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ORIGINAL ARTICLE
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Profile of pediatric tumors: A 10-year study at a tertiary care center in North India


 Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Date of Submission13-Nov-2021
Date of Decision11-Dec-2021
Date of Acceptance11-Dec-2021
Date of Web Publication09-Feb-2022

Correspondence Address:
Mushtaq Ahmad Sofi,
Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrcr.jrcr_52_21

  Abstract 


Objective: The objective of this study was to find the profile of childhood cancers in the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India, from 2010 to 2019. Materials and Methods: It was a retrospective study where medical records of children with cancer that was registered in regional cancer center SKIMS, Srinagar, from January 2010 to December 2019, aged 0–14 years diagnosed using histological or cytological examinations were reviewed to gather data on the prevalence and pattern of tumors according to age, sex, and rural and urban distribution. Results: There were 38,962 new confirmed cases registered in the regional cancer center at SKIMS, Srinagar, during these 10 years. Among which 1036 were below 15 years of age. An average of 103 cases attended per year. Overall pediatric tumors were 2.66% of total cancers. The frequency of cancer was found to be higher among boys (57.9%) than girls (42.1%) with a ratio of 1.37:1. The majority of the children were from rural areas (84.9%) compared to (15.1%) from urban areas. The results showed that leukemia (36.6%), lymphoma (19.8%), and bone tumors (9.3%) were the commonly found childhood cancers among the children attended at SKIMS, Srinagar, during these 10 years. Other less commonly found tumors were central nervous system tumors (6.7%), Wilms' tumor (4.1%), retinoblastoma (3.7%), and cancer of unknown primary with secondaries (1.5%). Conclusions: Leukemia, lymphoma, and bone tumors were the most common malignancies reported in the children treated at our cancer center.

Keywords: Cancer profile, cancer registry, pediatrics malignancies



How to cite this URL:
Sofi MA, Lone MM, Fatima K, Andleeb A, Fir A, Khan NA, Najmi AM, Dar NA, Nasreen S. Profile of pediatric tumors: A 10-year study at a tertiary care center in North India. J Radiat Cancer Res [Epub ahead of print] [cited 2022 Dec 4]. Available from: https://www.journalrcr.org/preprintarticle.asp?id=337485




  Introduction Top


Cancer is a leading cause of death in children between the ages of 0 and 14 years, particularly in high-income countries, and cannot generally be prevented or identified through screening. Each year, approximately 4 lakh children and adolescents of 0–19-year old are diagnosed with cancer.[1] The most common types of childhood cancers include leukemias, brain tumors, lymphomas, and solid tumors, such as neuroblastoma and Wilms tumors.[2] The cure rates are approximately 80% in developed countries and 15%–45% in less resource/poor countries.[3] Childhood cancers differ markedly from adult cancers in their nature, distribution, and prognosis. Treatment modalities of such tumors include surgery, chemotherapy, and radiotherapy that can adversely affect the children's growth/development, and hence, pediatric oncologists face unique challenges while treating such malignancies. Although the incidence of cancer under 15 years of age is very low compared to adults, the pattern of childhood cancers presents peculiar characteristics and deserves a separate analysis. Good-quality population-based incidence of childhood tumors has been more difficult to obtain than in adults,[4] and on the other side, there is underreporting of such malignancies even in the Western world.[5],[6] There is an increasing trend of childhood tumors in the developing world but dedicated population-based pediatric tumors registries are lacking. As many common childhood malignancies are curable, there is a dire need to have a dedicated pediatric cancer registry for assessing the real magnitude of childhood tumors in our country. Hence, the objective of this study was to find the profile of childhood cancers in the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India.


  Materials and Methods Top


This is a retrospective study where medical records of children with cancer that was registered in regional cancer center SKIMS, Srinagar, from January 2010 to December 2019, aged 0–14 years diagnosed using histological or cytological examinations were reviewed to gather data on the prevalence and pattern of tumors according to age, sex, and rural and urban distribution. The study was started after clearance from the Institutional Ethics Committee (SKIMS).


  Results Top


There were 38962 new confirmed cases registered in the regional cancer center at SKIMS, Srinagar, during these 10 years. Among which 1036 were below 15 years of age. An average of 103 cases attended per year. Overall pediatric tumors were 2.66% of total cancers. The frequency of cancer was found to be higher among boys (57.9%) than girls (42.1%) with a ratio of 1.37:1. The majority of the children were from rural areas (84.9%) compared to (15.1%) from urban areas [Table 1].
Table 1: Distribution of childhood cancer patient according to the place of residence and gender

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Tumors were arranged according to the patient's age group in 0–4 years, 5–9 years, and 10–14 years. The distribution of children according to their age showed that the majority of them belonged to 10–14 years (37.5%), followed by 0–4 years (32.4%), and rest 30.1% were from the 5 to 9-year age group. The mean age of the patients was 9.48 (standard deviation ± 2.66) years [Table 2].
Table 2: Distribution of pediatric tumors according to the age group

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Leukemia was the most prevalent childhood cancer reported in our institution (SKIMS), accounting for 379 (36.6%) cases. Among the leukemias, acute lymphoblastic leukemia (ALL) was the most common type found than other subtypes (Acute myeloid leukemia and chronic myelogenous leukemia). The majority of lymphoma patients were having age more than 5 years (67%) [Table 2].

