Childhood Cancer Awareness Month is an international event occurring every September that aims to increase awareness of childhood cancers and their impact on children, young people and their families. 
Childhood cancer: Facts and statistics
In the UK, there are approximately 1,900 new cases of childhood cancer (cancer within individuals aged 0 to 14 years) diagnosed annually,  which equates to about five new cases every day.  The types of cancer presenting in children differ quite considerably from those that typically affect teenagers and young adults, and these in turn differ from those found in adults.  Types of cancer seen in children include acute leukaemias, neuroblastoma and Wilms’ tumour,  whereas those seen in teenagers and young adults include lymphomas and carcinomas.  Mortality rates of childhood cancers have decreased by 69% since the early 1970s,  and today, 84% of children who receive a cancer diagnosis in England survive for five years or more. 
What are the causes of childhood cancer?
Unlike adult cancers, where environmental/lifestyle factors are known to play important roles in cancer development, it is thought that the majority of childhood cancers arise as a result of genetic variants. Such genetic variants can be inherited from parents or randomly acquired early in a child’s development, including before birth. [9, 10] Children with an inherited or acquired genetic variant have a genetic predisposition to developing cancer; for example, most children possessing an RB1 variant develop retinoblastoma, while leukaemia is 10 to 20 times more likely to occur in children with Down syndrome than in those without. However, in addition to having a predisposition, it is thought that exposure to certain factors (most likely at numerous different points in a child’s life) is needed for cancer to develop. [11, 12]
There is great uncertainty surrounding the initial causes of acquired genetic variants (aside from random error) and the factors that trigger subsequent cancer development.  Potential risk factors are thought to include: issues with development inside the womb, ionising and non-ionising radiation, and exposure to certain infections and chemicals. [11, 12] However, in most children with cancer, there is no known link with any of these factors; therefore, risk factors and initial causes of acquired genetic variants are not well understood, and much more research is needed. 
What are the signs and symptoms of childhood cancer?
The signs and symptoms of cancer in children can be very varied and similar to those that present as part of other childhood illnesses. Signs and symptoms include: an unexplained lump, firmness or swelling in any part of the body; back or bone pain that doesn’t recede; unexplained seizures or changes in behaviour; constant tiredness; unexplained vomiting; and shortness of breath. However, it is important to remember that although such signs and symptoms can be indicative of cancer, in most circumstances this is usually not the case. 
What treatments are available and what are the physical effects of treatment?
There are numerous treatments available for childhood cancers; the key ones are surgery, chemotherapy and radiotherapy, but immunotherapy and stem cell transplants may be used in some cases. Typically, a combination of treatments will be used. 
In some cases, cancer may return after treatment completion and after it being undetectable for a duration of time – this is known as recurrence or relapse.  In the UK, five to ten children with Wilms’ tumour will relapse each year and up to a quarter of children with acute lymphoblastic leukaemia and half of children with high-risk neuroblastoma. [16–18]
After successful completion of treatment, a follow-up plan extending into adulthood is implemented; as time since treatment completion increases, the focus of the plan shifts from checking for recurrence/relapse of the cancer to continuing to monitor for any potential side effects of treatment. 
Unfortunately, some children can experience long-term physical treatment effects (these can continue for months or years after finishing treatment) and/or ‘late’ physical effects (these often don’t arise until years after treatment has ended). Effects can range from infertility to kidney issues to growth impairment.  The risk of experiencing such effects depends on numerous factors, including the treatments and doses received, the site of treatment, and the age of the child during treatment;  such factors, among others, will help to influence the follow-up plan.  The potential complications reinforce the need for personalised treatments that deliver optimal therapeutic effect but minimise the risk of any adverse effects. 
What are the emotional effects of childhood cancer on patients and their families?
Receiving a cancer diagnosis is understandably devastating for the affected child and their family. In addition to the physical effects of the cancer and treatment, children can experience a range of emotional and social issues. It has been reported that 45% of families felt that their child’s mental health had been affected in the short term by their treatment, and the most common long-term side effect for patients with childhood cancers was found to be emotional and mental health issues (including anxiety, depression and post-traumatic stress disorder).  Children may experience social isolation because of having to miss school, and this can lead to low self-esteem and diminished development of interpersonal skills, in addition to having academic consequences. 
There are also many painful and challenging consequences for families. It has been reported that during the cancer journey, 74% of families felt that the family unit had been affected by emotional and mental health issues.  Parents may experience feelings of isolation, relationship breakdowns and job losses on account of needing to care for the affected child, which can lead to financial strain. [23, 24] Additionally, the lives of siblings will also be severely disrupted, and they too may experience post-traumatic stress and increased negative emotions. 
What can I do to get involved?
Childhood Cancer Awareness Month brings into the focus the need for progression within the field of childhood cancer treatment and care,  and there are many things that you can do to show your support. Every year, the initiative encourages as many people as possible to get involved in its ‘Be Bold. Go Gold.’ campaign, with potential activities such as holding awareness events, fundraising and wearing a gold ribbon to show support for and start conversations about the cause.  After all, every child deserves the chance to reach their potential and fulfil their dreams.
