Tumor markers

1,2 ( 3-1) (palpable abdominal mass)

653 Melicow 3 43
90 (retroperitoneal mass)
(hydronephrosis)

3-1

infantile hypertrophic pyloric stenosis 3-6
3 2

90
( 3-1) 4
(hydronephrosis) multicystic dysplastic kidney
(intestinal
duplication), meconium pseudocyst
(Hirschsprungs disease) choledochal cyst
(hydrop gallbladder)
sacrococcygeal teratoma
neuroblastoma, Wilms tumor teratoma

neuroblastoma Wilms tumor 20

teratoma
(hematocolpos)
( 3-1)

3-1
0-1
Retroperitoneum
Renal

hydronephrosis, multicystic kidney disease, infantile polycystic kidneys,

renal vein thrombosis, congenital musoblastic nephroma
Extra-renal
adrenal hemorrhage
Liver
hepatic hemangioma, mesenchymal harmatoma, hepatoblastoma
Anterior abdomen duplication, midgut volvulus
Pelvis
hydrocolpos, ovarian cyst, sarcrococcygeal teratoma
1 - 4
Retroperitoneum
Renal

hydronephrosis, multicystic kidney, polycystic disease of kidney,

Wilms tumor
Extra-renal
neuroblastoma, rhabdomyosarcoma, teratoma, lymphangtoma
Liver
hepatoblastoma, hepatocellular carcinoma, hemangioma,
mesenchymal harmatoma
Anterior abdomen infanfile hypertrophic pyloric stenosis, duplication, intussusception,
midgut volvulus, choledochal cyst, mesenteric cyst
Pelvis
fecal impaction, ovarian cyst, sacrococcygeal teratoma, genitourinary
rhabdomyosarcoma
5 - 15
Retroperitoneum
Renal
Extra-renal

Wilms tumor, hydronephrosis

neuroblastoma, lymphoma, rhabdomyosarcoma, teratoma, pancreatic
pseudocyst
Liver
hepatoblastoma, hepatocellular carcinoma, focal nodular hyperplasia,
adenoma, liver abscess
Anterior abdomen choledochal cyst, splenic cyst, duplication, mesenteric and omental
cyst appendiceal abscess, lymphoma, carcinoid tumor
Pelvis
pregnancy, fecal impaction, ovarian mass, hydrometrocolpos,
genitourinary rhabdomyosarcoma

(posterior urethral valve)

pylorus infantile hypertrophic pyloric stenosis hepatoblastoma
sacrococcygeal teratoma choledochal
cyst

pancreatic pseudocyst

(pressure symptoms)


(urinary retention) sacrococcygeal teratoma
( 3-2)
opsoclonus-myoclonus
catecholamine metabolite ganglioneuroma ganglioneuroblastoma
secretory diarrhea vasoactive intestinal peptide
neuroblastoma5 Cushings corticosteroid
adrenocortical carcinoma
paraneoplastic syndrome
(systemic symptoms)

3-2 sacrococcygeal teratoma

UB: urinary bladder, arrows:
bladder neck ()

(metastatic
symptoms) neuroblastoma blueburry
muffin syndrome

hepatocellular carcinoma

(retroperitoneum)
(intraperitoneum) (anterior
abdomen) (pelvis)

(bimanual palpation)
sacrococcygeal teratoma


neuroblastoma Wilms tumor

Beckwith-Wiedemann syndrome(A) Wilms tumor hepatoblastoma WAGR

complex(B) Wilms tumor


( 3-2)

(peritoneal cavity)
4 quadrants 9

(A)
(B )

Bechwith-Wiedemann syndrome; visceromegaly, , omphalocele, and insulin

WAGR complex; Wilmstumor with aniridia, genitourinary malformations and retardation

3-2

BeckwidthWiedemann6,7

11p15.5
macrosomia, umbilical hernia or
embryonal tumor:
loss of
omphalocele, hemihyperplasia,
hepatoblastoma, Wilms tumor
imprinting visceromegaly, neonatal hypoglycemia

