Dr. Anita Ramesh, a leading oncologist from India, at the 7th Emirate Pediatrics Hematology and Oncology Conference, discusses the significant challenges and ongoing progress in monitoring rare malignancies in children.

Key Challenges:

• Late Diagnosis: Rare pediatric cancers are often diagnosed late due to a lack of awareness, unknown epidemiology and etiology, and unclear clinical presentations.
• Lack of Consensus: There’s no clear consensus on treatment approaches for extremely rare cancers like pediatric pleural pulmonary blastomas, adrenocortical tumors, pediatric breast cancers, and pediatric colorectal cancers.
• Logistical Barriers: Factors such as finance, availability of specialized doctors, and travel distance contribute to delayed referrals, often resulting in diagnoses at advanced stages (three and four).
• Limited Facilities: In some areas, there’s a scarcity of proper labs, and pediatric oncologists, although India is seeing improvements in primary and tertiary care, training, and educational programs.

Progress and New Approaches:

• Multidisciplinary Tumor Boards: The importance of discussing cases in tumor boards with pathologists, radiation oncologists, and medical oncologists is highlighted for accurate diagnosis and treatment planning.
• Molecular Oncology: Advances in molecular oncology allow for specific diagnoses, leading to the best possible care.
• Innovative Treatments: While treatment principles are similar to adults, dosages and drugs differ. New therapies like immunotherapy and targeted drugs (e.g., lenvatinib, pembrolizumab for pediatric thyroid cancers) are being utilized to reduce toxicities. CAR T-cell therapy is also gaining ground in hematological malignancies.
• Focus on Reduced Toxicity: A major aim in pediatric oncology is to minimize treatment toxicities while maximizing effectiveness.

Future Outlook (Next 5-10 Years):

• Increased Survival Rates: Collaborative studies and clinical trials are expected to significantly improve survival figures and enable earlier diagnosis and more effective treatment for pediatric cancers.
• Survivorship: The focus is on ensuring these young patients become survivors, emphasizing the importance of continued advancements in the field.

Takeaway Message for Clinicians:

• Rare pediatric tumors, though accounting for about 2% of cases, do occur.
• A collaborative, multidisciplinary approach is crucial.
• High levels of awareness and screening are necessary for early detection.
• Always collaborate and discuss cases, as consensus for these rare tumors may not always exist.