Latest Research on childhood cancer : Jan 2022

Childhood cancer

Background. Cancers of individual organs generally are composed of various histologic types, each with its own frequency and demographic patterns. For childhood cancers in particular, a classification of cancers by histologic type is important for understanding the etiology and progression of the disease.

Methods. Data from the Surveillance, Epidemiology, and End Results (SEER) Program on 9308 microscopically confirmed malignant neoplasms in children younger than age 15, newly diagnosed during 1973-1987, were made available for analysis. Tumors were grouped histologically according to a classification previously utilized in an international volume of childhood cancer incidence.

Results. The most frequent histologic types were acute lymphocytic leukemia (23.6%), astrocytoma (9.6%), neuroblastoma (6.6%), and Wilms’ tumor (6.4%). Acute lymphocytic leukemia accounted for 75% of childhood leukemia. The most common form of Hodgkin’s disease was the nodular sclerosing subtype, which was diagnosed in 56% of all cases. Burkitt’s and Burkitt-like disease accounted for approximately one third of non-Hodgkin’s lymphoma, the sex ratio (male to female) being unusually high (5.7). Among the brain tumors, glioma was of interest because 198 cases (excluded from this analysis) were diagnosed without histologic confirmation—due, no doubt, to their inaccessibility for biopsy because they were located in the brain stem. The most common histologic type of soft tissue sarcoma was rhabdomyosarcoma, which accounted for 51% of the total, more than half of which were of the embryonal type. To the authors’ knowledge, this report offers for the first time the relative frequencies of rare types of leukemias, such as megakaryoblastic leukemia, in childhood. This report also includes the frequencies of 21 rarer forms of soft tissue sarcoma. Five forms of childhood cancer had a 5-year relative survival rate of 85% or better. Of the cancers with the poorest outcome, three had relative survival rates of 46.5-49%; the relative survival rate for acute myelogenous leukemia was only 26.4%. The trends in survival over time for 21 types of childhood cancer also are included in this report.

Conclusions. Further refinements in classification now are available through laboratory techniques utilizing molecular biology, immunology, and cytogenetics, which are of importance in etiologic studies, diagnosis, treatment, and prognosis. It would be important in the future for cancer registries to record the results of relevant laboratory tests for further analysis by subtype.[1]


Epidemiology of childhood cancer

The present contribution reports childhood cancer incidence and survival rates as well as time trends and geographical variation. The report is based on the databases of population-based cancer registries which joined forces in cooperative projects such as Automated Childhood Cancer Information System (ACCIS) and EUROCARE.

According to these data, which refer to the International Classification of Childhood Cancer, leukemias, at 34%, brain tumors, at 23%, and lymphomas, at 12%, represent the largest diagnostic groups among the under 15-year-olds. The most frequent single diagnoses are: acute lymphoblastic leukemia, astrocytoma, neuroblastoma, non-Hodgkin lymphoma, and nephroblastoma. There is considerable variation between countries. Incidence rates range from 130 (British Isles) to 160 cases (Scandinavian countries) per million children. Incidence rates have shown an increase over time since the mid of the last century. In Europe, the yearly increase averages 1.1% for the 1978–1997 period and ranges from 0.6% for the leukemias to 1.8% for soft-tissue sarcomas. The probability of survival has risen considerably over the past decades, with the EUROCARE data showing an improvement of the relative risk of death by 8% when comparing the 2000–2002 time span to the 1995–1999 period. Regarding the years 1995–2002, the data show an overall 5-year survival probability of 81% for Europe and similar values for the USA.

The data presented here describe the cancer situation with a specific, European focus. They are drawn from population-based cancer registries that ensure excellent data quality, and as a consequence represent the most valid European population-based data existing at present. It is also apparent that not all countries have data available from nationwide childhood cancer registries, a situation which warrants further improvement.[2]


The international incidence of childhood cancer

The International Agency for Research on Cancer has coordinated a worldwide study of the incidence of cancer in childhood. Contributors from over 50 countries have provided data. This paper presents a summary of some of the major results. The incidence rates and relative frequencies of childhood cancers are described according to I2 diagnostic groups, defined mainly in terms of tumour morphology. Variations in the risk of those tumours between different countries and different ethnic groups provide important information on the relative importance of environmental and genetic factors in their aetiology.[3]


Decision-making and Consent of Paediatric Cancer Patients: Between Guidance and Promotion of Child Autonomy

Aims: Assessing how medical teams in a paediatric cancer hospital cope with the legal requirement to search for the child’s consent for an inclusion in a clinical trial and children’s participation in tough medical decisions.