Denys-Drash8

WT1

congenital nephropathy, Wilms

tumor and intersex disorder

WAGR association 9

WT1

Wilms tumor, Aniridia, Genitourinary Wilms tumor

malformation and Mental retardation

Familial adenomatous

APC

intestinal polyposis

Peutz-Jeghers syndrome STK-11

(LKB1)

Wilms tumor

Colon cancer

circum-oral melanosis,
colon cancer, gastric cancer,
mucocutaneous lesions at palms
breast cancer and pancreatic
and soles, harmartomatous polyposis cancer

Turner syndrome

X
short stature, lymphadema,
monosomy broad chest, low hair-line,
low-set ears and web neck

gonadoblastoma, meningioma,
childhood brain tumor10

Kleinefelter syndrome

47XXY

tall stature, infertility, decreased

secondary sex characteristics and
gynecomastia

dysgerminoma and extragonadal

germ cell tumors, male breast11

Neurofibromatosis
type 1

NF1

caf au lait spot, neurofibroma of

the skin, freckling of the groin or
axillar, Lisch nodule on the iris

neurofibroma, neurofibrosarcoma,
optic nerve tumor

von Hippel-Lindau
disease9

VHL

no specific dermatological or
developmental defects. Diagnosis
is usually made by index tumors:
cerebellar hemangioblastoma, retinal
angioma, pheochromocytoma and
renal cell cancer

central nervous system

hemangioblastoma,
retinal angioma, adrenal
pheochromocytoma, pancreatic
and renal cyst, clear cell renal
cell carcinoma of kidney

Tuberous sclerosis12,13

TSC1
and
TSC2

hypomelanotic skin macules, facial

angiofibromas, periungual fibromas,
delayed development and seizure

widespread hamartoma especially

in brain, angiomyolipoma

quadrant



hepatocellular carcinoma
(Caf Ole spots) neurofibromatosis
( 3-3) ( 3-4)
Peutz-Jeghers
(hermaphrodite)
seminoma
testicular

3-3
Caf au lait spot neurofibromatosis
5
15
6

10

2,4,14
1.
2.
3.
4.
5.
6.

(radiologic
intervention)

3-4
(circumoral melanosis)
Peutz-Jeghers

(plain abdominal radiographs)

( 3-5)

11

neuroblastoma Wilms tumor

teratoma

plain x-rays 2,4 neuroblastoma
50-65 teratoma 50 Wilms tumor 3-15

5 2
retroperitoneal mass
()

(chest x-rays)

Wilms tumor, sarcoma lymphoma

Wilms
plain film

(ultrasonography)

12

Wilms tumor inferior vena cava15
color Doppler
(gold standard)

neuroblastoma Wilms tumor

(functioning renal parenchyma)

(computerized tomography CT scan)

1
( 3-6)

Wilms tumor CT scans

16



sedation protocol
spiral CT scans

CT scan resectability

13

neuroblastoma

3-6 CT scan 4
() ()
hepatoblastoma
enhancement

CT scan with contrast ()

(Magnetic resonance imaging, MRI)

MRI axial, coronal sagittal
inferior vena cava,
mediastinum, spinal canal

intravenous pyelography IVP (,

) voiding cystourethrogram VCUG (

14

, )
approach IVP
Wilms tumor neuroblastoma
IVP

IVP
CT scans
IVP

VCUG
posterior urethral valve

upper GI study
duodenum GI follow-through Barium enema

hypertrophic pyloric stenosis, lymphoma
barium enema

(pneumatic reduction)
diagnostic angiography, inferior venacavography

(radioactive substance)

99mTc diethylenetrianminepentaacetic acid scan (DTPA scan)
(ureteropelvic junction

15

obstruction)
4-6 (glomerular filtration rate)
17 99mTc methylene diphosphonate (MDP scan, bone scan)
osteoblast 131I metaiodobenzyl guanide
scan (MIBG scan) pre-synaptic sympathetic analog
neuroblastoma pheochromocytoma
5

