Summary of presenting signs and symptoms of childhood cancer

Symptoms/signs	Initial evaluation may include	Associated malignancies
Common presenting signs and symptoms
Constitutional symptoms: Unexplained fevers Unexplained weight loss Unexplained fatigue/pallor	Laboratory tests (CBC with differential, serum electrolytes, BUN, creatinine, LDH, uric acid, liver function tests) Microbiologic tests Imaging studies	Any malignancy
Neurologic symptoms: Early morning headaches and vomiting Cranial nerve palsies Papilledema Afebrile seizures Ataxia Focal motor deficits	Neuroimaging Neurosurgery consultation	Brain tumor
Lymphadenopathy unresponsive to antibiotics	Laboratory tests (CBC with differential, CRP, LDH) Microbiologic tests Chest radiograph	Leukemia Lymphoma
Musculoskeletal symptoms: Bone pain Limp/refusal to walk Soft tissue mass	CBC with differential Imaging studies	Ewing sarcoma Leukemia Neuroblastoma Osteosarcoma Soft tissue sarcoma
Unexplained cough or shortness of breath	Chest radiograph	Mediastinal tumors Metastatic tumors Soft tissue sarcomas
Abdominal or pelvic mass	Laboratory tests (CBC with differential, serum electrolytes, BUN, creatinine, liver function tests, urinalysis) Abdominal/pelvic imaging	Adrenal tumor Germ cell tumor Hepatoblastoma Neuroblastoma Rhabdomyosarcoma Soft tissue sarcoma Wilms tumor
Petechiae, bruising, or other bleeding symptoms	CBC with differential Coagulation studies	Leukemia Lymphoma Neuroblastoma
Eye findings: Leukocoria Proptosis Acute vision loss Double vision Intraorbital hemorrhage	Ophthalmologist consultation	Brain tumors Metastatic rhabdomyosarcoma Neuroblastoma Retinoblastoma
Other less common presenting features
Facial and neck swelling	Laboratory tests (CBC with differential, serum electrolytes, BUN, creatinine, liver function tests, urinalysis) Chest radiograph	Mediastinal tumors
Pharyngeal mass	Laboratory tests (CBC with differential) Imaging studies Otolaryngology consultation	Lymphoma Nasopharyngeal carcinoma Rhabdomyosarcoma
Dental issues: Periodontal mass Loose teeth	Dental consultation Imaging studies	Burkitt lymphoma Langerhans cell histiocytosis Neuroblastoma Osteosarcoma
Endocrine abnormalities: Growth failure Abnormalities in sexual maturation Salt imbalance Cushing syndrome	Endocrine consultation Laboratory testing (hormone levels, stimulation tests) Imaging studies	Adrenal tumors Gonadal tumors Pituitary or hypothalamic tumors
Thyroid nodules	Endocrine consultation Laboratory testing (thyroid function tests) Neck ultrasound	Thyroid cancer
Hypertension	Laboratory tests (serum electrolytes, BUN, creatinine, urinalysis) Renal ultrasound	Neuroblastoma Renal or adrenal tumor

This table summarizes some of the presenting signs and symptoms associated with childhood cancer. Childhood cancer may present with signs and symptoms that are shared by other childhood illnesses. Although a single finding in isolation does not always require evaluation for cancer, a combination of multiple findings (eg, unexplained weight loss, bone pain, and lymphadenopathy; easy bruising, abnormal blood counts, and hepatosplenomegaly) is worrisome and generally warrants evaluation for malignancy. In addition, certain findings are worrisome even as isolated findings (eg, abdominal or mediastinal masses, headaches associated with vomiting in the morning, blasts on the peripheral blood smear) and require prompt evaluation and consultation. For additional details, refer to UpToDate's topic on the presenting signs and symptoms of childhood cancer and topics on specific malignancies.

CBC: complete blood count; BUN: blood urea nitrogen; LDH: lactate dehydrogenase; CRP: C-reactive protein.

Graphic 131813 Version 1.0

خرید پکیج

Summary of presenting signs and symptoms of childhood cancer