What is childhood cancer?

About 10,700 children in the United States under the age of 15 will be diagnosed with cancer in 2010. Because of major treatment advances, 80% of these children will survive 5 years or more. This is a huge increase from before the 1970s, when the 5-year survival rate was less than 50%.

Despite its rarity and the major advances in treatment and supportive care, cancer is still the leading cause of death from disease in children younger than 15 years old. About 1,340 children are expected to die from cancer in 2010.

The types of cancers that occur in children vary greatly from those seen in adults. The most common cancers of children are

• Leukemia
• Brain and other nervous system tumors
• Kidney cancer
• Lymphoma (lymph tissue cancers)
• Soft tissue sarcoma
• Eye cancer
• Bone cancer

In contrast, skin, prostate, breast, lung, and colorectal cancers are the most common in adults. The stage of growth and development is another important difference between adults and children. The immaturity of children's organ systems often has important effects on treatment.

Cancer

More than 1 million Americans are diagnosed with cancer each year and nearly one in four die from the disease. Despite these statistics, advances in our understanding of cancer are providing new therapies that stave off disease, improve the quality of life and offer new hope for cancer patients.

The UCSF Helen Diller Family Comprehensive Cancer Center at Mount Zion is the only center in Northern California to receive the prestigious designation of "comprehensive" from the National Cancer Institute.

We treat all forms of cancer from AIDS-related to lung to prostate cancer. Our state-of-the-art outpatient center provides "one-stop" care — from beautifully designed clinics to a Cancer Resource Center for education and support. We also offer specialized programs such as our Cancer Risk Program, a genetic counseling service for patients with a family history of cancer.

With new facilities, expanded programs and innovative research, we help cancer patients live longer and fuller lives. The center ranks first in California and sixth nationwide in National Cancer Institute research grants and is home to pioneers in research into genetic, cellular and immune system causes and responses to cancer.

UCSF Benioff Children's Hospital also provides specialized care for young patients with cancer and blood diseases.

For general information about cancer treatment, support groups, exercise classes and workshops, please contact the UCSF Cancer Resource Center:

Cancer Resource Center	(415) 885-3693
Email	CancerResourceCenter@ucsfmedctr.org

Visit our online bookstore to see books written and recommended by the staff of the UCSF Cancer Resource Center.

Support Groups — Cancer support groups for patients and their families are open to the public.

Nutrition: Tips for Improving Your Health

Good nutrition is one of the keys to good health. You can improve your nutrition by regularly eating foods that have a lot of vitamins and minerals in them, such as fruits, vegetables, whole grains and low- or nonfat dairy.

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Do I need to change what I eat?
If you answer yes to any of the following questions, you may need to talk about improving your nutrition with your doctor:

* Has your doctor talked with you about a medical problem or a risk factor, such as high blood pressure or high cholesterol?
* Did your doctor tell you that this condition could be improved by better nutrition?
* Do diabetes, cancer, heart disease or osteoporosis run in your family?
* Are you overweight?
* Do you have questions about what kinds of foods you should eat or whether you should take vitamins?
* Do you think that you would benefit from seeing a registered dietitian, a member of the health care team who specializes in nutrition counseling?

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Won't it be hard to change my eating habits?
Probably, but even very small changes can improve your health considerably. The key is to keep choosing healthy foods and stay in touch with your doctor and dietitian, so they know how you are doing. Here are a few suggestions that can improve your eating habits:

* Find the strong points and weak points in your current diet. Do you eat 4 1/2 cups of fruits and vegetables every day? Do you get enough calcium? Do you eat whole-grain, high-fiber foods regularly? If so, you're on the right track! Keep it up. If not, add more of these foods to your daily diet.
* Keep track of your food intake by writing down what you eat and drink every day. This record will help you see if you need to eat more from any food groups (such as fruits, vegetables or dairy products) or if you need to eat less of a good group (such as processed or high-fat foods).
* Think about asking for help from a dietitian if you haven't already done so, especially if you have a medical problem that requires you to follow a special diet.

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Can I trust nutrition information I get from newspapers and magazines?
Nutrition tips and diets from different sources often conflict with each other. You should always check with your doctor first. Also, keep in mind this advice:

* There is no "magic bullet" when it comes to nutrition. Short-term diets may help you lose weight, but they are difficult to keep up and may even be unhealthy in the long run.
* Good nutrition doesn't come in a vitamin pill. Only take a vitamin with your doctor's recommendation, as your body benefits the most from eating healthy, whole foods.
* Eating a variety of foods is best for your body, so try new foods!
* Stories from people who have used a diet program or product, especially in commercials and infomercials, are advertisements. These people are usually paid to endorse what the advertisement is selling. Remember, regained weight or other problems that develop after someone has completed the program are never talked about in those ads.

