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Signs & symptoms of childhood cancer

Signs & symptoms of childhood cancer

Regional red flags

  • Childhood cancer is one of the most common causes of death of children in the UK.
  • It is not as rare as we may think with 1 child in every 450 receiving a diagnosis by their 15th birthday.
  • The average GP surgery would expect to see a case of cancer in a child or young person approximately every 1.8 years.
  • The average practicing GP would expect to see a case of childhood cancer just under every 11 years, meaning they may see 3 or 4 cases in a career.

Be aware in particular of:

  • Children presenting with two or more red flag symptoms or one red flag and other features of concern.
  • Three or more presentations for the same problem (consider referral).
  • Marked parental concern or repeated attendance.
  • New neurological symptoms.
  • Unusual or worsening symptoms despite intervention.

Emergency presentations

Symptoms to be aware of that are a medical emergency and need immediate emergency admission in children with cancer.

  • Spinal cord compression.
  • Symptoms of cauda equina. Although rare in children, it can and does happen in some children with cancer.
  • A child with shortness of breath and marked lymphadenopathy. They may have a mediastinal mass causing the shortness of breath and they can deteriorate quickly with airway obstruction.
  • Occasionally children with ALL may present with DIC, leukostasis or tumour lysis syndromes but these are less likely to be missed because the child is usually acutely so unwell.

How can we identify these children out of those presenting with symptoms of normal childhood illnesses?

 Look for:

  • Symptoms that are persistent, unusual or worsening, for example well localised pain that wakes a child up from sleep.
  • Recurrent attendances ( Three or more reattendances thought to increase the chance of a cancer diagnosis up to tenfold – Dommet et al).
  • Parental anxiety out of keeping with normal consulting behaviours of the family.
  • For more information see NICE Guidance: Suspected cancer: recognition and referral.
  • For an information summary, see NICE endorsed resource by the CCLG:  Referral guidance for suspected cancer in children and young people.
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