Mesothelioma in Children and Young Adults

Mesothelioma is a rare cancer, but it is even rarer in children and young people. The development of this type of cancer typically occurs over the decades after a person has been exposed to asbestos, so seeing it in children is highly unusual. Some may get it as a result of secondhand exposure from a parent working around asbestos, but there may be other factors at play as well.

Symptoms of mesothelioma are usually the same as those seen in adults and treatments are generally the same as well. The treatments like, chemotherapy and surgery, used on children must be adapted for their smaller sizes and may be more difficult. The prognosis for a diagnosis of mesothelioma in a child is usually no better than for adults and remission may not be possible.

Incidence of Mesothelioma in Children

The number of children and teens, and even young adults in their 20s, who have been diagnosed with any type of mesothelioma is very low. Statistics collected by the National Cancer Institute show that there are so few cases that they are not even reported in the database. For incident rates reported for age groups between infancy through 30, there were fewer than 16 cases to be reported per group.

There are very few studies that have investigated children with mesothelioma. Those that have looked into childhood mesothelioma had to cast a wide net to get medical records or case studies in significant quantities to glean any information. In one study, for instance, the researchers gathered information for 221 cases of children with mesothelioma, but these spanned the years between 1919 and 1961, a period of more than 40 years. In another study, the researchers looked worldwide and found a total of 80 cases to investigate, representing children from the U.S., Brazil, Canada, Germany, France, Poland, and ten other countries.

As with adults, pleural mesothelioma is most common in children. This is the type of cancer that attacks the lining of the lungs. Rarer 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 could only find nine cases of pediatric mesothelioma of any type between 1999 and 2002, and four between 2003 and 2007. There are no conclusive numbers for how many children develop mesothelioma, but these few studies and statistic demonstrate that it is very rare.

Causes

Overwhelmingly, the leading cause of mesothelioma generally is exposure to asbestos. Most adults diagnosed with mesothelioma had some exposure to asbestos earlier in life. Most of these were exposed in the workplace, before the risks of asbestos were well known and regulations put in place. In addition to this kind of primary exposure to asbestos, family members of these workers could also have experienced secondhand exposure. Someone working around asbestos may bring fibers of it home on clothing and in hair and expose his or her family as a result. Children may also be exposed to asbestos in the environment or from certain toys contaminated with asbestos, although this is unusual.

Even with so few cases of childhood and adolescent mesothelioma studied, researchers have determined that exposure to asbestos is not a leading cause for this age group. Part of the reason for this is that damage caused by inhaled asbestos fibers is not known to cause immediate health problems. It typically leads to the development of disease many years after exposure.

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

Symptoms

Children with mesothelioma report having similar symptoms as adults with mesothelioma. Those with the pleural form are likely to experience shortness of breath, chest pains, and pleural effusion, a buildup of fluid around the lungs. They also experience appetite loss and weight loss, fever, and fatigue. Children with peritoneal mesothelioma may feel fatigued, have abdominal pain, lose their appetite, lose weight, and have a fever.

As with adults, children’s symptoms of mesothelioma are easily confused with other conditions that are more common. This makes diagnosis tricky, especially since mesothelioma in young people is so rare. It is far more likely that a doctor will make one or more incorrect diagnoses before considering mesothelioma as a possible diagnosis.

Treatment

Treatment strategies for mesothelioma in a child or teen are similar to those used in adults: chemotherapy, radiation, and surgery, or any combination of the three. Chemotherapy drugs used are the same as adults receive, but doses have to be lowered to accommodate the lower weights of children. Surgery can be trickier with a child 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 that 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 pleural. Only two children survived five years after the diagnosis and for the other five children, treatment with radiation and surgery was not effective at all. For a few of the children, chemotherapy reduced tumors and for one this treatment allowed the child to live in remission for more than five years.

Mesothelioma is a tragic illness and to see a child struggle with it is even more tragic. This is fortunately rare, but there are children who develop mesothelioma and it remains a mystery as to how and why they do. Research is difficult to do with so few cases, but more studies in the future could shed light on incidence, causes, and better treatments for children with this cancer.