Understanding Childhood Cancer With Dr Geoff

Childhood cancer treatment leads to severe impairment of the ability to fight infections. This episode explains what immune suppression means, what causes it, and the problems that result.

A few years ago I described CAR T-cells, but they weren't available for routine use. I now update things, with the very important news about CAR T-cell therapy now becoming available. There is also an interview with Dr Caroline Bateman re this subject in another episode.

We take a lot of blood samples looking for infection in the bloodstream. This episode explains what blood cultures are all about.

A number of countries have research studies where childhood cancers are analysed in great detail, testing all the DNA in something called 'molecular profiling'. The national Australian study of this is called PRISM, and it is a very exciting project. This episode explains a molecular profiling project and covers issues of obtaining informed consent from parents and patients as well.

The MEK inhibitors are a newer class of drug, and include trametinib, selumetinib and others. They have an important role in paediatric oncology, particularly in glioma treatment and in neurofibromatosis.

Sophisticated techniques can detect one cancer cell amongst a million normal cells. This episode describes these methods and how they are used in treatment.

CAR T-cell therapy is an exciting new treatment for acute leukaemia. In this episode, Dr Geoff interviews his colleague Dr Caroline Bateman about CAR T-cells and introducing the treatment option to her unit.

For many years we didn't biopsy the tumour when the scans suggested that the tumour was a DIPG. This episode explains why that has changed, and the emerging role of biopsy.

DIPG is a type of brain tumor which occurs in children. This episode explains what the letters mean.

Ifosfamide is another chemotherapy drug, used particularly in certain sarcomas and certain patients with leukaemia. This episode explains how it is given, and common and rare side effects.

We often need to evaluate heart function during chemotherapy. This episode explains what the tests are, and why we need to do them.

At the American Society of Clinical Oncology meeting in June 2016, a study was presented looking at using two autologous bone marrow transplants in neuroblastoma. The results were exciting....

In this episode I read out for you an article written by Dr Susan Cohn from the University of Chicago. Dr Cohn is an eminent paediatric oncologist, and a world expert on children's cancer trials, particularly in neuroblastoma.

When families find themselves in a hospital, they meet all sorts of doctors with all sorts of titles, residents, interns, fellows, registrars. This episode explains who's who in the childhood cancer medical team.

Chemotherapy can make the white blood cell count drop, predisposing to infection. These drugs work to boost white blood cell production.

I talked about MIBG scans previously. In this episode I discuss the use of high doses of MIBG as a treatment of neuroblastoma.

Adolescents and Young Adults with Cancer: What's special about the AYA's? by Dr Geoff

MIBG scans are used to evaluate and monitor neuroblastoma.

My Christmas Special episode. Includes the Top 12 people who deserve a Christmas present more than the oncologist.

Parents always ask why their child developed cancer. They ask if it is genetic, meaning is it something hereditary, or some abnormality in the DNA that the child was born with. In this episode I discuss a recent paper that examined this question.

There are multiple ways to go looking for DNA, RNA and protein abnormalities. Many should still be considered research, not standard practice, but they may well be part of the future of cancer therapy.

Lymphomas make up about 11% of childhood cancer, and there are several different types.

There's multiple ways the DNA code can get messed up and lead to cancer. This episode describes some of them, along with some little green men.

The proteins have to have the right amino acids all assembled in the right order, and the DNA code is the recipe that's used. This episode explains how the correct DNA leads to the right protein being made.

To understand all this DNA analysis business, first one needs to know a bit about proteins. Proteins basically do all the work in cells, and so DNA mutations interfere with protein structures. Serious geek alert!

Gliomas are a type of brain tumour, and are usually called 'low grade' or 'high grade'. What do these terms mean?

Some chemotherapy drugs don't get into the brain and spinal fluid properly, so we have to inject drugs into the spinal fluid. This is mainly in leukaemia and lymphoma.

We often need to take samples of the spinal fluid, and regularly inject chemotherapy drugs there too. We do this using a lumbar puncture.

When eating and nasogastric feeding aren't working, we may need to give nutrition straight into the vein. That's called TPN or hyperalimentation.

There's a lot of discussion about 'personalised medicine'. What is personalised oncology?

If children just can't eat enough, we may need a feeding tube. This episode explains what these tubes are all about.

If nutrition is so important, then what food should kids eat while on chemotherapy?

Children on chemotherapy can really struggle to maintain their weight. This episode explains why.

Exciting new antibodies against cancer were reported at ASCO this year. This episode explains how they work. Will they end up useful in childhood cancer?

The doctors and nurses keep raving on about fevers, not cancer.... what's this all about? This information may be life-saving.

Most new drugs for cancer are first evaluated in adult patients, then we wait, and wait for access for children. The Europeans appear to have this sorted out.

CAR T-cells are an exciting new therapy. There is emerging data for their use in leukaemia, and other targets may follow.

High dose methotrexate is used in leukaemia, lymphoma, osteosarcoma and certain brain tumours. We give a sky-high dose, then give the antidote, folinic acid, to 'rescue' the patient!

Phase 3 trials are the big studies that compare a new treatment to the existing standard treatment. They enrol lots of patients and take years to complete.

How do we decide what clinical trials to open at a given institution?

Why I took two days off, and why kids on chemo should go to school (usually) by Dr Geoff

Platelets are tiny little cells that make blood clot properly. They go low after chemotherapy sometimes, and we often end up giving a platelet transfusion. That's one reason why blood donors save lives! This episode explains all about platelet transfusions.

We rely on central lines enormously, but they can bring their own problems. This episode describes the common things that can go wrong with a central line.

We often have to give blood transfusions following chemotherapy. This episode explains why we end up needing transfusions, when we give them, and what to expect.

AML requires chemotherapy treatment, and sometimes bone marrow transplantation.

We use phase 2 trials to conduct an initial evaluation of whether a new therapy has activity against cancer or leukaemia. This episode describes how phase 2 trials are performed.

Phase I trials are the studies we do to work out the safety and dosing of new drugs. This podcast explains how they are conducted in adults and children.

Clinical trials are core business in childhood cancer units. It is through clinical trials that we have worked out what treatments are effective, and future trials will lead to further gains. This episode describes what a clinical trial is, and introduces some of the key concepts.

This episode describes the two types of central lines that are generally used in children receiving chemotherapy.

Acute myeloid leukaemia is the second main form of leukaemia in childhood. This podcast explains what the disease is, and the tests and treatments done at initial diagnosis.

Most children on chemotherapy need a central line to give drugs into the veins. This episode explains why we need a central line.