Research on children's cancers
Cancer in childhood is rare – it affects about 1 in 500 children under the age of 15. Each year around 1,400 children are diagnosed with cancer in the UK, and the disease claims around 300 lives.
Children tend to develop different types of cancer to adults. Leukaemia is the most common form of childhood cancer, accounting for about a third of all cases. Tumours of the central nervous system (the brain and spine) account for another quarter. The other types of cancer found in children are very rare.
Due to major advances in treatment, around three-quarters of children with cancer are now successfully treated, compared to around a quarter in the 1960s. For some types of children’s cancer, survival rates are even higher – more than 80 per cent of children with acute lymphoblastic leukaemia now survive, compared with only 12 per cent in the early 1960s. At the end of 2000 there were more than 26,000 survivors of childhood cancer alive in the UK.
Cancer Research UK is the major funder of research into children’s cancer in the UK. We are committed to improving survival and quality of life for every child with cancer. Our top priorities are to:
- understand more about the causes of childhood cancer
- develop new treatments and further improve survival rates
- reduce side effects and improve quality of life
- identify and reduce any long-term effects of treatment
- provide information about childhood cancers
The Children’s Cancer and Leukaemia Group (CCLG)
The Children’s Cancer and Leukaemia Group (CCLG) co-ordinates the care of virtually all children with cancer in the UK, through 21 paediatric centres. This helps to ensure that they receive the most up-to-date treatment. Cancer Research UK funds the clinical trials work of the CCLG via its co-ordinating centre in Leicester. Children with cancer tend to fare better if they are treated as part of a trial, and recruitment has greatly improved in recent years.
The CCLG is currently co-ordinating around 30 trials throughout the UK. Their work is especially important for the rarer childhood cancers - by including as many children as possible from all over the UK, trials are more accurate and give results faster. For many children’s cancers, doctors must collaborate further afield and the CCLG works closely with groups in Europe and the United States on international trials.
Integral to the CCLG is its Newcastle Pharmacology Group, which develops and analyses new anti-cancer drugs in the laboratory and in early clinical trials in children. Cancer Research UK also funds the CCLG’s tumour bank, a collection of tumour samples that can be used to identify molecular markers associated with response or resistance to treatment. In future this could help doctors tailor treatment to individual patients.
For more information, visit the CCLG website.
Understanding the causes
Cancer is much more common in older people than in children. This is because most cancers are caused by damage to important genes that accumulates over a person’s lifetime. The causes of the genetic damage that leads to childhood cancer are not well understood.
We know that some cases occur when genes are altered during the early stages of a child’s development in the womb. Others are caused by inheriting faulty genes from a parent, but these cases are extremely rare.
Some childhood cancers may be a rare consequence of a common infection, or even the lack of exposure to infection. And there have been reports that exposure to electromagnetic fields (EMF) from, for example, overhead power lines, may slightly increase a child’s risk of certain cancers. But, it is still not clear whether they actually cause leukaemia. Further information can be found on the Healthy Living section of our website.
Cancer Research UK is committed to improving our understanding of the causes of childhood cancers. This will help us develop new ways of preventing and treating these diseases.
Our scientists are searching for genes involved in children’s cancers and are working out how damage to these genes causes disease.
WT1 is a gene that is often damaged in Wilms tumour, a type of kidney cancer that occurs in children. Professor Kathy Pritchard-Jones and her team at the Institute of Cancer Research (ICR) in Sutton have shown that it can also be faulty in acute myeloid leukaemia (AML). They are now investigating if faulty WT1 is directly involved in the development of AML, and if damage to this gene can affect a child’s response to treatment. Dr Stefan Roberts in Manchester is investigating other genes and proteins that may be involved in the development of Wilms tumour. Dr Chris Jones, also at the ICR, is investigating factors that may be involved in the resistance of Wilms tumour to chemotherapy.