Tumor marker


urinary vanillylmandellic acid (VMA) homovanillic acid (HVA)
neuroblastoma 70-90 17 ( 1)
alphafetoprotein (AFP) 90 hepatoblastoma
50 hepatocellular carcinoma18 AFP
(liver
regeneration)
1
1 tumor marker
Catecholamine metabolites:
Catecholamine dopamine, norepinephrine
epinephrine
Norepinephrine dopamine dopaminergic noradrenergic neurons sympathetic chromaffin cells
epinephrine norepinephrine adrenal medulla
metabolism catecholamine homovanillic acid (HVA)
vanillylmandelic acid (VMA)
(screening)
sympathetic adrenal medulla neuroblastoma pheochromocytoma
catecholamine excretion function
24 creatinine
HVA VMA 35 20 mg/g

16

1 ()
creatinine 0.50-6.55 mg/g creatinine
HVA urine VMA
tricyclic antidepressant

70-90 neuroblastoma 24-hour urinary VMA

urine VMA

Eisenhofer G, Huynh T, Hiroi M, Pacak K. Understanding catecholamine metabolism as

a guide to the biochemical diagnosis of pheochromocytoma. Reviews in Endocrine & Metabolic
Disorders 2001;2:297-311
Tuchman M, Ramnaraine BS, Woods WG, Krivit W. Three years of experience with random
urinary homovanillic and vanillylmandelic acid levels in the diagnosis of neuroblastoma. Pediatrics
1987;79:203-205
Manimi P, Andreoli R, Cavazzini S, Bergamaschi E, Mutti A, Niessen MA. Liquid chromatography-electrospray tandem mass spectrometry of acidic monoamine metabolites. J Chromatogr B
2000;744:423-431
-fetoprotein (AFP):

AFP glycoprotein (yolk sac)

AFP exponential
50,000 ng/ml 20 ng/ml 6-8
AFP 98 hepatoblastoma
50-70 hepatocellular carcinoma germ cell tumor
yolk sac tumor AFP hepatitis
cirrhosis
hepatoblastoma embryonal histology AFP
fetal histology AFP hepatic epithelial tumor (hepatoblastoma hepatocellular carcinoma) fraction AFP Yolk sac tumor
Lens culinaris haemagglutinin

Ikeda H, Matsunaga T, Tsuchida Y. Hepatic tumors. in Voute PA, Barret A, Steven MCG,
Caron HN (eds) Cancer in Children: clinical management 5th edition, London, Oxford University
Press, 2005

17

germ cells tumor marker

embryonal cell carcinoma human chorionic gonadotropin (-HCG) AFP
malignant teratoma HCG, AFP carcinoembryonic antigen (CEA) endodermal sinus
tumor AFP choriocarcinoma HCG tumor marker ( 3-3)
(definite diagnosis)
/

(fine needle biopsy or core needle biopsy) ( 2)

(laparoscopic biopsy) ( 3-7)

small round blue cell

hematoxylin&eosin (H&E)

immunohistochemistry cytogenetics
fluorescent in situ hybridization
mRNA 19 3-4

RNA ultrafreezer
-80
neuroblastoma
urine VMA20,21

cellular processes with

microgranules, neurosecretory
granules, synaptic junctions

NSE, synaptophysin, chromagranin

TFE3 nuclear staining9

Pediatric renal cell

carcinoma

pools of glycogen, primitive

cytoplasm, neurosecretory
granules, processes

Neuroblastoma

CD99, synaptophysin, vimentin,

NSE, PAS stain for glycogen

PNET and EWS

thick and thin filaments,

Z bands

primitive cytoplasm, lack of

intercellular junctions

desmin, muscle actin, MyoD,

PAS stain for glycogen

Rhabdomyosarcoma

Small cell lymphoma CD45, CD45RO, CD20, CD3,

CD43, CD30

Immunohistochemistry

t(X;1)

1p deletions,
double minutes,
homogeneous
staining regions
(non specific)

t(11;22), t(21;22)

t(1;13), t(2;13)

