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Cancer (Oncology)

Pediatric Cancer

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NewYork-Presbyterian Hospital has one of the largest pediatric oncology programs in the United States. Both the Herbert Irving Child & Adolescent Oncology Center at the Morgan Stanley Children's Hospital and the Division of Pediatric Hematology/Oncology at NewYork- Presbyterian/Weill Cornell Medical Center offer the most advanced cancer treatment available to these young patients in family-centered, compassionate environments.

Cancers that occur in children are not the same as those seen in adults. Unlike adults, in which the cause of cancer may be related to lifestyle factors such as smoking, diet, occupation, or exposure to cancer-causing agents, there is no specific cause for the development of cancer in children. Also, only a small percentage of adults reveal signs of metastases at the time of diagnosis, while approximately 80% of children show that cancer has spread to distant parts of the body. NewYork-Presbyterian Cancer Centers offer particular expertise in the following pediatric cancers:

• Acute and chronic leukemia
• Bone and soft tissue sarcoma
• Central nervous system tumors
• Fibromastosis
• Germ cell tumors
• Hemagiomas
• Hepatic tumors
• Hodgkin's disease
• Nephroblastomatosis
• Neuroblastoma
• Non-Hodgkin's lymphoma
• Retinoblastoma
• Rhabdomyosarcoma
• Wilm's tumor

Advances in diagnostics and treatments have dramatically improved the outlook for infants, children, and adolescents with cancer. In fact, NewYork-Presbyterian Hospital's nationally recognized team of physicians and researchers have pioneered many breakthrough therapies in pediatric cancer. Through the combined expertise of our pediatric oncology specialists, children with cancer have access to innovative and proven treatment regimens. The Hospital's pediatric oncologists are dually trained and board certified in both pediatrics and pediatric hematology/oncology, enabling them to best address the child's illness in the context of key developmental stages.

Therapeutic Excellence

Cancer diagnosis and treatment are difficult processes for patients and their loved ones. At NewYork-Presbyterian, physicians and health professionals give children the best possible chance of recovery and help them to return to their normal lives. In addition, adolescents and young adults with cancer merit special attention when you consider that only 5 percent of 15-to-25-year-olds with cancer are enrolled in clinical trials compared to 60 to 65 percent of younger patients. Each week, multidisciplinary conferences are held at both Hospital sites during which individualized programs for patients are developed by pediatric oncologists, surgeons, radiation oncologists, pathologists, oncology nurses and other specialists, who work together to provide the promise of superior treatment. A patient's comprehensive plan may include specialty consultations, evaluation, hospitalization, outpatient visits, home care, assistance with school integration, and family support. The Hospital also has the first pediatric oncology center in the country to mainstream complementary medicine into patients' therapies, enabling our physicians and health professionals to address not only the disease but care for the child's mind and spirit as well. Pediatric anesthesiologists, nurse practitioners, child life specialists, and pediatric psychologists work closely together, incorporating traditional techniques and complementary medicine approaches to alleviate pain associated with childhood cancers.

NewYork-Presbyterian's Cancer Centers are able to offer patients innovative and advanced therapeutics, including:

• the latest chemotherapy and/or radiation oncology regimens
• blood, bone marrow and stem cell transplant treatments
• immunotherapies
• drug therapies
• anti-angiogenic drugs
• complementary therapies

Each of the Hospital's pediatric oncology programs is a charter member of the Children's Oncology Group (COG) – the nation's largest consortium of medical centers for pediatric cancer therapy which collaborates on clinical trials. In the past, children were excluded from clinical trials of experimental therapeutics. This is now changing as a result of pressure from families and physicians. Morgan Stanley Children Hospital is one of only 20 institutions in the country designated by the National Cancer Institute through COG to conduct Phase I pediatric clinical trials. Pediatric patients from all over the city and beyond are being referred here to take advantage of potential breakthrough therapies.

Ongoing basic and clinical research enables the Hospital's physicians to continue advancing care for pediatric cancers. At the Herbert Irving Child & Adolescent Oncology Center, significant clinical investigations are underway in neuroblastoma, Wilm's tumor, childhood and adolescent lymphomas, sarcomas, Hodgkin's disease, retinoblastoma, and identification of patients at risk. There are over 20 Phase I/II Development Therapeutic Trials available for children who are not responsive to primary treatment for leukemia, lymphoma, or solid tumors. These therapies include chemotherapy, antibody therapies, cell immune therapy, stem cell transplantation, angiogenesis therapy that inhibits blood vessel growth in tumors, vaccine therapy, and gene therapy. Researchers here are also investigating cellular cancer immunotherapy for childhood leukemia and lymphoma; anti-angiogenic drugs for Wilm's tumors and neuroblastomas; gene therapy—replacing abnormal cancer genes with healthy ones; and modulation of the immune system to destroy neuroblastoma cells.

