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Childhood cancer is a rare disease diagnosed in around 1 in 600 children under age 15 years. This is in marked contrast to adults, for whom the lifetime risk of cancer is 1 in 3. Nonetheless, cancer is an important cause of death in children. After the first year of life, during which mortality is high largely due to congenital anomalies and complications arising from pregnancy and birth, cancer is the single most common disease-related cause of death in children and accounts for around a quarter of all childhood deaths due to disease. In 2004 in the United States, there were 11,619 deaths in children ages 1 to 14 years; of these, 5365 were due to disease and 26% of these (ie, 1418) were due to cancer (eTable 444.1).1

eTable 444.1. Childhood Deaths in the United States of America, 2004. by Age, Sex, and Cause

In adults, the majority of cancers are carcinomas, which arise in the epithelium of the colon, breast, lung, bladder, and skin. In children, carcinomas are rare, and the spectrum of disease is quite different to that in adults. In Canada from 2000 to 2004, leukemias accounted for around 33% of childhood malignancies, brain and other central nervous system tumors for 20%, lymphoma for 12%, neuroblastoma for 7%, soft tissue for 6%, renal tumors for 5%, bone tumors for 4%, and the remaining 13% represented a collection of very rare tumors (Fig. 444-1).2 The distribution is similar in other geographic areas.3,4 Over the course of childhood, the types of cancers change: In infants, the most common form of cancer is neuroblastoma (25% of cancer diagnoses) and for 1- to 14-year-olds, the most common is leukemia (42% of cases, ages 1–4; 34% of cases, ages 5–9; and 22% of cases ages 10–14; eFig. 444.1).2 The outcome for children with cancer varies with the type of disease, as discussed below. Overall, the rate of cancer is about 20% higher in boys than in girls, with the difference being most marked for lymphomas, which are twice as common in boys (eFig. 444.2).2

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