Cytogenetics

PRCC;TFE3

MYCN amplification
(also seen in some
alveolar RMS)

FLI-1;EWS or
ERG;EWS

PAX3;FHKHR or
PAX3;FKHR

Molecular genetics

3-4 small round cell tumor

immunohistochemistry, cytogenetics RT-PCR
( 19)

18

19

2
(Core needle biopsy)
11-16 G
(biopsy gun)
(imaging guidance)

( 2 x 0.16 )

(heterogeneity) teratoma
(soft tissue or bone sarcoma)
(mitotic figure)

3-7 laparoscopic view 11

laparoscopy

Burkitts lymphoma22

1.

2.
(tissue plane)

20

2 ()
3.

4% paraformaldehyde

4.
(orientation)

Rosenberg SA. Principles of surgical oncology. in Cancer: Principle and practice of oncology,
7th ed. Philadelphia. JB Lippincort 2005

(multidisciplinary tumor
conference)
tumor conference

21

1. Taylor LA, Ross AJ. Abdominal mass. In: Walker WA, Durie PR, Hamilton JR, et al. Pediatric
gastrointestinal diseases: Pathology, Diagnosis, Management, 2nd edn. WB Saunders, 1996:
227-240.
2. Felson B, Jacobsen HG. A modern approach to the abdominal mass in children. Semin Roentgenol
1988;23:147-231.
3. Melicow MM, Uson AC. Palpable abdominal masses in infants and children: A report bases on
a review of 653 cases. J Urol 1959;81:705-710.
4. Stevenson RJ. Abdominal masses. Surg Clin North Am 1985;65:1481-1504.
5. Caron HN, Pearson ADJ. Neuroblastoma in Voute PA, Barret A, Steven MCG, Caron HN (eds)
Cancer in Children: clinical management 5th edition, London, Oxford University Press, 2005.
6. Weksberg R, Shuman C, Smith AC. Beckwith-Wiedemann syndrome. Am J Med Genet 2005;137:
12-23.
7. Smith AC, Choufani S, Ferreira JC, Weksberg R. Growth regulation, imprinted genes, and
chromosome 11p15.5. Pediatr Res 2007;61:43R-47R.
8. Mueller RF. The Denys-Drash syndrome. J Med Genet 1994;31:471-477.
9. Nakashima Y, Inayama Y, Kato Y, Sakai N, Kanno H, Aoki I, Yao M. Pathological and molecular
biological aspects of the renal epithelial neoplasms, up-to-date. Pathol Int 2004;54:377-386.
10. Schoemaker MJ, Swerdlow AJ, Higgins CD, Wright AF, Jacobs PA; UK Clinical Cytogenetics Group.
Cancer incidence in women with Turner syndrome in Great Britain: a national cohort study.
Lancet Oncol. 2008;9:239-246.
11. Plon SE, Malkin D. Childhood cancer and hereditary. in Pizzo PA, Poplack DG (eds) Principles and
practice of pediatric oncology 5th edition, Philadelphia, Lippincott William & Wilkins, 2006.
12. Narayanan V. Tuberous sclerosis complex: genetics to pathogenesis. Pediatr Neurol 2003;29:
404-409.
13. Curatolo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet 2008;372:657-668.
14. Pizzo PA, Hays DM, Horowitz ME, et al. Solid tumors of childhood. in: Devita VT, Hellman S,
Rosenberg SA. Cancer: Principle and practice of oncology, 7th ed. Philadelphia. JB Lippincort 2005.
15. Ritchey ML, Kelalis PP, Breslow N, et al. Intracaval and atrail involvement with neuroblastoma:
review of National Wilms Tumor Study 3. J Urol 1988;140:1113-1118.
16. Ditchfield MR, De Campo JF, Waters KD, et al. Wilms tumor: a rational use of preoperative imaging.
Med Pediatr Oncol 1995;24:93-96.
17. Keating MA, Mclaughlin KP. Kidney. in Oldham KT, Colombini PM, Foglia RP (eds) Surgery of
infants and children: scientific principles and practice, Philadelphia. Lippincort-Raven 1997.
18. Stocker JT. Hepatic tumors in children. Clin Liver Dis 2001;5:259-281.
19. Pappo AS, Parham DM, Rao BN, et al. Soft tissue sarcoma in children. Semin Surg Oncol 1999;16:
121-143.
20. Gitlow SE, Dziedzic LB, Strauss L, et al. Diagnosis of neuroblastoma by qualitative and quantitative
determination of catecholamine metabolites in urine. Cancer 1970;25:1377-1383.