Lymphomas (206, 19.8%) were the second most common cancer among the children who attended SKIMS, Srinagar, during the study period. Hodgkin's lymphoma was more frequent than non-Hodgkin's and Burkitt's lymphoma. Hodgkin's disease constituted 46.1% of all lymphomas, Burkitt's lymphoma was about 9.2%, and non-Hodgkin's lymphoma was 44.7%. Both non-Hodgkin's and Hodgkin's lymphomas were more prevalent in males than in females. Bone tumors were the third most common type of childhood cancer reported and account for about 9.26% of all malignancies in our study. Among these, 5.21% belonged to osteogenic sarcoma of long bones and Ewing's sarcoma comprises around 4.05% of all childhood tumors. Central nervous system (CNS) tumors account for around 6.7% of all malignancies among our children. Medulloblastoma was the most common subtype found and comprises around 47% of all CNS tumors. The majority of medulloblastoma occurred in age >5 years. Nephroblastoma was common in male children and accounted for around 4.1% of all childhood cancers as identified in this study. The majority of the cases (90.6%) reported in this study were <10 years of age [Table 2]. The results showed that leukemia, lymphomas, and bone tumors were commonly found in children above 5 years in contrast to leukemia, lymphomas, and nephroblastoma which were prevalent in children <5 years of age [Table 2].

The majority of the patients (976, 92.4%) received treatment in our cancer center (SKIMS) and completed the prescribed treatment. However, overall treatment time was prolonged in 20 patients due to chemotherapy-induced morbidities. There was no difference in completing the prescribed treatment whether patients belong to rural or urban areas. However, only 57 and 3 patients belonging to rural areas and urban areas, respectively, did not take treatment at our regional cancer center. These patients defaulted soon after the visit and never came back. It has also been noticed that all patients completed the prescribed treatment irrespective of their socioeconomic status. The reason may be likely that the cancer society of Kashmir and other nongovernmental organizations in our part of country are fully supporting all cancer patients having poor socioeconomic status.


  Discussion Top


There is an increasing trend of childhood tumors as described by Parkin et al.[4] Our study showed that pediatric tumors constitute 4.4% of all malignancies and the results are similar to the study done by Rathi et al. where they found 3.58% pediatric tumors among all cancers.[7] However, in the USA, the proportion of pediatric tumors seems to be low as compared to that of developing countries. As per the study done by Ferlay et al., pediatric tumors comprise only 0.8% of all malignancies.[8] The possible reason for this difference could be that our data is from a hospital and does not represent the true burden of pediatric tumors.

The majority of our patients were males (57.9%). The male-to-female ratio was 1.37:1 and does not accord with our national statistics. In India, the reported incidence of childhood cancer in males is higher than in females, the ratio being 1.6:1,[9] which is higher than in the developed world (1.2:1), possibly reflecting gender bias in seeking health care.[10],[11] Most of the children with cancer came from rural areas (84.9%) compared to 15.1% from urban areas.

In our study, the two most common cancer groups found were leukemias (36.6%) and lymphomas (19.8%). The results are similar to the study done in North African countries, Morocco.[12] However, it is in contrast to the data from the developed world, for example, in the USA,[9] the three most frequent major childhood cancers diagnosed were leukemia (30.2%), CNS cancers (21.7%), and lymphomas (10.9%). Leukemia (36.6%) was the most common childhood cancer found in our institution (SKIMS). Almost 75.7% of leukemias were ALL. In the Childhood Cancer Report UICC 2006,[13] it is found that hematological malignancies were the second most common malignancies affecting 18.1% children. In our study, leukemia was more common in more than 5-year old. This is contrary to the observations made by McKinney[14] who found leukemia commonly among 0–4-year old.

Lymphomas (206, 19.8%) were the second most common cancer among the children who attended SKIMS during the study period. Hodgkin's lymphoma was more frequent than non-Hodgkin's and Burkitt's lymphoma. Hodgkin's disease constituted 46.1% of all lymphomas, Burkitt's lymphoma was about 9.2%, and non-Hodgkin's lymphoma was 44.7%. In some studies, Burkitt's lymphoma has been reported to be around 18%–20% of total lymphomas.[15] In our study, Hodgkin's disease frequency was found higher in the 5–9-year age group.

