Childhood cancer

TedWhat is child cancer?

Question - A friend's child was recently diagnosed with leukaemia and every time my daughter gets sick, I worry that she has it too. What are the signs of cancer in children? What should I look for?

Answer - This is a common worry among parents, especially when their children are sick for more than 5-7 days without a good explanation.

Question - My son has a headache. Could he have a brain tumour? My daughter has a swollen gland. Could she have leukaemia or lymphoma? Does my child have cancer?

Answer - Unfortunately, they often don't voice that worry to their doctor, who would usually be able to quickly reassure them that their child more than likely doesn't have any type of cancer. Even though there are many different types of childhood cancer, the risk for any one child to have cancer is fairly low and cancer is considered to be rare in children. However, cancer is one of the leading causes of death in children, so it is important to be aware of the signs and symptoms of cancer in children.

Types of child cancer

Types of cancer that children are most likely to get include:

  • Leukaemia - most common type of childhood cancer
  • Brain tumours - second most common form of cancer in children
  • Lymphoma - such as Hodgkin's and non-Hodgkin's lymphoma
  • Neuroblastoma - most common solid tumour outside of the brain in children
  • Bone tumours - including Ewing's sarcoma and Osteosarcoma
  • Retinoblastoma - an eye tumour that is usually detected by examining for a red reflex in a child's eye
  • Wilms' tumour - a kidney tumour that mostly affects young children between the ages of 2 and 4 years

Symptoms

The symptoms of these cancers are sometimes easy to recognise, such as the large abdominal mass in a child with Wilms' tumour.

Some other symptoms of cancer in children might include fever, frequent infections, bone pain, night sweats, vomiting, and headaches, all of which children often have when they have more common and less serious viral infections, or other common problems of childhood.

So how do you know if your child has one of these cancers?

In general, you have to think about the degree of symptoms (how bad they are), how long they are lasting, and if they are continuing to get worse over time. For example, while you shouldn't think that your child has cancer every time that he has a fever, if the fever is lasting more than 14 days and you and your doctors don't know why, then a complete blood count (CBC with differential) to screen for cancer and other tests would be a good idea.

Other examples of symptoms that might indicate a childhood cancer include:

  • Vomiting that persists for more than 7 days and is worse when your child wakes up in the morning, wakes your child up at night, or is associated with a headache. For children with common headaches, a red flag that it might be something more serious than a simple migraine would be if the headaches were becoming either more severe or more frequent. Brain tumours might also cause other neurological symptoms, such as trouble walking, seizures or sudden changes in their personality 
  • Bone pain or muscle pain that doesn't follow a known injury and doesn't improve in a few weeks. These types of pain are different to the usual 'growing pains' that children get at night, which usually don't cause pain in a specific spot, are helped by massage, don't limit your child's activities, and tend to be chronic (occurring on and off for months or years). Also remember that chronic back pain is not very common in younger children, and can be a sign of a spinal cord tumour 
  • A persistent cough or trouble breathing that doesn't respond to usual treatments for infections or asthma 
  • An enlarging mass, whether it is in the abdomen, neck, arms or legs

Other common symptoms to be mindful of in children include having very decreased activity, loss of appetite, easy bleeding, bruising or a red pinpoint rash (petechiae), rapid visual changes, an enlarged liver or spleen, or weight loss.

Losing weight is a big red flag that something serious might be going on, as children don't normally lose weight over long periods of time. Children might lose a pound or two with an acute illness, such as the flu or with a stomach virus, but they should quickly gain it back.

What about swollen glands (lymphadenopathy)? This is one of the most common findings that worries parents, a lymph node or gland that isn't going away. However, in younger children, having swollen glands, especially in their neck, is so common as to be almost normal.

A swollen gland that isn't going away after a few weeks can be a sign of cancer, but you would usually expect other symptoms, such as a lingering fever or weight loss or swollen glands in more than one part of their body (such as their neck and groin). Even without other symptoms, a swollen gland might be a worry in older teens though, who are at risk of lymphoma.

Still, a visit to your doctor if your child has a swollen gland that isn't going away would be a good idea. Your doctor might investigate for other causes, including infections like Cat Scratch Disease, and might do a TB test, complete blood count and chest x-ray to rule out more serious causes.

Talking to your doctor about cancer

Most importantly, no matter what symptoms your child has, tell your doctor if you are worried that your child may have cancer. It might be that you do have a reason to be concerned, or your doctor might be able to reassure you that your child is not at risk, either with a good history and physical examination, or a few screening tests.