22

21. Broder GN, Pritchard J, Berthold F, et al. Revision of the international criteria for neuroblastoma
diagnosis, staging and response to treatment. J Clin Oncol 1993;11:1466-1477.
22. Sangkhathat S, Domdee K, Chiengkriwate P, Patrapinyokul S. Diagnostic laparoscopy prevent
unnecessary laparotomy in selected cases of pediatric intraabdominal mass. Proceeding of the
annual scientific meeting of the Royal College of Surgeon of Thailand. 2005.

(concept)

2
85
1 150
2 93.0 (A)3

(A)

age-standardized incidence rate (ASR)

( 1-4 ) 8.5
( 5-15 )4 .. 2546 - 2550
0-14 547 5 ( 1-1)
carcinoma

retinoblastoma neuroblastoma
Wilms tumor (nephroblastoma) (rhabdomyosarcoma) epithelial tumor germ cell tumor
3,6 ( 1-1)

International Classification of Diseases

neuroblastoma, rhabdomyosarcoma germ cells
International Classification of Childhood Cancer (ICCC)
12 7 (
1-2) ICCC version 3
8
1-1 2546 - 2550
()

0-4
5-9
10-14
15-19

..2546

..2547

..2548

..2549

..2550

237
202
181
242

198
169
187
276

199
172
192
270

163
168
185
248

179
179
196
229

(: )

184.75
172
190
255.75

1-1

International Classification of Childhood Cancer

. ..
2001-2003 ( 10)
. .. 2003
( 12)

. .1987-1996
134 9 .. 2001-2003
166 10
104 80 11
5 9

acute lymphoblastic
leukemia (ALL) zA astrocytoma
(lymphoma) non-Hodgkin lymphoma (NHL)
Hodgkin disease
Neuroblastoma Wilms tumor (nephroblastoma) embryonal tumors

Wilms tumor
neuroblastoma11
retinoblastoma
hepatoblastoma hepatocellular carcinoma sarcoma

Great
Britain
(19871996)
Males Females Both
genders
I. Leukemias
35.5
27.5
43.1
II. Lymphomas
10.5
5.5
11.8
III. CNS and miscellaneous intracranial 15.2
13.5
31.3
and intraspinal neoplasms
IV. Neuroblastoma
13.3
9.1
9.6
V. Retinoblastoma
2.4
2.2
4.6
VI. Renal tumors
2.9
2.1
8.1
VII. Hepatic tumors
2.5
1.9
1.3
VIII. Malignant bone tumors
4.1
3.5
5.0
IX. Soft tissue and other extraosseous
5.1
3.8
9.7
sarcomas
X. Germ cell tumors, trophoblastic
5.2
5
4.4
tumors and neoplasms of gonads
XI. Carcinomas and other malignant
2.6
2.1
4.1
epithelial neoplasms
XII. Other and unspecified malignant
4.3
3.8
0.9
neoplasms
IXII 103.7
80.1
133.8 140.9
* 0-19 years, ** Ho-Chi-Minh City

Japan
(1993-2001)
US
(2001-2003)*
Vietnam
(1995-1997)**
Thailand
(2003)

