Although children appear to have the same physical structure as adults, doctors know they're not the same physiologically. That's why there's an entire branch of medicine, pediatrics, that specializes in the care of children. The difference is especially apparent in pediatric oncology, the treatment of cancers in children. Childrens' cancers are almost entirely different from those affecting adults, and require different care and treatment strategies.
The first step in treating any patient is diagnosis. Most childhood cancers are relatively rare, and difficult for non-specialists to identify. A family doctor or pediatrician who suspects cancer will usually refer the youthful patient to a pediatric oncologist for further testing. The pediatric oncologist will interview both patient and parents to form a picture of the child's symptoms, and then will order tests to identify the cancer that is the likeliest culprit. This might include blood tests, the inspection of cell samples, or more sophisticated genetic and molecular testing. Once the oncologist has enough information to make a confident diagnosis, constructing a treatment plan is the next step.
Since the 1960s, treatment of childhood cancers has advanced dramatically thanks to new drugs and techniques. For example, leukemia, once a sure death sentence, can now usually be cured with a bone marrow transplant. The pediatric oncologist decides which combination of treatments will be most effective for each patient. Treatment options include powerful chemotherapy drugs, precise dosages of radiation therapy, and surgical removal of tumors. Immunotherapy increases the body's own ability to fight the cancer, while various targeted therapies attempt to disrupt the cancers' ability to thrive and reproduce. These treatment plans are usually collaborative, with the pediatric oncologist coordinating care with the family doctor, radiologists and other specialists.
Many of the advances in pediatric oncology have come from the research efforts of individual doctors in the field. The relative rarity and variety of childhood cancers makes research unusually important, and a high percentage of pediatric oncologists work at major universities or children's hospitals where they have access to high-quality research facilities. Some devote their efforts to researching and documenting one specific cancer, while others participate in ongoing studies organized by other physicians. Often, pediatric oncologists will arrange for a patient to participate in the clinical trial of a new drug or treatment that shows promise. The results, whether positive or negative, will help determine the treatment's use in future.
Pediatric oncologists have a lengthy training period. Like all doctors, they start with a four-year undergraduate degree and four years of medical school. After medical college, they spend three years in a pediatric residency, followed by three more in a specialized pediatric oncology fellowship. If they're especially interested in research, some facilities offer a combined M.D./Ph.D. residency program. Although treating children with cancer might sound depressing to the layperson, in truth it's an exciting field, thanks to its growing success rates. An estimated 75 to 80 percent of children now survive their cancers, says the Pediatric Cancer Foundation.