Which statement is true regarding initial signs and symptoms of childhood cancer?

• A. It is not necessary to perform a comprehensive physical examination on a child when a diagnosis of cancer is suspected because of the nonspecific nature of the initial signs and symptoms of cancer in children.
• B. Abdominal mass, high WBC and pain are the presenting signs and symptoms of a child with neuroblastoma.
• C. Bone pain, pallor, bleeding, fatigue and fever are presenting signs and symptoms of a child with leukemia.
• D. If a child does not exhibit one of the fifteen cardinal signs and symptoms of childhood cancer, then a cancer diagnosis can be ruled out.

Answer: (C)

Initial signs of childhood cancer are often nonspecific, so a thorough evaluation is essential when cancer is suspected. Leukemia, the most common pediatric cancer, typically presents with a cluster of symptoms reflecting bone marrow involvement: bone pain from marrow expansion, pallor from anemia, bleeding tendencies due to low platelets, fatigue, and fever from infection or immune dysfunction. This combination is characteristic of leukemia and explains why the statement describing these presenting signs is true.

A comprehensive physical examination is important because it helps detect clues such as lymph node enlargement, liver or spleen enlargement, or other organ findings that accompany cancer, which a single nonspecific symptom cannot reveal.

Neuroblastoma can present with an abdominal mass and pain, but a high white blood cell count is not a typical defining feature of its initial presentation, so stating this as a presenting sign would be inaccurate.

There isn’t a fixed list of fifteen cardinal signs that, if absent, rules out cancer. Early childhood cancers often begin with nonspecific symptoms, and cancer cannot be excluded based on the absence of a single sign.