8.4
3.2
6.1
2.1
10.0
12.9
13.1
11.8
0.6
157.1

12.0
3.9
9.3
1.5
5.6
9.6
4.8
2.7
0.6
174.3

93.3

1.0

22.1

8.1

8.2
2.8
7.1
1.7
7.8
10.8

83.3

4.8

2.6

3.7

2.0
9.1
3.1
1.5
0.9
4.4

86.9

5.3

3.6

6.5

2.6
4.1
2.0
0.8
1.2
7.1

72.1

0.2

1.2

2.7

4.3
5.6
2.7
2.2
2.8
4.7

0.0

0.7

1.8

5.1
2.7
2.6
2.6
1.9
2.4

Both Males Females Males Females Males Females

genders
45.1
47.2
37.0
35.7
33.1
43.7
41.5
15.1
27.8
20.3
13.7
7.4
9.2
3.5
30.4
31.0
27.4
11.8
9.8
7.6
7.5

Europe
(19931997)

1-2 (age-standardized incidence rate) 15 International

Classification of Childhood Cancer ( 2,5,9 11)

Wilms tumor

9-11

aged-standardized
incidence rate

(Thai Pediatric Oncology Group)

20 12


( 1-2)
Wilms tumor
( 1-3)

1.
13

90 1
2.
1
3. hepatocellular carcinoma
B
14,15 age-standardized incidence rate hapatocellular
carcinoma 10 10 0.88
0.07 Kaposis sarcoma
human immunodeficiency
virus

4.

1

5. hepatoblastoma
(very low birth weight) 16,17
1,500 (relative risk)
hepatoblastoma 25-50 2,500 18,19

1-3 (age-standardized incidence rate)

15 (
)

(1988-1992) (1983-1992) (1985-1992) (1990-1993)

I. Leukemias
II. Lymphomas
III. CNS and miscellaneous intracranial
and intraspinal neoplasms
IV. Neuroblastoma
V. Retinoblastoma
VI. Renal tumors
VII. Hepatic tumors
VIII. Malignant bone tumors
IX. Soft tissue and other extraosseous
sarcomas
X. Germ cell tumors, trophoblastic
tumors and neoplasms of gonads
XI. Carcinomas and other malignant
epithelial neoplasms
XII. Other and unspecified malignant
neoplasms
IXII

35.0
9.8
8.2

24.8
7.7
12.4

28.2
7.6
11.8

26.6
5.5
7.6

3.9
4.7
4.0
1.9
2.1
4.4

2.6
3.7
0.9
2.2
1.5
1.7

1.2
4.6
3.7
1.9
2.0
2.7

3.0
3.8
2.4
1.3
2.5
2.8

3.0

1.7

2.0

2.0

3.1

2.6

1.4

1.9

4.5
84.7

1.7
63.7

3.4
70.6

5.1
64.5

embryonal tumor neuroblastoma,

hepatoblastoma, nephroblastoma rhabdomyosarcoma
(differentiating tissue) (blast cells)

Beckwidth-Wiedemann hepatoblastoma Wilms tumor ( 3-2
3) Li-Fraumani adrenocortical carcinoma

neuroblastoma
20
acute leukemia 21

papillary leukemia 22
papillary
23
papillary thyroid carcinoma
9 24

Ebstein-Barr virus Burrkit lymphoma,

Hodgkin disease nasopharyngeal carcinoma,
hepatocellular carcinoma, human immunodeficiency virus Kaposis
sarcoma9

TP5325


acute lymphoblastic leukemia 2-5 dysregulated immune
response26

(concept)

5 (5-year survival) 1990s 75
1960s 28% 90
leukemia lymphoma germ cell Wilms tumor

National Wilms tumor study ..196927,28

NWTS

(multidisciplinary care and centralization)



(protocol)

(centralization)29
(risk-based management)


27,30


Wilms tumor
(evidence based medicine)

immunohistochemistry,
mRNA
small round blue cell
(H&E)31

MYCN amplification
neuroblastoma32
(gene therapy)33 tumor vaccine
1 34,35
(supportive
and palliative cares)

36,37



recombinant human erythropoietin granulocyte colony-stimulating factor 38,39 cytoprotective
drug mesna platinum40
dexrazoxane anthracyclines41


