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5 Malignant Cancers in Children

HIGHLIGHTS:

  • Acute Leukemia is the most common cancer type found in children, accounting for about 50% of all pediatric cancer cases. Symptoms include fever, paleness, and bruising or bleeding throughout the body.
  • For patients with Acute Leukemia, chemotherapy can be used as a treatment. However, patients whose white blood cells are not responding to the medication or has a recurrence, the bone marrow transplantation then can be adopted as a treatment option.

Cancer is the second highest cause of death in pediatric patients under the age of 15. In Thailand alone, the incidence of cancer in children is about 900 cases per year. The 5 most common cancers in Thai children are:

  1. Acute Leukemia: found in almost 40 of every million Thai Children every year.
  2. Lymphoma: found in more than 6 of every million Thai Children every year.
  3. Brain Tumor: found in more than 6 of every million Thai Children every year.
  4. Neuroblastoma: found in 5 of every million Thai Children every year.
  5. Germ Cell Tumor: found in more than 4 of every million Thai Children every year.

 

  1. Acute Leukemia: This is the most common cancer type, accounting for about half of all pediatric cancer cases. These are divided into 2 types:

– Acute Lymphoblastic Leukemia (ALL), which is 3 times more common than AML

– Acute Myeloid Leukemia (AML)

The Most Common Symptoms are fever, pallor, and bruising or bleeding throughout the body. There may also be enlargement of the liver and spleen, pain throughout the body, swelling lymph nodes, and enlargement of either one or both testicles in males, and immature white blood cells found during complete blood counts (CBC).

Diagnosis of both ALL and AML is carried out by examining the child’s bone marrow for the types and abnormalities of white blood cells present. Additionally, a cerebrospinal fluid (CSF) analysis can be carried out to determine the spread of leukemia cells, which is important for treatment planning and prognosis.

Treatment of Acute Leukemia is currently carried out using chemotherapy, given in consecutive phases over a long period of time, depending on the type of leukemia. Treatment for ALL usually takes about 2.5-3 years, while AML treatment takes about 6 months. For patients in whom the disease is at an advanced stage or in whom it is recurrent, a bone marrow transplant is the next step. Today, patients no longer need to delay transplantation by waiting for a perfect or near-perfect match. Instead, one of their parents can be the bone marrow donor. This is known as Haploidentical Hematopoietic Stem Cell Transplantation. You can read more about this new, state-of-the-art treatment here: https://www.samitivejhospitals.com/th/haploidentical/

Currently the treatment success rate for ALL is excellent, at 80-85%, while AML has a 55% treatment success rate. The survival rate of AML for patients treated with chemotherapy is 50%, however this increases to 80% if patients were treated with bone marrow transplant from the beginning.

  1. Lymphoma: The second most common cancer after acute leukemia is lymphoma, which is divided into 2 types. These are:
  • Hodgkin Lymphoma
  • Non-Hodgkin Lymphoma

Patients suffering from this disease often experience chronic, prolonged fever with no apparent cause, weight loss, fatigue, night sweats, enlarged lymph nodes in various parts of the body and/or an enlarged spleen or liver. The latter two could also cause pain in the center of the chest or abdomen.

Diagnosis must be carried out using a biopsy, which involves removal of part of a tumor or a lymph node for a more detailed pathological examination. Additional testing must also be carried out to determine the spread of the disease, such as diagnostic radiology exams (CT scan, gallium scan/PET scan and bone scan), bone marrow aspiration and biopsy.

Treatment generally involves chemotherapy and radiation therapy, depending on the stage of the disease.

Treatment success rates are quite high, with a survival rate of 70-95%, depending on the type of lymphoma, and the stage of the disease.

 

  1. Brain Tumors: Patients often experience symptoms such as loss of balance, severe vomiting, vision problems, seizures, headaches and/or increased head size. The symptoms depend on the location of the tumor, and the type of cancer cells and whether they are fast growing or not.

Diagnosis involves imaging tests such as a CT or MRI scan in order to determine the location and size of the tumor. Removing a sample of the tumor (biopsy) may also be carried out for further examination.

Treatment of this particular disease is mainly in the form of surgery, chemotherapy and radiation therapy, depending on the type and location of the cancer cells.

  1. Neuroblastoma: This type of cancer can be found in pediatric patients any time from birth to 6 years of age.

Symptoms of this type of cancer are usually seen as a lump or mass in various locations. Common symptoms include a lump in the abdomen, along with other complications caused by the spread of the disease. These include fever, pallor, weakness, pain in the body or bones, loss of appetite and/or weight loss. Some patients may experience weakness in the legs if the tumor is causing spinal cord compression.

Diagnosis and stage classification of the disease generally rely on blood tests; bone marrow aspiration and biopsy; tests for certain substances (tumor markers) produced by a neuroblastoma tumor present in the blood or urine; and diagnostic imaging tests such as a CT, bone, or MIBG scan; as well as a biopsy of the tumor for further pathological analysis.

Treatment includes chemotherapy, surgery to remove the tumor, and radiation therapy in some cases.

Treatment Effectiveness

This depends on the patient’s age, at what stage the disease was found, and pathology test results. If the disease was detected and diagnosed in the early stages, patients will have better treatment outcomes than those in whom the cancer has spread to other organs.

  1. Germ Cell Tumors: Children can be diagnosed with this type of cancer between the ages of 1 and 4 years, and 15 and 19 years old.

Symptoms In young children, symptoms usually come in the form of a lump in the abdomen or bottom part of the spine. In young adults, they will be found in the gonadal sites, such as the testis and ovaries. If the disease occurs in the pineal gland, which controls the onset of puberty, it may be accompanied by symptoms of what is known as precocious puberty and symptoms of chest pain, chronic coughing, chest tightness and/or difficulty breathing.

Diagnosis and stage classification of the disease is carried out with a blood test to measure the level of hormones secreted by the tumor, diagnostic radiology exams such as a CT or bone scan, and a biopsy of the tumor for further analysis by a pathologist.

In cases where there is no secretion of hormones by the tumor, treatment includes chemotherapy, radiation therapy and surgery to remove the tumor.


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Nuttra Suwantarat, M.D. Summary: Pediatrics Pediatric Hematology And Oncology