The clinicopathological characteristics of childhood malignancies at ocean road cancer institute, Dar es salaam, Tanzania 2010

ABSTRACT Background: More than 85% of childhood malignancies occur in developing countries where the burden of infectious diseases is also high. Cancer associated with viral infections, such as Burkitt lymphoma (BL), Hodgkin Disease (HD), Kaposi’s sarcoma (KS) and Nasopharyngeal carcinoma (NPC) contribute a large percentage of cases in developing than in the developed countries. Worldwide one out of eight deaths is caused by cancer and in developed countries childhood cancers contribute 10% of all childhood deaths. Outcome of childhood malignancies in developing countries has remained poor as opposed to developed countries where more than 70% of children with cancer are cured. Poor outcome in developing countries is related to late presentation and lack of sufficient and appropriate resources to provide specialized and comprehensive services needed to manage these children. Despite the fact that cancers in children are common, very few studies have been done on this topic in Tanzania. Also the magnitude of malnutrition in children with cancer in our setting and the association of HIV/AIDS and childhood malignancies have not been systematically documented. This study addressed these gaps. Objectives: The study aimed at describing the clinicopathological characteristics of childhood malignancies at Ocean Road Cancer Institute (ORCI). The magnitude of malnutrition and HIV infection were also studied. Methodology: A descriptive cross-sectional hospital based study was conducted at Ocean Road Cancer Institute, the only specialized cancer hospital in Tanzania. Data was collected for eight months (May to December 2010). Participants were enrolled consecutively as they presented to the hospital. Demographic data, parents/guardians level of education, HIV status and clinical diagnosis were determined and recorded. Nutritional status was assessed using mid upper arm circumference (MUAC). Data collection for each patient was completed when a final diagnosis was reached and investigations for staging the patient were done. Results: A total of 151 patients were enrolled in this study where 51.7% were males. Mean age at presentation was 5.8 years (range 3-17years). Age at presentation influenced the type of malignancy with Retinoblastoma contributing 58.2% of patients aged 3 years or younger. Mean duration from symptoms to reaching ORCI was 7 months (range one week to six years). There was a significant delay between the first time a patient presented to a health facility and the time he/she reached ORCI (mean difference 5.5 months). Sixty three percent of patients had their diagnoses confirmed by either histology or cytology. Retinoblastoma was the commonest malignancy (29.1%) followed by Nephroblastoma (11.3%), Burkitt lymphoma (10.6%) and Acute Lymphoblastic Leukemia (10.6%). The majority of patients with solid tumors presented with either locally advanced or metastatic disease (86%). Only 4 patients (2.8%) were HIV positive; three patients with Kaposi’s sarcoma and one patient with Burkitt lymphoma. Twelve percent of patients had severe wasting. Conclusion and Recommendations: Retinoblastoma was the leading childhood malignancy at ORCI during the study period followed by Nephroblastoma. Despite more than 75% of parents/guardians seeking health services within one month of symptoms, majority of patients reached ORCI late with advanced disease. There was no significant association of HIV infection and childhood malignancies at ORCI. There is need for affirmative actions to facilitate patients’ access to proper treatment early. This can be achieved by regular training of primary health care providers on presentation of childhood malignancies throughout the country. A bigger multicenter study is needed in order to establish the prevalence of different types of childhood malignancies in Tanzania