Ask Me Anything About Childhood Cancer

Exploring the mysteries of childhood cancer, Lianna Marks, MD, a pediatric oncologist at Stanford Medicine Children’s Health who specializes in the treatment of patients with leukemia and lymphoma, shares her expertise in a candid “Ask Me Anything” session, delving into the complexities of the causes, symptoms, and future of treatment.

Drawn from our ‘Ask Me Anything’ series on Instagram, this Q&A has been lightly edited for clarity and length.

What causes childhood cancer?

We are always looking to learn more about what causes childhood cancer, so that we can help people prevent it. Unlike adult cancers where environmental factors, such as smoking, are big risk factors, there are very few environmental exposures or lifestyle factors associated with childhood cancer. We do know that radiation and some pesticides could play a role in the development of childhood cancer.

What are symptoms or red flags for childhood cancer?

Unfortunately, there are a wide variety of symptoms that could potentially lead to a cancer diagnosis. The big red flags are if your child looks much more pale than usual, easily bleeds or bruises, or has a mass that isn’t getting better with time. If you see these symptoms, you should bring your child in to the doctor.

What’s different about childhood cancer versus adult cancer?

Many childhood cancers are not associated with any lifestyle factors, such as smoking. They often occur due to random mutations in DNA. There is nothing that can be done to prevent them. On the other hand, childhood cancers have a lot of different treatment options and we’re seeing better and better outcomes. Although we’re seeing some of those advancements in adults, children have better outcomes, because they are better able to tolerate therapy–it perhaps is something about the biology of their disease.

What’s the biggest misconception families have at the start of treatment?

The biggest misconception parents have at the start of treatment is that we don’t have good cures for pediatric cancer. They might think about adults they know who’ve gone through cancer therapy, when in fact, treatments in children with cancer are often well tolerated and have very good outcomes.

What steps in the treatment process do you adjust for teenagers versus young children?

Our child life specialists, doctors, and nurses are great at working with kids and young adults to explain their disease and treatment to them at an appropriate level.

We have a sedation team that can help younger children with procedures. We give teenagers the option to use sedation or be awake for procedures, such as lumbar punctures, so they can have some control in their treatment.

What are the most common medications used to treat childhood cancer?

The most common medications used to treat childhood cancers are cytotoxic chemotherapy drugs, such as methotrexate, doxorubicin, and vincristine, which are used in both children and adults. In pediatrics we try to develop treatment protocols that limit the long-term side effects from the chemotherapy.

How has the chemotherapy drug shortage impacted kids’ treatment at the Bass Center?

Fortunately, the Bass Center for Childhood Cancer and Blood Diseases has been prepared for many drug shortages, and has drugs stocked so that patients have not needed significant modifications to chemotherapy treatment. However, if shortages go on too long, it becomes disruptive to patient care, and drug substitutions may be necessary. Advocacy to maintain appropriate drug supplies is needed.

Why have cure rates improved so much for some cancers and not others?

We have seen tremendous improvements in the cure rates for some cancers, such as leukemia and lymphoma. Where there are other solid tumors that have not seen the improvements, a lot of that has to do with the biology of the tumors and whether we can find targeted mutations that have good therapies. This is an area where we’re focusing our research efforts to improve cure rates.

What’s the next big innovation in pediatric oncology that excites you?

I’m excited about targeted therapies, which are medications specifically designed to target mutations in tumor cells. These therapies are targeted to the tumor, so they have fewer side effects compared to conventional chemotherapy that targets both tumor cells and healthy cells.