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Compare and contrast: pediatric cancer versus adult malignancies

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Abstract

Cancer is a leading cause of death in both adults and children, but in terms of absolute numbers, pediatric cancer is a relatively rare disease. The rarity of pediatric cancer is consistent with our current understanding of how adult malignancies form, emphasizing the view of cancer as a genetic disease caused by the accumulation and selection of unrepaired mutations over time. However, considering those children who develop cancer merely as stochastically “unlucky” does not fully explain the underlying aetiology, which is distinct from that observed in adults. Here, we discuss the differences in cancer genetics, distribution, and microenvironment between adult and pediatric cancers and argue that pediatric tumours need to be seen as a distinct subset with their own distinct therapeutic challenges. While in adults, the benefit of any treatment should outweigh mostly short-term complications, potential long-term effects have a much stronger impact in children. In addition, clinical trials must cope with low participant numbers when evaluating novel treatment strategies, which need to address the specific requirements of children.

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Acknowledgments

NK, RF, and HS would like to acknowledge the support from the Master Course in Molecular Medicine at Ulm University, on which, during their time as students, the initial idea for this review was conceived. Sara E. Barry kindly read an early version of the manuscript and gave invaluable suggestions. MAW and KMD are, as always, grateful for the administrative support of Bianca Welz and Elke Lützner, as well as the support from the Förderkreis für tumour- und leukämiekranke Kinder Ulm e.V. Vicariously for all the pediatric patients seen in our clinics, the authors would like to dedicate this paper to Kilian Schlabach and his parents. We learn so much more about courage and the human spirit from these families than one could ever have imagined.

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  1. Patricia Kattner and Hannah Strobel contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstrasse 24, 89075, Ulm, Germany

    Patricia Kattner, Hannah Strobel, Nika Khoshnevis, Stephan Bartholomae, Rahel Fitzel, Mike-Andrew Westhoff & Klaus-Michael Debatin

  2. Department of Radiology, German Armed Forces Hospital of Ulm, Ulm, Germany

    Michael Grunert

  3. Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany

    Maximilian Pruss, Marc-Eric Halatsch & Georg Karpel-Massler

  4. Faculty of Medicine, Ulm University, Ulm, Germany

    Katharina Schilberg

  5. Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA

    Markus D. Siegelin

  6. Pediatric Neurosurgery Section, Department of Neurosurgery, University Medical Center Ulm, Ulm, Germany

    Aurelia Peraud

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  1. Patricia Kattner
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Kattner, P., Strobel, H., Khoshnevis, N. et al. Compare and contrast: pediatric cancer versus adult malignancies. Cancer Metastasis Rev 38, 673–682 (2019). https://doi.org/10.1007/s10555-019-09836-y

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