Recent advances in childhood cancer

Abstract

Although the incidence of childhood cancer is extremely low, it remains the second most common cause of death in children over the age of 1 year. Today, two-thirds of children with access to optimal medical treatment are cured of cancer, but the different types of cancer have highly variable cure rates. As determined by the German National Cancer Registry, children with Hodgkin's disease, retinoblastoma, and Wilms' tumour all have a 5-year survival rate of 86% or higher. Patients with acute lymphocytic leukaemia, non-Hodgkin's lymphoma, and germ cell tumours also have a favourable long-term prognosis, but children with many of the subtypes of acute myeloid leukaemia, central nervous system tumours, neuroblastoma, and hepatic tumours continue to have a poor prognosis. Depending on the type of cancer and the stage at which it is diagnosed, children may be treated with one or more modalities, including chemotherapy, radiotherapy, and surgery. Various combinations of chemotherapeutic agents have been extremely effective in inducing, consolidating, and maintaining remission. Advances in orthopaedic surgery have reduced the number of therapeutic amputations that are performed and made possible the administration of smaller doses of radiation. A growing knowledge of the immunohistological, genetic and molecular characteristics of many types of cancer have facilitated the accurate diagnosis and stratification of patients into risk groups. As a result, children can receive individualised treatment and many low-risk patients can receive less intensive therapy, thus avoiding some of the late sequelae of intensive cytotoxic therapy, such as severe organ damage, infertility, and second malignancies. Although the incidence of childhood cancer is extremely low, it remains the second most common cause of death in children over the age of 1 year. Today, two-thirds of children with access to optimal medical treatment are cured of cancer, but the different types of cancer have highly variable cure rates. As determined by the German National Cancer Registry, children with Hodgkin's disease, retinoblastoma, and Wilms' tumour all have a 5-year survival rate of 86% or higher. Patients with acute lymphocytic leukaemia, non-Hodgkin's lymphoma, and germ cell tumours also have a favourable long-term prognosis, but children with many of the subtypes of acute myeloid leukaemia, central nervous system tumours, neuroblastoma, and hepatic tumours continue to have a poor prognosis. Depending on the type of cancer and the stage at which it is diagnosed, children may be treated with one or more modalities, including chemotherapy, radiotherapy, and surgery. Various combinations of chemotherapeutic agents have been extremely effective in inducing, consolidating, and maintaining remission. Advances in orthopaedic surgery have reduced the number of therapeutic amputations that are performed and made possible the administration of smaller doses of radiation. A growing knowledge of the immunohistological, genetic and molecular characteristics of many types of cancer have facilitated the accurate diagnosis and stratification of patients into risk groups. As a result, children can receive individualised treatment and many low-risk patients can receive less intensive therapy, thus avoiding some of the late sequelae of intensive cytotoxic therapy, such as severe organ damage, infertility, and second malignancies.