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Learning problems in childhood cancer

From Wikipedia, the free encyclopedia

Certain treatments for childhood cancer are known to cause learning problems in survivors, particularly when central nervous system (CNS)-directed therapies are used (e.g. cranial radiation; high-dose methotrexate or cytarabine; or intrathecal chemotherapy). As the mortality rates of childhood cancers have plummeted since effective treatment regiments have been introduced, greater attention has been paid to the effect of treatment on neurocognitive morbidity and quality of life of survivors. The goal of treatment for childhood cancers today is to minimize these adverse "late effects", while ensuring long-term survival.[1]

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  • The Cell Cycle and Cancer
  • The Nurture Room (Child Psychology Documentary) - Real Stories
  • Air Pollution for Kids


Captioning is on! Please click the CC button at the bottom right to turn off. Follow the amoebas on Twitter (@amoebasisters) and on Facebook. Today's topic is the cell cycle and mitosis. But before we get into the cell cycle and mitosis, we want to be sure to talk about why these words are important and how they relate to real life. So if I say the word cancer, this words probably means something to you. Either you know somebody who has been diagnosed with cancer or you've heard about it on the news. There's many different types of cancers but one thing they all have in common is that they are caused by uncontrolled cell growth. That means, someone's own cells grow out of control. Now, that doesn't mean that there aren't other contributing factors for example for some cancers having genetic links, meaning it runs in the family, can make someone more likely to develop it, or having excessive exposure to UV light for some cancers. Those are risk factors that can increase your risk. But the main cause of cancer is uncontrolled cell growth. That also means it's something that it is not contagious and that it's something that anyone can develop. You have to realize that all the cells in your body are very busy. And they're either in one of two different phases. They are either in a phase called interphase and during interphase they are just growing, replicating DNA, their doing their cell functions or they are in mitosis. Mitosis is a fancy word that means they are dividing, they are making new cells. If you think about the cell cycle, whether they are in interphase or mitosis, it's kind of like a pie graph. They are spending about 90% of their time in interphase. Most of the time cells are not dividing, most of the time they are in interphase, they are growing, they're doing their daily cell functions and they are replicating their DNA. Most of the time, not dividing. Now, depending on what kind of cell, it might do mitosis more or less often; for example, your hair follicle cells, they do mitosis frequently which is why your hair can grow up to half an inch every month. But other cells like for example your brain cells, your neurons, some of them do not perform mitosis, which is why if you have some type of major injury to the spinal cord or to the brain, sometimes those do not heal very well because those cells do not replicate. So mitosis is very important to generate new cells, which can help with growth and also if you damage your cells. If you're walking down the street and you have some kind of accident, and you skin your knee, well you're going to need to repair those damaged cells. You're going to need to be able to mitosis to repair those cells. The thing is you don't want your cells to be always doing mitosis because if their always doing mitosis, then they are always dividing and then they're not carrying out their actual function and that's a problem. That's where check points come in handy. See, along the cell cycle there are check points to check that the cell is growing correctly and replicating it's dna correctly and doing everything it's supposed to correctly before it divides. And what happens if the cell fails it's check point? The cell does something called apoptosis which basically means the cell destroys itself, it self-destructs. This might seem kind of harsh but actually it's really important because it ensures you don't have these cells that are messed up continue on and divide. You don't want damaged cells to continue on and divide because they might do not do what they are supposed to, they might start to grow out of control, they might not be regulated correctly. That's where cancer cells come in. See cancer cells, as we had said, are your body's own cells that are growing out of control. So they are not following the rules of these checkpoints, they are flying past the check points going through the cell cycle and frequently doing mitosis, which means they are dividing very, very often. And so by doing that they can grow into these things called tumors which are really a mass of cancer cells. So we're not really sure what causes them to escape these check points. There are a lot of factors that a person can have that will increase their risk of this happening, but when these cells get past these check points and grow out of control, they become a problem. Because many times they can travel through the bloodstream, they started growing out of control, the body can't identify them and destroy them with the immune system and so this becomes an issue and usually one the treatments that someone with cancer will go through is called chemotherapy. And this works by targeting cells that go through the cell cycle quickly and hit mitosis quickly. And that's one reason why many people will lose their hair when they are on chemotherapy because their medication that's targeting fast growing cells and their hair follicle cells are also fast growing cells. Cancer cells have some other factors that make them difficult to treat. One is that cancers have the ability to secrete their own growth hormone. This is very bad because growth hormone in the sense, think of it as a hormone that says, "FEED ME." What happens is the blood vessels will divert over to those cancer cells and supply the cancer cells with nutrients. This is not good because it means the cancer cells will have the nutrients they need to keep growing out of control. It also can take nutrients away from nearby healthy cells. There are some medications that are being researched that maybe could stop the growth hormone from cancer cells and in the sense that would be great because the cancer cells would not be able to get the nutrients to grow out of control. Of course, you have to make sure the medication is targeting just cancer cells and that hurting the growth hormone of nearby healthy cells. You wouldn't want that. So it's kind of a tricky situation. So let's recap what we talked about today. We talked about the cell cycle, how cells are more frequently in interphase than in mitosis. Interphase is when cells are replicating their DNA or their growing, and carrying out cell processes. In mitosis, the cells are actually dividing. We talked about how during this cell cycle there are checkpoints that regulate the cell and keep the cell from being able to continue on if it's damaged...unless we're talking about cancer cells which are cells that have escaped the checkpoints and are growing out of control. Be sure to check out our clip on mitosis. This process is really fascinating, but it's also a really important one in order to understand how your body cells work. That's it for the Amoeba Sisters, and we remind you to stay curious!


