This Battle Which I Must Fight
Cancer in Canada's Children and Teenagers

NEW DEVELOPMENTS AND FUTURE DIRECTIONS

The greatest success of the past two to three decades with respect to cancer in the young has been the development of more effective treatments. Treatment for childhood cancer has become more complex and intensive; new chemotherapy drugs have been developed, and existing ones are administered in new ways. Better drugs for controlling the side effects of treatment and approaches that reduce the need for extensive surgery are other welcome improvements. Transplantation of stem cells from peripheral blood as well as methods for targeting radiation and chemotherapy to cancer cells, for enhancing the immune system, and for inducing cancer cells to mature and become benign are being explored. These improvements, which are helping increasing numbers of children and teenagers to survive cancer, are largely the result of the multi-centred studies conducted by the international childhood cancer study groups. Since children are now discharged from hospital earlier than in the past, more of their care is given at clinic visits and by their parents. Resources and support for their families must keep pace with these changes.

Advances in molecular genetics (the study of the chemical functions of genes) have contributed new information on how cancer develops and progresses. This information has led to the development of sophisticated laboratory tests that contribute to making or confirming a diagnosis, to selecting the best treatment, and to anticipating outcome. Increasingly, molecular analysis is suggesting new approaches to treatment and to other clinical concerns, such as the presence of currently undetectable disease and the need for more sensitive monitoring of the effects of treatment.

Despite improvements in treatment, prevention remains an important goal. Research into the causes of cancer in the young is urgently needed and ongoing. To prevent cancer, factors that contribute to its development must be identified so that exposures can be reduced. An example is reduction in the use of prenatal X rays. For cancers where the causes are either unknown or cannot be eliminated, early detection offers hope for reducing the severity of disease. Screening for neuroblastoma, which is being evaluated in Canada (Quebec) and in Japan, is an example of early detection.

The Canadian Childhood Cancer Surveillance and Control Program is adding impetus to work already underway and is fostering new activities. Disease surveillance and the development of a more detailed data base are two activities that should contribute substantially to the identification of risk factors for childhood cancer. The development of national tumour banks will contribute to further advances in tumour biology. A plan for monitoring late effects of treatment is another initiative. Finally, communication is an important part of a concerted effort to attack the problem of cancer in the young. This book is the first of a planned series of contributions in this area.

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