Childhood Cancer – An Introduction, with Dr. Michael Link

Last Updated: April 25, 2017

Dr. Michael Link outlines the basics of care and treatment of children with cancer, including current areas of research.

More Information

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Full text transcript

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

Childhood Cancer: An Introduction

What is Childhood Cancer?

Michael P. Link, MD, FASCO: The tumors that occur in children actually are quite different from those that occur in adults, and, generally, the break point is around the early 20s, when the adult kind of cancers take over and the childhood cancers become much rarer. 

So,  surprisingly, we don’t think of cancer in children as very common, but it turns out that one in 350 children in the United States develops cancer before the age of 20, and there’s about 12,500 new cases of childhood cancer in the United States each year.

The diseases are different in children and adults, and, of course, children have different needs than adults.  So, although we still use the same methods -- surgery, radiation, chemotherapy -- the kinds of regimens that we use are different.

Recent Progress in Treating Children with Cancer

Dr. Link: And children are young and healthy and don’t have any other health conditions, and so they tolerate chemotherapy and intensive treatment much better than adults would, so we can do things with children that we could never possibly think of doing with older adults.

Over the past three or four decades, the prognosis for children with cancer has improved dramatically, and we now cure almost 80 percent of children with cancer.  We cure 90 percent of the children with the most common childhood cancer, which is acute lymphoblastic leukemia.

Progress in the treatment of childhood cancer is one of the great success stories of modern medicine.  In the last three or four decades, we have made enormous progress in treating almost all of the different childhood cancers

How we’ve made this progress is through clinical trials.  We have run trials comparing therapies, comparing new strategies to old strategies.  And with each trial we have made a little bit of progress, but added together over four to five decades, this has translated into enormous improvement in outcome.

So the majority of children in the United States are entered on clinical trials through pediatric cancer centers and children’s hospitals, and that’s the way we have made progress.

Caring for Children with Cancer

Dr. Link: This is a lesson that could be learned for adults as well, because this is the way forward to make progress is through clinical research.

We have to understand that when we treat a child with cancer we’re really treating an entire family, and there are other needs that are unique to children.

Schooling, something that we don’t really think about, but that’s what children do, and they have to go to school.

Also, the family, transportation, who’s going to take care of the other children?  These are some of the needs that are best served in centers that are specifically geared to take care of children with cancer, notably, the major children’s hospitals in the United States and the major cancer centers.

This is probably where the majority of children should get the best care, both in terms of the specific anti-cancer therapy and all of the supportive care needs that they have.

We understand that some families live too far from a major center or a children’s hospital to get all of their care there, but they can still take advantage of clinical trials and the expertise available at those centers by having the care choreographed by that center.

They could have their care choreographed at the center and then have the majority of the care actually take place closer to home under the auspices of a medical oncologist or somebody suitably trained to do so.

Current Challenges

Dr. Link: the challenge for the future is to design therapies that minimize those late effects, so that we improve the quality and quantity of life for the survivors.

And, then, for those patients that we don’t yet have curative therapy for, we need new therapies.  The challenge for us is to incorporate new targeted therapies into our current treatments to improve the outcome.

We already have preliminary information about how successful they can be.  And so our challenge is to incorporate that into therapies for children to improve their outcome.

In addition, we have the problems of the cost of cure.  Children who survive their cancer are left with a number of side effects related to the therapy that they have received.

The Latest in Childhood Cancer Research

Dr. Link: Some of the important advances lately have been the development of targeted therapies, where we really understand the molecular basis of the cancer and use a drug that is specific to that pathway that drives the cancer, and this has proven to be enormously successful in some adult cancers, but also in childhood cancers as well.

There’s been very exciting results in childhood acute lymphoblastic leukemia where we take the patient’s T cells and educate them to target their own leukemia and then give those T cells back, and this has been very exciting in children who have refractory leukemia who are actually going into remission with this treatment.

We have some very exciting technologies on the horizon, including immunotherapy, use of CAR T cells.  These are all therapies which hold great promise for treatments of cancers. 

We already have preliminary information about how successful they can be.  And so our challenge is to incorporate that into therapies for children to improve their outcome.

Some of the most exciting findings now are attempts to manipulate the immune system of the patient in an effort to allow the immune system to attack the patient’s tumor.

Where to Get More Information

Dr. Link: So this is, I think, the way forward.  Attempts to manipulate the immune system to target other kinds of cancers and solid tumors as well, that, I think, is the very near-term future.

There’s a wonderful resource that is great for parents and families at cancer.net.  Here, they have available information for all the different types of childhood cancer, some of the questions that you should be asking your physician to make sure that you’re getting all of the information you need to decide the best care and make some treatment decisions.

There’s also additional information on other resources that are available to you at cancer.net.

This is a site that I recommend for my patients to use, and I recommend it for all families of children with cancer.

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical Oncology. ConquerCancerFoundation.org  

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

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