Children in UK and Ireland later diagnosed with larger kidney cancers than in the rest of Europe

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Children with kidney cancer continue to be diagnosed with larger and more advanced tumors in the UK and Ireland than in other Western European countries, according to a study presented at the NCRI Festival.

As a result, a leading childhood cancer specialist has called for all staff providing primary health care to children in the UK’s National Health Service (NHS) to be trained in pediatric medicine so that diseases such as kidney cancer can be trained. be detected earlier.

Ms Reem Al-Saadi, Senior Director of Translational Research at UCL Great Ormond Street Institute of Child Health, University College London, UK, presented the results of the first study to systematically examine how children are diagnosed with kidney cancer in the UK.

Reporting on 603 of the 712 children registered with kidney cancer between 2012 and 2018 at 20 treatment centers in the UK and Ireland (around 90% of all children diagnosed with kidney cancer in those countries), she said that 86% had Wilms tumor (the most common type of kidney cancer in children) and 14% had kidney tumors other than Wilms. Computed tomography (CT) and magnetic resonance imaging (MRI) which create detailed images of the inside of the body were centrally examined as part of the investigations to ensure consistency of diagnosis.

“We found that the spread of cancer from the kidney to the lungs was detected in 24% of children; this was certain in 18% of the children and detected only by CT scans in 6%, which means that the nodules were so small that there is uncertainty as to whether they are cancerous or not, ”she said. declared.

“The majority of children were not diagnosed until they started showing symptoms: 77% had tumor-specific symptoms at the time of diagnosis, such as an abdominal lump, abdominal pain, or blood in the stomachs. urine; 16% had nonspecific symptoms; 5% were diagnosed following genetic screening and 2% following a child’s health check-up. This means that only a few cancers are accidentally detected before symptoms start to appear.

The mean (median) size of the tumors was 547 ml in volume, one quarter exceeding 901 ml.

“The tumor volumes that we observed were not significantly different from those of an analysis of children diagnosed in 2002-2011, when the tumor volumes were found to be greater than those found during the diagnosis in Germany. The median volume was then 572 ml in the United Kingdom against 382 ml. in Germany, ”Ms. Al-Saadi said.

The results come from the IMPORT (Improving Outcomes of Childhood Kidney Tumor Populations) study, which has since been expanded to include international research groups and became the UMBRELLA study. With the exception of work in Germany, it is the only initiative in the world to collect standardized data on the diagnostic journey of a child with kidney cancer.

Kathy Pritchard-Jones, professor of pediatric oncology at the Great Ormond Street Institute of Child Health, is the chief investigator of the IMPORT and UMBRELLA studies. Speaking to the NCRI festival, she said: “We only have very early comparative data for around 1,000 cases diagnosed as of 2019, but this first analysis of the UMBRELLA study found that 75% of Children in the UK and Ireland are diagnosed with a tumor. associated symptoms, which is higher than in most other European countries. This confirms similar results from an international trial conducted between 2001 and 2011. “

She continued: “We know that in European countries where children have smaller tumors at diagnosis, primary care is provided by trained pediatricians working in the community. They may be more likely to examine a child anywhere. when he arrives with vague symptoms, and, therefore, is more likely to detect that something is quite wrong in the abdomen.

“Efforts are needed to achieve an earlier diagnosis of kidney cancer in children in order to improve survival rates in the UK and Ireland. We believe that primary primary health care for children should be provided by staff trained in pediatric medicine. Cancer is part of a larger problem of late diagnosis of serious illness in children in the UK, which has been identified by the Royal College of Pediatrics and Child Health. “

Results reported today include two years of child follow-up after 2018. During that time, 78 (13%) relapsed and 44 (7%) died.

Professor Pritchard-Jones said: “Treatments have not changed over the past decade, and we expect the UMBRELLA study to show overall survival rates to remain similar at just over 90%. The study will allow us to make international comparisons to see how the UK is performing in terms of early diagnosis and treatment of children with abdominal tumors, and it will help us monitor improvements. “

Childhood kidney cancer is a rare disease. Wilms tumor is diagnosed in around 87 children each year in the UK. Treatment is one of the success stories of childhood cancer in recent years, with over 90% of children surviving. However, some subgroups have a poor prognosis, suffer from cancer recurrence, and in some cases die. Early diagnosis before the cancer starts to spread, combined with improved treatments, could help improve outcomes in these children.

Professor Pritchard-Jones and his colleagues are investigating ways to personalize treatment for each child based on biological signals that could be used to identify the intensity of treatment needed. They are also testing the use of artificial intelligence to assess the likelihood that the nodules seen on CT scans are cancer that has spread (metastasized) from the primary tumor.

Richard Neal, a member of the NCRI Screening, Prevention and Early Diagnosis (SPED) group and professor of primary care at the University of Exeter, UK, who was not involved in the research, said : “It is disappointing that there has been little progress over the past 20 years in diagnosing this disease at an earlier stage, when the tumors are smaller and easier to treat successfully. also demonstrate the difficulty of detecting these tumors at an early stage.There may be additional challenges in diagnosis due to the COVID-19 pandemic, with fewer patients, including children, seen face to face and submitted physical exams. We urgently need work to explore what interventions might work to improve the situation. ”


UK diagnoses later stage childhood kidney cancer than Germany


More information:
“Efforts to achieve earlier diagnosis of kidney tumors in children are needed to improve survival rates in the UK and Ireland”, by Ms Reem Al-Saadi et al. Short presentations – Prevention and early detection session, 6.30 p.m.-7.00 p.m., Thursday 11 November: conference.ncri.org.uk/program… and-early-detection /

Provided by the National Cancer Research Institute

Quote: Children in UK and Ireland later diagnosed with larger kidney cancers than in the rest of Europe (2021, November 8) retrieved November 8, 2021 from https://medicalxpress.com/news/ 2021-11-children-uk-ireland- grand-rein.html

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