Childhood Cancer Awareness Month
September is Childhood Cancer Awareness Month, which is a time to shine a light on the thousands of children and their families across the world who are dealing with a cancer diagnosis.
In 2020, we recognised Childhood Cancer Awareness Month by helping Kiwis better understand different types of childhood cancer and how they impact on the lives of tamariki in Aotearoa.
There are many different types of cancer that affect children, some occurring more often than others. In the graph below, you can see the incidence rates of cancers diagnosed in children (0-14 years) in New Zealand between 2000-2019 by major diagnostic group. Source: National Child Cancer Network
Types of cancers we’re introducing in this series are:
Leukaemia is the most common type of childhood cancer in Aotearoa, which is a group of cancers that develop in the bone marrow (the spongy tissue inside some of your bones) as a result of cancerous change in immature blood cells. No one knows exactly what causes leukaemia – most cases arise due to a spontaneous genetic mutation. In the 1960s, the five-year survival rate for children diagnosed with cancers in the leukaemia group was just 6%. Since then, many Kiwi children have participated in international collaborative clinical trials to test new methods of treatment. Great advances have been made, and the average five-year survival rate for cancers in the leukaemia group today is now close to 90%.
The most common type of leukaemia in children is acute lymphoblastic leukaemia (ALL), named ‘acute’ because it progresses quickly and ‘lymphoblastic’ because of the excessive number of lymphoblasts (immature white blood cells) which crowd the bone marrow and enter the bloodstream. ALL occurs much more often in young children than in adults and makes up one quarter of all new child cancer cases. Children diagnosed with ALL undergo a particularly long course of treatment which usually lasts for just over two years. These children receive several cycles of multi-agent chemotherapy (where two or more drugs are used together), delivered according to strict protocols designed to target their cancer most effectively and minimise the amount of harmful side effects. Depending on disease factors and their initial response to treatment, some children also undergo biological therapy, radiation therapy, and stem cell or bone marrow transplantation.
Read Micaiah’s story to learn how being diagnosed with ALL turned his family’s life upside down.
Brain and spinal tumours (otherwise known as Central Nervous System or CNS tumours) arise from different types of cells in these organs and are classified according to the cell type and area of the CNS in which they began. Most CNS tumours start in glial cells – the supporting cells of the brain. These tumours are known as gliomas and include astrocytomas, ependymomas and oligodendrogliomas.
Another group of tumours arise from embryonal cells. These tumours include medulloblastoma and ATRT (Atypical Teratoid/Rhabdoid Tumours). Altogether there are more than 100 different types of brain tumour, most of which are very rare.
CNS tumours as a group account for around 22% of all childhood cancers diagnosed in New Zealand, which makes it the second most common group of cancers affecting children in Aotearoa.
Tumours classified as low-grade are very slow growing and tend to remain in the part of the brain in which they started. High-grade brain tumours are likely to both be more aggressive in their behaviour and spread into the brain tissue which surrounds them. This can cause pressure and damage to the surrounding areas.
The treatment and likely outcome for a CNS tumour depends on a range of factors. Most CNS tumours require surgical removal, with many needing further treatment such as chemotherapy and/or radiotherapy. For these children, ongoing follow up is important as they can experience a range of long-term or ‘late’ effects from the tumour and treatment.
At present the five-year survival rate for CNS tumours is around 70% in New Zealand children. This is a significant improvement on the 1960s, when survival rates were closer to 30%.
Read Alex’s story on how his shocking brain tumour diagnosis affected his whānau.
Lymphomas are the third most common type of cancer in New Zealand children. Lymphomas are a group of malignancies (cancerous growths) that start in immune system cells called lymphocytes. Typically, lymphomas develop in the lymph nodes or other lymph tissues, such as the spleen and tonsils. However, they can begin in almost any region of the body and spread widely similarly to other cancers. Common symptoms of lymphoma include weight loss, fever, tiredness and swollen lymph nodes. We don’t know why, but lymphomas are more common in boys than girls.
Based on the characteristics and appearance of the cancer cell, lymphomas are often divided into two groups; Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma in children is similar to forms seen in adolescents and young adults but the types of non-Hodgkin lymphoma diagnosed in children are quite different to those seen in adults.
The specific type of lymphoma and the extent of its spread will determine the necessary treatment. Treatments may include chemotherapy, stem cell transplant, radiation therapy or surgery. Most children in New Zealand who are diagnosed with lymphoma will be treated according to a clinical trial or according to a disease-specific clinical protocol.
With current approaches, the vast majority of New Zealand children with lymphoma are cured of their disease.
Read Mya’s story to learn about the immense challenges that being diagnosed with lymphoma created for her family.
Neuroblastoma is the fourth most common childhood cancer and accounts for one quarter of all cancers diagnosed in the first year of life. It can develop anywhere throughout the sympathetic nervous system, but most commonly originates in the adrenal glands on top of the kidneys.
Neuroblastoma belongs to a family of embryonal tumours which also includes cancers such as retinoblastoma, medulloblastoma and hepatoblastoma. These cancers are all caused by uncontrolled growth in precursor cells, known as blasts. We don’t yet know why blastomas develop but they are thought to be caused by genetic errors during early development.
Neuroblastoma is divided into low, intermediate, and high-risk groups based on factors such as the child’s age, how much the cancer has spread and genetic features. Those with low-risk neuroblastoma can often be cured by surgery alone and for some babies, close monitoring is all that is required. In contrast, those with high-risk disease are usually treated with a combination of therapies including intensive chemotherapy, surgery, radiation therapy, stem cell transplantation, biological-based therapy and antibody therapy.
New Zealand has participated in many international clinical trials for neuroblastoma. For those with low and intermediate risk disease, these trials have largely focused on reducing therapy while maintaining high survival rates. For those with high-risk disease, the focus has been on intensifying treatment to improve survival rates. Although the addition of antibody therapy a decade ago has significantly raised survival, high-risk neuroblastoma remains a difficult cancer to treat. Many survivors will have long-term effects due to their cancer treatment.
Read Caleb’s story to learn how his neuroblastoma diagnosis has impacted his whānau.
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