Effect of cancer and its treatment on brain development

Research shows that children with cancer are at risk for developing various cognitive or learning problems. These difficulties may be related to brain injury stemming from the cancer itself, such as a brain tumor or central nervous system metastasis or from side effects of cancer treatments such as chemotherapy and radiation therapy. Studies have shown that chemo and radiation therapies may damage brain white matter and disrupt brain activity.

Cognitive problems that have been associated with cancer and its treatments in children include deficits in attention, working memory, processing speed, mental flexibility, persistence, verbal fluency, memory, motor skills, academic achievement and social function. These deficits have been shown to occur irrespective of age, socioeconomic status, months since onset or cessation of treatment, anxiety, fatigue and dosage schedule.

Cognitive rehabilitation

Some clinicians and research groups in neuropsychology are developing programs to help treat the cognitive problems associated with childhood cancer. Treatment typically involves a program of cognitive rehabilitation which aims to help improve cognitive function either by restoring capacities that were impaired and/or helping the patient learn ways to compensate for the impairment(s). Cognitive rehabilitation therapy usually involves evaluation to determine the specific impairments involved, an individualized program of specific skills training and practice and metacognitive strategies. Metacognitive strategies include helping the patient increase self-awareness regarding problem solving skills by learning how to better monitor the effectiveness of these skills and self-correct when necessary. Cognitive rehabilitation is conducted under the supervision of a neuropsychologist or other trained professional.


  1. ^ "Late Effects of the Central Nervous System (Health Professional Version)". Late Effects of Treatment for Childhood Cancer (PDQ®). National Cancer Institute. Retrieved 20 May 2014.
  • Butler RW, Haser JK (2006). "Neurocognitive effects of treatment for childhood cancer". Ment Retard Dev Disabil Res Rev. 12 (3): 184–191. doi:10.1002/mrdd.20110. PMID 17061287.
  • Mulhern RK, Butler RW (2004). "Neurocognitive sequelae of childhood cancers and their treatment". Pediatr Rehabil. 7 (1): 1–14. doi:10.1080/13638490310001655528. PMID 14744668.
  • Zou P, Mulhern RK, Butler RW, Li CS, Langston JW, Ogg RJ (2005). "BOLD responses to visual stimulation in survivors of childhood cancer". NeuroImage. 24 (1): 61–69. doi:10.1016/j.neuroimage.2004.08.030. PMID 15588597.
  • Cetingul N, Aydinok Y, Kantar M, et al. (1999). "Neuropsychologic sequelae in the long-term survivors of childhood acute lymphoblastic leukemia". Pediatr Hematol Oncol. 16 (3): 213–220. doi:10.1080/088800199277263. PMID 10326219.
  • Duffner PK (2006). "Long-term effects of radiation therapy on cognitive and endocrine function in children with leukemia and brain tumors". Neurologist. 10 (6): 293–310. doi:10.1097/01.nrl.0000144287.35993.96. PMID 15518596.
  • Langer T, Martus P, Ottensmeier H, Hertzberg H, Beck JD, Meier W (2002). "CNS late-effects after ALL therapy in childhood. Part III: neuropsychological performance in long-term survivors of childhood ALL: impairments of concentration, attention, and memory. Medical and pediatric oncology". Medical and pediatric oncology. 38 (5): 320–328. doi:10.1002/mpo.10055. PMID 11979456.

External links

Cognitive rehabilitation for children with cancer

See also

This page was last edited on 19 December 2017, at 10:33
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