Cancer and Children

In spite of much progress in the diagnosis and treatment of children with cancer the disease remains a major cause of death in children. Indeed cancer and accidents are the most common causes of death in children up to the age of 14. The risk of developing cancer in childhood is approximately 1 in 500, accounting for some 1600 new cases per year in the UK.

The causes of cancer in children are not fully understood and are difficult to identify, particularly as some cancers develop before birth. However a disturbing trend shows that the incidence of childhood cancers has increased by over one third in the past 40 years. The impact of this has been reduced somewhat by better diagnosis and treatment, resulting in an overall decrease in deaths by over 50% in the same period. However, cancer in children remains a major cause of death and illness and the development of new and improved treatments is essential if advances in cure rates are to be continued, particularly if the incidence of the disease continues to rise.

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The forms of cancer most commonly seen in children (leukaemias and neural tumours) are not the same as those seen in adult populations (lung, breast, colon etc). Treatments for childhood cancers should therefore be looked at as a specialised area of research that focuses on those diseases seen in paediatric patients.

Cancer – the disease and the challenges

Cancer is a not a single disease but is a collective name for over 300 diseases that all share the same characteristics. The human body is made up of over 50 trillion (50 million million) cells, all arising from the single cell formed at conception. Growth of the foetus into a child and then into an adult is a result of the division of the cells within the body.

The process of cell division is highly controlled and, in adulthood, most cells only divide to replace dead or damaged cells. A cancer forms when one of the cells in the body changes and starts to grow and divide out of control. If the cancer is not treated then it will continue to grow, spreading through the body, eventually killing the patient. To be successful any treatment must kill the cancer cells (or at least stop cancer cells dividing) without causing too much damage to the healthy cells of the body.

“1,600 children are diagnosed with cancer every year”

As the cancer is actually part of the patient then this makes treatment difficult. Developing treatments that are specific for cancer cells, and which have no activity against healthy cells, remains the ‘Holy Grail’ of cancer treatment. It is perhaps unlikely that this will be achieved due to the similarity between cancer and normal cells. However, we do have treatments that can selectivity kill cancer cells. The use of these therapies is a compromise – killing the maximum number of cancer cells whilst causing the minimum possible damage to normal tissues in the body.

In children this problem is even more difficult. A child is growing and therefore cell division is a natural process. Many cancer treatments are aimed at killing cells that are dividing. Damage to healthy cells during therapy can give rise to the short term side effects seen in both adults and children. However, in children damage to normal tissues during therapy is both more serious and long lasting. These ‘late effects’ arise because of damage to the healthy tissues of the child’s body. The growing child is more sensitive than adults due to damage to healthy cells of the body that are dividing as part of the normal growth process.

The result of this can be impaired growth, physical development, emotional development and IQ. Clearly if treatment could be made more specific this would have a major impact on patient care. Our aim is to reduce short and long term side effects whilst still retaining the effectiveness of treatment.

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The forms of cancer most commonly seen in children (leukaemias and neural tumours) are not the same as those seen in adult populations (lung, breast, colon etc). Treatments for childhood cancers should therefore be looked at as a specialised area of research that focuses on those diseases seen in paediatric patients.

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