Childhood cancer

Last updated
Childhood cancer
Other namesPediatric cancer
Trying out hats to wear after chemotherapy - cropped.jpg
A girl trying out hats to wear after chemotherapy against a Wilms' tumor [1]
Specialty Pediatrics, oncology

Childhood cancer is cancer in a child. About 80% of childhood cancer cases in high-income countries can be successfully treated via modern medical treatments and optimal patient care. [2] [3] However, only about 10% of children diagnosed with cancer reside in high-income countries where the necessary treatments and care is available. [4] [5] Childhood cancer represents only about 1% of all types of cancers diagnosed in children and adults, It is often more complex than adult cancers with unique biological characteristics and research and treatment is yet very challenging and limited.[ citation needed ] For this reason, childhood cancer is often ignored in control planning, contributing to the burden of missed opportunities for its diagnoses and management in countries that are low- and mid-income. [6]

Contents

In the United States, an arbitrarily adopted standard of the ages used are 0–14 years inclusive, that is, up to 14 years 11.9 months of age. [7] [8] However, the definition of childhood cancer sometimes includes adolescents between 15 and 19 years old. [8] Pediatric oncology is the branch of medicine concerned with the diagnosis and treatment of cancer in children.

Signs and symptoms

Leukemia

This is the most common type of cancer during childhood, and acute lymphoblastic leukemia (ALL) is most common in children. ALL usually develops in children between the ages of 1 and 10 (it could occur at any age). This type of cancer is more prevalent in males and in whites. [9]

Signs & Symptoms:

Frequent delayed diagnosis (early symptoms are nonspecific)

Physical examination:

Important: It is recommended that a complete blood count is obtained (CBC) if any suspicious finding arise.

Central nervous system tumors

This is the second most common malignancy diagnosed during childhood. [10]

Signs and Symptoms

Hodgkin's disease

The likelihood of developing Hodgkin's disease increases during childhood and it peaks in adolescence. [9] [11]

Hodgkin's disease

Signs and Symptoms

Non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma is more common in older children, and it is less prevalent than Hodgkin's disease. [12]

Signs and Symptoms

If abdomen is affected

If mediastinum is affected

If head and neck masses are affected

Neuroblastoma

This cancer is an extracranial solid tumor commonly diagnosed in childhood.  

Signs and Symptoms

Wilms' tumor

This malignancy presents as an abdominal mass in a child. [14]

Signs and Symptoms

Malignancies of the musculoskeletal system

A tumor that arises in the musculoskeletal system often presents as a mass, a painful extremity or, occasionally, a pathologic fracture. [9]

Signs and Symptoms

Genetic syndromes associated with cancer

The cause of cancer is not yet well understood. Several chromosomal disorders and constitutional syndromes are associated with it. [9] [15]

Learning problems

Children with cancer are at risk for developing various cognitive or learning problems. [16] These difficulties may be related to brain injury stemming from the cancer itself, such as a brain tumor or central nervous system metastasis or from side effects of cancer treatments such as chemotherapy and radiation therapy. Studies have shown that chemo and radiation therapies may damage brain white matter and disrupt brain activity.

This cognitive problem is known as post-chemotherapy cognitive impairment (PCCI) or "chemo brain." This term is commonly use by cancer survivors who describe having thinking and memory problems after cancer treatment. [17] Researchers are unsure what exactly causes chemo brain, however, they say it is likely to be linked to either the cancer itself, the cancer treatment, or be an emotional reaction to both. [17]

This cognitive impairment is commonly noticed a few years after a child endures cancer treatment. When a childhood cancer survivor goes back to school, they might experience lower test scores, problems with memory, attention, and behavior, as well as poor hand-eye coordination and slowed development over time. [18] Children with cancer should be monitored and assessed for these neuropsychological deficits during and after treatment. [19] Patients with brain tumors can have cognitive impairments before treatment [20] and radiation therapy is associated with increased risk of cognitive impairment. [21] Parents can apply their children for special educational services at school if their cognitive learning disability affects their educational success. [22]

Risk factors

Risk factors are any genetic or environmental exposure that increase the chances of developing a pathological condition. Some examples are age, family history, environmental factors, genetics, and economic status among others. [23]

Demographic risk factors

Environmental factors

Genetic factors

Identified Cancer Predisposition Syndromes [26]

