Good practice points

Persistent symptoms:

For this guideline, ‘persistent’ indicates the continuation of specified symptoms and/or signs beyond a period that would normally be associated with self-limiting problems. This should take into account what the parent/carer/young person considers unusually persistent for them and the child’s baseline and overall clinical picture. The precise period will vary depending on the severity or combination of symptoms/associated features, as assessed by the health professional.

 

Lymphadenopathy:

Lymph nodes in the neck that are under 2 centimetres in longest dimension may be reactive and can commonly be felt in slim young people. Other reassuring features could include a recent infection, masses which are reducing in size and those which are very tender. Neck nodes which are 2 centimetres or larger, nodes palpable in supraclavicular fossae, axillae and large nodes in the groin merit further assessment and consideration of cancer. If there is associated splenomegaly, night sweats, weight loss, bone pain, unexplained respiratory symptoms, or limp then this is concerning regardless of the size of nodes and should prompt a USC referral. It is important to note that rapidly enlarging malignant nodes can be tender and/or uncomfortable and so do not fit the classic “painless lymphadenopathy” scenario.

 

Emergency referral:

The following clinical scenarios are emergencies and must be referred immediately to secondary care:

• Malignant spinal cord compression is a severe, often irreversible complication of para- or intra-spinal pathology. It is rare in paediatrics but not in children with cancer.
• Mediastinal involvement with cancer (most frequently lymphoma or germ cell tumours) causing airway compromise (wheezing, orthopnoea, stridor) or superior vena cava compression (breathing difficulties, distended neck veins, facial swelling).

 

Thyroid cancer:

For the assessment of suspected thyroid cancer in children and young people, please see the Head and neck cancer and thyroid cancer guideline.