Pediatric Oncology

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Childhood cancer-An Overview Dr.K.S.Reddy Director, Regional Cancer Center, JIPMER, Pondicherry

 

BURDEN OF CHILDHOOD CANCER regarded as a d disease isease of • Cancer generally regarded adults •

Globally children:Annually >200,000No of New Cancers in • More than 80% are in developing world • MOST COMMON :  – LEUKEMIAS  – CNS TUMORS  – LYMPHOMAS

 

• IN UK 0.5% OF ALL CANCERS ARE SEEN IN CHILDREN

(18% POPULATION ARE CHILDREN) •

IN INDIA VARIES FROM 1.6 TO 4.8% (33% POPULATION ARE CHILDREN)

 

  In the United States, the incidence of childhood cancer overall is approximately 125 per million (0-15yrs) with slightly increased rates in males and white children. • • • •

 Leukemias account for approximately 25% of all childhood cancers, followed by  Tumors  T umors of the CNS (17%),



 Neuroblastoma (7%), Non-Hodgkin lymphoma (6%), Wilms tumor (6%), Hodgkin disease (5%), Rhabdomyosarcoma (3%), retinoblastoma (3%), Osteosarcoma (3%), and Ewing sarcoma (2%).



Numerous rare tumor types account for the remainder.



 

MALE TO FEMALE RATIO OF MAJOR CHILDHOOD CANCER TYPES IN EACH POPULATION BASED CANCER REGISTRY CANCER TYPE (ICD 10 CODE)

AHMEDABAD

BANGALOR  E

BARSHI

BHOPAL

CHENNAI

DELHI

MUMBAI

NORTH EAST

LEUKEMIA

0.95

1.20

1.86

0.69

1.55

2.26

1.21

1.09

LYMPHOID LEUKEMIA (C91)

0.70

1.51

1.32

0.81

1.64

2.60

1.26

1.32

MYELOID LEUKEMIA (C92-94)

-

0.77

-

0.29

0.92

1.79

1.54

0.46

LEUKEMIA UNSPECIFIED (C95)

-

0.32

2.99

0.62

1.82

1.44

0.82

1.41

LYMPHOMA

-

4.29

1.56

11.26

3.25

4.93

2.19

0.75

HODGKIN’S DISEASE (C81)  (C81) 

-

3.84

3.57

-

3.71

11.85

3.11

0.00

 NON HODGKIN’S HODGKIN’S L LYMPHOMA YMPHOMA (C82-85, C96)

-

4.81

0.00

7.78

2.81

3.11

1.74

0.98

BRAIN, CNS(C70-72)

-

1.66

2.09

0.31

1. 1.74 74

1.37

1.65

0.00

ADRENAL GLAND (C74)

-

0.27

-

-

0.81

1.81

1.23

0.00

EYE (C69)

-

0.60

0.90

0.92

1.10

1.90

0.95

1.17

KIDNEY (C64) LIVER (C22)

-

1.21 0.15

0.00 -

2.05 0.00

1.31 0.20

1.31 3.04

1.38 2.02

1.13 -

BONE (C40-41)

-

1.39

1.50

1.10

1.34

1.52

1.23

0.66

CONNECTIVE & SOFT TISSUE (C47, C49)

-

0.83

-

0.82

0.91

1.53

0.82

1.62

GONADAL (C56, C62)

-

0.00

-

0.31

1.16

0.32

0.89

0.88

OTHER SPECIFIED AND UNSPECIFIED

1.63

0.83

0.55

5.91

1.12

1.42

0.92

0.31

ALL SITES

2.24

1.26

1.29

1.07

1.55

1.92

1.34

0.75

 

GLOBOCAN-2012- INDIA CHILDHOOD CANCER BOTH SEXES AGE ADJUSTED

 

CHILDHOOD CANCERS AT JIPMER - 2012/13  S.NO  1. 

DIAGNOSIS  ALL 

2012 

2013 

36 

40 

 

 

 

 

2. 3. 

AML CML 

9 3 

07 01 

4. 