Aspects that make the risk factors of childhood cancer different from those seen in adult cancers include: [29]

Also, a longer life expectancy in children avails for a longer time to manifest cancer processes with long latency periods, increasing the risk of developing some cancer types later in life. [29]

Advanced parental age has been associated with increased risk of childhood cancer in the offspring. [30] There are preventable causes of childhood malignancy, such as delivery overuse and misuse of ionizing radiation through computed tomography scans when the test is not indicated or when adult protocols are used. [31] [32]

Diagnosis

Types

Two girls with acute lymphocytic leukemia demonstrating intravenous access for chemotherapy. Pediatric patients receiving chemotherapy.jpg
Two girls with acute lymphocytic leukemia demonstrating intravenous access for chemotherapy.

The most common cancers in children are (childhood) leukemia (32%), brain tumors (18%), and lymphomas (11%). [33] [34] In 2005, 4.1 of every 100,000 young people under 20 years of age in the U.S. were diagnosed with leukemia, and 0.8 per 100,000 died from it. [35] The number of new cases was highest among the 1–4 age group, but the number of deaths was highest among the 10–14 age group. [35]

In 2005, 2.9 of every 100,000 people 0–19 years of age were found to have cancer of the brain or central nervous system, and 0.7 per 100,000 died from it. [35] These cancers were found most often in children between 1 and 4 years of age, but the most deaths occurred among those aged 5–9. [35] The main subtypes of brain and central nervous system tumors in children are: astrocytoma, brain stem glioma, craniopharyngioma, desmoplastic infantile ganglioglioma, ependymoma, high-grade glioma, medulloblastoma and atypical teratoid rhabdoid tumor. [36]

Other, less common childhood cancer types are: [36] [34]

Medical specialties

Overall, treating childhood cancer requires a multidisciplinary team of doctors, nurses, social workers, therapists, and other members of the community. Here is a brief list of doctors that can treat childhood cancer: [37]

Other specialties that can assist in the treatment process include radiology, neurosurgery, orthopedic surgery, psychiatry, and endocrinology.

Treatment

Childhood cancer treatment is individualized and varies based on the severity & type of cancer. [38] In general, treatment can include surgical resection, [39] chemotherapy, [40] radiation therapy, [41] or immunotherapy. [42]

Recent medical advances have improved our understanding of the genetic basis of childhood cancers. Treatment options are expanding, and precision medicine for childhood cancers is a rapidly growing area of research. [43]

The side effects of chemotherapy can result in immediate and long-term treatment-related comorbidities. [44] For children undergoing treatment for high-risk cancer, more than 80% experience life-threatening or fatal toxicity as a result of their treatment. [45]

Psychosocial care of children with cancer is also important during the cancer journey, but the implementation of evidence-based interventions need to be further spread across pediatric cancer centers. [46] In general, psychosocial care can include therapy with a psychologist or psychiatrist, referral to a social worker, or referral to a pastoral counselor. [37] Family-centered psychosocial care is one approach that can be used to not only support the patient's psychosocial well-being but also support the parents and any caregivers of the patient. [47]

Prognosis

With the advancement of new treatments for childhood cancer, 85% of individuals who had childhood cancer now survive 5 years or more. This is an increase from the mid-1970s where only 58% of children with childhood cancer survived 5 years or more. [48] However, this survival rate is dependent on many factors such as the type of cancer, age of onset, location of the cancer, cancer stage, and if there is any genetic component to the cancer. [49] Survival rate is also impacted by socioeconomic status and access to resources during treatment. [49]

Since adult survivors of childhood cancer are living longer, these individuals may experience long-term complications that are associated with their cancer treatment. [50] This can include problems with organ function, growth and development, neurocognitive function and academic achievement, and risk for additional cancers. [50] [51]

Premature heart disease is one example of a major long-term consequence seen in adult survivors of childhood cancer. [52] These individuals are eight times more likely to die of heart disease than other people, and up to one quarter of the children treated for cancer develop some type of cardiac abnormality, mainly left ventricular systolic dysfunction [53] although this may be asymptomatic or too mild to qualify for a clinical diagnosis of heart disease. [52]