42

43

pulmonary fibrosis,

alkylating agents44

10

fairly tale

45 Ribero
( 1-2)

( 1-3)

46
37

disease related guarantee

2-1 Pearsons correlation

(government health-care expenditure) $US
( 47)

11

3-1 ( 1)

0 1 47 25-30

body
cavity
8 10

immunohistochemistry 47
1

12

Pediatric Oncology
Group International Study of Pediatric Oncology

(protocol)


48

outreach program St Jude Childrens Research Hospital
Twinning program
My Child Matters Program 47

80
49

50


(gross domestic product)51
1,51

1-4

National Cancer Institutes

Surveillance, Epidemiology and End Results (SEER) [http://www.seer.cancer.gov]
Automated Childhood Cancer Information System Project
(ACCIS) [http://www-dep.iarc.fr/accis.htm]

13

Cancer Research UK
[http://info.cancerresearchuk.org/cancerstats/childhoodcancer/]
population based Thai Pediatric Oncology
Group [http://www.nci.go.th/]

[http://medinfo2.psu.ac.th/cancer/]
1-4
( 52)
Phase ()

(pilot project)

(pediatric cancer unit)

(twinning
program)

(center of excellence)

(satellite centers)

Regional program

National program

14

Footnotes
1.
2.
3.
4.

Table I-1 (http://seer.cancer.gov/csr/1975_2005/results_single/sect_01_table.01.pdf)

All Sites Section (http://seer.cancer.gov/csr/ 1975_2005/results_merged/ sect_02_all_sites.pdf)
Table I-11 (http://seer.cancer.gov/csr/1975_2005/results_single/sect_01_table.11_2pgs.pdf)
Table I-13 (http://seer.cancer.gov/csr/1975_2005/results_single/sect_01_table.13_2pgs.pdf)
* The APC is significantly different from zero (p<.05).
a. Incidence data for Hispanics is based on NHIA and excludes cases from Alaska Native Registry
and Kentucky. Hispanic death rates exclude deaths from Minnesota, New Hampshire and
North Dakota.
b. Incidence and mortality data for American Indians/Alaska Natives is based on the CHSDA
(Contract Health Service Delivery Area) counties.
Definitions:
Annual percent change (APC)
: The average annual percent change over several years. The APC is used to measure trends or
the change in rates over time. For information on how this is calculated, go to Trend Algortihms
in the SEER*Stat Help system. The calculation involves fitting a straight line to the natural
logarithm of the data when it is displayed by calendar year.
Joinpoint analyses
: A statistical model for characterizing cancer trends which uses statistical criteria to determine
how many times and when the trends in incidence or mortality rates have changed. The results
of joinpoint are given as calendar year ranges, and the annual percent change (APC) in the rates
over each period.
Survival rates
: Survival examines how long after diagnosis people live. Cancer survival is measured in a
number of different ways depending on the intended purpose.
Relative survival rate
: A measure of net survival that is calculated by comparing observed (overall) survival with
expected survival from a comparable set of people that do not have cancer to measure the
excess mortality that is associated with a cancer diagnosis.
Stage distribution
: Stage provides a measure of disease progression, detailing the degree to which the cancer
has advanced. Two methods commonly used to determine stage are AJCC and SEER historic.
The AJCC method (see Collaborative Staging Method) is more commonly used in the clinical
settings, while SEER has standardized and simplified staging to ensure consistent definitions
over time.
Lifetime risk
: The probability of developing cancer in the course of ones lifespan. Lifetime risk may also
be discussed in terms of the probability of developing or of dying from cancer. Based on cancer
rates from 2003 to 2005, it was estimated that men had about a 44 percent chance of
developing cancer in their lifetimes, while women had about a 37 percent chance.
Probability of developing cancer
: The chance that a person will develop cancer in his/her lifetime.
Prevalence
: The number of people who have received a diagnosis of cancer during a defined time period,
and who are alive on the last day of that period. Most prevalence data in SEER is for limited
duration because information on cases diagnosed before 1973 is not generally available.

15

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