The prevalence of signs and symptoms of childhood leukemia and lymphoma in Fars Province, Southern Iran
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.
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Materials and methods
In a study of 368 patients under 15 years of age referred to three hospitals of Shiraz University of Medical Sciences (Faghihi, Dastgheyb and Nemazee hospitals as reference hospitals in Southern Iran), from April 1997 to March 2002, the International Classification of the Diseases for Oncology (ICD-O) was employed to standardize data. We studied patients diagnosed as ALL (n = 211), acute myeloid leukemia (AML, n = 64), Burkitt lymphoma (BL, n = 40), chronic myeloid leukemia (CML, n = 5), Hodgkin's
Results
Among the 368 studied cases, the male to female ratio was more than 1.5 in all malignancies. ALL was more common in the age range of 3–8 years, while this range was 10–12 years for AML.
Discussion
In Europe and the United States, cancer is a major cause of death among children aged 5–14 years [19]. Leukemia and lymphoma are among the most common malignancies of the childhood age [1], [2]. During 1996–2002, the 5-year relative survival rates for ALL were 65.2% and 90.5% overall and in children under 5 respectively while the figures for AML were 20.4% and 53.1% overall and in children under 15. The rate for CLL was reported 74.2% and for CML 42.3% [1]. The prevalence of the disease in
Conflict of interest
None declared.
Acknowledgments
The authors would like to thank the Office of Vice Chancellor for Research of Shiraz University of Medical Sciences for financial support.
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