Study Design: Anthropologic Field Study.

Place and Duration of Study: Department of Paediatric Solid Cancer of La Timone Hospital (Marseille, France) between August 2004 and February 2007.

Methodology: The author attended medical staff meetings, visits and conversations between doctors, children and their parents. About 200 patients where included in the study. Numerous interviews took place with staff, parents and children, as well as with two cancer-survivors, who were cured of their childhood cancer 30 or 40 years ago. Two “blogs” written by mother of young patients were read in order to assess how medical information was disseminating towards families.

Results: The announce of a cancer diagnosis, the search for the child’s consent or participation in tough medical decisions, imply new kinds of relationships between medical teams and children. That modification of positions is not easy for several reasons. First, children do not always feel free to express their views and choices. Besides, these changes disrupt the traditional model of a “medical paternalism”, where physicians would know by themselves what is good for their patients. Above all, confronting children with medical choices may be of the utmost psychic violence, since children are faced with impossible choice or “double bind”. Thus, medical teams have to recognise the child as a person capable of autonomy but also to provide special protection regarding their vulnerability. They experiment different ways to establish a dialog with children, through picturing, “discursive avoidance” and symbolisation.

Conclusion: Looking for the right balance between guidance and promotion of child autonomy, medical staff can create some “protected areas”, where children are sheltered from the naked truth by symbolisation and “discursive avoidance”, and where a genuine dialog may be established.[4]


Burden and Pattern of Cancer in the Sudan, 2000-2006

Aims: The aim of this study is to determine the number of newly diagnosed cancer cases and their distribution in two cancer-care providing facilities in Sudan.

Study Design: This is a retrospective descriptive study.

Methodology: Data was retrieved from patients’ records that were diagnosed and treated at the Radiation Isotope Center in Khartoum (RICK) and National Cancer Institute at Wadmadani (NCI -UG) in Sudan over the period between 2000 and 2006 and then statistically analyzed.

Results: A total of 26652 cancer cases were retrieved with a noticeable increase in numbers from year 2000 to 2006. The maximum cancer number was observed in 45-64 year age group in both male and female patients with a male to female ratio of 1.3:1.0. The most common cancer sites for females were: the breast (29.3%), cervix uteri (8.2%), leukemia (7.2%), ovary (6.8%), and esophagus (5.9%) and for males: were prostate (7.6%), followed by leukemia, (7.0%), NHL (6.8%), esophagus (5.4%) and bladder (4.4), while leukemia (25.2%), NHL (12.4%), lymphoma (10.8%), retinoblastoma (6.6%) and brain tumors (3.3%) dominated in younger patients (<14 years old). Conclusions: This study provided some knowledge about the cancer situation in two institutions providing cancer care in Sudan that may draw attention of policy maker and aid in formulating appropriate cancer-control strategies in the country.[5]

Reference

[1] Miller, R.W., L Young Jr, J. and Novakovic, B., 1995. Childhood cancer. Cancer, 75(S1), pp.395-405.

[2] Kaatsch, P., 2010. Epidemiology of childhood cancer. Cancer treatment reviews, 36(4), pp.277-285.

[3] Parkin, D.M., Stiller, C.A., Draper, G.J. and Bieber, C.A., 1988. The international incidence of childhood cancer. International Journal of Cancer, 42(4), pp.511-520.

[4] Bonnet, M., 2014. Decision-making and Consent of Paediatric Cancer Patients: Between Guidance and Promotion of Child Autonomy. Advances in Research, pp.231-239.

[5] Mohammed, M.E., Hassan, A.M., Elsadig, M.G., Adam, D.M., Abdelhadi, H.A., Elmamoun, K., Hamid, R., Elias, H., Abdallah, M., Abdelkarim, Z. and Elwali, N.E., 2014. Burden and pattern of cancer in the Sudan, 2000-2006. Journal of Advances in Medicine and Medical Research, pp.1231-1243.

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