What are the symptoms of childhood cancer?

Author:  Gesche Tallen, MD, PhD, Editor:  Maria Yiallouros, Reviewer:  Prof. Dr. med. Dr. h. c. Günter Henze, English Translation:  Hannah McRae, Last modification: 2012/04/25 https://kinderkrebsinfo.de/doi/e1828

It is difficult to diagnose cancer early in children and teenagers. Most of the early symptoms seem to be harmless since they are non-specific, such as bruises, headaches and fever. Nevertheless, parents should never hesitate to present their child to a paediatrician. In particular, if symptoms persist longer than a common cold, or if they progress, a paediatrician should see the child as soon as possible.
In general, patients with a malignant disease suffer from health problems affecting both the whole body (general symptoms) and the site from which the cancer is originating (local symptoms).

Health problems affecting the whole body (general symptoms)

General symptoms occur as a result of the body's response to the increasing number of malignant cells. This response is a tough fight for the body, and requires great energy and strength, and is thus very exhausting for the patient.

General symptoms of a maligant disease are, for example:

  • fever
  • pallor
  • frailty, lack of concentration, loss of interest in playing
  • growth- and developmental delay
  • loss of appetite, weight loss

Note: Having these symptoms does not automatically mean that a cancer is present. Nevertheless, it is important to seriously consider the possibility that the child could have cancer, which should be verified by a paediatrician, especially if the symptoms persist.

Health problems originating from the cancer site (local symptoms)

Local symptoms develop from the space occupying effect, that the uninhibitedly dividing cancer cells produce on the organ or site of origin. Especially, when the cluster of cancer cells starts to invade the affected organ or pushes it aside, and thus impairs its normal function, local symptoms occur.

Examples of local symptoms are the following:

  • local swelling, a lump and pain (for example: lymph node swelling can be a symptom of lymphoma, a distended tummy can be a sign of Wilms tumour, headaches can be a sign of a brain tumour, loss of vision can be a sign of retinoblastoma)
  • reduced consciousness, palsies, seizures (can be signs of certain brain tumours)
  • bone pain (can be caused by dividing leukaemia or other cancer cells while they are invading the bone marrow)

Some cancer cells can produce certain substances that can influence and impair various organ functions, and thus cause specific symptoms. For example, neuroblastomas can produce hormones, that can induce serious blood pressure dysregulations.

Some cancer cells produce tumour markers - substances, the levels of which can be elevated in the blood, urine or body tissues, and are indicative of a particular cancer. However, an elevated level of a tumour marker can also have causes other than cancer. In paediatric oncology, tumour markers are used to help detecting a certain cancer, also to monitor its response to treatment and to screen for recurrent disease. A tumour marker typical for some childhood cancers is, for example, alpha-1-fetoprotein (often elevated in the blood of patients with hepatoblastoma or germ cell tumours).