CNS 

15 

11 

5. 

GCT 



06 

6. 

HL 

14 

15 

7. 

HCC 



02 

8. 

LCH 



03 

9. 

NEUROBLASTOMA  



04 

10. 

NON-HODGKIN’S LYMPHOMA 



07 

11. 

NASOPHARYNGEAL 



09 

12. 

OSTEO SARCOMA 



10 

13.  14. 

PNET  RETINOBLASTOMA  

2  2 

02  01 

15. 

RMS 



05 

16. 

SKIN CANCER  



03 

17. 

STOMACH 



01 

18. 

SIGMOID COLON 



01 

19. 

WILM’S TUMOR  



06 

123 

134 

TOTAL 

 

Cancer Predisposition Factors •

• • •



The increased numbers of adults withcancer have enabled the ascertainment of causative factors, such as alcohol and smoking. Relatively few causative factors have been identified for cancer.of children with cancer have Thechildhood small numbers made environmental factors difficult to evaluate. However,, analysis for inherited factors is increasingly However fruitful, given the explosion in availability of molecular biologic technology and Resources engendered by the Human Genome Project 

 

  At its most basic level, CANCER IS A GENETIC DISEASE. DISEASE. Production of genetic instability that confers some kind of mutator phenotype is most likely the chief characteristic of any inherited predisposition for cancer. These instabilities take one of several forms: (1) mutations in key genes that are directly involved in tumoral development(eg, WT1, WT2 )),, (2) mutations in genes that generate mutations and gross chromosomal deletions at key loc(eg, in Fanconi anemia and mismatch repair), (3) mutations in genes directly involved in DNA re repair pair of specific lesions (eg, xeroderma pigmentosum), and (4) complex chromosomal syndromes that increase the person's susceptibility to develop cancer  

 

Down syndrom e • •





Children with Down syndrome have a 1% risk of developing before age 10. children than in The ratio of leukemia types is different in these children overall in that 60% of children with Down syndrome develop acute lymphoblastic leukemia (ALL), and 40% develop acute myelogenous leukemia (AML). general, theworse prognosis in some reported series isInno better or in children with Down syndrome and ALL than in children without Down syndrome and ALL. In contrast, outcomes tend to be better in children with Down syndrome and AML than in children without Down syndrome and AML. Interestingly,, AML in Down syndrome is skewed Interestingly toward the megakaryoblastic form. 

 

• • • • • • •

Turner syndrome Retention of the Y chromosome in female individuals with Turner syndrome mosaicism or androgen insensitivity syndrome increases their lifetime risk of gonadoblastoma gonadoblastoma..

This risk is as high as 25% by adulthood.[67] Wilms tumor  Association of gross deletions at the 11p13 11p13 locus with Wilms tumor led to isolation of the WT1 gene. Clinical abnormalities associated with WT1 mutations include aniridia, genital abnormalities, and mental retardation. A As s many as 40% of individuals with Wilms tumor have some familial component 

 

A u t o s o m al r e ec c e s s i v e d i s o r d e rrs s •

Xeroderma pigmentosum results from several genetic complementation groups that are part of the nucleotide excision repair system and transcriptional transcriptional apparatus. •

Patients with xeroderma pigmentosum are at increased risk for basal cell squamous cell carcinoma, andcarcinoma, melanoma.

 

S ev e v e r e c o m b i n e d i m m u n o d e f iic cie en nc y •





Patients with severe combined immunodeficiency are difficult to examine because of the severity of their underlying defect. However,, their inherent propensity toward lymphoid However malignancy is clear clear.. Patients with prolonged survival may ahave some residual immune function, and, thus, prolonged period before cancer develops.

