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.
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.
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.
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).
The most common presenting
features of brain tumours are:
·Headache (typically on waking).
·Vomiting.
·Ataxia.
·Papilloedema.
·Deteriorating conscious level.
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).
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