Childhood cancer survivors are also at risk of sustaining adverse effects on the kidneys [54] and the liver. [55] Specific cancer treatments such as cisplatin, carboplatin, and radiotherapy are known to cause kidney damage. [54] The risk of liver damage is increased in those who have had radiotherapy to the liver and in those with other risk factors, such as a higher body mass index or chronic viral hepatitis. [55] Certain treatments and liver surgery may also increase the risk of adverse liver effects in childhood cancer survivors. [55]

To help monitor for these long-term consequences, a set of guidelines have been created to facilitate long term follow up for childhood, adolescent, and young adult cancer survivors. [51] This provides guidance for healthcare professionals on how to provide high quality follow-up care and appropriate monitoring. These guidelines also help healthcare providers collaborate with oncology specialists, in order to create recommendations specific to an individual patient. [51]

Quality of Life in survivors

Usually, Quality of Life improves with time since diagnosis, especially for children with solid tumors and hematological malignancies. Children with a CNS tumors, on the other hand, show little or no improvement over time. [56] Quality of Life is often measured both during and after treatment, but international comparisons of both outcomes and predictors are hindered by the use of a large number of different measurements. [57] Recently, a first step for a joint international consensus statement for measuring Quality of Life in survivors of childhood cancer has been established. [58]

Epidemiology

Epidemiology is the study of the distribution and determinants of disease frequency in the human population and the study of how to control health problems. [59] Internationally, the greatest variation in childhood cancer incidence occurs when comparing high-income countries to low-income ones. [60] This may result from differences in being able to diagnose cancer, differences in risk among different ethnic or racial population subgroups, as well as differences in risk factors. [60] An example of differing risk factors is in cases of pediatric Burkitt lymphoma, a form of non-Hodgkin lymphoma that sickens 6 to 7 children out of every 100,000 annually in parts of sub-Saharan Africa, where it is associated with a history of infection by both Epstein-Barr virus and malaria. [60] [61] [62] In industrialized countries, Burkitt lymphoma is not associated with these infectious diseases. [60] Non-Hispanic white children often have a better chance of survival compared to other racial and ethnic groups. Where an individual lives is one of the biggest determinants of health in the world, as illness and healthcare options can vary by an individual's postal code.[ citation needed ]

United States

In the United States, cancer is the second most common cause of death among children between the ages of 1 and 14 years, exceeded only by unintentional injuries such as injuries sustained in a car wreck. [35] [63] More than 16 out of every 100,000 children and teens in the U.S. were diagnosed with cancer, and nearly 3 of every 100,000 died from the disease. [35] In the United States in 2012, it was estimated that there was an incidence of 12,000 new cases, and 1,300 deaths, from cancer among children 0 to 14 years of age. [64] Cancer is the second leading cause of death in males and fourth in women under the age of 20 in the United States. The survival rate of children with cancer has improved since the late 1960s which is due to improved treatment and public health measures. The estimated proportion surviving 5 years from diagnosis increased from 77.8 percent to 82.7 percent to 85.4 percent for those diagnosed in the 1990s, 2000s, and 2010–2016. [65]

Statistics from the 2014 American Cancer Society report:

Ages birth to 14 [66]
SexIncidenceMortalityObserved Survival %
Boys178.023.381.3
Girls160.121.182.0
Ages 15 to 19 [66]
SexIncidenceMortalityObserved Survival %
Boys237.734.580.0
Girls235.524.785.4

Note: Incidence and mortality rates are per 1,000,000 and age-adjusted to the 2000 US standard population. Observed survival percentage is based on data from 2003 to 2009.

Sub-Saharan Africa

A large number of children in Africa live in low- and middle-income countries where there is limited access to prevention or treatment of cancer. The under-five mortality rate (U5MR), a robust indicator of child health, is at 109 per 1,000 live births. [67] The proportion of childhood cancer is higher in Africa than in developed countries, at 4.8%. [68] Kids with cancer are disadvantaged compared to kids in developed countries; therefore their statistic for childhood cancer is higher.[ clarification needed ] In sub-Saharan Africa, 10% of children die before their 5th birthday, yet it is not due to cancer; communicable diseases such as malaria, cholera, and other infections are the leading cause of death. [69] Children with cancer are often exposed to these preventable infections and diseases. Tumor registries only cover 11% of the African population, and there is a significant absence in death registration, making the mortality database unreliable. Overall, there is a lack of reliable data, as there is limited funding and many diseases are largely unknown to this population.

