A child’s CANCER is not just the disease of an organ, but the disease of an organ in a developing organism. For this reason, even for this alone, developmental cancer deserves a separate classification, different from that of adults. Well, this classification now exists: it is the first Blue Book of childhood cancers of the International Agency for Research on Cancer (IARC), a body of the World Health Organization. It will be available online in January 2022, but Cancer Discovery, the journal of the American Association for Cancer Research, anticipated the findings.
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What are the WHO Blue Books
Since 1956, WHO has promoted the publication of Blue Books. “The Blue Books are official bodies by which cancer diagnoses are made,” he says Rita Alaggio, head of the complex operational unit of Pathological Anatomy of the Child Jesus in Rome, and full professor of Pathological Anatomy at the Sapienza University: “They represent a sort of common and coordinated language that pathologists, oncologists, molecular biologists and all the actors who participate in the identification of a tumor all over the world “.
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Traditionally the Blue Books follow the organ criterion: there is the Blue Book of lung cancers, for example, or that of the gastrointestinal system and children’s cancers have been treated up to now in a separate chapter within the Adult Blue Books. “This new classification – explains Alaggio, who is one of the 5 experts of the international editorial coordination group who oversaw the new classification – is not limited to a system of organs, but offers a specific compendium of all the tumor pathologies that can occur. in childhood and adolescence. This is a fundamental step in making more precise and accurate diagnoses and, consequently, in identifying the best treatment options in this age group. Which are different from those of adults “.
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Different diseases
Children’s cancers are not the result of the accumulation of damage that time or the environment or lifestyle or bad habits cause on DNA, as it usually is for adults. Also because time and the environment could have little effect on children. And lifestyle or bad habits for nothing. In fact, the oncological diseases that affect the pediatric range are often embryonic tumors, that is, they reproduce the characteristics of the embryo tissues, and originate from a single genetic alteration. “That’s how it is – confirms the expert – for this reason the tumors of children and young people have simpler genetic profiles. It is almost always an alteration of the somatic cells, therefore not hereditary: only 10% of pediatric tumors can be ascribed to syndromes that have a family origin “.
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An integrated approach
Once the diagnosis of tumors was made with a microscope: the anatomopathologist studied the morphology of the tissue observing it in every detail. Today we study the molecular imprint of the disease, that is, we do not look at the disease but we enter the disease, sequencing the tumor genome and looking for precise alterations in search of therapeutic targets to hit with targeted therapies, particularly useful for patients who are in evolution . Here, the new classification takes into account both of these approaches, the morphological one and the molecular one, which allows us to better understand how aggressive the disease is and how to deal with it. “The Pediatric Blue Book – continues the anatomopathologist – perfectly reflects the transition from a traditional diagnostic approach based exclusively on histological examination, towards molecular diagnosis technologies. An integrated approach in which the Child Jesus is at the forefront “.
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Diagnosis in the poorest countries
But also an expensive approach. There are many countries in the world where it is impossible to subject children with cancer to genetic tests to make refined diagnoses that allow treatments that are as targeted as possible. Or not? “We wanted to pay special attention to the usability of the new classification in low-income countries with a shortage of resources – says the expert – and for this reason in the Pediatric Blue Book we have provided basic diagnostic criteria, regardless of the use of expensive techniques. In practice, we have given and described different diagnostic possibilities, calibrating them on the access to technologies: it is called the multilayer approach. Pathologists from all over the world participated in this work, not only Westerners or from rich countries, in order to represent all realities. But it is clear that our hope – adds Alaggio – is that molecular tests at affordable prices will be developed in the future, to increase diagnostic precision and also ensure diagnoses for children in these countries based on impartial and reproducible criteria ”.
Continuous updating
Classifications by their nature provide a snapshot of current knowledge at the time of their writing. But in recent years the knowledge is fast also for children, thanks to large international collaborations that allow us to know much more than in the past about pediatric cancers. And more knowledge means more therapeutic successes, but also more updating. “In this regard – concludes Alaggio – WHO has implemented mechanisms to update specific aspects of the classifications between the different editions. In addition, all cancer classifications will be in an online format and can also be updated in real time ”.
Image credits: Roman Kraft via Unsplash
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