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Chapter 23

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System

Signs and symptoms

Malignancy

General

Malaise, fever, adenopathy

Lymphoma, leukemia, EWS, NBL

Hypertension

Renal or adrenal tumors, NBL

Weight loss

Any malignancy

Growth failure

Pituitary tumors

Electrolyte disturbances

Hypothalamic tumors

HEENT

Earache

STS

White spot on eye in photograph

Retinoblastoma

Orbital ecchymoses

NBL, LCH, RMS (Rhabdomyosarcoma)

Rhinitis

STS

Epistaxis

Leukemia

Pharyngitis

STS

Adenopathy

NBL, thyroid, STS, lymphoma, leukemia

Thorax

Extrathoracic

Soft tissue mass

STS, PNET (primitive neuroectodermal tumor)

Bony mass

EWS, NBL

Intrathoracic

Adenopathy

Lymphoma, leukemia

Abdomen

External: Soft tissue

STS, PNET

Internal: Diarrhea, vomiting, HSM

NBL, lymphoma, hepatic tumor, leukemia, WT

Urinary

Hematuria

WT, STS

Trouble voiding

Prostatic or bladder STS

Genital

Vaginitis

STS

Scrotal mass

STS, lymphoma, leukemia, germ cell tumor, yolk sac tumor

Musculoskeletal

Soft tissue mass

RMS, other STS, PNET, germ cell tumor

Bony mass or pain

Osteosarcoma, EWS, NHL, NBL, leukemia, LCH

Neurologic

Headache, vomiting

Brain tumor, leukemia

Cranial nerve palsy, ataxia

Brain tumor, leukemia, NBL

Signs of spinal cord compression

NBL, brain tumor, spinal cord tumor, LCH, leukemia, lymphoma

Skin

Petechiae

Leukemia, NBL

EWS, Ewing sarcoma; NBL, neuroblastoma; STS, soft tissue sarcoma; LCH, Langerhan's cell histiocytosis; RMS, Rhabdomyosarcoma; PNET, primitive neuroectodermal tumor; WT, Wilm's tumor

Adapted from Principles and Practice of Pediatric Oncology, 5th ed. 2005:Tables 6-1 and 6-3.

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Malignancies or sites

Age <1 yr

Age 1–3 yr

Age 3–11 yr

Age 12–21 yr

Leukemia

Congenital leukemia, AML, AMMoL, CML (juvenile)

ALL, AML, CML (juvenile)

ALL, AML

ALL, AML

Lymphoma

Rare

NHL

NHL, Hodgkin's lymphoma

Hodgkin's lymphoma, NHL

CNS

Medulloblastoma, ependymoma, astrocytoma or glioma, choroid plexus papilloma

Medulloblastoma, ependymoma, astrocytoma or glioma, choroid plexus papilloma

Cerebellar astrocytoma, medulloblastoma, ependymoma, astrocytoma or glioma, craniopharyngioma

Cerebellar astrocytoma, astrocytoma, craniopharyngioma, medulloblastoma

HEENT

Retinoblastoma, NBL, RMS

Retinoblastoma, NBL, RMS

RMS, lymphoma

Lymphoma, STS

Thoracic

NBL, teratoma

NBL, RMS, teratoma

Lymphoma, NBL

Lymphoma, EWS

Abdomen

NBL, mesoblastic nephroma, hepatoblastoma, WT, yolk sac tumor of testes

NBL, WT, leukemia, hepatoblastoma, RMS

NBL, WT, lymphoma, hepatoma, RMS

Lymphoma, hepatocellular carcinoma, STS, dysgerminoma

GU

Teratoma

RMS, yolk sac tumor of the testes, kidney clear cell carcinoma

Uncommon

Teratocarcinoma, teratoma, embryonal carcinoma of testes, embryonal carcinoma and endometrial sinus tumors of ovary

Extremity

Fibrosarcoma

Fibrosarcoma, RMS, EWS

RMS

Osteosarcoma, EWS, STS

ALL, acute lymphoblastic leukemia; AMMoL, acute myelomonocytic leukemia; AML, acute myeloid leukemia; CML, chronic myeloid leukemia; EWS, Ewng's sarcoma; NBL, neuroblastoma; NHL, non-hodgkin lymphoma; RMS, rhabdomyosarcoma; STS, soft tissue sarcoma; WT, Wilms tumor

Adapted from Principles and Practice of Pediatric Oncology, 5th ed. 2005:157.

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Fever and Neutropenia

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  • Often the first and only sign of serious infection. It should be evaluated immediately.
  • Definition
    • Fever: Single temperature ≥38.3°C (101°F) or a temperature ≥38.0°C (100.4°F) on two occasions 1 h apart. (Note: The temperature should not be taken rectally for immunocompromised patients!)
    • Neutropenia: ANC <500/mm3.
  • Diagnosis
    • History and physical exam: HR (tachycardia) and/or BP (hypotension), mental status (AMS) ...

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