United Kingdom

Cancer in children is rare in the UK, with an average of 1,800 diagnoses every year but contributing to less than 1% of all cancer-related deaths. [70] Age is not a confounding factor in mortality from the disease in the UK. From 2014 to 2016, approximately 230 children died from cancer, with brain/CNS cancers being the most commonly fatal type.

Foundations and fundraising

Part of the proceeds from the sale of yellow silage wrappings goes to childhood cancer research, Brastad, Sweden Yellow silage bales in Heden 3.jpg
Part of the proceeds from the sale of yellow silage wrappings goes to childhood cancer research, Brastad, Sweden

Currently, there are various organizations whose main focus is fighting childhood cancer. Organizations focused on childhood cancer through cancer research and/or support programs include: Childhood Cancer Canada, Young Lives vs Cancer and the Children's Cancer and Leukaemia Group (in United Kingdom), Child Cancer Foundation (in New Zealand), Children's Cancer Recovery Foundation (in United States), [71] American Childhood Cancer Organization (in United States), [72] Childhood Cancer Support (Australia) and the Hayim Association (in Israel). [73] Alex's Lemonade Stand Foundation allows people across the US to raise money for pediatric cancer research by organizing lemonade stands. [74] The National Pediatric Cancer Foundation focuses on finding less toxic and more effective treatments for pediatric cancers. This foundation works with 24 different hospitals across the US in search of treatments effective in practice. [75] Childhood Cancer International is the largest global pediatric cancer foundation. It focuses on early access to care for childhood cancers, focusing on patient support and patient advocacy. [76]

According to estimates by experts in the field of pediatric cancer, by 2020, cancer will cost $158 million annually for both research and treatment which marks a 27% increase since 2010. [77] Ways in which the foundations are helped by people include writing checks, collecting spare coins, bake/lemonade sales, donating portions of purchases from stores or restaurants, or Paid Time Off donations [78] as well as auctions, bike rides, dance-a-thons. Additionally, many of the major foundations have donation buttons on their respective websites.

In addition to advancing research focusing on cancer, the foundations also offer support to families whose children are affected by the disease. The estimated total cost for one child with cancer (medical costs and lost parental wages) is $833,000. [79] Organizations such as the National Children's Cancer Society and the Leukemia and Lymphoma Society can provide financial assistance for the costs associated with childhood cancer like medical care, home care, child care, and transportation.

Importance of family support

The emotional challenges that a parent may encounter can disrupt their child's treatment, parenting and support for the child who is ill and their siblings, and impact overall family stability. [47] Therefore, having a support network during this time is important. Different foundations fund support groups within hospitals and online for parents and families to aid in the coping process. [80] Targeted support for siblings of children with cancer is also warranted. Resources that account for family context, age, and gender can help siblings process cancer-related emotional reactions. [81] These targeted resources help promote family activities and normal family functioning, while enhancing family adjustment over time. [81] [82] [83]

The foundations for pediatric cancer all fall under the 501(c)3 designation which means that they are non-profit organizations that are tax-exempt. [84] The "International Childhood Cancer Day" occurs annually on February 15. [85] [86]

Related Research Articles

<span class="mw-page-title-main">Leukemia</span> Blood cancers forming in the bone marrow

Leukemia is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called blasts or leukemia cells. Symptoms may include bleeding and bruising, bone pain, fatigue, fever, and an increased risk of infections. These symptoms occur due to a lack of normal blood cells. Diagnosis is typically made by blood tests or bone marrow biopsy.

<span class="mw-page-title-main">Brain tumor</span> Neoplasm in the brain

A brain tumor occurs when abnormal cells form within the brain. There are two main types of tumors: malignant (cancerous) tumors and benign (non-cancerous) tumors. These can be further classified as primary tumors, which start within the brain, and secondary tumors, which most commonly have spread from tumors located outside the brain, known as brain metastasis tumors. All types of brain tumors may produce symptoms that vary depending on the size of the tumor and the part of the brain that is involved. Where symptoms exist, they may include headaches, seizures, problems with vision, vomiting and mental changes. Other symptoms may include difficulty walking, speaking, with sensations, or unconsciousness.

