Cancer in childhood is no longer a diagnosis yielding no hope as it used to be. For acute lympho-
blastic leukaemia, the cure rate has increased from less than 10% to greater than 80% in only three decades, and the survival rate has increased dramatically also for many other types of cancer in children. This is the result of improved diagnostic procedures, staging, treatment protocols and follow-up procedures. As many more patients survive, more attention now needs to be paid to later sequelae of the disease itself, and perhaps even more from the treatment.
No text on childhood cancer would be complete
without consideration of aetiology and epidemioology.
The first aim of this chapter is to review the literature on incidence patterns, temporal trends, seasonal variation, clustering and ecological studies. The second aim is to review
the literature on genetic and environmental
risk factors, especially from case-control and cohort studies. For this exercise relevant papers have been identified using PubMed (http://www.ncbi.nlm.nih.gov/PubMed). Due to limitations of space it is not possible to cite all references. The main findings are summarised
and only key references are given.
Malignant lymphoid and myeloid diseases in children are the largest subgroup of childhood cancers. They are the consequence of acquired genetic alterations that modify cell growth, differentiation
and apoptosis. The most frequent of these alterations include up-regulation of normal genes through chromosomal translocations
(e.g. in the mature B-cell lymphoma) or formation of new fusion-genes (e.g. in the Philadelphia
chromosome positive leukaemia) .
Solid tumours (excluding brain tumours and lymphoma) account for approximately 45% of all malignant disease in children . There are, in addition, a number of conditions with “borderline”
characteristics of malignancy that geneerally
come under the remit of the paediaatric
oncologist, for example Langerhans cell histiocytosis
and the fibromatoses. Some of these will also be briefly discussed in this paper.
Brain and spinal central nervous system (CNS) tumours are the most frequent solid tumours occurring in children under 15 years of age, and the second most prevalent group of malignancies
in this age group after leukaemia and lymphoma [1-3]. Indeed, they account for 80% of all tumours. With quite uniform distribution in western countries, CNS neoplasms have a total incidence in the range of 25-40 cases per million. Between the 1970s and the late 1980s, the incidence of childhood CNS tumours increased
by almost 20% as reported by the North American Surveillance, Epidemiology and End Results (SEER) programme, the most complete source of population-based epidemiological data on cancer incidence .
Advances in the treatment of childhood mali-
gnancies have achieved a high level of survi-
val, which currently exceeds 70% . However, the application of modern treatment protocols and/or the primary disease itself, have vaarious
negative effects on a child’s nutritional status. Furthermore, there is strong evidence that poor nutritional status is associated with higher complication rates that adversely impact di-
sease outcomes. The need for providing nutritional
support to this group of patients is therefore
most likely universal. The spectrum of nutritional consequences of cancer to children and the methods for nutritional intervention are reviewed below.