Although childhood cancer is rare, and the early symptoms are often insidious and nonspecific, a high index of suspicion should be maintained, especially when children complain of persistent lethargy or are noted to have progressive pallor. Approximately one child in 600 develops cancer by 16 years of age. Early diagnosis improves clinical outcome and can benefit family coping strategies and relationships with health care professionals.
Anemia is frequently the presenting condition for cancers, particularly leukemia and lymphoma.
Unusual masses and bone pain should also raise suspicion of malignancy. Cervical nodes smaller than 2 cm in diameter are unlikely to be associated with malignancy in a child who has no other signs or symptoms, but a chest radiograph, an abdominal ultrasound examination and a full blood count may be useful to exclude malignancy in suspicious cases. The pathologic features of myocarditis depend on the cause and the immune response, but cell death and fibrosis may result. The clinical picture may also vary depending on the etiology and extent of the inflammation. Sudden death is possible.