Solid tumours in children

Question 1

Signs of childhood cancer

Answer 1

Continued unexplained weight loss
Headaches often with early morning vomiting
Increased swelling or persistent pain in bones, joints, back or legs
Lump or mass, especially in the abdomen, neck, chest pelvis or armpits
Development of excessive bruising, bleeding or rash
Constant infections
A whites colour behind the pupil
Nausea which persist or vomiting without nausea
Constant tiredness or noticeable paleness
Eye or vision changes occurring suddenly and persist
Recurrent persistent fevers of unknown origin

Question 2

Warning signs of cancer in children

Answer 2

Seek - medical help for persistent symptoms
I eye - white spot, bulging eye, blindness
Lump - abdomen and pelvis, head and neck, testes, gland, limbs
Unexplained - fever, loss of weight and appetite, pallor and fatigue
Aching - bones, back, joints and easy fractures
Neurological signs - change in behaviour, balance, gait and milestones

Question 3

CNS tumours

Answer 3

2nd most common childhood after leukaemia
usually posterior fossa tumours - do MRI
Clinical presentation
- non specific signs
early morning headaches, N + V - raised ICP
cerebellar ataxia - change in gait, writing
pyramidal tract signs
cranial nerve palsies
acute onset strabismus
associated genetic syndromes
- neurofibromatosis
- tuberous sclerosis

Question 4

Neuroblastoma

Answer 4

Develop in the SNS
commonly in the adrenal gland
can arise anywhere along the sympathetic neural chain
highly aggressive

weight loss
bone pain
dairrhoea
abdominal tumour

diagnosis
CT scan
increased urinary levels of catecholamines HVA and VMA
NSE - neutron specific enolase

Dumb bell tumour - thoracic tumour that compresses the spinal cord - sudden paralysis

Question 5

Nephroblastoma

Answer 5

Wilm's tumour 
kidney tumour 
age 1-5 
abdominal tumour 
associated congenital abnormalities 
- hemihypertrophy 
- aniridia 
- urogenital abnormalities 

renal vein + IVC involvement as complications

Question 6

Danger signs of cancer

Answer 6

abnormal bleeding 
abnormal masses 
unexplained fever 
weight loss --> most NB with adequate nutrition 
pale 
pain 
change in personality, gait, balance 
absent red reflex or red eye not responding to treatment 
lethargy 
or if the mother says so