Fever of unknown origin, weight loss, Lymphoreticular malignancy Hodgkin disease, non-Hodgkin lymphoma night sweats
Painless lymphadenopathy Lymphoreticular malignancy, Leukemia, Hodgkin disease, non-Hodgkin lymphoma, metastatic solid tumor Burkitt lymphoma, thyroid carcinoma
Cutaneous lesion Primary or metastatic disease Neuroblastoma, leukemia, Langerhans cell histiocytosis, melanoma
Abdominal mass Abdominal/pelvic organ Neuroblastoma, Wilms tumor, lymphoma, hepatoblastoma, germ cell tumor
Hypertension Sympathetic nervous system tumor Neuroblastoma, pheochromocytoma, Wilms tumor
Soft tissue mass Local or metastatic tumor Ewing sarcoma, osteosarcoma, neuroblastoma, thyroid carcinoma, rhabdomyosarcoma, germ cell tumor
Diabetes insipidus, galactorrhea, poor Neuroendocrine involvement of Adenoma, craniopharyngioma, prolactinoma, growth hypothalamus or pituitary gland Langerhans cell histiocytosis
Emesis, visual disturbances, ataxia, Increased intrathecal pressure Primary brain tumor; metastasis headache, papilledema, cranial nerve palsies
Miosis, ptosis, heterochromia Horner syndrome: Neuroblastoma compression of cervical
Opsomyoclonus, ataxia Neurotransmitters (?) Neuroblastoma
Autoimmunity (?)
Exophthalmos, proptosis Orbital tumor Rhabdomyosarcoma, lymphoma Thoracic
Anterior mediastinal mass Cough, stridor, pneumonia, Germ cell tumor, T-cell lymphoma, Hodgkin disease, tracheal-bronchial compression primary mediastinal large B-cell lymphoma
Posterior mediastinal mass Vertebral or nerve root compression; Neuroblastoma, ganglioneuroblastoma, dysphagia ganglioneuroma
VMA, HVA mIBG scan
Rhabdomyosarcoma Yes Yes Yes Yes Yes, for parameningeal tumors only
Germ cell tumors Yes Yes AFP, β-hCG Consider brain MRI
Yes, if MRI Yes (brain) ± Yes
AFP, Alpha-fetoprotein; BMA/bx, bone marrow aspirate/biopsy; CNS, central nervous system; CSF, cerebrospinal fluid; CT, computed tomography; CXR, chest x-ray; β-hCG, beta-human chorionic gonadotropin; HVA, homovanillic acid; mIBG, metaiodobenzylguanidine; MRI, magnetic resonance imaging; PET, positron emission tomography; Rb, retinoblastoma; VMA, vanillylmandelic acid. *Individual cases may require additional studies.
The overall goal of pediatric oncology is to cure all patientswith minimal toxicity. Treatment for children with cancer isoften multimodal and may involve surgery, radiation therapy,and chemotherapy. Surgery and radiation are generally localtreatment modalities (an exception is total body irradiation as part of a bone marrow or stem cell transplant), whereas chemotherapy has both local and systemic effects.