W i s k o t t -A -A l d r i c h s y n d r o m e •



Wiskott-Aldrich syndrome is an immunodeficiency disorder characterized by thrombocytopenia, eczema, and T-cell T-cell dysfunction. dysfu nction. It increases the risk of non-Hodgkin lymphoma (NHL) 

 

L y m p h o p r o l iiff e err a att i v e s y n d r o m e s •

• •

Lymphoproliferative syndromes, which may be both genetic Lymphoproliferative and therapeutic, increase the risk of lymphoid proliferation triggered by Epstein-Barr (EBV) infection. In the X-linked form of thevirus disease, EBV infection accounts for 70% of deaths.  After prolonged immunosuppression (eg, chronic graft versus host disease after bone marrow transplantation), the patient's susceptibility to lymphoproliferative disease increases

H IV IV i n fe cti o n •

HIV has not left the paediatric population unaffected, despite promising regimens for preventing vertical transmission and promotion of safe sex practices.



The progression to AIDS AIDS is generally more rapi rapid d in children than in adults. The spectrum of cancers associated with HIV includes Kaposi sarcoma, NHL (especially in the CNS), and leiomyosarcoma. 



 



Environmental Factors

Ionizing radiation •

 Although increased cancer rates in children have been been associated with



radiation exposure, noatomic threshold effect has been Data derived from the bomb exposures at noted. Hiroshima and Nagasaki represent the most convincing body of evidence.  A link also has been established between third-trimester radiologic radiologic examinations and leukemia. Exposure to ionizing radiation in Japan resulted in increased AML risks.

• • •

Data from Japan atomic bomb exposures, exposures to nuclear from testing, and link therapeutic radiation for tonsillitis and tinea have allfallout been associated with increased risks of leukemia and thyroid cancer. •

P r ec e c o n c e p t iio on ra ad d i a t io i o n e x p o s u r e r e m a i n s a s o u r c e o f c o n t r o v e r s y . 

Electromagnetic fields • • •

Research has produced great controversy but little solid evidence of a relationship between cancer and electromagnetic fields. Published reports have suggested that electromagnetic fields have some potential effect on the promotion of leukemia. However,, when the available data are combined, the relative risk is probably However no morethan 1.5, and in many cases no correlation has been seen 

 

Chemicals •

• • •

• •

Most data about chemical exposure and its relationship to adult cancers imply that a lifetime of exposure is required to cause cancer.. This supposition is exemplified by tobacco exposure. cancer However,, exceptions have been reported. However Dioxin has been associated with thyroid cancer cancer,, acute myelogenous leukemia (AML), and Hodgkindisease. Trichloroethane has been implicated in a case in Woburn, Massachusetts, that suggested a link between exposure and leukemia.  A strong relationship has been s suggested uggested between parental exposure and subsequent childhood cancer.  Agents and their associated cancers include include pesticides (CNS tumors), solvents (eg, CNS tumors, leukemia, neuroblastoma, hepatoblastoma), metals (hepatoblastoma), petroleum products (eg, Wilms tumor, leukemia, hepatoblastoma), lead (Wilms tumor), boron (Wilms tumor), furnaces (lymphoma), and chemotherapy (leukemia).



Exposure to chemotherapeutic agents such as Topo   II drugs and alkylators also predispose to secondary AML.

 

Viral • •





 Associations with viruses have been difficult difficult to ascertain in childhood cancer cancer.. Perhaps the strongest link has been to Epstein-Barr virus (EBV), with a clear connection in African Burkitt lymphoma. On the other hand, a causal link remains more obscure in Hodgkin lymphoma and nasopharyngeal carcinoma, in which the EBV genome is found,but the question of etiology is less established. In the case of HIV, malignancies such as CNS lymphoma and leiomyosarcoma are correlated but are probably the result of HIV HIV-induced -induced immunosuppression. 

