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Childhood cancers in a referral hospital in northern Nigeria
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2009; 30(03): 95-98
DOI: DOI: 10.4103/0971-5851.64253
Abstract
Background:We undertook this study to determine the relative frequencies of childhood malignancies and their age - sex distribution in this environment.Materials and Methods:Hospital-based data of histological and cytologically confirmed cases of malignancies in children, aged ≤ 15 years, was collated over a period of 11 years, from the Cancer Registry.Results:A total of 329 children aged ≤ 15 years, with confirmed malignant disease, was recorded. This constituted 8.44% of all malignancies diagnosed in the same period with a Male : Female ratio of 1.5:1. Burkitt′s lymphoma accounted for 27.01% of the cases followed by retinoblastoma (17.02%), non-Hodgkin′s non-Burkitt′s Lymphoma (9.42%), and Rhabdomyosarcoma (9.42%). Others were Nephroblastoma (8.81%), Hodgkin′s lymphoma (6.69%), Neuroblastoma (3.34%), Colorectal carcinoma (2.43%), Osteosarcoma (2.13%), and Unspecified lymphomas (1.82%). Burkitt′s lymphoma was most prevalent in the 5-9 and 10-15 year age groups, retinoblastoma in the 0-4 year age group, and Non-Hodgkin′s lymphoma, Hodgkin′s lymphoma, and unspecified carcinomas were more prevalent in the 10-15 year age group.Conclusion:Lymphomas were the most prevalent malignancies of childhood seen in this region and the majority were of the Burkitt type, in contrast to the predominant leukemic and central nervous system trend seen in developed nations.
Publication History
Article published online:
19 November 2021
© 2009. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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Background:
We undertook this study to determine the relative frequencies of childhood malignancies and their age – sex distribution in this environment.
Materials and Methods:
Hospital-based data of histological and cytologically confirmed cases of malignancies in children, aged ≤ 15 years, was collated over a period of 11 years, from the Cancer Registry.
Results:
A total of 329 children aged ≤ 15 years, with confirmed malignant disease, was recorded. This constituted 8.44% of all malignancies diagnosed in the same period with a Male : Female ratio of 1.5:1. Burkitt’s lymphoma accounted for 27.01% of the cases followed by retinoblastoma (17.02%), non-Hodgkin’s non-Burkitt’s Lymphoma (9.42%), and Rhabdomyosarcoma (9.42%). Others were Nephroblastoma (8.81%), Hodgkin’s lymphoma (6.69%), Neuroblastoma (3.34%), Colorectal carcinoma (2.43%), Osteosarcoma (2.13%), and Unspecified lymphomas (1.82%). Burkitt’s lymphoma was most prevalent in the 5–9 and 10–15 year age groups, retinoblastoma in the 0–4 year age group, and Non–Hodgkin’s lymphoma, Hodgkin’s lymphoma, and unspecified carcinomas were more prevalent in the 10–15 year age group.
Conclusion:
Lymphomas were the most prevalent malignancies of childhood seen in this region and the majority were of the Burkitt type, in contrast to the predominant leukemic and central nervous system trend seen in developed nations.
INTRODUCTION
The emerging threat of cancers in developing countries, especially in the pediatric age group, has received little attention. This can be explained by the preoccupation with infectious diseases, such as malaria, which contributes to about 25% of the deaths in children under the age of one.[1] However there are some growing concerns on the incidence and management of childhood cancers in tropical African countries.[2,3] Studies of cancer in children have contributed greatly to the understanding of the genetic processes involved in carcinogenesis.[4,5] As there are peculiarities and variations in the occurrence of specific cancers with respect to age, sex, race and so on, it was considered appropriate to undertake this retrospective study, with a view to determining the most common malignancies in children aged ≤ 15 years, including their age and sex distribution in this environment. This will form a basis for comparison with studies from different parts of the country and other parts of the world. The report may also help relevant institutions focus on the planning of intervention programs.
MATERIALS AND METHODS
Ahmadu Bello University Teaching Hospital (ABUTH) is a teaching and referral facility located in the north central region of Nigeria. Most cases of childhood and adult cancers in the northern region are referred here for confirmation of diagnosis and / or treatment.
