Signs and Symptoms

The symptoms and signs of cancer are variable and nonspecific in pediatric patients. The types of cancer that occur during the first 20 yr of life vary dramatically as a function of age—more so than at any other comparable age range (Chapter 485). Unlike cancers in adults, childhood cancers usually originate from the deeper, visceral structures and from the parenchyma of organs rather than from the epithelial layers that line the ducts and glands of organs and compose the skin. In children, dissemination of disease at diagnosis is common, and presenting symptoms or signs are often caused by systemic involvement. Pain was one of the initial presenting symptoms in more than 50% of children with cancer in one study. Infants and young children cannot express or localize their symptoms well. Another factor is the variability in the physiology and biology of the host related to growth and development during infancy, childhood, and adolescence.

The signs of cancer in children often are often attributed to other causes before the malignancy is recognized. Delays in diagnosis are particularly problematic during late adolescence and are due to a variety of factors prominent in this age group, including loss of health insurance coverage.

Although there is no clearly established set of warning signs of cancer in young people, the most common cancers in children suggest some guidelines that may be helpful in early recognition of signs and symptoms of cancer (Tables 487-1, 487-2, 487-3). Most of the symptoms and signs are not specific and might represent other possibilities in a differential diagnosis. Nonetheless, these hints encompass the common cancers of childhood and have been very useful in early detection.

Table 487-2 COMMON MANIFESTATIONS OF CHILDHOOD MALIGNANCIES