Suspected Cancer in Children

Question 1

If you see leukocoria (white eye reflex) what disease must you rule out?

Answer 1

Retinoblastoma

Question 2

If you see opsoclonus/myoclonus, pallor, pain, peri-orbital ecchymoses, and Horner’s syndrome what disease must you rule out?

Answer 2

Neuroblastoma

Question 3

If you see proptosis, what would be on your DDx for cancer related causes?

Answer 3

Rhabdomyosarcoma, Glioma, NHL

Question 4

A 14 month old male presents to the ED. Parents state that he has been extremely irritable over the last week and is not eating. He had started to walk around 12 months but over the last two weeks will only crawl. On exam, the child has macrocephaly, split sutures and the anterior fontanelle is bulging. You also note the setting sun sign. What investigation do you pursue?

Answer 4

MRI

Question 5

A 4 year old female presents with a mild fever, fatigue and general malaise. On exam she appears pale, hepatospenomegaly is present, and she has cervical lymphadenopathy. What investigations do you order?

Answer 5

CBC with differential
Blood smear

The likely diagnosis here is leukemia. A CBC consistent with this diagnosis may reveal anemia, thrombocytopenia, and neutropenia. The blood smear may show leukemic blast cells. A bone marrow would be indicated if there are atypical or blast cells on the smear, a decrease in >1 cell line, and infectious causes have been ruled out.