Using predesigned data sheets, details on all children aged ≤ 15 years, diagnosed with malignant conditions, was extracted from the cancer registry of the Hospital for the period January 1994 to December 2004. The information retrieved was verified against the admission registers and laboratory registers kept by the hospital’s Records Department. All cases with inconsistencies were excluded from the study (there were three cases of non-statement of the child’s sex in the records). The sex and age distribution of the different malignancies were described using percentages and relevant data displayed in Tables. The International Classification of Childhood Cancers (ICCC) was used.[6]
RESULTS
A total of 3899 malignancies were diagnosed over the 11-year period (1994 – 2004) and of these, 329 cases were in children ≤ 15 years, constituting 8.44% of all the cases. Using the ICCC, the malignancies seen over this period are outlined in Table 1. This shows the age – sex distribution of all cancers diagnosed during the period. Overall, Burkitt’s lymphoma, retinoblastoma, non-Hodgkin’s lymphoma, and rhabdomyosarcoma accounted for 59.88% of all tumors recorded over the study period. Burkitt’s lymphoma accounted for 27.01% of the cases, followed by retinoblastoma (17.02%), non-Hodgkin’s non-Burkitt’s Lymphoma (9.42%), and Rhabdomyosarcoma (9.42%). Others were Nephroblastoma (8.81%), Hodgkin’s lymphoma (6.69%), Neuroblastoma (3.34%), Colorectal carcinoma (2.43%), Osteosarcoma (2.13%), and unspecified lymphomas (1.82%). Table 2 gives the sex distribution of the ten most common malignancies in each age group.
| ICCC | N | Male | Female | M/F ratio | Relative frequency % | |
|---|---|---|---|---|---|---|
| I | Leukemia | 1:2 | ||||
| ALL | 2 | 0 | 2 | – | 0.60 | |
| Unspecified | 1 | 1 | 0 | – | 0.30 | |
| II | Lymphoma | |||||
| Hodgkins | 22 | 19 | 3 | 6.3:1 | 6.69 | |
| Non-Hodgkins non-Burkitt’s | 31 | 24 | 7 | 3.4:1 | 9.42 | |
| Burkitt’s | 79 | 55 | 24 | 2.3:1 | 24.01 | |
| Others specified | 1 | 0 | 1 | – | 0.30 | |
| Others non-specified | 6 | 4 | 2 | 2:1 | 1.82 | |
| III | CNS, Intracranial, Intraspinal neoplasms | 0 | 0 | 0 | – | |
| IV | Neuroblastoma | 11 | 4 | 7 | 1:1.8 | 3.34 |
| V | Retinoblastoma | 56 | 27 | 29 | 1:1.1 | 17.02 |
| VI | Nephroblastoma | 29 | 17 | 12 | 1.4:1 | 8.81 |
| VII | Hepatoblastoma | 1 | 0 | 1 | – | 0.30 |
| VIII | Bone Tumor | |||||
| Osteosarcoma | 7 | 2 | 5 | 1:2.5 | 2.13 | |
| hondrosarcoma | 1 | 1 | 0 | – | 0.30 | |
| Ewing’s sarcoma | 2 | 2 | 0 | – | 0.61 | |
| IX | Soft tissue | |||||
| Rhabdomyosarcoma | 31 | 17 | 14 | 1.2:1 | 9.42 | |
| Neurofibrosarcoma | 1 | 1 | 0 | – | 0.30 | |
| Kaposi Sarcoma | 3 | 2 | 1 | 2:1 | 0.91 | |
| Others | 2 | 1 | 1 | 1:1 | 0.61 | |
| X | Germ cell/gonadal | |||||
| Sacrococcygeal tumor | 3 | 0 | 3 | – | 0.91 | |
| Testicular tumor | 1 | 1 | 0 | – | 0.30 | |
| Ovarian tumor | 2 | 0 | 2 | – | 0.61 | |
| XI | Carcinomas | |||||
| Nasopharyngeal | 2 | 2 | 0 | – | 0.61 | |
| Skin | 4 | 2 | 2 | 1:1 | 1.22 | |
| Colorectal carcinoma | 8 | 5 | 3 | 1.6:1 | 2.43 | |
| Conjuctival tumors | 5 | 3 | 2 | 1.5:1 | 1.52 | |
| Thyroid tumors | 1 | 0 | 1 | – | 0.30 | |
| Salivary gland tumors | 1 | 0 | 1 | – | 0.30 | |
| Genitourinary tumors | 2 | 2 | 0 | – | 0.61 | |
| Endometrial tumors | 1 | 0 | 1 | – | 0.30 | |
| Oral tumors | 1 | 0 | 1 | – | 0.30 | |
| Breast | 1 | 0 | 1 | – | 0.30 | |
| Unspecified | 2 | 1 | 1 | 1:1 | 0.61 | |
| XII | Other malignant tumors | |||||
| Specified | 3 | 1 | 2 | 1:2 | 0.91 | |
| Unspecified | 6 | 1 | 5 | 1:5 | 1.82 | |
| Total | 329 | 196 | 133 | 100.00 | ||
| 59.57% | 40.43% |
