Paediatrics: Oncology Clinical assessment: history

Clinical assessment: history

Include specific questions about:

·Fevers, night sweats, anorexia, weight-loss, pallor, bruising and abnormal bleeding.

·Family history, including malignancy and inherited conditions.

Also be aware that childhood malignancy may present with a variety of clinical features and so special attention should be paid to the following.

Respiratory symptoms

New episode of wheeze (usually monophonic and fixed) may be caused by intrathoracic mass. Treatment with oral steroids, based on a presump-tive diagnosis of asthma, may lead to partial response in symptoms and therefore delay the diagnosis of leukaemia or lymphoma involving medias-tinal lymphadenopathy compressing the airways.

Bone and joint pain/swelling

Persistent back pain should not be dismissed as innocent in children. It may refl ect bone pain of bone marrow expansion (leukaemia or bone marrow metastases) or a spinal tumour.

Abdominal mass

May be:

·Painless and isolated (e.g. Wilms’ tumour, ovarian teratoma).

·Associated with general malaise (e.g. B-cell lymphoma, neuroblastoma).

·Pelvic (e.g. rhabdomyosarcoma).

Raised intracranial pressure

The most common presenting features of brain tumours are:

·Headache (typically on waking).

·Vomiting.

·Ataxia.

·Papilloedema.

·Deteriorating conscious level.

Growth and endocrine disturbances

Midline CNS tumours may result in disturbance in the hypothalamic– pituitary hormone axes and present with:

·Poor feeding or failure to thrive (diencephalic syndrome).

·Polyuria and polydipsia (diabetes insipidus).

·Poor growth and short stature (growth hormone deficiency).

·Hypoglycaemia (ACTH deficiency).