Children, Teenagers and Young Adult Cancers
Urgent suspicion of cancer referral
- Unexplained petechiae or purpura is always an indication for emergency referral.
- Unexplained fatigue, persistent pallor, failure to thrive or weight loss.
- Any new persistent unexplained pain, particularly back pain or nocturnal pain.
- Unexplained abdominal mass or distension.
- Unexplained visible haematuria.
Bone pain, especially if: |
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Lymphadenopathy, if: |
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Headache, if increasing in severity or frequency and: |
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Any new neurological signs, (such as weakness, loss of balance, etc.) especially if: |
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Other possible signs of brain tumours: |
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Soft tissue mass, if: |
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Eyes: |
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Good practice points
Consider referral for any patient with repeat presentations (three or more times) of any symptoms which do not appear to be resolving or following an expected pattern, taking into account parental or carer and patient concern.
In a child where symptoms and signs do not clearly fit with these guidelines but nevertheless lead to concern about excluding cancer, the referrer should consider discussing the case with a senior paediatric colleague at their earliest convenience.
Many of the tumour specific guidelines in this document are relevant to all
ages e.g. melanoma, brain and CNS, sarcoma etc.
Primary care management
X-ray if there is unexplained bone pain of:
- increasing severity
- persistent
- tender
- non-mechanical bone pain particularly if disturbing rest or sleep
If symptoms persist but X-ray is normal, repeat X-ray (after discussion with a radiologist) and consider referral, especially if the patient presents 3 or more times.
Spontaneous or minor trauma fracture should raise suspicion of bone cancer.