Interview with Professor Marc Wijnen

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The month of February marks two very special days on calendars throughout the world: February 4th, World Cancer Day, and February 15th, the International Day of Childhood Cancer, when organisations, institutions, doctors and families around the world come together to raise awareness on behalf of those who are fighting this disease every single day.

In honour of these very important occasions, Best Doctors is pleased to feature an exclusive interview with Professor Marc Wijnen, Director of Surgery at the recently inaugurated Prinses Máxima Centre for Paediatric Oncology in Utrecht, the Netherlands.

As the leader of the surgical team for this new centre of excellence, Dr Wijnen comes to Princes Máxima with extensive experience in general and paediatric surgery. He himself specialises in the surgical treatment of solid tumours of the abdomen and chest.

-In what ways is cancer in children different from adults?

In general childhood cancers advance rapidly and are often treated with chemotherapy before operation. Chemotherapy is often very effective and local control after chemo is achieved by surgery, radiation, or both.

If we divide cancer into those affecting bodily fluids (blood, bone marrow) and solid tumours, which are the types most commonly seen in children?

Roughly 50% of all cases are so-called fluid type cancers such as leukaemia and lymphomas. About 20% are brain tumours and 30% are solid tumours (such as those originating in the kidney, liver, nerve tissue, soft tissues of the trunk and extremities, and reproductive organs).

What is known about the causes behind children developing cancer?

Unfortunately very little. We do know that environmental causes, such as smoking and diet, do not play a role. Hereditary and developmental factors do play a role, yet the exact nature of this remains the subject of ongoing research.

Is there anything that has proven effective or that is being investigated in terms of preventive measures or lowering the risk factor for childhood cancer?

Not that we know of. Screening methods that have been applied for certain tumours, such as neuroblastoma (a type of solid tumour that forms in the nerve tissue) have not influenced the results.

What has been the main research focus for cancer treatment and surgery in children?

Cancer is not “one size fits all”, and the aim of most paediatric cancer research has been to determine the right combination of chemotherapy and surgery for each type of cancer, while at the same time minimising the side effects of treatment on the patient.

What new developments in paediatric cancer surgery have you witnessed, and which future developments do you think are the most promising?

In paediatric surgical oncology, we have made a lot of progress in localised control of cancer, which means focusing treatment very specifically on a tumour instead of generally on the body. Adding radiotherapy to certain treatment protocols has also been a very effective development.

As for future developments, we are currently working on improving surgical procedures and outcomes for neuroblastomas (solid tumours forming in nerve tissue) perhaps the most challenging group of tumours when it comes to operating. This is research that combines basic biological and genetic knowledge with clinical and imaging techniques.

Do you think enough is being done to advance the development of paediatric oncology? If not, what are the most important areas that need attention?

Paediatric cancer is rare and as such expertise is something that, in most countries, is acquired slowly. Bringing together experts to join in research protocols helps to improve results and this can only be done by international collaboration. Many excellent examples of this exist around the world.

Could you tell us about a particular case that had a real impact on you?

I don’t think there is a case that doesn’t have an impact on you in some way, although when I am treating a child who is the same age as one of my own children it definitely strikes a more personal chord.

The Princes Máxima Centre is a recently inaugurated facility which will be solely dedicated to paediatric cancer patients. As the hospital’s Director of Surgery, what are you most excited about and what challenges lie ahead?

The prospect of working with so many experts under one roof is very exciting. This will no doubt help clinical expertise but also, and perhaps more importantly, will facilitate research by bringing such a great number of projects together in one place. We are a long way from a 100% cure rate for paediatric cancer, but we are optimistic about the future. We hope to play a larger and more beneficial role in the Netherlands, in Europe and in the international community as a whole in the fight against childhood cancer.

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