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Giving Every Child with Cancer a Brighter Future

A childhood cancer diagnosis is devastating. While scientists are still uncovering the causes of many childhood cancers, pediatric oncologists fight daily to give their young patients a chance at life. Dr Anselm Lee, Consultant and Medical Director at Mount Elizabeth Hospital’s Children’s Haematology and Cancer Centre shares his thoughts on childhood cancers and the role of genomic testing.

Tell us more about treating childhood cancers and the journey you go through with children who have cancer, and their families.

There is only one goal in treating childhood cancer: giving every child the best future. To this end, there is no final end to what we do for patients. Just as parenthood does not stop when a child becomes an adult, our care does not stop when treatment is finished. Our treatment can only be said to be successful when parents can watch their children live lives to the fullest.

Having a cancer diagnosis in the family, let alone a child, can be earth-shattering. Every family goes through a cycle of grief upon receiving a cancer diagnosis: denial, anger, bargaining, depression, and finally and hopefully, acceptance. I have seen the most beautiful faces as well as the toughest sides of human beings. I’ve also shared the happiest and saddest moments in the lives of my patients and their families.

How common is cancer in children?

In general, cancers in children are uncommon, affecting 150 out of one million children a year. If you divide this small number into various cancers such as blood, brain and kidney cancer, the numbers for each are even smaller. TRK fusions are oncogenic drivers of various adult and paediatric cancers1, and TRK fusion cancer is extremely rare.

There are a few common myths and misconceptions about cancers in children. People tend to think that children contract cancer in the same way as adults, with smoking or food carcinogens as some of the causes of adult cancers. However, the way cancers occur in children is far more complicated and scientists still do not have the answers. People should also stop thinking about what children with cancer should or should not eat. Sugar, dairy products or any alternative medicines all have nothing to do with childhood cancer.

What are currently available treatment options, and how do you see childhood cancer treatment evolving in future?

Treatment of childhood cancers is constantly evolving. Surgery for cancer nowadays is much better than 10 years ago in terms of precision, operative safety and functional reconstruction. We also have more options in radiation therapy, which is advancing for safer and more precise treatment. These include electron, proton, and carbon ion therapy. Chemotherapy, cellular therapy, immunotherapy and molecular therapy are also on our menu of treatment options.

Over the last 35 years of treating childhood cancers, what I have found is that newer treatment does not necessarily mean better treatment. Only good clinical studies can inform us what to do next. Clinical studies in childhood leukaemia, for instance, have clearly told us that by using the same drugs in smarter ways, childhood leukaemia can be cured in as many as 90 per cent of cases and with fewer side effects. Innovations in the various forms of treatment now provide us new directions for more studies in the quest for better lives for children with cancer.

What is your opinion of precision medicine in childhood cancers?

I am supportive of precision medicine as an option. We have been using genomic testing to diagnose childhood cancers for over 20 years. When it comes to TRK fusion cancer in children, the problem is that there are no established guidelines on how TRK fusion can be detected. It is found in a few cancers such as mesoblastic nephroma (a type of pediatric renal tumor²) and fibrosarcoma. In these cases, we will ask for a TRK fusion genomic test to support the diagnosis. For TRK-fusion-positive cancers in children, surgery is the mainstay treatment. Chemotherapy and radiotherapy are sometime used as adjuvant treatment. Precision medicine may be considered if the mainstay treatment fails or cannot be carried out.