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By far the most common type of cancer seen in childhood is Leukaemia. Then tumours of the Central Nervous system (Brain & spine) comes next followed by Lymphomas and Germ cell tumours. In decreasing order, bone cancers, soft tissue cancers, neuroblastoma and retinoblastoma occur. Rarer cancers include renal, liver, thyroid, skin and nasopharyngeal cancers. Hence the type of cancers seen in childhood is very different from those seen in adults.
The need for accurate diagnosis of cancer followed by timely appropriate treatment is of paramount importance if we want to offer cure for cancers. Many childhood cancers are treated with chemotherapy alone especially the leukaemias and lymphomas. Other cancers like central nervous system cancers, bone cancers, soft tissue sarcomas will require surgery. Some types of cancers will need radiation therapy when total resection cannot be achieved.
By far the most common type of cancer seen in childhood is Leukaemia. Then tumours of the Central Nervous system (Brain & spine) comes next followed by Lymphomas and Germ cell tumours. In decreasing order, bone cancers, soft tissue cancers, neuroblastoma and retinoblastoma occur. Rarer cancers include renal, liver, thyroid, skin and nasopharyngeal cancers. Hence the type of cancers seen in childhood is very different from those seen in adults.
The need for accurate diagnosis of cancer followed by timely appropriate treatment is of paramount importance if we want to offer cure for cancers. Many childhood cancers are treated with chemotherapy alone especially the leukaemias and lymphomas. Other cancers like central nervous system cancers, bone cancers, soft tissue sarcomas will require surgery. Some types of cancers will need radiation therapy when total resection cannot be achieved.
Types of Childhood Cancer
Leukaemia
50%
Leukaemia comprises nearly 50% of all cancers seen in the 0- 14 year old age group.
80-95%
chance of cure
The main mode of treatment for leukaemia is by chemotherapy and over the past few decades, the cure rates have improved tremendously so that the average patient with ALL can expect an 80 to 95% chance of cure.
The most common leukaemia is Acute lymphoblastic leukaemia (ALL) followed by acute myeloid leukaemia and then the rarer chronic myeloid leukaemia.
Diagnosis is dependent of examination of the bone marrow which includes studying the morphology, looking at the antigens on the surface of the cells – immunophenotyping, looking at cytogenetics of the bone marrow, studying the gene mutations which occur commonly in leukaemias.
Better ways of identifying risk groups in leukaemia, better supportive measures and ways to monitor for minimal residual disease have all contributed to the improved cure rates. For the small number of patients who are have high risk disease not responding to chemotherapy or who relapse, then stem cell transplantation /bone marrow transplantation and CAR-T therapy are now offering better chances of cure.
Stem Cell Transplantation is available in Subang Jaya Medical Centre but CAR-T therapy is done through joint service with the National University Hospital of Singapore.
Types of Childhood Cancer
Central Nervous System (CNS) Cancers
Radiation therapy is often used to obtain control of the tumour which cannot be surgically removed by virtue of the location to vital structures of the brain.
The next most common tumour seen in children is Central Nervous System (CNS) Cancers. These would include tumours in the brain and spinal cord. There are different types of CNS tumours depending on whether they start from the glial tissue of the CNS or from the neural/embryonal tissue.
Hence astrocytomas, low and high grade gliomas, ependymomas are tumours from glial tissue while medulloblastoma would come from the neural component of the brain. Most CNS tumours require good surgical clearance to give good outcome but there are some which respond well to chemotherapy.
Challenges in treating CNS tumours include the location of the tumours which cannot be surgically removed, young age of patients which precludes use of radiation therapy, residual effects of the tumour and treatment on the developing brain.
Types of Childhood Cancer
Lymphoma
The third most common cancer seen in children is Lymphoma.
Basically they can be divided into Non-Hodgkin Lymphoma or Hodgkin Lymphoma.
Both are highly amenable to chemotherapy and overall cure rates reach 80 to 90%. Again for those who relapse, salvage would often require further chemotherapy followed by stem cell transplantation.
Types of Childhood Cancer
Germ Cell Tumours
Germ cell tumours are cancers which arise in cells of the germline. This means cells which are related to the egg/ovum in the female or the sperm/testicular tissue in the male. Germ cell tumours may be located in any part of the body (from the brain down to the sacrum), may have different types of tissues and so they present challenges to both the pathologist and the oncologist.
Again good surgical clearance , chemotherapy and occasionally radiation therapy are needed for treatment of these cancers.
Types of Childhood Cancer
Bone and Soft Tissue Cancers
0-4 yrs age
Bone and soft tissue cancers occur in the slightly older children beyond the 0-4 year age group.
For bone cancers the common types are osteosarcoma followed by Ewing Sarcoma. Early presentation is critical for cure and it is hoped that persistent pain and then swelling in one of the bones of the limbs will alert parents to seek medical attention. Sometimes patients have sought traditional therapy resulting in advanced stage cancer by the time the patient presents to the oncologist. Treatment of bone cancers require good chemotherapy followed by resection of the tumour with or without limb replacement. For patient who have advanced disease, surgery and radiation to the lung metastases may be necessary. The advancement in orthopaedic procedures, availability of prosthetic limbs, physiotherapy, occupational therapy all contribute to good outcome for patients.
Soft tissue sarcomas are heterogenous as these cancers can occur in any of the tissues of the body including muscle (rhabdomyosarcoma), connective tissue, fatty tissue, skin, tendons ( non-rhabdomyosarcoma tumours).
Biopsy of the tumour is needed to establish accurate diagnosis and then staging of the disease before treatment can be started. Treatment includes chemotherapy, surgery and radiation therapy.
Types of Childhood Cancer
Neuroblastoma
40-50%
chance of cure
In spite of all these modalities of treatment, the cure rate is only about 40 to 50%.
Neuroblastoma refers to cancer which arise from the early nerve cells which are destined to form the sympathetic nervous system. This cancer tends to be seen in children only and present many challenges over the years as the cure rate has not improved as much as the other types of childhood cancers.
It is more common to see advanced stage neuroblastoma which means that the patient needs chemotherapy, surgery, stem cell transplantation using the patient’s own cells, radiation therapy and also immunotherapy.
The less common cancers mentioned earlier all need to follow the same principles of management. Accurate diagnosis depends on tissue examination (hence good pathologist/ haematologist). Correct staging of disease often requires good radioimaging services where children need the extra care of general anaesthesia to obtain the images of the tumour in the body. Hence PET scans, CT scans, MRI scans are often necessary.
KKLIU 0399 / EXP 31.12.2025
SJP Medical Centres Sdn. Bhd.
(Formerly known as RSD Hospitals Sdn. Bhd.)
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