Mesothelioma in Children and Young Adults

Mesothelioma is a rare cancer in adults, but is even more rare in children and young people. Because this cancer typically develops over decades after asbestos exposure, seeing it in children is highly unusual. Some may develop mesothelioma through secondhand exposure from a parent working around asbestos. However, there may be other factors at work.

The symptoms of mesothelioma children experience are similar to those seen in adults. Treatments are generally the same as well. Chemotherapy, surgery, and other treatments may be more difficult for children and many must be adapted. Unfortunately, the prognosis for children is usually no better than for an adult, and remission may not be possible.

Incidence of Mesothelioma in Children

The number of children, teens, and young adults diagnosed with mesothelioma is very low. There are so few cases that they are not even reported in the National Cancer Institute’s database. There are fewer than 16 reported cases for age groups between infancy through 30.

Because it is so rare, there have been few studies investigating children with mesothelioma. Those few studies had to cast a wide net for medical records or case studies in significant quantities to glean information. In one study, researchers gathered information for 221 cases of children with mesothelioma, but these spanned the years between 1919 and 1961, more than 40 years. In another study, researchers looked worldwide and found a total of 80 cases to investigate. These cases represented children from the United States, Brazil, Canada, Germany, France, Poland, and ten other countries.

As with adults, pleural mesothelioma is the most common form found in children. This cancer attacks the lining of the lungs. Even more rare are peritoneal mesothelioma in the abdomen, and pericardial mesothelioma in the lining of the heart. One study looked into the incidence of these rarer types in children and only found nine cases of pediatric mesothelioma of any type between 1999 and 2002. There were only four between 2003 and 2007. There are no conclusive numbers for how many children develop mesothelioma, but these few studies demonstrate that it is very rare.

Causes

The leading cause of mesothelioma is exposure to asbestos. Most adults diagnosed with mesothelioma were exposed to this harmful mineral earlier in their lives. Most were exposed in the workplace before regulations when risks were not well-known. Family members of these workers could have experienced secondhand exposure. Someone working around asbestos could potentially bring fibers home on their clothing, skin, and hair, exposing family members as a result. In addition, children could have been exposed to asbestos in the environment or from contaminated toys, although this is not common.

Even with so few cases of childhood and adolescent mesothelioma, researchers have determined that asbestos exposure is not a leading cause for this age group. Because inhaled asbestos fibers cause damage over time, it takes years for mesothelioma to develop from exposure.

In the international study of 80 cases of children with mesothelioma, researchers found only two children had a confirmed history of asbestos exposure. Researchers hypothesized that radiation could be a factor. Radiation exposure has caused other cancers in children, and it has also caused mesothelioma in adults. Another idea is that exposure to a drug called isoniazid during fetal development could play a role in childhood mesothelioma. Finally, genetic predisposition may also be a factor. The BAP1 gene is known to predispose people to a variety of cancers, including mesothelioma.

Symptoms

Children with mesothelioma report symptoms similar to those experienced by adults with mesothelioma. Those with pleural mesothelioma often experience shortness of breath, chest pains, and pleural effusion, which is a buildup of fluid around the lungs. They also experience a reduction in appetite, weight loss, fever, and fatigue. Children with peritoneal mesothelioma may feel fatigued, experience abdominal pain, lose weight, and have a fever.

As with adults, doctors often confuse a child’s mesothelioma symptoms for other more common conditions. This makes diagnosis tricky, especially since mesothelioma in young people is so rare. A doctor is far more likely to make one or more incorrect diagnoses before considering mesothelioma as a possibility.

Treatment

Treatments for children with mesothelioma are similar to those used in adults. These include chemotherapy, radiation, and surgery, or a combination of the three. Chemotherapy drugs administered to children are the same adults receive. However, doctors must adjust dosages to accommodate the lower weights of children. Surgery on a child may be more complicated, because operating on a small body is usually more difficult. If the cancer has metastasized, surgery may not be an option at all.

A study that reviewed seven cases of childhood mesothelioma found treatment for children and adolescents is just as difficult as for adults. Of the seven cases, one child had peritoneal mesothelioma and the other six had pleural mesothelioma. Only two children survived five years after the diagnosis. For the other five, treatment with radiation and surgery was not effective. For a few children, chemotherapy reduced tumors. One child lived in remission for more than five years after chemotherapy.

Mesothelioma is a tragic illness. To see a child struggle with it is even more tragic. Fortunately, children rarely develop this devastating disease. For those that do, how and why they develop it remains a mystery. Research is difficult with so few cases. However, further research could shed light on incidence, causes, and better treatments for children with this cancer.