“It started with an ache that just wouldn’t go away.”
That’s not something pediatricians want to hear.
Sometimes it starts with a bump that doesn’t go away. Children are bound to get some bumps, aches and pains. More often than not, a bump or an ache in a child is just that. Nothing a little rest, an icepack, maybe some Tylenol and a cuddle from mom can’t handle.
When the pain or bump doesn’t go away, or at least improve, after a week or so, then something more is going on.
Pediatricians, as well as ER and urgent-care doctors, are the first stop in sorting out what bump or ache just needs some more time to heal and what needs more investigating. There is a fine balance of not overreacting in either direction. If we demand an MRI for every child with leg pain, we would be putting tons of children through unnecessary and uncomfortable tests.
Time will often determine if more testing is appropriate; however, that doesn’t mean ignoring things. It means listening to your child and doctor, following the doctor’s instructions and following up, especially if things aren’t improving.
One of the worst things that an ache or bump could be is cancer. Is any pain that lasts more than a couple weeks a cancer? Of course not. In the U.S., there are about 1.35 million pediatric ER visits annually just for sports-related injuries. Compare that to only about 16,000 children a year diagnosed with cancer, and only about 1,500 diagnosed with a bone or muscle cancer. Generally speaking, when a child has an ache, pain, lump or bump, the odds are in their favor that cancer is not the cause, but the challenge becomes not missing those few.
X-rays or other scans are usually the next step if things haven’t gotten better. If a concerning mass is seen, request to be referred to a center with experience in such cases. For children, this is often a large academic medical center with pediatric sub-specialists. Without the proper expertise, surgeries can be performed thinking it is just something that needs to be “cut out,” only to find out later that it was cancer. These “whoops surgeries” often leave cancer behind, can delay appropriate care and sometimes require other, more complex, surgeries.
Cancers arising from bone and muscles are called “sarcomas” (from the Greek “sarco” meaning flesh and “oma” meaning mass). There are more than 50 types of sarcomas seen in children. The most common are osteosarcoma and Ewing sarcoma, which mostly come from bones, and rhabdomyosarcoma, which arises from muscle.
These are aggressive cancers requiring intensive treatment with chemotherapy, surgery and sometimes radiation. The treatments are designed to treat the sarcoma we see and also sarcoma cells floating around in the blood that, if not eradicated, cause the sarcoma to spread to other parts of the body.
While the treatment of childhood cancers is considered a success story in medicine, with some cure rates of 85 percent to 90 percent or higher, the cure rates for sarcomas have lagged behind. Patients with localized sarcomas have cure rates of about 60 percent to 70 percent. If the sarcoma has already metastasized — spread to other parts of the body — the chance of cure drops to less than 30 percent.
It takes a dedicated team experienced in sarcomas to maximize the chances of cure, including:
▪ Radiologists reviewing imaging studies.
▪ Pathologists confirming diagnosis by looking at tissue under a microscope.
▪ Orthopedic surgeons skilled at removing the sarcoma and reconstructing the bone and muscle.
▪ Radiation specialists safely providing radiation treatments for children.
▪ Pediatric oncologists and nurses experienced in which combinations of chemotherapy to use, and handling side effects.
Guiding a child and family through all this is no small feat. If your child is diagnosed with a sarcoma, choosing to be treated at a hospital that sees many sarcomas has been shown to improve the chances of your child beating the cancer. In addition, given the very real risk of sarcomas coming back, collaborating with researchers to develop and test promising new therapies for sarcomas is essential to receiving cutting-edge treatment and improving outcomes.
Bumps and aches are part of growing up. Fortunately, most go away. Any pain or bump that doesn’t improve after a couple of weeks of appropriate rest and care needs to be seen by a doctor. Following their recommendations and communicating if things aren’t improving are key. In the rare but life-threatening instances where a sarcoma is suspected, seeking care from a dedicated team of sarcoma specialists is vital.
If your child has a lingering pain or bump, call 305-243-5302 to schedule an appointment with a medical expert.
Matteo Trucco, M.D., is a pediatric hematologist-oncologist at Sylvester Comprehensive Cancer Center at the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.