Justin Cowen had an insatiable love for sports. It didn’t matter which sport, he just liked sports in general. His favorite football team was the Minnesota Vikings. His favorite basketball team was the Golden State Warriors. His favorite baseball team was the New York Mets. His favorite hockey team was the Anaheim Ducks. His favorite soccer team was Everton FC.  He dreamed of being a sports reporter, writing about the things he loved.

In the spring of 2015, Justin began experiencing neck pain. His parents, Tom and Ronee Cowen, took him to his pediatrician. He was diagnosed with a benign tumor, which was removed with surgery. 

But as testing continued, doctors discovered that Justin had osteosarcoma, a form of bone cancer. He began treatment in July 2015, when he was just 12 years old. 

Over the next 13 months, Justin underwent four surgeries, chemotherapy and radiation. He worried about the effect cancer would have on his family, not himself. He battled the disease with courage. But in August 2016, when he was just starting middle school, Justin lost his battle.

Words No Parent Wants To Hear

“Your child has cancer.” 

Those are words no parent wants to hear. Yet, every day in the United States, 42 moms and dads will hear those words from their child’s doctor.

Maybe cancer was suspected by the parents when their child began to experience alarming symptoms that prompted a doctor’s visit in the first place. Maybe the parents had no idea, believing their child had a routine illness — a head cold or influenza. 

Either way, the results are the same: families are turned upside down. And, sometimes, things are never again the same.

About 15,000 American children are diagnosed with cancer each year. In general, the five-year survival rate for childhood cancers has increased to 80 percent — but that still means that one-in-five families who hear those dreaded words will ultimately lose their child to the disease.

Claiming the lives of 2,000 kids under the age of 19 each year, cancer is the leading killer of children by disease. Even those who survive will sometimes find their lives forever altered, either because their organs have been damaged by treatment or because they suffer from depression and other mental health disorders as a result.

Unfortunately, the causes of childhood cancer are mostly unknown. Unlike many types of adult cancers, which have risk factors that can be avoided or controlled, childhood cancers usually strike without warning, and without discriminating.

Brain Tumors

Brain tumors are the most common type of childhood cancer in the U.S. Some are highly treatable, with five-year survival rates of 95 percent. Others have a much poorer prognosis, carrying survival rates of just 30 percent.

While astrocytomas, which are non-cancerous, are the most common type of brain tumors in children, medulloblastomas are the most common type of childhood brain cancer. They usually occur before age 10.

Other cancers of the brain that affect children include ependymomas and brainstem gliomas.

Symptoms of brain tumors vary widely, depending on the type of tumor. Headaches are the most common symptom, but the overwhelming majority of headaches are benign — meaning they do not signal an underlying condition, such as a tumor. Headaches that are worse upon waking up and then go away, headaches that occur while sleeping and headaches that get worse with coughing or exercise are more commonly linked to brain tumors.

Other symptoms include personality and behavioral changes, problems with concentration, increased sleepiness, memory loss, gradual loss of movement in an arm or leg, hearing loss, speech difficulties, unexpected vision problems and balance issues. Particularly among older children, brain tumors can cause vomiting, vision changes, head tilt and weakness of a specific body part. 

Neuroblastoma

Neuroblastoma is a cancer of the nerve tissue, usually forming in the adrenal glands but sometimes starting in the neck, chest, spine or abdomen. It almost always develops before the age of five, and can either be a low-risk cancer or a high-risk cancer. In the low-risk category, the outlook is good. The prognosis for high-risk patients drops considerably, however, and the long-term survival rate is just 15 percent. Neuroblastomas account for 15 percent of all childhood cancer deaths.

Symptoms of neuralastoma include fatigue, loss of appetite, fever and joint pain, with other symptoms depending on where the tumor is located.

Retinoblastoma

Retinoblastoma is an eye cancer that usually occurs in children younger than the age of six. Between 200 and 300 children are diagnosed with the cancer each year in the U.S., and it is often discovered by parents when the pupil of their child’s eye has a white glow in photographs.

Retinoblastoma is highly treatable, with a five-year survival rate near 100 percent when the cancer is discovered early, but long-term problems such as blindness and vision impairment can result. 

Leukemia

Leukemia is a common form of childhood cancer, but can be found in varying types. Acute lymphoblastic leukemia occurs when the bone marrow makes too many immature lymphocytes, a type of white blood cell. Acute myeloid leukemia occurs when the bone marrow makes a large number of abnormal brain cells. Juvenile myelomonocytic leukemia occurs when too many bone marrow stem cells become two types of white blood cells. There’s also chronic mylegenous leukemia.

The treatment for leukemia varies depending on the type. The prognosis in children also varies. For children with acute lymphoblastic leukemia, the five-year survival rate is more than 85 percent. Juvenile myelomonocytic leukemia carries the poorest prognosis, with a five-year survival rate of about 50 percent.

Lymphoma

Lymphoma is the third most common type of cancer impacting children. It is divided into two types: Hodgkin lymphoma and non-Hodgkin lymphoma.

Hodgkin lymphoma occurs when a specific kind of cell, called the Reed-Sternberg cell, begins to reproduce uncontrollably. About six percent of all childhood cancers are Hodgkin lymphoma, and it usually occurs in teens between the ages of 15 and 19. The five-year survival rate is about 95 percent.

Non-Hodgkin lymphoma is more common in slightly younger children, up to the age of 14, and is diagnosed in about 500 children each year. The five-year survival rate for non-Hodgkin lymphoma is greater than 90 percent when it’s caught early, and even in advanced cases the five-year survival rate is in excess of 80 percent.

Symptoms of lymphoma can mimic the flu, with swollen lymph nodes, body aches and low-grade fever, among other symptoms.

Sarcomas

Sarcomas are cancerous tumors that develop in the bone and soft tissue — like the osteosarcoma that claimed the life of Justin Cowen. They generally carry a poorer prognosis than other forms of childhood cancer.

Osteosarcoma, the most common bone cancer, usually occurs in teenagers. If the cancer has not spread, the five-year survival rate is 60 to 80 percent. Once it has spread, however, the five-year survival rate drops to 15 to 30 percent. 

Ewing sarcoma forms either in the bone or soft tissue, occurring in teenagers. The five-year survival rate is nearly 80 percent and has improved significantly over the years. However, children who develop the cancer can suffer later effects, such as organ and growth problems, and they have a higher chance of developing a secondary cancer.

Rhabdomyosarcoma is a cancer of the muscles that attach to bone, occurring in the arms, legs and eye orbit. The five-year survival rate ranges from just 15 percent to around 70 percent, depending on the location of the cancer.

Non-rhabdomyosarcoma is a soft tissue sarcoma with a five-year survival rate of 70 percent when it hasn’t spread, and a five-year survival rate of just 10 percent once it has spread.

Symptoms of sarcomas include lumps in the arms or legs that grow over time and may not be painful. Other symptoms can include abdominal ailments that occur when tumors interfere with digestive function — such as blood in stool or vomit. 

Research is Vital

Want to get involved and raise money for child cancer research? Visit childrenscancer.org to get started.

This article is the September 2018 installment of Focus On: Health, presented by Brennan's Foot & Ankle Care, Big South Fork Medical Center, Roark's Pharmacy and Danny's Drugs on the second week of each month as part of the Independent Herald's Focus On series. A print version of this article can be found on Page A3 of the September 13, 2018 edition of the Independent Herald.