Long-term childhood cancer survivors are at great risk of developing late adverse effects after treatment, such as, reduced growth, obesity, decreased fertility, high blood pressure, cardiovascular diseases, impaired glucose, another form of cancer, among others organ dysfunctions, some of them are part of the metabolic syndrome. Metabolic syndrome and cancer connection is still not entirely understood, but there are some notions about it. Metabolic alterations produced during childhood cancer are more likely determined by treatments like radiotherapy, chemotherapy, glucocorticoids therapy, and surgery. Cancer treatment is associated to vascular alterations, hormone deficiencies, changes in insulin sensitivity, lipid metabolism, and inflammatory mediators. Obesity has been considered a crucial component in metabolic syndrome; obesity risk factors during childhood cancer include cranial radiation, female gender, and exposure to glucocorticoids such as dexamethasone. In addition, local radiotherapy or surgery may cause endocrine deficiencies, depends on the directly damage of endocrine organs. Patients who received some types of cancer treatment should be evaluated periodically to early diagnostic metabolic disorders associated to antineoplastic therapy.

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Acute lymphoblastic leukemia is the most important childhood cancer. Multidrug resistance is an important factor of poor prognosis. We present the P-glycoprotein (P-gp) activity in 2 patients with different outcomes. Both patients had B-cell acute lymphoblastic leukemia; they were responding properly to the treatment, but one of them had an increment in the P-gp activity that correlates with an increment in the disease manifestation, the patient had to be hospitalized and developed sepsis and subsequently died. P-gp levels were correlated with disease progression. P-gp activity needs to be evaluated during treatment to assess and prevent disease relapse or the patient´s death.

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Introduction: At present, in the world, there are approximately 360,000 children with cancer, many of them without social security in developing countries. Materials and methods: In this study, a retrospective analysis was performed of medical records from subjects younger than 21 years of age with cancer who live in extreme poverty and lack social security. The main purpose was to identify a pediatric cancer distribution pattern in the state of Puebla, Mexico, as well as sociodemographic characteristics and main types and incidences of disease. Results: A total of 406 medical records were reviewed; 4 years was the age with the highest rate of diagnosis, and male gender was predominantly affected. The most commonly found malignancy was acute lymphoblastic leukemia, followed by germ cell tumors and acute myeloblastic leukemia, with histiocytosis abnormal behavior also being found. Conclusions: These data are useful for health systems to detect municipalities with higher incidence and this way creates alerts for earlier diagnosis of the disease and thereby increases children survival. (creativecommons.org/licenses/by-nc-nd/4.0/).