Mesothelioma in Children and Young Adults
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Mesothelioma in children and young adults is extremely rare. Young people may develop mesothelioma through secondhand exposure from a parent working around asbestos. The symptoms, treatments, and poor prognosis are generally the same for children as adults.
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.
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 mesothelioma diagnosed between 1919 and 1961. Just four of those were children with pleural mesothelioma and one child with peritoneal mesothelioma.[1]
- In another study, researchers looked worldwide and found a total of eighty cases to investigate. These cases represented children from the United States, Brazil, Canada, Germany, France, Poland, and ten other countries.[2]
- As with adults, pleural mesothelioma is the most common form found in children. 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 asbestos exposure. Most adults diagnosed with mesothelioma experienced exposure to asbestos 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, but this is not common.
Even with so few childhood and adolescent mesothelioma cases, 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 eighty 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.[2]
Another idea is that exposure to a drug called isoniazid during fetal development could play a role in childhood mesothelioma.[2] 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 pain
- Pleural effusion
- Reduction in appetite
- Weight loss
- Fever
- Fatigue
Children with peritoneal mesothelioma may feel fatigued, experience abdominal pain, lose weight, and 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 as adults receive; however, doctors must adjust dosages to accommodate children’s lower weights. Surgery on a child may be more complicated because operating on a small body is usually more difficult. If 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.[3]
What Is the Prognosis for Pediatric Mesothelioma?
The prognosis for childhood mesothelioma is generally poor. It may be slightly better than for adults. In a study of 33 children with peritoneal mesothelioma, researchers found the average five-year survival rate to be over 82%, much higher than in adults. The children received surgery and heated intraperitoneal chemotherapy.[4]
In a case study of an eight-year-old with pleural mesothelioma, doctors performed a pneumonectomy followed by chemotherapy. Two years later, the child was still in remission and disease-free.[5]
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 who 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.
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Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.