 



Leukemias are the most common type of childhood cancer,, accounting for 25% of new diagnoses cancer









Nearly 80% of leukemia childhood(ALL). leukemias are acute lymphoblastic The advent of modern molecular techniques has resulted in the further dissection of A ALL LL into several subtypes with therapeutic implications. For example, the recently described TEL-AML1 translocation is present in approximately 20% of pediatric cases ofALL. The TEL-AML1 translocation is now considered to be a favorable prognostic indicator for the outcome of ALL, Whereas the presence of Philadelphia chromosome, a 9;22 translocation involving the bcr and abl oncogenes, is a poor prognostic indicator  

 

Ac ute myelogenou s leukae em m ia •



• •

 Approximately 18% of childhood leukaemia cases involve AML. This ratio of ALL-to-AML remains constant throughout childhood, except for a predilection for AML in the neonatal period.  AML comprises a heterogeneous array of subtypes. Molecular diagnostic methods have advanced the ability to subtype myeloid leukemias The analysis of translocations is helping to define and confirm the histologic designations. For example, the t(8;21) translocation tran slocation is found in 15% of patients with AML. Of interest, this translocation is a favorable predictor of long-term survival. 

 



For instance, the risk of acute myelogenous leukemia (AML) with the 9;11 translocation is approximately 3-6% within 5 years of therapy that includes high-dose etoposide or alkylating agent therapy, depending on dosage and tumor type.

•  Additional  Additionally ly,,

in utero exposure to diagnostic radiation has been associated with an increased risk of childhood cancer  

 

  Tumors of the CNS • Roughly 20% of childhood cancers are brain tumors. •



• •

Patients with CNS tumors remain an underreported segment of the pediatric population with cancer because only one half are referred to specialty centers. Morbidity is clearly the greatest problem in patients with brain tumors because many of these tumors are in locations that are difficult to treat. Most pediatric brain tumors occur in the first decade of life. Unlike adult brain tumors, most true childhood brain tumors occur in the posterior fossa 

 









• •

The most common brain tumor in children is medulloblastoma , which accounts for 10-20% of medulloblastoma, childhood brain tumors and 40% of tumors in the posterior fossa. Most brain tumors, chiefly medulloblastomas and glial tumors, involve the posterior fossa after the first 2 years of life. Most CNS tumors are glial tumors, which are classified by their location as supratentorial,cerebellar, or brainstem.  Supratentorial astrocytomas comprise 30-40% of cases, with cerebellar astrocytomas and brainstem gliomas (15% each) comprising the remainder of the glial tumors. Unique variants in each of these groups have strong prognostic significance. For example, patients with exophytic gliomas do extremely well, whereas individuals with diffuse infiltrative tumors do poorly. 

 



Various genetic syndromes predispose to brain tumors, including neurofibromatosis, Li-Fraumeni syndrome syndrome,, and tuberous sclerosis.. sclerosis



Environmental exposure and immunosuppression are also associated with increased risk, including radiation (gliomas) and HIV (lymphoma) 

 

Hodgkin Disease •



Hodgkin disease, which accounts for 5% of childhood cancers, peak in children younger than 14 years, in young adults, and in adults older than 55 years. Most statistical reports comment on childhood cancers in individuals aged 14 years or younger. Like non-Hodgkin lymphoma (NHL), Hodgkin disease is reportedand to be associated with immunodeficiency infection with the Epstein-Barr virus (EBV), as well as cytomegalovirus. cytomegalovirus.[ 

 



Patients who survive Hodgkin disease remain at high risk for secondary tumors, a phenomenon that may indicate an underlying immunodeficient state.



Breast cancer in young patients with a



history of Hodgkin disease is mostly associated with irradiation as a treatment modality. 

 

N o n -H -H o d g k i n l y m p h o m a •



• •



Lymphomas make up a large, if heterogeneous, category of Lymphomas childhood cancers. Chief among these cancers are the NHLs, which are responsible for 6% of all pediatric cancers. NHL is a disease of young children and is more prevalent than Hodgkin lymphoma in the first decade of life; it has an overall predilection for boys, probably because of a subset of T T-cell -cell lymphoma. A major factor in NHL is its association with immunodeficiency secondary to underlying genetic diseases, viral infection, or drugs ] Burkitt lymphoma, roughly 40% of all NHL, is associated with EBV infection and endemic on the t he African continent. Burkitt lymphoma accounts for roughly one half of all incidents of NHL, a number which translates to an incidence of approximately 2-3% among childhood cancers. In its endemic form, the incidence of Burkitt lymphoma can increase as much as 50-fold. Endemic Burkitt lymphoma is associated with EBV and appears to occur in equatorial Africa.  Additional environmental environmental factors appear to be at work in the pathogenesis of Burkitt lymphoma

