Childhood Cancer

Childhood Cancer

·        Cancer: 10% of childhood deaths, most common cause of death after accidents Þ have high index of suspicion

·        Distribution:

·        Signs and Symptoms:

o  Often non specific 

o  Adult symptoms rare, eg epistaxis, dysphagia, non healing lesion, rectal bleeding, change in bowel habit

o  Para-neoplastic syndromes are rare

·        Headaches warranting investigation.  Headaches are common, but watch out for:

o  Recurrent morning headaches

o  One that awakens the child

o  Intense and incapacitating

o  Headaches that change in quality, frequency and pattern (eg getting more frequent)

o  Focal signs or ataxia

o  MRI more sensitive than CT

·        Lymphadenopathy:

o  Common finding in cervical, axillary and inguinal chains. Usually < 1 cm

o  Most enlarged nodes are due to infection

o  Suspicious if found in mediastinum, posterior auricular, epitrochlear and supraclavicular

·        Bone and Joint Pain:

o  Early symptoms rarely include pain – except in bone (bone cancer and malignancy) 

o  Usually no pathognomic signs on Xray ® need biopsy

·        Pancytopaenia:

o  Common finding in ALL and AML 

o  Need neutrophil count specifically.  ­Lymphocytes may mask ¯neutrophils.

o  From 6 months to puberty, anaemia is 110 g/L.  50% of leukaemia presents with Hb < 75 g/L 

o  Involvement of two or more lines ® bone marrow evaluation

·        Leukocytosis: Common in AML and ALL. But count may get up to 50,000 with septicaemia and some viruses, also in Down syndrome and post-natal

·        Presenting signs of cancer:

o  Recurrent bone pain, paleness, weight loss: leukaemia

o  Morning headache with vomiting: brain tumour (usually a migraine)

o  Lump in neck not responsive to antibiotics: Lymphoma

o  White dot in new born eye: Retinoblastoma

o  Proptosis (bulging eye): Leukaemia, neuroblastoma

o  Swollen face and neck: lymphoma, leukaemia (compression of veins)

o  Abdominal mass: Wilm‟s, neuroblastoma, liver & spleen enlargement in leukaemia

o  Cough, stridor, haemoptasis, Horner‟s: Mediastinal tumour

·        Diagnosis: tumour markers (only in neuroblastoma: catecholamine), imaging, bone scan, biopsy