Bone tumors were the third most common type of childhood cancers reported and account for about 9.26% of all malignancies in our study. Almost 5.21% belonged to osteogenic sarcoma of long bones and Ewing's sarcoma comprises around 4.05% of all childhood tumors. These results are consistent with Mirabello study,[16] where they have reported that osteosarcoma comprises 5% of childhood tumors and predominantly occurs in the adolescent age group.

CNS tumors were the fourth most common type of childhood cancer reported and account for around 6.7% of all malignancies among our children. Medulloblastoma was the most common subtype found and comprises around 47% of all CNS tumors. The majority of medulloblastoma cases occurred in age >5 years. In developed countries, CNS cancers are the second most common childhood cancer (22%–25%).[17] However, in India, lymphomas often exceed CNS tumors, particularly in males. Interestingly, the incidence of CNS tumors in children in the developed world has increased in the past 30–40 years with the increasing availability of computed tomography and magnetic resonance imaging scanners.[18]

Nephroblastoma (43, 4.1%) was the fifth most common cancer identified in this study. The majority of the cases (90.6%) reported in this study were <10 years of age. The results are consistent with the study done by Breslow et al.[19]

The pattern of childhood tumors showed wide variation among the different age groups. The frequency of leukemia, lymphomas, and bone tumors was found more in above 5 years aged children, and the result is similar to the study done by Haroun et al.,[20] where they found lymphoma, ALL, and bone tumors commonly occurred in children above 5 years. However, the frequency of leukemia, lymphomas, and nephroblastoma was reported more in <5 years aged children. Our study findings may not reflect our national statistics, as we have collected data from hospitals, not from the population.

From this study, it can be concluded that leukemia, lymphoma, and bone tumors were the most common malignancies reported in the children treated at our cancer center.


  Conclusions Top


Leukemia, lymphoma, and bone tumors were the most common malignancies reported in the children treated at our cancer center.

Financial support and sponsorship

This study was not financially supported by the department of Radiation Oncology.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Steliarova-Foucher E, Colombet M, Ries LA, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001-10: A population-based registry study. Lancet Oncol 2017;18:719-31.  Back to cited text no. 1
    
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Gupta S, Howard SC, Hunger SP, Antillon FG, Metzger ML, Israels T, et al. Treating Childhood Cancer in Low- and Middle-Income Countries. Cancer: Disease Control Priorities, Third Edition (Volume 3). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Nov1.Chapter 7. Available from: https://www.ncbi.nlm.nih.gov/books/NBK343626/ doi: 10.1596/978-1-4648-0349-9_ch7.  Back to cited text no. 2
    
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Draper GJ, Bower BD, Darby SC, Doll R. Completeness of registration of childhood leukaemia near nuclear installations and elsewhere in the Oxford region. BMJ 1989;299:952.  Back to cited text no. 5
    
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Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. Lyon: IARC Press; 2004.  Back to cited text no. 8
    
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Das S, Paul DK, Anshu K, Bhakta S. Childhood cancer incidence in India between 2012 and 2014: Report of a population-based cancer registry. Indian Pediatr 2017;54:1033-6.  Back to cited text no. 9
    
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Dorak MT, Karpuzoglu E. Gender differences in cancer susceptibility: An inadequately addressed issue. Front Genet 2012;3:268.  Back to cited text no. 11
    
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Hussain MA, Abass FE, Ahmed HM. Malignant disease in Sudanese children. East Afr Med J 1988;65:507-13.  Back to cited text no. 12
    
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McKinney PA, Feltbower RG, Parslow RC, Lewis IJ, Glaser AW, Kinsey SE. Patterns of childhood cancer by ethnic group in Bradford, UK 1974-1997. Eur J Cancer 2003;39:92-7.  Back to cited text no. 14
    
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Linet MS, Ries LA, Smith MA, Tarone RE, Devesa SS. Cancer surveillance series: Recent trends in childhood cancer incidence and mortality in the United States. J Natl Cancer Inst 1999;91:1051-8.  Back to cited text no. 15
    
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Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: Data from the surveillance, epidemiology, and end results program. Cancer 2009;115:1531-43.  Back to cited text no. 16
    
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Stiller C, editor. Childhood Cancer in Britain: Incidence Survival, Mortality. Oxford: Oxford University Press; 2007.  Back to cited text no. 17
    
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Black WC. Increasing incidence of childhood primary malignant brain tumors – Enigma or no-brainer? J Natl Cancer Inst 1998;90:1249-51.  Back to cited text no. 18
    
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Breslow NE, Beckwith JB, Perlman EJ, Reeve AE. Age distributions, birth weights, nephrogenic rests, and heterogeneity in the pathogenesis of wilms tumor. Pediatr Blood Cancer 2006;47:260-7.  Back to cited text no. 19
    
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