The p53 protein is faulty in many types of cancer. However, in a children’s cancer called neuroblastoma (which usually occurs in the abdomen), scientists have found that p53 is normal, but may be located in the wrong part of the cell. This could prevent it from doing its usual job of protecting cells from damage. Dr Deborah Tweddle from Newcastle is investigating the effects of p53’s location on its function, and also whether a gene called MYCN, which is often faulty in neuroblastoma, has any effect on p53’s function.
Scientists in London are investigating other genes involved in children’s cancers. Professor Silvia Marino is examining the role of a gene called BMI1 in the development of medulloblastoma, the most common form of brain tumour in children. Professor Nazneen Rahman and her group recently identified a gene, PALB2, which appears to play a role in an inherited disorder called Fanconi anaemia. This condition increases the risk of a child developing cancer.
Using data from the regional Children’s Tumour Registry, Professor Jill Birch and her team in Manchester are searching for common features - including genetic and environmental factors - among children with cancer in order to identify possible causes.
Certain infectious agents are thought to play a role in some types of childhood cancer. The Epstein-Barr virus (EBV) is a common infection, which can cause glandular fever. In rare cases, the virus can contribute to the development of cancers like Hodgkin’s lymphoma and Burkitt’s lymphoma. We are funding some of the world’s leading experts in this field, including Professor Alan Rickinson in Brimingham, to understand exactly how EBV causes cancer. We are also funding the work of Dr Robert Newton of the University of York, who is investigating the links between effects of HIV on the immune system and the incidence of childhood cancer in southern Africa.
Improving treatment
Although three-quarters of children are now successfully treated, there are still some cancers that are very difficult to treat successfully. In addition, the treatments themselves can sometimes have serious side effects. Our scientists are developing treatments for childhood cancers that are more effective and have fewer side effects. And thanks to our support for its development of new treatments and early clinical trials, the CCLG is one of only a few groups in the world with the ability to take new treatments for children from the lab to the clinic.
We are helping to fund clinical trials to investigate treatments for many types of children’s cancer, including leukaemia, brain tumours, neuroblastoma, Ewing’s sarcoma (a type of bone cancer) and Rhabdomyosarcoma (muscle cancer). Some studies are testing new drugs, while others are exploring different ways of using existing drugs or giving radiotherapy. More information on clinical trials for children’s cancers can be found on our Clinical Trials database.
Scientists also aim to improve the outcome of treatment by finding ways to predict each child’s response to particular chemotherapy drugs. By comparing the genetic profiles of children with acute lymphoblastic leukaemia, researchers in Manchester, led by Professor Vaskar Saha, are pinpointing markers that can be used to help personalise treatment. They also plan to use the information to develop new drugs for this type of leukaemia.
Improving quality of life
Cancer has a major impact on a child’s life. It is almost inevitable that they will miss some schooling and may fall behind as a result. There may also be social difficulties, which can be aggravated by missing school or by physical problems that reduce a child’s ability to participate in everyday activities. In order to help parents and teachers understand how this might affect the child, we have produced information booklets to explain more about childhood cancer. These have been produced in collaboration with our scientists and the CCLG.
‘Welcome back!’ provides teachers with information about the problems cancer can cause in young people at school. It raises issues concerning not only the affected individual, but parents, brothers, sisters and classmates, and suggests practical ways of tackling them. And ‘Children with a brain tumour in the classroom’ provides information to help teachers and parents support young people returning to school after treatment for a brain tumour. These booklets can be ordered from our website.
Because of the improvements in survival, there are now thousands of childhood cancer survivors alive in the UK. But success in treatment is bringing new challenges. Most of these people will have received intensive treatments to cure them of the disease, which could have long-term side effects. The problem is that we don’t fully understand what these are at the moment. To help address this, we are funding the British Childhood Cancer Survivors Study, led by Dr Mike Hawkins of the University of Birmingham. Over 10,000 survivors have completed a detailed questionnaire about their life and wellbeing. This, and follow-up studies, will help to inform doctors about the types of problems survivors may face later in life and how they can be avoided or tackled more effectively. Encouragingly, the evidence suggests that in the vast majority of cases, survivors of childhood cancer go on to lead perfectly normal lives.