| Tumours |
Age group
|
Total | Percentage | |||||
|---|---|---|---|---|---|---|---|---|
|
0 – 4
|
5 – 9
|
10 – 15
|
||||||
| M | F | M | F | M | F | |||
| Burkitt’s lymphoma | 4 | 3 | 37 | 15 | 14 | 6 | 79 | 24.01 |
| Retinoblastoma | 17 | 23 | 9 | 5 | 1 | 1 | 56 | 17.02 |
| Non-Hodgkins non-Burkitt’s lymphoma | 2 | 1 | 7 | 4 | 15 | 2 | 31 | 9.42 |
| Rhabdomyosarcoma | 6 | 8 | 5 | 2 | 6 | 4 | 31 | 9.42 |
| Nephroblastoma | 11 | 9 | 4 | 2 | 2 | 1 | 29 | 8.81 |
| Hodgkins lymphoma | 1 | 0 | 5 | 0 | 13 | 3 | 22 | 6.69 |
| Neuroblastoma | 2 | 3 | 0 | 3 | 2 | 1 | 11 | 3.34 |
| Colorectal carcinoma | 1 | 0 | 0 | 0 | 4 | 3 | 8 | 2.43 |
| Osteosarcoma | 0 | 0 | 1 | 0 | 1 | 5 | 7 | 2.13 |
| Unspecified lymphomas | 0 | 0 | 4 | 0 | 0 | 2 | 6 | 1.82 |
| Total/Percent | 44 | 47 | 72 | 29 | 58 | 24 | 280 | 85.09 |
- National Malaria Control Programme in Nigeria; Annual Report, 2005. The Federal Ministry of Health Abuja, Nigeria.
- Agugua NE, Okeahialam T. Malignant diseases of childhood seen at the University of Nigeria Teaching Hospital (UNTH), Enugu Nigeria. East Afr Med J 1986;63:717-23.
- Williams AO. Tumours of childhood in Ibadan, Nigeria. Cancer 1975;36:170.
- Israel MA. Pediatric oncology: Model tumors of unparalleled import. J Natl Cancer Inst 1989;81:404-8.
- Malkin D, Portwine C. The genetics of childhood cancer. Eur J Cancer 1994;30A:1942-6.
- Kramαrovα E, Stiller CA. The international classification of childhood cancer. Int J Cancer 1996;68:759-65.
- Samaila MO. Malignant tumours of childhood in Zaria. Afr J Paediatr Surg 2009;6:19-23.
- Martνn AA, Alert JA, Renσ JS, Lonchong M, Grueiro S. Incidence of childhood cancer in Cuba (1986-1990). Int J Cancer 1997;72:551-5.
- Tanko NM, Echejoh GO, Manasseh NA, Mandong MB, Uba AF. Pediatric solid tumours in Nigerian children: A changing pattern? Afr J Paediatr Surg 2009;6:7-10.
- Omololu AB, Ogunbiyi J O Ogunlade SO, Alonge TO, Adebisi A, Akang EE. Primary Malignant bone tumours in Ibadan. West Afr J Med 2002;21:201-3.
- Mohammed A, Isa HA. Pattern of primary bone tumours and tumour like lesions in Zaria. northern Nigeria: a review of 127 cases. West Afr J Med 2007;26:37-41.
- 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.
- National Malaria Control Programme in Nigeria; Annual Report, 2005. The Federal Ministry of Health Abuja, Nigeria.
- Agugua NE, Okeahialam T. Malignant diseases of childhood seen at the University of Nigeria Teaching Hospital (UNTH), Enugu Nigeria. East Afr Med J 1986;63:717-23.
- Williams AO. Tumours of childhood in Ibadan, Nigeria. Cancer 1975;36:170.
- Israel MA. Pediatric oncology: Model tumors of unparalleled import. J Natl Cancer Inst 1989;81:404-8.
- Malkin D, Portwine C. The genetics of childhood cancer. Eur J Cancer 1994;30A:1942-6.
- Kramαrovα E, Stiller CA. The international classification of childhood cancer. Int J Cancer 1996;68:759-65.
- Samaila MO. Malignant tumours of childhood in Zaria. Afr J Paediatr Surg 2009;6:19-23.
- Martνn AA, Alert JA, Renσ JS, Lonchong M, Grueiro S. Incidence of childhood cancer in Cuba (1986-1990). Int J Cancer 1997;72:551-5.
- Tanko NM, Echejoh GO, Manasseh NA, Mandong MB, Uba AF. Pediatric solid tumours in Nigerian children: A changing pattern? Afr J Paediatr Surg 2009;6:7-10.
- Omololu AB, Ogunbiyi J O Ogunlade SO, Alonge TO, Adebisi A, Akang EE. Primary Malignant bone tumours in Ibadan. West Afr J Med 2002;21:201-3.
- Mohammed A, Isa HA. Pattern of primary bone tumours and tumour like lesions in Zaria. northern Nigeria: a review of 127 cases. West Afr J Med 2007;26:37-41.
- 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.