Distinguishing Pediatric Cancer from Adult Cancer: A Path to Enhanced Pediatric Treatments

 

Distinguishing Pediatric Cancer from Adult Cancer: A Path to Enhanced Pediatric Treatments

Introduction:

While pediatric cancer is relatively rare, it stands as one of the primary causes of death among children under 15 in the United States. The conventional understanding of cancer suggests that it emerges as a result of accumulated cellular damage, which, due to the weakening safeguards in our genetic code with age, becomes more prevalent in adults. However, a fundamental question arises: why do children, who haven't had the time to accumulate such damage, develop cancer? In this article, we delve into the evolutionary origins of pediatric cancer to shed light on this perplexing question and discuss tailored treatment approaches.

The Evolutionary Lens:

Cancer, viewed through an evolutionary lens, arises from the breakdown of cellular collaboration that once allowed our cells to function cohesively as a single organism. In children, cells are still in the process of learning how to collaborate effectively. Pediatric cancer emerges when rogue cells that resist cooperation emerge and grow at the expense of the child's well-being.

Distinct Dynamics: Pediatric vs. Adult Cancer

The genetic code inherent in our cells serves as a blueprint, dictating their specific functions. When cells divide, this genetic code is passed on, and errors during this process can lead to cancer. In adults, cancer typically results from a gradual accumulation of errors and genetic damage over time, often due to aging, environmental factors, or unhealthy lifestyles. On the other hand, children's rapidly dividing cells are still in the process of forming tissues, and their limited immune surveillance makes it an ideal environment for cancer development. However, children have robust safeguards and mechanisms that counteract cancer, making it a rare occurrence in this age group.

Pediatric cancers often differ from adult cancers in terms of their genetic makeup. While adults accumulate small errors during cell division, pediatric cancers are often driven by large-scale genetic code rearrangements. These changes can occur in tissues with constant turnover, such as the brain, muscles, and blood. In some cases, genetic alterations may silence the genetic code region responsible for cell specialization, leading to uncontrolled cell division and cancer.

Challenges in Pediatric Cancer Treatment:

Pediatric cancer treatments must account for the distinct nature of the disease. Children's cells exhibit greater growth, mobility, and flexibility, resulting in more invasive and aggressive cancers that can impact development even after successful therapy. Traditional cancer treatments, like radiotherapy and chemotherapy, impact both cancerous and healthy cells. However, in children, these treatments can have amplified side effects due to active cell growth. Moreover, pediatric cancers have fewer genetic targets, making it challenging to test new therapies through large-scale clinical trials.

Adopting an Evolutionary Approach to Treatment:

To address treatment resistance in pediatric cancer, an evolutionary approach is emerging. Extinction therapy, inspired by natural mass extinction events, aims to eradicate cancer cells before they can evolve. This approach involves an initial "first strike" drug to kill most cancer cells, followed by smaller-scale interventions to target the remaining few.

Adaptive therapy takes advantage of the competition for survival among cancer cells. Treatment is dynamically turned on and off to keep the tumor stable while enabling sensitive cells to outcompete and suppress resistant ones. This approach not only preserves the tissue but also improves overall survival.

A Brighter Future:

Recognizing the developmental differences between pediatric and adult cancers and utilizing evolutionary theory to guide cancer trajectories can enhance outcomes for children. Although pediatric cancer patients generally have a better prognosis than adults, cancer remains a significant threat to young lives. Through a deeper understanding of the evolutionary origins of pediatric cancer and tailored treatment strategies, we aim to improve the chances of a brighter, cancer-free future for young patients.