A new state-of-the-art Pediatric Cancer Research Foundation (PCRF) research laboratory at Morgan Stanley Children's Hospital features the most sophisticated equipment available to support novel studies. Among the basic science research projects occurring in this laboratory include investigations into experimental hematopoiesis (blood cell formation), stem cell biology, developmental and experimental immunology, and molecular genetics of hematologic malignancies.

Research at NewYork-Presbyterian/Weill Cornell is supported in part by the National Institutes of Health, Maternal Child Health, the American Cancer Society, and the Children's Blood Foundation. Current research endeavors include protocols for acute lymphoblastic leukemia, mature B-cell lymphoma/leukemia, acute myelogenous leukemia, and myelodysplasia. Other pilot studies are underway for the treatment of advanced stages of Hodgkin's disease. In addition, several studies are in progress for solid tumors in children, including those with newly diagnosed rhabdomyosarcoma and Wilm's tumor. Researchers here are also investigating cytokines (inflammatory cell proteins) in children and adolescents with cancer for clues that may facilitate treatment and help determine prognosis related to fevers and life-threatening infections that can be side effects of chemotherapy. Also under investigation is the role of angiogenesis in brain tumors and leukemia.

A Phase I trial is now underway to evaluate a radiolabeled antibody that is directed against a protein found only on lymphoma cells and will be studied in pediatric patients with non-Hodgkin's lymphoma, Hodgkin's lymphoma, and HIV-associated lymphomas. Another Phase I trial is evaluating a fusion protein in children with refractory neuroblastoma and other GD2-positive tumors. This antibody is linked to interleukin 2 (IL-2) and is expected to bind to the tumor cells, after which the IL-2 should attract lymphocytes to the tumor cells and destroy them.

NewYork-Presbyterian/Columbia is a world leader in umbilical cord blood transplantation, a less invasive procedure than a bone marrow transplant that is used to treat certain diseases in infants and young children. Cord blood offers a rich source of stem cells, or immature blood cells. Physicians at the Morgan Stanley Children's Hospital are conducting promising research into unrelated umbilical cord transplantation, with the aim of preserving cord blood for post-transplant specific adoptive cellular immunotherapy. The Hospital is one of the top five unrelated cord blood transplant centers in the nation. Pediatric oncologists here are focusing basic research on understanding the differences between gene expression in umbilical cord blood and adult blood and are at the forefront of using gene expression profiling for pediatric lymphomas. Such profiling enables doctors to view and differentiate up to 15,000 genes at a time, permitting better assessment of the patients' prognoses and promoting a fuller understanding of the mechanisms responsible for the malignancies.

A Supportive Environment

NewYork-Presbyterian Cancer Centers make every effort to help patients and their loved ones cope with the stresses of illness and hospitalization. Care is provided in comforting and cheerful child and family-friendly environments. The Herbert Irving Child & Adolescent Oncology Center's new spacious facility uses bold colors and a nature decor to create a soothing arena. Chemotherapy treatment areas are equipped with individual TVs and internet connections to help pass the time. A family room provides a quiet area for patients and families; a play area is furnished for toddlers.

At NewYork-Presbyterian/Weill Cornell, a new oncology center boasts brightly painted murals and a solarium where children receiving chemotherapy have a spectacular view of the East River and 59th Street Bridge. Comfortable over-sized chairs and entertainment activities, including internet access, ease the passage of time during treatments.

In addition to providing state-of-the-art treatment, our pediatric oncology programs offer the following services and resources:

Reproductive Health Services - Teenage and young adult patients with cancer whose treatments may affect their future fertility can benefit from specialized sperm or egg preservation services.

Integrative Therapies - To encourage patients and their families to learn more about the value of integrative therapies, the Hospital offers programs and information on dietary changes, mental health exercises, vitamins, herbs, and other possible therapeutic benefits outside of traditional treatment that can help facilitate the healing process.

Pediatric Pain Service - The Hospital offers the only pediatric pain program in the region with a specific focus in pain management for children. Both traditional and complementary therapies are provided to alleviate a child's pain.

Psychosocial Services - The psychosocial team – including child psychologists, child-life specialists, social workers, and clergy – provides counseling, therapeutic play, pet therapy, music therapy, pastoral care, and individual and age-appropriated group therapy for patients and their families. Support groups and child-life programs are offered throughout the course of treatment and during recovery at home.

Child-centered programs at both sites help to ease fears and provide important emotional and supportive care - For example, during a surgical procedure, a family member may be present while the child is being anesthetized, which helps to reduce the stress and anxiety associated with a procedure. Regular visits from the Big Apple Clown Care Unit bring fun and distraction to children coping with illness.

For More Information For more specific information about the Hospital's pediatric oncology programs, visit the Children's Hospital of NewYork-Presbyterian website at www.childrensnyp.org and www.cornellpediatrics.org.