A Brief Synopsis of AFPs "Signs and Symptoms of Childhood Cancer: A Guide for Early Recognition"

Signs and Symptoms of Childhood Cancer: A Guide for Early Recognition
IOANNA FRAGKANDREA, MD, PhD, The Royal Marsden Hospital, Sutton, London, United Kingdom JOHN ALEXANDER NIXON, MD, Epsom and St. Helier NHS University Hospital, Sutton, London, United Kingdom PARASKEVI PANAGOPOULOU, MD, MPH, PhD, Panagiotis and Aglaia Kyriakou Children’s Hospital, Athens, Greece
Am Fam Physician. 2013 Aug 1;88(3):185-192.
http://www.aafp.org/afp/2013/0801/p185.pdf

     childhood cancer is oftentimes a delayed diagnosis because most of the signs and symptoms are nonspecific and are more common in other diseases. Thus, cancer should always be in back of your mind when symptoms don't resolve appropriately. Common symptoms of adult cancer are rare in childhood cancer. Common red flags in childhood cancer include fever, pallor, fatigue, malaise, anorexia, weight loss, lymphadenopathy, hemorragia, headaches, and many more. Prolonged fever of unknown origin can be associated with lymphoma or leukemia. Night sweats, fever, and weight loss (B symptoms) are seen in Hodgkin lymphoma. Lymphadenopathy that does not resolve should be evaluated with further tests, including CBC, differential, ESR, and a chest x ray. Headaches that occur in the morning, at night or that awake the child are suspicious. Accompanied symptoms include vomiting,  irritability, lethargy or developmental delay.
     GI symptoms that may be cancerous include an abdominal mass or new onset constipation.  A mass should be assessed with an ultrasound to rule out neuroblastoma or nephroblastoma. Constipation that does not respond to treatment could be an obstruction or spinal cord lesion. Diarrhea may be associated with leukemia, lymphoma, or VIPoma.
     Bone pain associated with cancer may occur at night or awaken the child. A bone tumor may have associated swelling or deformity. An x ray, CRP, CBC and blood smear will help with the diagnosis. Hematuria may be due to a renal tumor or sarcoma if more common causes are ruled out. Other symptoms include vaginal bleeding, scrotal mass, nonproductive cough, dyspnea, gingival swelling or bleeding.
     Patients with eye symptoms can get a fundoscopic exam to look for abnormalities which include malignancy. Paraneoplastic syndromes are more common in adults, but are seen in wilms tumor and neuroblastoma.
    Medical conditions which may preclude children to malignancy include down syndrome, gardner syndrome, WAGR syndrome, Turner syndrome, von Hippel Landau, SCID, Li-Fraumeni syndrome, xeroderma pigmentosum among many many others.