 

Neuroblastoma • Neuroblastoma is the most common non-CNS solid tumor. Both long-term survival and short-term treatment remain challenges

in the care of patients with neuroblastoma. •

O f  interest, the patient's age at presentation has prognos prognostic tic

implications.  implications.  •



The type that emerges in infancy greatly improves the likelihood of long-term survival and is marked by a lack of N-myc amplification; by hyperdiploidy; by low-stage, limited distant sites in stage I or II disease (marrow (marrow,, liver, or skin involvement in < 10% of patients); by the absence of 1p chromosomal abnormalities; by a lack of changes on chromosome 17; and by evidence of neuronal differentiation.  However,, the form that emerges in children aged 1-10 years  However has a much worse prognosis. Association with genetic alterations have been characterized, including germline mutations in the ALK gene and chromosome 1p deletions  

 

Renal Tumors • • • •





Wilm’s tumor

is the most common renal tumor overall, comprising approximately 5-6% of childhood cancers; However, in infancy, related tumors such as mesonephric nephroma are more common.  As in neuroblastoma, the patient's age affects the prognosis, prognosis, in that patients who present in infancy have the best outcomes.  Wilms tumor is strongly associated with a host of genetic syndromes, including Beckwith-Wiedemann syndrome syndrome;; DenysDrash syndrome; syndrome; and Wilms tumor, aniridia, genitourinary abnormalities, and mental retardation (W (WAGR) AGR) syndrome. syndrome. Studies of chromosome 11 11 have led to the description of the products of the WT1 and WT2 genes, which are associated with WAGR syndrome and Beckwith-Wiedemann syndrome, respectively. Prognostic factors associated with long-term survival include low-stage disease, favorable histology histology,, and young age.[ 

 

Retinoblastoma • With an overall incidence of around 2%, • •



retinoblastoma is a relatively rare but classic solid tumor. Its study led tothe development of the 2-hit hypothesis of carcinogenesis. Studies of family trees and analysis of known mutations have demonstrated an incidence of unilateral plus sporadic (60%), unilateral plus inherited (15%), and bilateral plus inherited (25%). Hereditary retinoblastoma occurs early early,, often at birth and 80% before age 2 years and is most likely to be bilateral, implying that a second mutation in the RB gene with the first hit having been inherited in the germline. 

 

Rhabdomyosarcoma •





• • • •

Comprises roughly 3% of childhood cancers, is another solid tumor with an incidence that peaks in children younger than 6 years and again in early adolescence  This incidence is roughly correlated with the type of tumor. tumor. Head and neck tumors are generally diagnosed in young patients (two thirds of cases), and the t he histology is usually embryonal. Older patients (one third of cases) are most likely to have tumors in the extremities with alveolar histology histology.. In general, patients with embryonal tumors and individuals with hyperdiploidy have improved outcomes However,, these data remain somewhat controversial. However  Associations with Li-Fraumeni Li-Fraumeni syndrome, BeckwithWiedemann, and neurofibromatosis have all been reported  

 

Osteosarcoma common •  Although more common overall, it is less common than Ewing sarcoma in the first decade of life.  life.   • Osteosarcoma is most common in patients who are taller than their peers and is diagnosed at an early age in more girls than boys. • Tumors are localized to the metaphyseal part of long bones, with most common sites including distal femur (30%), proximal tibia (15%), and •

proximal (10%).agents have been Radiationhumerus and alkylating implicated in the etiology of osteosarcoma, along with retinoblastoma and Li-Fraumeni syndrome 

 

