Childhood cancer is relatively rare affecting around 1600 children (0-15 years) each year in the United Kingdom (UK)[1].
Incidence of childhood cancers
Early diagnosis is challenging due to this rarity and the diverse nature of childhood cancers. Early diagnosis may result in better outcomes, and may reduce distress to the child, young person and family.
It is estimated that a GP will see on average 1 child in 20 years with a diagnosis of Cancer; some may never encounter this.[1]
As a professional it is helpful to be aware of how some of the more common childhood cancers present.
There are numerous campaigns around the UK at the moment to raise awareness of childhood cancers such as:
HeadSmart for childhood brain tumours
Referral guidelines are also widely available for general practitioners from NICE
NICE referral guidelines for suspected cancer
I am worried my child has cancer
Childhood cancer is rare and about 1,600 children (out of 11 million aged 0-14) in the UK are diagnosed with cancer every year. But every parent dreads to hear that their child has cancer and it is understandable to worry if your child becomes unwell.
Symptoms depend on the type of cancer and where it is in the body. They can also be quite vague, varied and are usually caused by something other than cancer.
I am worried my child has cancer: further information
Common presentations
Further information about types of childhood cancer
Acute lymphoblastic leukaemia (ALL)
Usually presents as an acute illness similar to many childhood illnesses [2] however the following symptoms are often associated:
- Fever
- Fatigue
- Thrombocytopenia
- Anaemia
- Neutropenia
- Pallor
- Weight loss
- Bone pain
- Lymphadenopathy
- Hepatosplenomegaly
Acute myeloid leukaemia (AML)
Usually presents as acute illness similar to viral infection. The symptoms are usually similar to ALL on presentation.
Brain and spinal cord tumours
Children who present with a short history and obvious symptoms are likely to have aggressive disease in comparison with those who have a long history of subtle symptoms.[2]
Symptoms include:
- Persistent headache
- Headache and vomiting on waking or early morning
- New onset seizures
- Visual disturbances
- Cranial nerve abnormalities
- Gait abnormalities
- Deteriorating school performance or developmental milestones
- Behaviour changes - lethargy
- Ataxia
Symptoms in children under 2 years of age may include:
- Bulging fontanelle
- Altered eye movements (not fixing and following)
- Poor feeding/failure to thrive
HeadSmart Know the symptoms of childhood brain tumours
Non-Hodgkin lymphoma
Most common between age 5 and 15. Symptoms include:
- Swelling of glands or lymph nodes (chest, neck, groin or armpit)
- Abdominal pain
- Fatigue
- Weight loss
- Breathlessness
- Persistent non productive cough
- Pancytopenia
- Bone pain
- Night sweats
- Fever
- Airway obstruction
- SVC obstruction
Hodgkin lymphoma
More common in older teenagers and young adults. Symptoms include:
- Swelling of glands or lymph nodes (groin, neck, chest, armpit)
- Enlarged glands lasting up to six weeks
- Non productive cough
- Breathlessness
- Chest pain
- Recurrent infections
- Fatigue
Neuroblastoma
30% of patients are under the age of one year at presentation. Symptoms include:
- Loss of appetite
- Vomiting
- Weight loss
- Fatigue
- Periorbital bruising (racoon eyes)
- Pancytopenia
- Bladder and bowel dysfunction
- Bone pain
- Hypertension
- Decreased leg movements/weakness
- Skin lesions “Blueberry Muffin”
- Ataxia, rapid eye movements, irregular muscle movements
- Respiratory distress
Rhabdomyosarcoma
Most common type of soft tissue sarcoma. Fewer than 60 children are diagnosed with rhabdomyosarcoma in the UK each year. Most of them are younger than 10 years old. It is more common in boys than girls. Symptoms include:
- Lump under the skin, often on the arm leg or trunk
- Pain or weakness at the site of the lump that often presents with a history of injury
Ewing sarcoma
Symptoms include:
- Bone pain
- Swelling of the affected area
- Tenderness to touch
- Often presents as impact related
- Palpable mass
Osteosarcoma
Most common in age 10-15 years. Osteosarcoma can occur in any bone but most commonly the growth plates of the long bones (distal femur, proximal tibia, proximal humerus). Symptoms include:
- Bone pain- intermittent at first becomes persistent especially at night
- Joint pain
- Often presents as impact related
- Pain at rest
- Swelling
- Reduced movement
Wilms' tumour
Most common in children two - three years of age. Symptoms include:
- Abdominal mass
- Abdominal pain
- Haematuria
- Urinary tract infection
- Hypertension
Germ cell tumours
Common in adolescence 15-19 years. Symptoms include a lump that can be felt or is causing pain.
Retinoblastoma
Most common in infants and young children (almost all diagnoses before age six years) [2]. Symptoms include:
- Leukocoria - white pupil that does not reflect the light
- Strabismus - loss of central vision causing the eye to become crossed
- Decreased vision in one eye
- Painful red eye
Liver tumours
Rare tumours only accounting for approximately 10 per year in UK. Hepatoblastoma (80%) usually occurs in under 5s, and hepatocellular carcinoma (HCC) (20%) usually older children. Symptoms include:
- Painful lump or swelling in the abdomen
- Weight loss,
- Loss of appetite
- Nausea/vomiting
Further information
CCLG produces a series of factsheets on each of the main types of childhood cancer, with information about diagnosis and treatment. Although these are designed for parents, the information will be useful to those involved in the care of children and supporting the family.
CCLG tumour specific factsheets
References
[1] Children’s Cancer and Leukaemia Group (2014) Children and Young People with Cancer: A Parent’s Guide, (www.cclg.org.uk)
[2] Tomlinson D and Kline N, E (2010) Paediatric Oncology Nursing; Advanced Clinical Handbook, 2nd Ed,
[3] Cancer Research UK. (2006-2008) Childhood Cancer - UK Statistics. Cancer Research UK. (http://www.cancerresearchuk.org/health-professional/cancer-statistics/childrens-cancers/incidence#heading-zero .