Childhood cancers are under scrutiny—up to the molecular level—and this research avenue has proven fruitful.
Compared to adult cancers, the ones that impact children may significantly differ in how they originate, spread, and can be treated.
The differences are not minor nor mere scientific curiosities. They showcase unique ways in how cancer starts, grows, and devises its devastating consequences in children.
Cancer Hallmarks: The Distinct Nature of Childhood Cancers
The Hallmarks of Cancer—a framework used to explain how cells become cancerous—is a convenient model to compare how pediatric and adult cancers differ.
In essence, the Hallmarks of Cancer suggest that cancer is a consequence of interconnected biological processes that create the ideal conditions for developing malignancies.
So, what makes pediatric cancers unique? Here are some key differences:
- Genetic Mutations: Childhood cancers originate from mutations in genes that direct the normal development of a child. In adults, mutations are more frequent and tend to affect cellular process genes.
- Genomic Instability: Adult cancer results from multiple cells accumulating mutations as the years pass. Pediatric cancers are promoted by specific chromosome rearrangements rather than widespread mutations.
- Unrestricted Cell Growth: Pediatric cancers hijack the body’s natural developmental pathways, relying on signals orchestrating a child’s growth. Adult cancers generally emerge from cellular malfunctions regulating cell division and proliferation.
- Cell Death Evasion: Cancer cells in adults avoid death—a critical process for keeping unhealthy cells in check—by dismantling the safeguards designed to trigger self-destruction in damaged/ abnormal cells. In children, cancer cells evade destruction by reactivating survival mechanisms associated with embryonic development.
- Metastasis: Pediatric cancers spread through the same pathways supporting children’s development. Adult cancers metastasize through a cellular shape-shifting process that “allows” them to break free from their original site and colonize distant tissues.
- Metabolic Alterations: Childhood cancers’ metabolic profiles are reminiscent of the rapid cell multiplication during embryonic development, fueling aggressive growth. Adult cancer cells disrupt ordinary metabolic processes, modifying how fats, sugars, and amino acids are used to support their uncontrolled proliferation and survival.
These are fundamental differences. Why are they noteworthy?
The Visible Value of an Invisible Molecular World
If you are not immersed in clinical research, it’s easy to dismiss the practical value of the unique traits of childhood cancers.
For instance, for the average person, cancer is believed to be the result of personal preferences.
Lifestyle choices—like smoking—are indeed correlated with many (not all, though) cancers in adults. However, the majority of childhood cancers are not associated with environmental or lifestyle factors.
In children, inherited genetic mutations drive around 15% of the cancers affecting them, while alterations in DNA structure (when chromosome parts change position or location, disrupting cell functioning) are critical for the development and growth of childhood cancers.
Children with melanoma, for example, develop cancer in parts of their bodies not exposed to the sun, showcasing that kids may be susceptible to different risk factors than adults.
The potential of unearthing the specific characteristics of childhood cancers is massive, considering that 50% of pediatric cancers possess a distinctive genetic alteration that can be targeted with a potential drug target.
How Childhood Cancer Uniqueness Shapes Medical Research
Distinguishing the differences between adult and childhood cancers is not an academic exercise. It’s a practical endeavor with tangible effects.
Dr. Meropi Toumba is a Pediatric Endocrinologist and a Clinical Associate Professor of Pediatrics at the University of Nicosia Medical School. Her research on the mechanisms behind the development of pediatric thyroid cancer is groundbreaking.
In a conversation with Breaking Cancer News, she discussed the importance of comprehending the unique pathways that can result in childhood cancer.
“It is imperative to focus our research efforts on the unique circumstances that may cause epigenetic changes leading to cancer susceptibility in children. Advanced research in stress pathways, for instance, can shed light on theories for early diagnosis, prevention, developing medication for treatment, and expanding gene treatments.”
As Dr. Toumba clarifies, the stakes are high in pediatric oncology. Here’s what the next two decades may look like.
How Cancer Differences May Shape the Next 20 Years of Pediatric Oncology Care
Predicting the future is not one of humanity’s strongest capabilities.
Nevertheless, as the differences between childhood and adult cancer become more evident, the impact on pediatric oncology care of these developments promises to be immense.
Animesh Ray, PhD, is a geneticist, Keck Graduate Institute professor, and a Caltech visiting faculty member specializing in cancer genomics and systems biology.
In a recent chat with Breaking Cancer News, he explained the impact of a deeper understanding of the intricacies of the Hallmarks of Cancer and what it means for pediatric oncology care.
“I think certain circulating RNA molecules in the blood and urine might turn out to be valuable for identifying cancer in its early stages. Catching cancer early is fundamental. As for cancer hallmarks, based on the differences in cancer types, we should look for changes that disrupt normal cell growth regulation, bypass the body’s natural safeguards, or promote the spread of cancer cells to other parts of the body.”
Apart from Dr. Ray’s insights, other areas will considerably benefit from a better comprehension of the specificities of pediatric cancers.
Diagnosis: As the characterization of pediatric cancers pinpoints their biological differences, testing on children may focus more on genes involved in embryonic development and specific chromosomal translocations.
Treatment: Therapeutic interventions for children may differ from adults as they could target developmental pathways hijacked by cancer cells in pediatric patients while focusing on inhibiting cell division and reactivating cell death pathways in adults.
Drug Development: Pharmaceutical research may rely on the identified differences to develop drugs that modulate transcription factors, regulate chromatin, and address rapid multiplication similar to embryonic states, which are better suited for the attributes of pediatric cancers.
Outcomes: As the understanding of the peculiarities of pediatric cancer augments, treatments may become more personalized as they could be adjusted to a child’s developmental stage and specific mutations or translocations, opening the door to more effective interventions and better outcomes.
The Time Is Now
It’s an exciting time in history. Fighting childhood cancer is not only a clinical priority but probably one of the most defining challenges we face as a society.
As medical science advances and we get a clearer picture of what the cancers that affect children look like—down to their cellular differences— we are better equipped to develop more robust tools to help children live long, healthy lives.
The time is now.