E w i n g s a rc rc o m a •



• •





Ewing sarcoma represents a group of tumors that includes peripheral primitive neuroectodermal tumors and primary bony tumors. The diagnostic standard involves detection of either the chromosome 11;22 11;22 or the 21;22 translocation, at least one of which is found in as many as 95% of individuals with Ewing sarcoma.  An interesting feature of Ewing sarcoma is its extreme rarity among blacks and significant occurrence in whites.  whites.    Although the greatest incidence is observed observed in the second decade of life, Ewing sarcoma occurs more throughout the age spectrum than does osteosarcoma.  Ewing sarcoma is not associated with rapid bone growth and may be found anywhere along the bone or adjacent soft tissue or may even occur as an isolated soft-tissue soft -tissue mass. The most common sites of Ewing sarcomas are the pelvis (26%), femur (20%), tibia (10%), and chest wall (16%)  

 

FIVE-YEAR OVERALL SURVIVAL (EXPRESSED IN PERCENTAGE) OF COMMON CHILDHOOD CANCERS IN INDIA, EUROPE AND USA Population registry data CANCER TYPE (CATEGORIZED BY THE INTERNATIONAL CHILDHOOD CANCER CLASSIFICATION)

Population registry data

Bangalore

Chennai

Mumbai

Europe

USA

1982 to 1987

1990 to 2001

Various periods

1993 to 1997

1996 to 2004

77

81

82 52

86 57

85

87

LEUKEMIA LYMPHOID LEUKEMIA ACUTE MYELOID LEUKEMIA

Single Hospital

36 35 10

LYMPHOMAS

39 30

60 58

55

HODGKIN’S DISEASE  DISEASE 

72

65

94

93

95

 NON-HODGKIN’S  NONHODGKIN’S LYMPHOMAS  LYMPHOMAS 

33

47

58

79

84

67

71

CNS TUMORS ASTROCYTOMA MEDULLOBLASTOMA

27 40 43

 NEUROBLASTOMAS  NEUROBLASTOM AS AND OTHER PNS TUMORS

39

85 52

26

67

70

 NEUROBLASTOMAS  NEUROBLASTOM AS

28

37

RETINOBLASTOMAS

71

48

95

97

58

86

88

86

89

RENAL TUMORS  NEPHROBLASTOMA  NEPHROBLAST OMA

27

64

70

85

HEPATIC TUMORS

11

64

58

MALIGNANT BONE TUMORS

31

63

67

OSTEOSARCOMA

44

44

69

61

68

EWING’S AND RELATED SARCOMAS OF THE BONE  BONE  

23

58

66

64

SOFT TISSUE SARCOMAS

36

66

71

RHABDOMYOSARCOMAS

13

36

68

65

64

GERM CELL TUMORS

36

38

87

89

89

 

OTHER MALIGNANT EPITHELIAL AND MELANOMAS

61

35

86

90

ALL CANC CANCERS ERS

37

40

75

79



The decreased mortality rate of pediatric cancers has been one of the major success stories of medicine in the last 30 years.



 Improvements in the survival rates of leukemias, Hodgkin disease, and sarcomas have been notable successes. Most of these improvements can be traced to the use of aggressive multimodal therapy and





The judicious use of blood products, use of cytokines, and improved supportive care to prevent and treat infections. 

 



The success of the treatment of pediatric cancer engenders the new challenge of caring for the growing number of cancer survivors.



The risk of a second cancer appearing within 20 years after an initial diagnosis of cancer is approximately 8%.



The existence of this group also suggests that risk factors (eg, treatment, heredity, heredity, other environmental factors) might be identifiable. 