<span class="mw-page-title-main">Lymphoma</span> Hematologic cancer that affects lymphocytes

Lymphoma is a group of blood and lymph tumors that develop from lymphocytes. The name typically refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired. The enlarged lymph nodes are usually painless. The sweats are most common at night.

<span class="mw-page-title-main">Chronic lymphocytic leukemia</span> Medical condition

Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes. Early on, there are typically no symptoms. Later, non-painful lymph node swelling, feeling tired, fever, night sweats, or weight loss for no clear reason may occur. Enlargement of the spleen and low red blood cells (anemia) may also occur. It typically worsens gradually over years.

<span class="mw-page-title-main">Rhabdomyosarcoma</span> Medical condition

Rhabdomyosarcoma (RMS) is a highly aggressive form of cancer that develops from mesenchymal cells that have failed to fully differentiate into myocytes of skeletal muscle. Cells of the tumor are identified as rhabdomyoblasts.

<span class="mw-page-title-main">Acute lymphoblastic leukemia</span> Blood cancer characterised by overproduction of lymphoblasts

Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, pale skin color, fever, easy bleeding or bruising, enlarged lymph nodes, or bone pain. As an acute leukemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated.

<span class="mw-page-title-main">Neuroblastoma</span> Medical condition

Neuroblastoma (NB) is a type of cancer that forms in certain types of nerve tissue. It most frequently starts from one of the adrenal glands but can also develop in the head, neck, chest, abdomen, or spine. Symptoms may include bone pain, a lump in the abdomen, neck, or chest, or a painless bluish lump under the skin.

<span class="mw-page-title-main">Follicular lymphoma</span> Medical condition

Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes. The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts. These cells normally occupy the follicles in the germinal centers of lymphoid tissues such as lymph nodes. The cancerous cells in FL typically form follicular or follicle-like structures in the tissues they invade. These structures are usually the dominant histological feature of this cancer.

<span class="mw-page-title-main">Cancer survivor</span> Person with cancer who is still alive

A cancer survivor is a person with cancer of any type who is still living. Whether a person becomes a survivor at the time of diagnosis or after completing treatment, whether people who are actively dying are considered survivors, and whether healthy friends and family members of the cancer patient are also considered survivors, varies from group to group. Some people who have been diagnosed with cancer reject the term survivor or disagree with some definitions of it.

The Children's Oncology Group (COG), a clinical trials group supported by the National Cancer Institute (NCI), is the world's largest organization devoted exclusively to pediatric cancer research. The COG conducts a spectrum of clinical research and translational research trials for infants, children, adolescents, and young adults with cancer.

<span class="mw-page-title-main">Medulloblastoma</span> Most common type of primary brain cancer in children

Medulloblastoma is a common type of primary brain cancer in children. It originates in the part of the brain that is towards the back and the bottom, on the floor of the skull, in the cerebellum, or posterior fossa.

Certain treatments for childhood cancer are known to cause learning problems in survivors, particularly when central nervous system (CNS)-directed therapies are used. As the mortality rates of childhood cancers have plummeted since effective treatment regiments have been introduced, greater attention has been paid to the effect of treatment on neurocognitive morbidity and quality of life of survivors. The goal of treatment for childhood cancers today is to minimize these adverse "late effects", while ensuring long-term survival.

<span class="mw-page-title-main">Atypical teratoid rhabdoid tumor</span> Medical condition

An atypical teratoid rhabdoid tumor (AT/RT) is a rare tumor usually diagnosed in childhood. Although usually a brain tumor, AT/RT can occur anywhere in the central nervous system (CNS), including the spinal cord. About 60% will be in the posterior cranial fossa. One review estimated 52% in the posterior fossa, 39% are supratentorial primitive neuroectodermal tumors (sPNET), 5% are in the pineal, 2% are spinal, and 2% are multifocal.

<span class="mw-page-title-main">Epidemiology of cancer</span> The study of factors in cancer causes and treatments

The epidemiology of cancer is the study of the factors affecting cancer, as a way to infer possible trends and causes. The study of cancer epidemiology uses epidemiological methods to find the cause of cancer and to identify and develop improved treatments.