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What changes can I make now in my diet?
Almost everyone can benefit from cutting back on unhealthy fat. If you currently eat a lot of fat, try just one or two of the following changes, or those suggested in our handout on healthier food choices:

* Rather than frying meat, bake, grill or broil it. Take the skin off before eating chicken or turkey. Eat fish at least once a week.
* Cut back on extra fat, such as butter or margarine on bread, sour cream on baked potatoes, and salad dressings. Use low-fat or nonfat versions of these condiments.
* Eat plenty of fruits and vegetables both with your meals and as snacks.
* When eating away from home, watch out for "hidden" fats (such as those in salad dressing and desserts) and larger portion sizes.
* Read the nutrition labels on foods before you buy them. If you need help reading the labels, ask your doctor or your dietitian.
* Drink no- or low-calorie beverages, such as water, unsweetened tea and diet soda. Sugar-sweetened drinks, such as fruit juice, fruit drinks, regular soft drinks, sports drinks, energy drinks, sweetened or flavored milk and sweetened iced tea can add lots of sugar and calories to your diet. But staying hydrated is important for good health.

Balanced nutrition and regular exercise are good for your health, even if your weight never changes. Try to set goals that you have a good chance of reaching, such as making one of the small changes listed above or walking more in your daily life.

Nutrition: How to Read a Nutrition Facts Label

What is a Nutrition Facts Label?

The Nutrition Facts Label helps you determine the amount of calories and nutrients in one serving of food. This information helps you know whether you're eating a healthy, balanced diet.

The label, which is included on every packaged food product, lists the amount of:

• Fat
• Total fat
• Saturated fat
• Trans fat
• Cholesterol
• Sodium
• Total carbohydrate
• Dietary fiber
• Sugars
• Protein
• Vitamins and minerals

Here is an example:

What is a serving size?

Serving size is the first piece of information listed on the label. A serving size is the amount of food that is typically eaten in one serving. It is listed as a general household measurement, such as pieces, cups or ounces (for example, 7 potato chips or 1/2 cup of cereal).

Serving size is an important part of a healthy diet. Eating very large servings, or portions, can contribute to weight gain because as you eat larger portions, you eat more calories.

It?s important to compare the serving size listed on the container to the amount of that food that you normally eat. For example, the label may list a serving size as 7 potato chips or 1 ounce of cake. If you usually eat twice that amount, you are also eating twice the amount of calories and nutrients.

What is the Percent Daily Value?

A healthy person should consume a certain amount of fats, carbohydrates (especially fiber), protein and vitamins and minerals each day. Certain ingredients, such as saturated fats and trans fats, are considered unhealthy and should only be eaten in very small amounts. The nutrition label provides a list of percentages (called the Percent Daily Value) that tell how much of a certain nutrient one serving of food contains, to how much of that nutrient you should consume daily.

One serving of food with 5% or less of the daily value is considered low. One serving of a food with 20% or more of the daily value is considered high.

The Percent Daily Value is based on a daily diet of 2,000 calories. You will need to adjust the percentages if you eat more or less than 2,000 calories per day. For more information on calorie allowances, read our handout on determining calorie needs.

What ingredients should I limit in my diet?

• Saturated fat. Saturated fat can increase your risk of heart disease and high cholesterol. The average adult should consume no more than 20 grams of saturated fat per day.
• Trans fat. Trans fat also increases your risk of heart disease. Ideally, you should get 0 grams of trans fat per day. When you read a nutrition label remember that companies are allowed to list the amount of trans fat as ?0 grams? if it contains less than .5 grams of trans fat per serving. This means that your food can contain some trans fat even if the nutrition label says ?0 grams? per serving! Always check the ingredient list for trans fat, which may be listed as ?hydrogenated vegetable oil? or ?partially hydrogenated vegetable oil.? Trans fat is usually found in commercially prepared baked goods, fried foods, snack foods and margarine.
• Cholesterol. You should eat less than 300 milligrams of cholesterol per day (and less than 200 milligrams per day if you have heart disease). Read our handout on cholesterol for more information.

What ingredients should I get more of in my diet?

• Fiber. Fiber helps your body digest the food you eat, and it can help lower your risk of diabetes and heart disease. A food is considered high in fiber if it contains 5 grams of fiber or more per serving. Men age 50 and younger should get at least 38 grams of fiber per day, while women age 50 and younger should consume at least 25 grams of fiber per day. Fiber is found in foods such as fruits, vegetables and whole grains. Look for the words ?whole grain? on the package and ingredient list.
• Vitamins and Minerals. The nutrition label lists vitamin A, vitamin C, calcium and iron. You should try to get more of these nutrients in your daily diet, as well as other vitamins and minerals that are not listed on the label. You can learn more about vitamins and minerals here.

