Paediatrics: Oncology Clinical examination

Clinical examination

Thorough general examination including:

·  All lymph node stations: neck, axillae, inguinal regions.

·  Skin: assess pallor, petechiae, bruising, mucosal bleeding, signs of infection.

·  Masses: measure dimensions of any mass and organomegaly.

·  If leukaemia/lymphoma suspected, assess testes for swelling and optic fundi.

Specific diagnoses or concerns may be indicated by the following findings.

Lymphadenopathy

Malignancy accounts for a small proportion of cases of persistent lymphad-enopathy in children. Possible diagnoses include acute leukaemia, non-Hodgkin’s lymphoma, Hodgkin’s disease, metastases from neuroblastoma or sarcoma.

Features of enlarged lymph node that should raise concern

·  Diameter >2cm

·  Persistent or progressive enlargement

·  Non-tender, rubbery, hard, or fixed

·  Supraclavicular or axillary position

·  Associated with other features, e.g. pallor, lethargy

·  Hepatosplenomegaly

Unexplained mass—at any site

The following features should raise suspicion of malignancy:

·  Non-tender.

·  Progressive enlargement.

·  Diameter >2cm.

·  Associated lymphadenopathy.

Neurological signs

The following should raise suspicion of a brain tumour:

·  Cranial nerve deficits from direct tumour involvement.

·  False localizing signs: III and VI nerve palsies (mass effect from raised

·  Cerebellar signs (e.g. ataxia).

·  Visual disturbances or abnormal eye movements: field and/or acuity defects (optic tract and suprasellar tumours); Parinaud’s syndrome (paralysis of upward gaze) suggests pineal tumour.

·  Abnormalities of gait.

·  Motor or sensory signs.

·  Behavioural disturbances.

·  Deteriorating school performance or neurodevelopmental milestones.

·  Unexplained focal seizures.

Increasing head size (infants).