The prevalence of signs and symptoms of childhood leukemia and lymphoma in Fars Province, Southern Iran

Abstract

Background: Leukemia and lymphomas are still the common childhood cancers in Iran. This study was undertaken to determine the prevalence of signs and symptoms of these malignancies in children of Fars Province, Southern Iran. Methods: A total of 368 cases of children who were less than 15 years old and diagnosed as acute lymphocytic leukemia (ALL, n = 211), acute myeloid leukemia (AML, n = 64), Burkitt lymphoma (BL, n = 40), chronic myeloid leukemia (CML, n = 5), Hodgkin's disease (HD, n = 33) or non-Burkitt-type, non-Hodgkin's lymphoma (NBNHL, n = 15) referring to the hospitals of Shiraz University of Medical Sciences from April 1997 to March 2002 were enrolled. A questionnaire was provided to record the age, median age at the onset of the disease, sex, type of malignancy and the signs and symptoms at the time of presentation. Results: The common sign or symptoms were fever (74%), in ALL, AML, NHL, and BL patients, hepatosplenomegaly (100%) in CML patients, and lymphadenopathy (54%) and fever (54%) in Hodgkin's disease. Conclusion: Knowledge of signs and symptoms and types of presentations of childhood leukemia and lymphoma may help a physician to improve the patient's outcome. This study revealed that attention to uncommon signs and symptoms in history taking and physical examination together with laboratory tests may increase the physicians’ awareness and better diagnosis of pediatric malignancies and would also be beneficial for the patient.

Introduction

Leukemia and lymphomas, the most common malignant diseases affecting children, account for approximately 30% of childhood cancers [1], [2]. About 32% of cancers in children ages 0–14 years are leukemia [1]. The most common forms of leukemia among children under 19 years of age is acute lymphocytic leukemia (ALL). The incidence of ALL among 1–4-year-old children is more than nine times greater than that of young adults (ages 20–24) [1]. Before the advent of chemotherapy in the 1960s, these malignancies were usually fatal. However, treatment with new agents resulted in approximately 79% of pediatric cases with 5-year survival [1], [2], [3]. Lymphoid, myeloid and monocytic leukemia were reported to be 0.5%, 0.8% and 0.0% in Qidong County of China in 1992 and 39, 29 and 3 cases in Goiania, Brazil in 1993. The figures for non-Hodgkin's and Hodgkin's lymphoma were 1.6% and 0.0% in Qidong, China and 62 and 36 cases in Goiania, Brazil [4]. There are some studies showing a correlation between the prognosis and various clinical and laboratory findings at the time of diagnosis, such as organ infiltration (especially liver, spleen, thymus, and the lymph nodes) [5], the white blood cell (WBC) count [6], age [7], [8], race [9], sex [10], [11], [12], cytogenetic alterations [13] and specific immunophenotypes [14], [15]. The initial presentation of leukemia usually has non-specific signs and symptoms and relatively brief duration such as anorexia, fatigue and irritability. Bone marrow involvement and infiltration of blast in bone marrow may be followed by pallor, fever, bleeding tendency, bone pain, lymphadenopathy (LAP), hepatosplenomegaly and arthritis [1], [16].

In lymphoma, lymphadenopathy, abdominal and mediastinal masses were reported to be the most common presenting signs [17], [18]. Signs and symptoms in non-Hodgkin's lymphoma vary with the disease site and its progression and in turn differ with histological subtypes [18].

A thorough history taking and complete physical examination have always been and still are the first tools in the diagnosis of the diseases; however, with progressive development of laboratory instruments, the significance of traditional history taking and examinations have unfortunately lost their significance for most physicians. Nowadays most physicians progressively rely on laboratory tools. However, in order to have an adequate degree of alertness, one must always keep in mind the signs and symptoms of important diseases, otherwise they may easily be misdiagnosed and mismanaged.

The present study was undertaken to determine the prevalence of signs and symptoms of leukemia and lymphoma in children in Fars Province, Southern Iran in order to help physicians a faster and more accurate diagnosis and also to prevent delayed treatment and management.