What You Can Do to Maintain Your Health

Do my habits really affect my health?

Yes, very much so. All of the major causes of death (such as cancer, heart disease, stroke, lung disease and injury) can be prevented in part by making healthy lifestyle choices.

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Don't smoke or use tobacco.

Smoking and using tobacco are very dangerous habits. Smoking causes 440,000 deaths in the United States every year. More preventable illnesses (such as emphysema, mouth, throat and lung cancer, and heart disease) are caused by tobacco use than by anything else. The sooner you quit the better.

Limit how much alcohol you drink.

This means no more than 2 drinks a day for men and 1 drink a day for women. One drink is equal to 1 can of beer (12 ounces), a 4-ounce glass of wine or a jigger (1 ounce) of liquor.

Too much alcohol can damage the liver and contribute to some cancers, such as throat and liver cancer. Alcohol also contributes to deaths from car wrecks, murders and suicides.

Eat healthy.

A healthy diet has many health benefits. Heart disease, certain cancers, stroke, diabetes and damage to your arteries can be linked to what you eat. By making healthier food choices, you can also lower your cholesterol and lose weight.

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Lose weight if you're overweight.

Many Americans are overweight. Carrying too much weight increases your risk for high blood pressure, high cholesterol, diabetes, heart disease, stroke, certain cancers, gallbladder disease and arthritis in the weight-bearing joints (such as the spine, hips or knees). A high-fiber, low-fat diet and regular exercise can help you lose weight and keep it off.

Exercise.

Exercise can help prevent heart disease, high blood pressure, diabetes, osteoporosis and depression. It can also help prevent colon cancer, stroke and back injury. You'll feel better and keep your weight under control if you exercise regularly. Try to exercise for 30 to 60 minutes, 4 to 6 times a week, but remember that any amount of exercise is better than none.

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Don't sunbathe or use tanning booths.

Sun exposure is linked to skin cancer, which is the most common type of cancer in the United States. It's best to limit sun exposure and wear protective clothing and hats when you are outside. Sunscreen is also very important. It protects your skin and will help prevent skin cancer. Make sure you use sunscreen year round on exposed skin (such as your face and hands). Choose a broad-spectrum sunscreen with at least an SPF 15 and one that blocks both UVA and UVB light.

Practice safe sex.

The safest sex is between 2 people who are only having sex with each other and who don't have a sexually transmitted infection (STI) or share needles to inject drugs.

Use latex condoms and a spermicide (a product that kills sperm) gel or cream. Talk with your doctor about being tested year for STIs.

Keep your shots up to date.

Adults need a tetanus-diphtheria booster every 10 years. Your doctor may substitute one Td booster with Tdap, which also protects you against pertussis (whooping cough). You should also get a flu shot each year. Ask your doctor if you need other shots or vaccines.

Check your breasts.

Breast cancer is the second most common cause of death for women. Have your doctor check your breasts every 1 to 2 years until you're 40 years of age. After age 40, you should have a yearly clinical exam and a mammogram.

Get regular Pap smears.

Cancer of the cervix in women can be detected by regular Pap smears. Start having them when you begin having sex or by age 18. You'll need them once a year at first, until you've had at least 3 normal Pap tests. After this, you should have them at least every 3 years.

Ask your doctor about other cancer screenings.

Adults over 50 years of age should ask their doctor about being checked for colorectal cancer. Men 50 years of age or older should discuss with their doctor the risks and benefits of being screened for prostate cancer.

Should I have a yearly physical?

Health screenings are replacing the yearly physical. Instead of every person getting the same exams and tests, only the appropriate ones are given. Talk to your family doctor about your risk factors and what tests and exams are right for you.

Cancer: Medical Vocabulary

The following are terms that you might hear during the diagnosis and treatment of cancer:

Adjuvant therapy: Chemotherapy, radiotherapy or hormone therapy used to kill remaining cancer cells left behind after surgery.

Advance Directive: Instructions on what kind of care you would like to receive (or not receive) if you become unable to make medical decisions.

Benign: Any tumor, growth or cell abnormality that is not cancerous. The growth will not spread to deeper tissues or other parts of the body.

Biological Therapy: Therapy that uses the body's own immune system to attack cancer cells. Biological therapy is sometimes called immunotherapy, biotherapy or biological response therapy.

Biopsy: Removal of a small portion of tissue to see whether it is cancerous.

Carcinoma In Situ (CIS): Cancer that involves only the cells in which it started and has not spread to deeper tissues or other parts of the body.

Chemotherapy: Therapy that uses drugs to damage cancer cells and make it difficult for them to grow in number.

Clinical Breast Exam: Examination done by a health-care professional who has training in breast health.

