Patterns Of Presentation Flashcards
What is the problem with the diagnosis of cancer?
Early symptoms of cancer in children are often non-specific and easily explained by more common illnesses, which can lead to delayed diagnosis
When should children undergo further investigation or referral for cancer?
Repeat attendance without a unified diagnosis
What is an important component of the history in suspected cancer?
Developmental review
Why is developmental review important in suspected cancer?
Loss of previously attained developmental milestones in a young child, and changes in school performance in an older child, may be the only indicators of a spinal cord compression or underlying brain tumour
What are the common patterns of presentation in children with malignancy?
- Pancytopenia
- Lymphadenopathy/unexplained mass
- Respiratory symptoms
- Bone/joint pain and swelling
- Abdominal mass
- Raised ICP
- Neurological signs
- Endocrine or systemic disturbances
What causes pancytopenia in malignancy?
Displacement of marrow by leukaemia or disseminated malignancy
What are the clinical features of pancytopenia?
- Pallor/lethargy due to low haemoglobin
- Recurrent fever/infection due to low white count
- Bruising and/or petechiae due to low platelets
What features of lymphadenopathy are suspicious of malignancy?
- Lymph node with diameter greater than 2cm
- Non-tender, rubbery, hard or fixed in character
- Supraclavicular or auxiliary location
- Associated with other features, e.g. pallor or lethargy or hepatosplenomegaly
- Systemic symptoms, e.g. fever, weight loss, night sweats
What are the respiratory symptoms suspicious of malignancy?
- Orthopnoea
- Reduced air entry
Why is orthopnoea a feature suspicious of malignancy?
It is suggestive of intrathoracic mass
What should be considered when there is reduced air entry with suspected malignancy?
- Pleural effusion
- Tumour bulk
What features of bone pain are suspicious of malignancy?
- Persistent back pain
- Night pain
- Reluctance to weight-bear, or limp
What might cause bone pain and joint swelling in malignancy?
- Bone marrow infiltration with leukaemia
- Mets
- Spinal tumour or impending/actual spinal cord compression
What are the features suspicious of malignancy with abdominal masses?
- Association with general malaise
- Hypertension
What malignancy can cause abdominal mass associated with general malaise?
Neuroblastoma
What is the association between an abdominal malignancy and hypertension?
Can occur secondary to compression of the renal vasculature in Wilms’ tumour or neuroblastoma
When might an abdominal mass be a painless and isolated finding in malignancy?
Wilms tumour
What a re the clinical features of raised ICP?
- Headache, especially if associated with vomiting or ataxia
- Papilloedema
- III and VI CN palsies
What is the classical feature of a headache caused by raised ICP?
Upon waking (but timing can be non-specific)
What is the limitation of papilloedema as a sign of raised ICP?
It is a late sign
What neurological signs are suspicious for malignancy?
- Cranial nerve deficits or cerebellar signs, including head tilt
- Visual disturbances or abnormal eye movements
- Behaviour change, deteriorating school performance, or developmental regression
- Increasing head circumference in infants
What are the endocrine signs that are suspicious of malignancy?
- Diabetes insipidus
- Growth hormone deficiency
- Precocious puberty
What are paraneoplastic phenomena?
Symptoms that are not directly attributable to the tumour, but arise as part of the bodies response to the disease
Are paraneoplastic syndromes common in paediatrics?
No, they are rare
What is the best example of paraneoplastic phenomena in paediatric malignancy?
Opsoclonus-myoclonus-ataxia syndrome (dancing eyes) in neuroblastoma
