"Will I die?"
"There were so many things I wanted to do in life!"
"How many more days do I have?"
"How painful will it be?"
"Is there anything I can do to get better?"
These are just a few of the questions you might ask if you found out you had cancer. But what would your first questions be if you found out your toddler had cancer, such as hepatoblastoma?
Cancers in children are a very different beast. When treating cancer in an adult, you can really beat up the body to kill the cancer, and the damage to healthy tissue can repaired. But in a child, the tissue is much more fragile, and there are issue of future development that come into play. Dumping loads of chemotherapy drugs, and dosing with large amounts of radiation can drastically interfere with the growth of the child, especially during adolescence. For example, bombarding a child with radiation to destroy a cancer in a child's abdomen may kill the unwanted neoplastic tissue, but greatly increase the child's chances of heart disease as early as their teens. (Check out this news report for more about childhood cancer and heart disease.)Hepatoblastoma is a liver cancer that tends to develop in children under 3 years old; the reason for the young age is that the tumor is born out of developmental cells called blasts. In a body that small, small medical procedures can have big effects. So treating this disease has to be done VERY carefully. Surgical interventions can be very effective if the cancer is caught early. The external scar may be significant, since surgeons hands often are bigger than a child's abdominal cavity. However, since livers regenerate, resectioning a liver or performing a liver transplant can often lead to a full recovery...as long as you are able to remove ALL of the cancerous tissue. Chemotherapy agents are often included with the surgical option to help the doctor fully excise the tumor.
Cisplatin and doxorubicin are two common drugs used to kill cancers, including hepatoblastoma. Both act by crosslinking DNA, which leads to cellular apoptosis. While all DNA is crosslinked, it is mainly dividing cells that are effected. This is because all cells have machinery that can repair and remove crosslinked DNA, given enough time. Cells that are dividing don't necessarily have the needed time, though. Right before cellular division the cell's quality control mechanisms check to see if the DNA has been copied correctly. If it hasn't (and it won't be if it is crosslinked), the cell instead triggers self-destruct mechanisms, a process called apoptosis. And since cancers are cancers because of out-of-control tissue growth, the hope is that these neoplasms die before the rest of the person. This explains why other rapidly dividing structures are affected during chemotherapy, such as hair loss.
But in a child, EVERYTHING is dividing. This small person's body is busy growing, developing, and maturing. So chemotherapeutic drugs can ravish a child's body if not selected and dosed correctly.
There is so much more to say about childhood cancer's such as hepatoblastoma. A great website to learn more about hepatoblastoma can be found on MDiTV.
