized advice. More rarely, there might be a change like severe headaches or a mass. 

How does one diagnose the cancer? (That it’s cancer, what type of cancer)?

It mostly depends on the symptoms with which a patient presents. Usually doctors order some imaging if an abnormal mass is felt or seen. Sometimes a patient has an abnormal blood test. Ultimately, the doctors decide they are concerned enough that they arrange for the patient to get a biopsy or even have the mass removed by a surgeon. Then they can figure out if the patient has a cancerous tumor, and what type it is.

How is treatment decided upon?

At Seattle Children’s, most new cases are presented at a tumor board. When you’re in a place as great as Seattle Children’s, you tap into your colleagues’ expertise. Are they thinking the same thing? These tumor boards often include participation from St. Luke’s in Boise, Sacred Heart in Spokane, and Mary Bridge in Tacoma. 

Chemotherapy, surgery and radiation are the usual treatments. 

In terms of radiation, we rarely treat patients with leukemia. In Lymphoma we use radiation occasionally. For solid tumors such as brain, radiation is used more often. Our most common solid tumor cancer patients have brain tumors, then sarcoma (muscles and bones). 

Are certain childhood cancers more common than others (or categories of cancers, such as brain)?

Leukemia, lymphoma and brain cancers are the most common. Medulloblastoma is the most common childhood tumor treated with radiation—600 diagnosed each year in the United States, of which we treat 15 to 25. 

Are there oncologists who specialize in certain childhood cancers? 

At hospitals that treat children with cancer, there is always a pediatric oncologist. Many oncologists have their niches. At Seattle Children’s the subgroups of medical oncologists roughly break down to solid tumors outside the brain, brain tumors, and liquid tumors. 

Are children better able to fight cancer? Better survival overall than adults?

Yes, children are remarkably resilient and they get different tumors than adults do. They can get stronger treatment and can handle it better than adults can. In fact, they are able to get some therapies that adults couldn’t get because they can recover better. Overall, three in four children will ultimately be cured of their cancer. Some children are cured of metastatic cancer whereas in adults that’s quite rare. 

What are the benefits of going to a place like Seattle Children’s?

Seattle Children’s is a great hospital. Many world leaders in oncology care are there. They are amazing clinicians and pioneers in research. The biggest childhood cancer research organization, the Children’s Oncology Group, has discipline chiefs that are the head of entire classes of cancer. Seattle Children’s is the only institution that has three of these discipline heads in one hospital. 

Of course the most important reason to get treatment at Seattle Children’s is the breadth of its services and expertise, and that certainly includes that we offer proton therapy to many of our patients. 

Is Children’s  especially recognized in cancer care? Does it offer all treatment options?

Seattle Children’s is ranked number one in cancer care west of Rockies and is one of the top five children’s hospitals in the country. 

Final thoughts?

For many children with cancers where radiation is required, proton therapy offers the same results with respect to the cancer, but with better managed side effects.