Page 23 - IJCS Journal Vol.1.cdr

theijcs.com The IJCS / Vol 1 / Issue 1

CANCER IN CHILDREN AND ADOLESCENTS

Dr. Pankaj Abrol

SGT Medical College Hospital & Research Institute
GURUGRAM
A few decades back infections and malnutrition were rampant contributing to increased mortality and morbidity in children. With improving
economy and social awareness, incidence of malnutrition is falling. With improving health facilities infections are getting controlled. With
universal immunization incidence of infectious diseases is also decreased. Small pox and poliomyelitis have been eliminated. Tetanus
and Rheumatic heart disease are rarely seen. Diphtheria and measles are getting controlled. There is increasing incidence of lifestyle
disease and cancer. Pediatric cancers are less common compared to adults but its incidence is also increasing.
A. Incidence of cancer in children
Each year approximately 16,400 children and adolescence are reported in United States. About 12,000 in 0-14 year age group and 4,400
in adolescents. In our country India, number is not known due to lack of cancer registry and of
awareness. Number of oncology centres is also very less as per the population. In 0-14 years age group. Acute lymphoblastic leukemia
(ALL) is the commonest cancer accounting for >25% of all cancer patients. One-fifth of this number are also diagnosed as acute myeloid
leukemia (AML). Central nervous system, mostly involving brain accounts for more than 20% of cases of cancers. So 50-55% of all cancer
patients in this age group have either leukemia or CNS tumor. Commonest solid tumor after CNS is neuroblastoma (7-10%) followed by
Wilms tumor in 6-7% cases. These are followed by non-Hodgkin lymphoma (NHL), Hodgkin disease, rhabdomyosarcoma (RMS), germ
cell tumor, retinoblastoma, osteosarcoma, hepatoblastoma etc.
The distribution in 15-19 years age adolescent group is different. Hodgkin disease is more common (16%). Other tumors in this age group
are non-Hodgkin lymphoma, germ cell tumor, non-rhabdomyosarcoma, osteosarcoma, Ewings sarcoma etc. Incidence of leukemia and
CNS tumor is less than in 0-14 year age group.
B. Sex and predilection for cancer:
Cancers like ALL, Hodgkin disease, NHL, retinoblastoma, hepatoblastoma, Ewings sarcoma, rhabdomyosarcoma and nasopharyngeal
carcinoma are more common in males and also carry poor prognosis. Female sex is a good
prognostic factor in leukemia. Thyroid cancer is more common in females.
C. Cancer survival in children and adolescents
In 1960’s cancer survival in 0-14 years age group was 28% in United States. In India it was very poor as it was rarely
diagnosed and even if diagnosed, facilities for treatment were scarcely available. Diagnosis of cancer usually
meant a death sentence. Only socio-economically better positioned individuals used to go abroad to seek treatment.
Not many new drugs have been discovered but due to factors like increased patient/social awareness, better
diagnostic facilities (like radioimaging, genetic work up, FISH, molecular diagnosis), better staging, stage
stratification, protocol based therapy, monitored chemotherapy, targeted therapy, better radiotherapeutic procedures
like IMRT/IGRT and improved surgical tecniques etc., results are much better. Improved supportive care like
prevention of infections, appropriate treatment if there, blood component support, asepsis, isolation, laminar flow,
ventilator support – all have played role in improving results.
D. Prognosis in childhood cancer:
Improvement in therapy and risk stratification have resulted in significant improvement in 5 year survival rate around
90% in acute lymphoblastic leukemia. Even in acute myeloid leukemia remission induction rate is 85- 90%. Current
survival rate in AML is 60-70% improvement from 15% in 1970’s. Acute promyelocytic leukemia (APML) has cure rate
of >90% with targeted therapy. With favorable prognostic factors, pediatric patients having Hodgkin disease in early
stage can have event free survival of 85-90%. NHL in children is usually more aggressive. Still a patient with localized
disease has a survival chance of 90-100%. Even in advanced disease,survival rate is 70-95%. If a child is having
Wilms tumor with favorable histology, overall survival can be >90%. At present status of pediatric oncology is not very
good. Number of good centres is very less. We don’t have many pediatric oncologists. India is a poor resource country.
A common man cannot afford treatment in corporate hospitals. Some NGO’s have come up. Some among them are
based abroad. Some of them are helping to improve pediatric oncology set ups in Government and other centres
keeping long-term objective in mind. Incidence of pediatric and adolescent cancers is increasing with time. Early
detection is possible due to increased awareness. Treatment at right place by a trained pediatric oncologist with
support of surgeon and/or radiation oncologist when required, is the need of the hour. Parents should be
counseled appropriately. As results have shown remarkable improvement with time, one should try to treat every child
with cancer, lest we lose him/her. We can hope for a normal full life that he has to live. So don’t miss a child with cancer.
Always counsel and treat.

Corresponding Author
Dr. Pankaj Abrol
Pediatric Hematologist Oncologist
Professor & Head Department of Pediatrics
SGT Medical College Hospital & Research Institute, GURUGRAM
The Integrated Indian Journal of Cancer Sciences