Aetiology of Childhood Malignancies
Authors: A. Stewart
Journal: BMJ (1961)

CHILDREN BRr J us to u ,e their results.These are shown in Table XIII, togethef with those for the 259 non-neural, non-epithelial tumours included in the Children's Tumour Register and for the adult blood donors in Manchester.TABLE XIII 0 A B AB Children (burns units) 49.5% 39%, 7 8% 3 7% Adultblooddonors(Manchester) 48% 41% 8% 3% Non-neural, non-epithelial tumours in Register .. .. 51t8% 38-9Y% 7-8% 1-3%Distribution of Rh Groups The only tumours in which the ratio rhesus positive: rhesus negative appears abnormal are the gliomas.Rh Positive Rh Negative Controls (Manchester) 8,445 1,929 Gliomas . .64 .. 7 P =007The interpretation of this distribution of Rh groups among the children with gliomas is much more difficult than that of the ABO groups, not only because of the various subdivisions of the Rh factor, but also because their geographical variations have not been determined (A. C. Kopec, 1959, personal communication).Thus the blood-group distributions among children in the Register show the following pattern: (a) There is a very significant excess of group A over group 0 in children with gliomas and a less significant excess of group A over group 0 in children with epithelial tumours.Children with gliomas also show an excess of Rh positive which may be significant.(b) Possibly children with tumours of the sympathetic nervous system and retinoblastomas may have an abnormal 0: A ratio.(c) Children with other tumours seem to have a normal ABO and Rh distribution.Mayr, Diamond, Levine, and Mayr (1956) did not find any abnormal blood-group distributions in brain tumours except in pituitary adenomas.Their series was collected from various neurosurgical centres in Boston and New York and was not broken down according to age.The nature of the hospitals and the types of glioma suggest, however, that the number of children included was so small that any variation from normal would not be apparent.As a result of our finding an abnormal O: A ratio among children with gliomas in the Register, Yates and Pearce (1960) examined the blood-groups in patients of all ages with astrocytomas in Manchester, diagnosed between 1933 and 1958, and found an abnormat 0: A ratio in those under 20 years old who were treated after 1945.However, their cases included those in the Register, so they could not be described as forming a completely independent series.Summary and Conclusions An analysis of cases included in the Manchester Children's Tumour Register has been made with two objects: (I) to give a picture of the problems involved in the treatment of children with tumours; and (2) to investigate certain aetiological and epidemiological problems.Over one-third of the tumours were reticulo- endothelial, another third were derived from some part of the nervous system, and an eighth were connective tissues in origin.The high mortality rate (approximately 70%) is mainly due to the fact that most tumours in children by the time they can be diagnosed are already too far advanced to be cured by present therapeutic methods.One family with retinoblastoma was included in the Register, but, apart from this, the survey did not demonstrate that tumours in children were familial.There was no evidence that social class and geographical location were significant aetiological factors.However, there was an abnormal blood-group distribution among children suffering from gliomas and possibly other tumours of neurectodermal origin.This work could not have been done without the ready co-operation of the clinicians and pathologists of the Manchester Region who have allowed their cases to be included in the Register.Our thanks are also due to the panel of pathologists who have given their services to the project, and to Mrs. N. Rowe and Miss V. Maybury-Clare for secretarial and technical assistance.