What are the Signs of Childhood Cancer?

Question of the Week

Q. A friend's child was recently diagnosed with leukemia 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?

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

My son has a headache. Could he have a brain tumor?

My daughter has a swollen gland. Could she have leukemia or lymphoma?

Does my child have cancer?

Unfortunately, they often don't voice that worry to their Pediatrician, who would usually be able to quickly reassure them that their child 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. Overall, there are only about 150 cases of childhood cancer for every 1 million children in the United States. Still, 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.

Among the types of cancer that children are most likely to get include:

  • leukemia - most common type of childhood cancer
  • brain tumors - second most common form of cancer in children
  • lymphoma - such as Hodgkins and non-Hodgkins lymphoma
  • neuroblastoma - most common solid tumor outside of the brain in children
  • bone tumors - including Ewing's sarcoma and Osteosarcoma
  • retinoblastoma - an eye tumor that is usually detected by examining for a red reflex in a child's eye
  • Wilm's Tumor - a kidney tumor that mostly affects young children between the ages of 2 and 4 years
The symptoms of these cancers are sometimes easy to recognize, such as the large abdominal mass in a child with Wilm's Tumor.

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 continued to get worse over time, becoming either more severe or more frequent. Brain tumors 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 than the usual 'growing pains' that children get at night, which usually doesn't cause pain in a specific spot, is helped by massage, doesn't limit your child's activities, and tends 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 tumor.
  • 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 that might alert you that your child might have cancer 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 worry 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 for lymphoma.

Still, a visit to your Pediatrician 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 xray to rule out more serious causes.

Talking to Your Pediatrician About Cancer

Most importantly, no matter what symptoms your child has, tell your Pediatrician if you are worried that your child could 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.

1) Young G. Recognition of common childhood malignancies. Am Fam Physician - 1-Apr-2000; 61(7): 2144-54

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