A six-year-old child has been admitted in paediatric medical ward as a case of malignant tumour. Which one of the following is the most common in the above age group?

1. A

   Acute myeloid leukaemia

2. B

   Juvenile myelomonocytic leukaemia

3. C

   Acute lymphoblastic leukaemia

4. D

   Chronic myeloid leukaemia

Appeared in: ESIC Nursing Officer-7July 2024

Explanation

• Acute Lymphoblastic Leukaemia (ALL) is the most prevalent cancer in children, representing about 75-80% of all paediatric leukaemia cases.
• The peak incidence for ALL occurs between the ages of 2 and 5 years. A six-year-old child falls very close to this peak age range, making ALL the most statistically likely diagnosis.
• In contrast to adult populations where myeloid leukaemias are more common, the lymphoblastic variety is overwhelmingly more frequent in children.

Why Other Options Were Wrong

• Option A: Acute Myeloid Leukaemia (AML) is the second most common type of leukaemia in children, but it is significantly less common than ALL, accounting for only 15-20% of cases.
• Option B: Juvenile Myelomonocytic Leukaemia (JMML) is a very rare malignancy, making up less than 2% of childhood leukaemias. It primarily affects infants and very young children, typically under the age of 5.
• Option D: Chronic Myeloid Leukaemia (CML) is extremely rare in young children, accounting for only 2-3% of all paediatric leukaemias.

Related Visual

• Visual 1: Pie Chart - A chart illustrating the relative percentages of different types of leukaemia in the paediatric population (ALL vs. AML vs. CML/JMML/Other) to visually emphasize the prevalence of ALL.
• Visual 2: Age Distribution Graph - A bar graph showing the incidence of ALL, AML, and CML across different childhood age groups (0-2, 3-5, 6-10, 11-15) to highlight the peak incidence of ALL in early childhood.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Epidemiology of childhood cancers, specifically leukaemia as background academic context rather than a clinical decision trigger.
• For a nurse, knowing the most common childhood cancers based on age is crucial for anticipatory guidance, initial assessment, and understanding the rationale behind diagnostic workups.
• A key nursing priority for any child with suspected leukaemia is implementing infection and bleeding precautions immediately, as bone marrow failure leads to neutropenia and thrombocytopenia.
• What if the child was 16 years old? The differential diagnosis would shift. While ALL is still common, the incidence of AML and CML increases significantly in adolescents, making them stronger possibilities.

How to Approach the Question

• First, identify the key information in the question stem: the patient's age ('six-year-old') and the question's core task ('most common' malignant tumour).
• Recognize that the options are all types of leukaemia, a common category of childhood malignancy.
• Access your knowledge of paediatric oncology epidemiology. Recall which type of leukaemia has the highest incidence in the early school-age demographic.
• Compare the peak incidence ages for each type of leukaemia. ALL peaks at 2-5 years, AML is more common in infants/teens, JMML in infants, and CML in adolescents.
• Conclude that for a six-year-old, ALL is by far the most statistically probable diagnosis among the choices.

Concept Tested & Keywords

• Concept Tested: Epidemiology of childhood cancers, specifically leukaemia.
• Stem keywords: six-year-old child, paediatric medical ward, malignant tumour, most common
• Lead-in keywords: Which one of the following
• Clinical cues: Age (six-year-old) is a key factor in determining the most common type of cancer.

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