If you’d like further information on Childhood Cancer Awareness Month and what you can do to make a difference, please visit https://www.cclg.org.uk/ccam/about. Additionally, for further information and support, please visit https://www.younglivesvscancer.org.uk and/or https://www.childrenwithcancer.org.uk
The information in this article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content is for general information purposes only. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding the health or medical condition of yourself / another individual.
1. Children’s Cancer and Leukaemia Group. About Childhood Cancer Awareness Month. Available at: https://www.cclg.org.uk/ccam/about. Accessed September 2021.
2. Cancer Research UK. What is children’s cancer? Available at: https://www.cancerresearchuk.org/about-cancer/childrens-cancer/about. Accessed September 2021.
3. Cancer Research UK. Children’s cancer statistics: Children’s cancers incidence. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/childrens-cancers#heading-Zero. Accessed September 2021.
4. Children with Cancer UK. Types of cancer in children. Available at: https://www.childrenwithcancer.org.uk/childhood-cancer-info/understanding-cancer/types-of-cancer/. Accessed September 2021.
5. Cancer Research UK. What is children’s cancer? Available at: https://www.cancerresearchuk.org/about-cancer/childrens-cancer/about. Accessed September 2021.
6. Children with Cancer UK. Teenage and young adult (TYA) cancers. Available at: https://www.childrenwithcancer.org.uk/childhood-cancer-info/understanding-cancer/teenage-young-adult-cancers/. Accessed September 2021.
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8. Cancer Research UK. Children’s cancer statistics: Children’s cancers survival. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/childrens-cancers#heading-Two. Accessed September 2021.
9. American Cancer Society. Risk factors and causes of childhood cancer. Available at: https://www.cancer.org/cancer/cancer-in-children/risk-factors-and-causes.html. Accessed September 2021.
10. MedlinePlus. What is a gene variant and how do variants occur? Available at: https://medlineplus.gov/genetics/understanding/mutationsanddisorders/genemutation/. Accessed September 2021.
11. Children with Cancer UK. Causes of childhood cancer. Available at: https://www.childrenwithcancer.org.uk/childhood-cancer-info/understanding-cancer/causes-childhood-cancer/. Accessed September 2021.
12. Cancer Research UK. Risks and causes of cancer in children. Available at: https://www.cancerresearchuk.org/about-cancer/childrens-cancer/risks-causes. Accessed September 2021.
13. Cancer Research UK. Signs and symptoms of cancer in children. Available at: https://www.cancerresearchuk.org/about-cancer/childrens-cancer/symptoms. Accessed September 2021.
14. Children with Cancer UK. Childhood cancer treatments. Available at: https://www.childrenwithcancer.org.uk/childhood-cancer-info/understanding-cancer/treatments/. Accessed September 2021.
15. Children’s Cancer and Leukaemia Group. When your child’s cancer comes back or does not respond to initial treatment. Available at: https://www.cclg.org.uk/write/MediaUploads/Publications/PDFs/When_your_child’s_cancer_comes_back_2017.pdf. Accessed September 2021.
16. Children’s Cancer and Leukaemia Group. My child’s Wilms’ tumour has come back. https://www.cclg.org.uk/write/MediaUploads/Publications/PDFs/Relapsed_Wilms_Tumour_Factsheet.pdf. Accessed September 2021.
17. Children with Cancer UK. Acute lymphoblastic leukaemia. Available at: https://www.childrenwithcancer.org.uk/childhood-cancer-info/cancer-types/acute-lymphoblastic-leukaemia/. Accessed September 2021.
18. Neuroblastoma UK. Relapsed neuroblastoma UK study. Available at: https://www.neuroblastoma.org.uk/newcastle-epidemiology-study. Accessed September 2021.
19. Children’s Cancer and Leukaemia Group. What happens after treatment? Available at: https://www.cclg.org.uk/what-happens-now. Accessed September 2021.
20. Children with Cancer UK. Childhood cancer treatments. Available at: https://www.childrenwithcancer.org.uk/childhood-cancer-info/understanding-cancer/treatments/. Accessed September 2021.
21. Children’s Cancer and Leukaemia Group. Follow-up care. Available at: https://www.cclg.org.uk/Follow-up-tests. Accessed September 2021.
22. Macmillan Cancer Support. Follow-up care after treatment. Available at: https://www.macmillan.org.uk/cancer-information-and-support/after-treatment/follow-up-care-after-treatment. Accessed September 2021.
23. Children with Cancer UK. Almost half of childhood cancer patients suffer mental health problems. Available at: https://www.childrenwithcancer.org.uk/stories/almost-half-of-childhood-cancer-patients-suffer-mental-health-problems-due-to-harsh-treatments/. Accessed September 2021.
24. Children’s Cancer and Leukaemia Group. Childhood cancer emotional health and wellbeing research fund (part of Children’s Cancer and Leukaemia Group). Available at: https://www.cclg.org.uk/researchfunds/ehwb/impact. Accessed September