Cancer in children and young people is a multifaceted problem as symptoms usually mimic more common ailments. The wide range of clinical presentations can be applied to the differential diagnosis of almost any clinical presentation. Practitioners wait for evidence of symptom persistence or progression to evolving symptom clusters before initiating further investigations, not all of which can be organised from primary care for children in the UK. This approach delivers life-threatening and disabling presentations at diagnosis due to characteristically rapidly advancing disease.
The individual risk of cancer from birth to age 25 years is now 1 in 180, so whilst it may be regarded as an uncommon presentation in primary care, it is important that it is considered in a differential diagnosis in a child presenting with unexplained symptoms. Early identification of cancer must be a goal for all healthcare practitioners. Clear warnings are needed where possible, but there are many occasions when a pattern of symptoms and signs point strongly to cancer. Individual features alone are too imprecise. Children often cannot express symptoms clearly, and for this reason, the level of suspicion must necessarily be kept high.
Delays in the diagnostic pathway may well lead to more advanced disease at presentation, with subsequent greater risk of death, greater morbidity, and inevitably, distrust of the medical system.
We provide resources including referral guidelines to support GPs and other healthcare professionals to diagnose cancer in children and young people. Our Child Cancer Smart is an ongoing project to raise awareness of the signs and symptoms of cancer in children and young people, and provide resources to support healthcare professionals with diagnosis. These resources will be added to this page as they become available.
Referral guidance for suspected cancer in children and young people
We have developed referral guidance for suspected cancer in children and young people, which is a NICE endorsed supporting resource to NICE guideline NG12 'Suspected cancer: recognition and referral'.
This guidance is specific to children as it is recognised that there are a number of differences in the presentation, referral pathways and care of children with cancer compared with those of adults.