Types of malignancies diagnosed

Hematological malignancies accounted for 48.38% and nonhematological malignancies for 51.62% of total pediatric malignancies.

In hematological malignancies, acute lymphoblastic leukemia was the most common accounting for 22.58% of total malignancies, 39.53% of total hematological malignancies, and 77.78% of acute leukemia. Among hematological malignancies, acute lymphoblastic leukemia is followed equally by Hodgkin's disease and non-Hodgkin's lymphoma (20% of total hematological malignancies each) followed by acute myeloid leukemia (13.33% of total hematological malignancies).

Among nonhematological malignancies, CNS malignancies accounted for 50% of malignancies followed by Wilm's tumor and hepatoblastoma, each accounting for 06.45% of total childhood malignancies and 12.5% of total nonhematological malignancies. These were followed by sympathetic nervous system tumors (neuroblastoma), anterior mediastinal teratoma, yolk sac tumor, and ovarian tumor each accounting for 3.23% of total childhood malignancies and 6.25% of total nonhematological malignancies.

Craniopharyngioma was the most common CNS malignancy. It accounted for 9.68% of total malignancies, 18.75% of total nonhematological malignancies, and 37.5% of CNS malignancies. Medulloblastoma was the second most common CNS malignancy. It accounted for 25% of total CNS malignancies followed by meningioma, pinealoblastoma, and thalamic glioma accounting for 12.5% of total CNS malignancies each as shown in [Table 1].

[Table 2] shows the age-wise distribution of pediatric malignancies.

Age distribution of different childhood malignancies

In the age group of 0–5 years, nonhematological malignancies were more common (70.00%) than the hematological malignancies (30.00%). Leukemia (20.00%) was the most common malignancy in the 0–5-year group. All cases of leukemia were ALL. CNS malignancies were the most common nonhematological malignancies. All cases of neuroblastoma, yolk sac tumor, and ovarian tumor were in this age group. Almost 50%-cases of hepatoblastoma and Wilm's tumor were in this age group. In the age group of 5–10 years, hematological malignancies were more common (77.78%) than the nonhematological malignancies (22.22%). Leukemia (44.44%) was the most common malignancy followed by lymphoma (33.33%). Nearly 75%-cases of leukemia were ALL and 25% were AML. Only two cases of nonhematological malignancies were as follows: one of craniopharyngioma and one of Wilm's tumor. Almost 50%-cases of Wilm's tumor were in this age group. In the age group of 10–14 years, hematological malignancies (n = 3) and nonhematological malignancies (n = 3) were equally common. Lymphoma (33.33%) was the most common malignancy in this age group. Among hematological malignancies, lymphoma (66.67%) was more common than leukemia (33.33%). All cases of leukemia were ALL. CNS (66.67%) malignancies were the most common nonhematological malignancies. In the age group of 14–18 years, hepatoblastoma constituted 16.67% of cases in this age group. Almost 50%-cases of hepatoblastoma were in this age group. Nonhematological malignancies were more common (66.67%) than the hematological malignancies (33.33%). CNS malignancies (50%) were the most common malignancies in this age group followed by lymphoma (33.33%). Craniopharyngioma, meningioma, and pinealoblastoma were equally common. Lymphoma was more common (66.67%) than leukemia (33.33%). ALL and AML were equally common. All cases of teratoma were in this age group.

A limited number of retrospective and prospective studies have been conducted on demographic profile of childhood malignancies all over the world and more so from India and especially from the Northern part of the country. Most of these studies are on hematological malignancies, especially acute leukemia, the most common malignancy being observed all over the world among children. There are a very few places, especially in the western countries,[9] where cancer registration system has been established and well maintained and that is why population-based studies can be conducted in those countries. Since our country lacks a well-maintained cancer registration system, we have to rely on hospital-based studies for epidemiological as well as other statistical data. In this study, the pediatric tumors constituted 1.57% of all the malignancies; our result is similar to Jignasa and Mandakini [10] where they found 2.0% childhood cancer among all malignancies. [Table 3] shows the comparison of various studies.

Percentage of pediatric malignancies

In this study, nonhematological malignancies were more common (51.62%) than the hematological malignancies (48.38%) and the three most common childhood malignancies were leukemia (29.03%), CNS tumors (25.80%), and lymphoma (19.35%). It is comparable with the data from the developed world, for example, in the USA,[10] the three most frequent childhood cancers diagnosed were leukemia (30.2%), CNS cancers (21.7%), and lymphomas (10.9%).

Leukemias were the most common form of childhood malignancies and together with lymphoma constituted 30%–50% of all malignancies in different regions as seen in [Table 4]. In the present study, lymphoma and leukemia together constituted 48.38% of childhood malignancies. Among leukemias, the most common in different studies were acute leukemias, 75%–80%-being ALL and 20%–25% AML.[11] In the present study, ALL constitutes 77.78%-of total leukemias and AML was 22.22%-of leukemias.

Comparison of proportion (%) of different pediatric malignancies

In the present study, the incidence of pediatric CNS tumor is 25.80%, which is almost comparable with a study which is carried out at Delhi,[15] but the incidence is much higher in our study than other studies done in and outside India. This may be because of round-the-clock availability of high-quality CT and MRI and early imaging of pediatric patients done on priority basis in our hospital. The incidence of Wilm's tumor (06.45%) is almost comparable with the data from the studies conducted in developed countries such as the USA,[13] Australia,[15] and developing African countries [14] but slightly higher than other Indian studies.[4],[5],[16] The proportion of neuroblastoma (03.23%) in our study was much lower than studies conducted in developed countries such as the USA,[13] the UK,[14] and Australia [15] but comparable with different Indian studies.[4],[5],[16] No case of bone tumors, soft-tissue tumors were diagnosed during this study period of 1 year. The incidence of childhood malignancies is higher in male than in female. Male and female ratio in the present study is 1.58:1, which is almost quite similar to Yeole et al.[11] and Joshi and Kumar.[17]

Male preponderance in our country could also be as a result of our cultural factors wherein boys get more attention and are brought to the hospital more often for management.[10] The highest incidence was seen in 0–5 years (32.26%), followed by 5–10 years (29.04%), 10–14 years (19.35%), and 14–18 years (19.35%). The incidence of childhood malignancies varied among different age groups. Although except this study, rest of the studies have not included adolescents above 14 years, so proportions in different age groups cannot be compared, but trends in our study are almost similar to Yeole et al.[11] This study shows that the overall incidence of childhood malignancies was more in 0–5 years of age group and decreases gradually with age toward late adolescence and this is in concordance with other Indian studies.[10],[11] The number of cases belonging to rural area (90.32%) is more than those belonging to an urban area (9.68%) which is well comparable with the general population.

Conclusions

In this part of the country, the three most common malignancies are leukemia (29.03%), CNS tumors (25.80%), and lymphoma (19.35%). Nonhematological malignancies are more common (51.62%) than the hematological malignancies (48.38%). Acute lymphoblastic leukemia is the most common hematological malignancy. The most common nonhematological malignancies are CNS malignancies followed by Wilm's tumor and hepatoblastoma. Craniopharyngioma is most common CNS malignancy. Acute leukemia is most common in 5–10 years' age group and CNS malignancies are most common in 14–18 years' age group (37.50%). Male preponderance is seen in hematological malignancies (86.67%) (both leukemia and lymphoma). Female preponderance is seen in nonhematological malignancies. The number of cases belonging to rural area (90.32%) was more than those belonging to an urban area (9.68%).

Conflict of Interest

There are no conflicts of interest.

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Publication History

Article published online:
17 June 2021

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