Condition
Association
Genetic abnormalities, including:
Down syndrome
Acute myeloblastic leukaemia
Beckwith-Wiedemann
Wilms tumour, hepatoblastoma
Fanconi anaemia
Acute myeloblastic leukaemia
Immunodeficiency, including:
All conditions (congenital and acquired)
Lymphoma
HIV
Non-Hodgkin’s lymphoma, Kaposi sarcoma
Congenital malformations, including:
Aniridia (absent iris), hemi-hypertrophy
Wilms tumour
Neurocutaneous syndromes, including
Benign and malignant tumours, e.g. sarcoma, optic glioma and other brain tumours
Neurofibromatosis
Previous malignancy and treatment with chemotherapy and radiotherapy
Osteogenic sarcoma, leukaemia, brain tumour, etc.
Sibling with a malignancy
e.g. retinoblastoma
Cirrhosis
Hepatocellular carcinoma
Cryptorchidism
Testicular germ cell tumour
Recognizing the “Red Flag Signs” of Childhood Cancer
The majority of childhood cancers present with some distinguishing signs that can alert the clinician to such a diagnosis. Although many of these signs and symptoms are not exclusive to childhood cancer, it is still essential to consider malignancy in the differential diagnosis. Symptoms that should raise suspicion are summarized in Table 6.2.
Table 6.2
Symptoms and signs raising suspicion of childhood cancer
General symptoms | Unexplained fever, fatigue, listlessness, nausea, loss of appetite, weight loss, night sweats |
Haematological malignancies | Pallor, fatigue, fever, recurrent infections, bone pain, refusal to walk, epistaxis, easy bruising, petechiae, lymphadenopathy, abdominal distension, mass at any site |
Abdominal solid tumours | Change in bowel habits (often constipation), vomiting, hypertension, abdominal pain, abdominal distension, abdominal mass, haematuria |
Neurological malignancies | Change in temperament, regression of milestones, abnormal balance (ataxia), signs of raised intracranial pressure (progressive headache, vomiting (especially early morning), altered level of consciousness, bulging fontanelle, increasing head circumference), double vision, new-onset squint, convulsions, focal neurological abnormality |
Ophthalmological malignancy | Leukocoria, new-onset squint, proptosis, visual disturbance |
Bone tumours | Swelling or mass, persistent pain, pathological fracture |
Soft tissue tumours | Masses at any site |
Neuroblastoma | Pallor, hypertension, lymphadenopathy, Horner syndrome, raccoon eyes, bony masses, abdominal mass, petechiae, ecchymoses, opsoclonus myoclonus, watery diarrhoea |
Campaigns Targeting Early Warning Signs of Cancer in Children
Many international organizations promote awareness of childhood cancer. The International Confederation of Childhood Cancer Parent Organizations (ICCCPO) and the International Society of Paediatric Oncology (SIOP) raised awareness in 2013 through the campaign and slogan: “Early detection…making a difference”. These and other campaigns have led to many checklists or awareness acronyms being designed to assist in recognizing early warning signs. One example is “CHILD CANCER” which is endorsed by the Union for International Cancer Control (UICC) and the SIOP (Table 6.3).
Table 6.3
Child cancer (acronym)
C | Continued, unexplained weight loss |
H | Headaches, often with early morning vomiting |
I | Increased swelling or persistent pain in the bones, joints, back or legs |
L | Lump or mass, especially in the abdomen, neck, chest, pelvis or armpits |
D | Development of excessive bruising, bleeding or rash |
C | Constant infections |
A | A whitish colour behind the pupil |
N | Nausea that persists or vomiting without nausea |
C | Constant tiredness or noticeable paleness |
E | Eye or vision changes that occur suddenly and persist |
R | Recurring or persistent fevers of unknown origin |
Another example is the Saint Siluan warning signs list used in South Africa [11, 12] (Table 6.4). The list consists of easily recognizable symptoms and signs arranged according to the mnemonic: SILUAN after Saint Silouan the Athonite, a Russian Orthodox monk.
Table 6.4
Saint Siluan warning signs
S | Seek medical help early for persistent symptoms |
I | Eye: white spot in the eye (leukocoria), new squint, new blindness, bulging eyeball |
L | Lump: abdomen and pelvis, head and neck, limbs, testes, glands |
U | Unexplained: prolonged fever over 2 weeks, loss of weight, pallor, fatigue, easy bruising or bleeding
Related posts: Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
|