 

sta ndardized for world population  Average Annual Number (AAN) of cases of cancer and cancer incidence rates standardized (ASR) in children 0 to 14 years of age Male 

Population based cancer registry

AAN 

% of all

Female  ASR  

AAN 

cancer  

% of all

Total  ASR  

AAN 

cancer  

% of all

ASR  

cancer  

Ahmedabad (Rural

15

3.8

51

5

1.9

23

20

3.1

38

Bangalore (Urban)

69

3.5

87

50

2.1

69

119

2.8

78

Barshi (Rural)

6

5.6

69

4

3.7

53

10

4.6

62

Bhopal (Urban)

16

3.1

58

13

2.8

55

29

2.9

57

Chennai (Urban)

78

3.9

150

47

2.2

97

125

3.0

124

Delhi (Urban)

335

6.5

146

152

3.1

76

487

4.8

1 113 13

Mumbai (Urban)

173

3.9

105

117

2.6

79

290

3.2

93

North East

25

1.2

39

34

2.1

51

59

1.6

45

 

Male to female ratio of o f major childhood cancer types in each population based cancer rregistry egistry Cancer type (ICD 10 Code)

Ahmedabad

Bangalore

Barshi

Bhopal

Leukemia

0.95

1.20

1.86

0.69

Lymphoid Lymphoid leukemia (c91) Myeloid leukemia (C92-94)

0.70 -

1.51 0.77

1.32 -

Leukemia unspecified (C95)

-

0.32

Lymphoma Lymphoma

-

Hodgkin’s disease (C81)  (C81) 

Chennai

Delhi

Mumbai

North East

1.55

2.26

1.21

1.09

0.81 0.29

1.64 0.92

2.60 1.79

1.26 1.54

1.32 0.46

2.99

0.62

1.82

1.44

0.82

1.41

4.29

1.56

11.26

3.25

4.93

2.19

0.75

-

3.84

3.57

-

3.71

11.85

3.11

0.00

 Non Hodgkin’s Hodgkin’s lymphoma lymphoma (C82-85, C96)

-

4.81

0.00

7.78

2.81

3.11

1.74

0.98

Brain, nervous system (C70-72)

-

1.66

2.09

0.31

1.74

1.37

1.65

0.00

Adrenal gland (C74)

-

0.27

-

-

0.81

1.81

1.23

0.00

Eye (C69)

-

0.60

0.90

0.92

1.10

1.90

0.95

1.17

Kidney (C64)

-

1.21

0.00

2.05

1.31

1.31

1.38

1.13

Liver (C22)

-

0.15

-

0.00

0.20

3.04

2.02

-

Bone (C40-41)

-

1.39

1.50

1.10

1.34

1.52

1.23

0.66

Connective and soft tissue (C47, C49)

-

0.83

-

0.82

0.91

1.53

0.82

1.62

Gonadal (C56, C62)

-

0.00

-

0.31

1.16

0.32

0.89

0.88

Other specified and unspecififed

1.63

0.83

0.55

5.91

1.12

4.42

0.92

0.31

All Sites

2.24

1.26

1.29

1.07

1.55

1.92

1.34

0.75

 

Five-year overall survival (expressed in percentage) of common childhood cancers in India, Europe and USA Population registry data Cancer type (Categorized by the International Childhood Cancer Classification)

Population registry data

Bangalore

Chennai

Mumbai

Europe

USA

1982 to 1987

1990 to 2001

Various periods

1993 to 1997

1996 to 2004

77

81

82 52

86 57

85

87

Leukemia Lymphoid leukemia Acute myeloid leukemia

Single Hospital

36 35 10

Lymphomas

39 30

60 58

55

Hodgkin’s disease  disease 

72

65

94

93

95

 Non-Hodgkin’s  NonHodgkin’s lymphomas  lymphomas 

33

47

58

79

84

67

71

CNS tumors

27

Astrocytoma

40

Medulloblastoma

43

 Neuroblastomas and and other PNS tumors

39

85 52

26

67

70

 Neuroblastomas

28

37

Retinoblastomas

71

48

95

97

58

86

88

86

89

Renal tumors  Nephroblastoma

27

64

70

85

Hepatic tumors

11

64

58

Malignant bone tumors

31

63

67

Osteosarcoma

44

44

69

61

68

Ewing tumor and related sarcomas of the bone

23

58

66

64

Soft tissue sarcomas

36

66

71

Rhabdomyosarcomas Rhabdomyosarcom as

13

36

68

65

64

Germ cell tumors

36

38

87

89

89

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