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  • Acute leukemia is the most common malignancy in childhood and may present with a variety of symptoms including fever, fatigue, bleeding, adenopathy, or bone pain.
  • Complications of childhood cancer result from the disease itself or from the therapy aimed at treating the cancer. Most oncologic emergencies arise from metabolic, hematologic, structural, or toxic chemotherapy effects.
  • Infection is one of the most common complications of the treatment of children with cancer, and is a significant cause of morbidity and mortality. Findings associated with inflammation may be absent in the neutropenic patient, with fever the only sign of serious infection.
  • Infection may progress rapidly in the neutropenic host; evaluation and initiation of antibiotic therapy must be done urgently.
  • Initial antibiotic coverage usually includes an aminoglycoside and a beta-lactam penicillin or cephalosporin, but must be tailored to local bacterial sensitivities.
  • Tumor lysis syndrome results from the death of tumor cells and release of their intracellular contents leading to hyperuricemia, hyperphosphatemia, and hyperkalemia.
  • Mediastinal compression from the tumors may result in superior vena cava syndrome or superior mediastinal syndrome. Management of these patients may be difficult as airway collapse from tumor compression may occur.


Approximately 10% of childhood deaths are related to cancer.1 The leukemias, central nervous system (CNS) tumors, and lymphomas account for more than one-half of all childhood malignancies (Table 103–1). Advances in cancer treatment have led to improvements in survival. However, much of this progress has come with increased intensity of treatment regimens. It is important for the emergency physician to be aware of the common malignancies that occur in children and to be ready to treat the complications of cancer at presentation and during treatment.

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Table 103-1. Cancer Incidence Rates in Children Aged 0 to 14 Years: SEER 2000–2004

Acute Leukemias


Leukemia is a condition in which there is uncontrolled, clonal proliferation of an immature white blood cell within the bone marrow, with subsequent suppression of normal hematopoiesis. Acute leukemia is the most common childhood malignancy, representing approximately 30% of newly diagnosed cancers.2 Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of pediatric leukemia, with acute myelogenous leukemia (AML) accounting for the other 25%. Chronic leukemia is rare in pediatrics, with chronic myelogenous leukemia (CML) accounting for less than 1% of all childhood cancers.


The peak incidence of ALL in children occurs between the ages of 3 and 5 years. Overall, 75% ...

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