<span class="mw-page-title-main">Childhood leukemia</span> Medical condition

Childhood leukemia is leukemia that occurs in a child and is a type of childhood cancer. Childhood leukemia is the most common childhood cancer, accounting for 29% of cancers in children aged 0–14 in 2018. There are multiple forms of leukemia that occur in children, the most common being acute lymphoblastic leukemia (ALL) followed by acute myeloid leukemia (AML). Survival rates vary depending on the type of leukemia, but may be as high as 90% in ALL.

Embryonal rhabdomyosarcoma (EMRS) is a rare histological form of cancer in the connective tissue wherein the mesenchymally-derived malignant cells resemble the primitive developing skeletal muscle of the embryo. It is the most common soft tissue sarcoma occurring in children. Embryonal rhabdomyosarcoma is also known as PAX-fusion negative or fusion-negative rhabdomyosarcoma, as tumors of this subtype are unified by their lack of a PAX3-FOXO1 fusion oncogene. Fusion status refers to the presence or absence of a fusion gene, which is a gene formed from joining two different genes together through DNA rearrangements. These types of tumors are classified as embryonal rhabdomyosarcoma "because of their remarkable resemblance to developing embryonic and fetal skeletal muscle."

Prophylactic cranial irradiation (PCI) is a technique used to combat the occurrence of metastasis to the brain in highly aggressive cancers that commonly metastasize to brain, most notably small-cell lung cancer. Radiation therapy is commonly used to treat known tumor occurrence in the brain, either with highly precise stereotactic radiation or therapeutic cranial irradiation. By contrast, PCI is intended as preemptive treatment in patients with no known current intracranial tumor, but with high likelihood for harboring occult microscopic disease and eventual occurrence. For small-cell lung cancer with limited and select cases of extensive disease, PCI has shown to reduce recurrence of brain metastases and improve overall survival in complete remission.

Cancer in adolescents and young adults is cancer which occurs in those between the ages of 15 and 39. This occurs in about 70,000 people a year in the United States—accounting for about 5 percent of cancers. This is about six times the number of cancers diagnosed in children ages 0–14. Globally, nearly 1 million young adults between the ages of 20 and 39 were diagnosed with cancer in 2012, and more than 350,000 people in this age range died from cancer.

<span class="mw-page-title-main">Extracranial germ cell tumor</span> Type of tumor

An extracranial germ cell tumor (EGCT) occurs in the abnormal growth of germ cells in the gonads and the areas other than the brain via tissue, lymphatic system, or circulatory system. The tumor can be benign or malignant (cancerous) by its growth rate. According to the National Cancer Institute and St. Jude Children's Research Hospital, the chance of children who are under 15 years old having EGCTs is 3%, in comparison to adolescents, a possibility of 14% with aged 15 to 19 can have EGCTs. There is no obvious cut point in between children and adolescents. However, common cut points in researches are 11 years old and 15 years old.

<span class="mw-page-title-main">T-cell acute lymphoblastic leukemia</span> Type of acute lymphoblastic leukemia

T-cell acute lymphoblastic leukemia (T-ALL) is a type of acute lymphoblastic leukemia with aggressive malignant neoplasm of the bone marrow. Acute lymphoblastic leukemia (ALL) is a condition where immature white blood cells accumulate in the bone marrow, subsequently crowding out normal white blood cells and create build-up in the liver, spleen, and lymph nodes. The two most common types of ALL are B-lymphocytes and T-lymphocytes, where the first protects the body against viruses and bacteria through antibody production which can directly destroy target cells or trigger others to do so, whilst the latter directly destroy bacteria or cells infected with viruses. Approximately 20% of all ALL patients are categorized specifically to suffer from T-ALL and it is seen to be more prevalent in the adult population in comparison to children, with incidences shown to diminish with age. Amongst T-ALL cases in the pediatric population, a median onset of age 9 has been identified and the disease is particularly prominent amongst adolescents. The disease stems from cytogenic and molecular abnormalities, resulting in disruption of developmental pathways controlling thymocyte development, tumor suppressor development, and alterations in control of cell growth and proliferation. Distinct from adult T-cell leukemia where T-cell lymphotropic virus Type I causes malignant maturation of T-cells, T-ALL is a precursor for lymphoid neoplasm. Its clinical presentation most commonly includes infiltration of the central nervous system (CNS), and further identifies mediastinal mass presence originating from the thymus, along with extramedullary involvement of multiple organs including the lymph node as a result of hyperleukocytosis.

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