Clinical Trials: Research studies that involve actual patients. They are designed to find better ways to manage cancer (and other medical conditions and diseases) from prevention and detection to diagnosis and treatment.

Colonoscopy: Insertion of a long, flexible, lighted tube through the rectum and into the colon. This allows the physician to check the lining of the colon for abnormalities.

Colposcopy: procedure where a lighted, magnifying instrument (colposcope) is used to examine vaginal and cervical abnormalities.

Complementary and Alternative Medicine (CAM): Therapy used during or after cancer treatment that may help relieve the symptoms of cancer and/or standard cancer treatments. Some examples of CAM include meditation, yoga, spiritual counseling, acupuncture, acupressure and transcutaneous electrical nerve stimulation (TENS).

Digital Rectal Exam: Exam where the doctor feels inside the rectum with his or her finger and checks for abnormalities.

Family History and Genetic Risk Factor: Increased risk of cancer because a close relative (such as a mother or a sister) had or has had the disease.

Family Physician: A doctor who specializes in treating every part and disorder of the human body. He or she may manage all or part of your cancer treatment.

Fecal Occult Blood Test: Test that checks for the presence of blood in the stool. This test can be used to help diagnose colorectal cancer.

Fibroid: A benign tumor usually found in the uterus.

Flexible Sigmoidoscopy: Insertion of a flexible, lighted tube into the rectum. This tube is shorter than the tube used in a colonoscopy. It allows the physician to check the rectum and part of the colon for abnormalities.

Follow-up: An appointment with your doctor after treatment to check the status of your cancer and overall health.

Invasive Cancer: Cancer that starts in one area of the body and then spreads to the deeper tissues of that same area.

Localized: Cancer affecting only the cells of a certain area.

Lumpectomy: Surgery that removes abnormal or cancerous tissue and sometimes part of the surrounding healthy tissue.

Malignant: Indicates that cancer cells are present and may be able to spread to other parts of the body.

Mammogram: An X-ray taken of the breast in order to check for abnormalities.

Mastectomy: Surgical procedure that removes all or part of a diseased (cancerous) breast.

Melanoma: A type of skin cancer where the cancerous cells are found in the melanocytes (cells that make the skin darker after being exposed to natural or artificial sunlight).

Nonmelanoma: A type of skin cancer where the cancerous cells are found in places other than the melanocytes.

Metastasis: The spread of cancer from one area of the body to another. For example, breast cancer may spread to the lymph nodes and lung cancer may spread to the brain.

Neoadjuvant Therapy: Chemotherapy or radiotherapy given before surgery.

Oncologist: A physician who specializes in cancer and its treatment.

Palliative Care: Therapy that focuses on improving one's quality of life rather than curing his or her cancer.

Polyp: Usually a benign growth. Some polyps on the wall of the colon or rectum can contain cancer or become cancerous over time.

Pap Smear: A test that involves the scraping and study of cells that line the cervix. Pap smears (also called pap tests) are used to detect precancerous and cancerous cells, as well as other noncancerous conditions.

Pathologist: A doctor who identifies diseases (such as cancer) by studying cells under a microscope.

Prognosis: The expected outcome of a disease and chances for recovery.

Prosthesis: An artificial replacement for a body part such as a breast or leg.

Prostate Specific Antigen (PSA) Test: A test that measures the amount of a substance created by the prostate gland in the blood. An elevated amount could be the result of infection, prostate cancer or an enlarged prostate.

Radiation Therapy (also called radiotherapy): Therapy that uses high-energy rays (beams of light) or radioactive materials to damage cancer cells, making it more difficult for them to grow in number.

Reconstructive Surgery: Operation preformed to repair skin and muscles after surgery to treat cancer has been performed. Often used to reconstruct a breast after a mastectomy.

Recurrence: The development of cancerous cells in the same area or another area of the body after cancer treatment.

Risk Factors: Behaviors (such as smoking) or other circumstances (family or genetic history) that may increase your risk of cancer.

Side effects (of therapy): problems caused by the damage of healthy cells along with cancerous cells during treatment. Some common side effects of cancer therapy include being tired, feeling sick to your stomach (nausea), throwing up, hair loss and mouth sores.

Stages of Cancer: The progression of cancer from mild to severe. Usually indicates whether it has spread to deeper tissues or other parts of the body. One method used by doctors to stage different types of cancer is the TNM classification system. In this system, doctors determine the presence and size of the tumor (T), how many (if any) lymph nodes are involved (N) and whether or not the cancer has metastasized (M). A number (usually 0-4) is assigned to each of the three categories to indicate its severity.

Surgery: A procedure that removes, repairs or allows for the further study of a part of the body.

Tumor: An abnormal mass of tissue that can be benign or malignant.