GPAtlas🧭 When to suspect
Childhood cancer is rare – but it is the leading medical cause of death in children beyond infancy, and outcome depends heavily on early recognition. The diagnostic challenge is that childhood cancers seldom announce themselves: most present with non-specific symptoms – fatigue, intermittent pain, recurrent infection, vague abdominal complaints – that overlap almost entirely with the common, benign illnesses a GP sees every day. Only around one in five children later diagnosed with cancer presents with a classic ‘alarm’ symptom.
Two features make the primary-care task distinctive. First, the positive predictive value of any single symptom is very low, yet because the disease is serious and frequently curable, investigation and referral are justified at a far lower threshold than in adults. Second, the referral routes are faster and different: most suspected childhood cancers follow a very urgent (48-hour) pathway rather than the adult two-week wait, and some require immediate, same-day specialist assessment.
The GP’s job is not to diagnose the tumour but to recognise the pattern, act on the correct urgent pathway, and listen to parents – whose persistent concern is itself a NICE-recognised reason to refer.
| Tumour group | Hallmark primary-care presentation | NICE NG12 action |
|---|---|---|
| Leukaemia | Pallor, persistent fatigue, fever, recurrent infection, generalised lymphadenopathy, persistent bone pain, bruising or bleeding | Very urgent FBC (48h); immediate referral if petechiae or hepatosplenomegaly |
| Brain / CNS | Early-morning or persistent headache with vomiting; abnormal balance, coordination or gait; visual change; new-onset squint | Very urgent referral (48h) for newly abnormal central neurological function |
| Lymphoma | Unexplained, persistent or enlarging lymphadenopathy or splenomegaly (± fever, night sweats, weight loss) | Very urgent referral (48h) |
| Neuroblastoma / Wilms’ tumour | Palpable abdominal mass or enlarged abdominal organ; Wilms’ may also show visible haematuria | Very urgent referral (48h) |
| Bone sarcoma | Unexplained bone pain or swelling – classically waking the child at night | Very urgent direct-access X-ray (48h) |
| Soft tissue sarcoma | Unexplained lump that is increasing in size | Very urgent direct-access ultrasound (48h) |
| Retinoblastoma | Absent red (fundal) reflex, white pupil (leukocoria) or new-onset squint | Ophthalmology on the suspected-cancer (2-week) pathway |
Source: NICE NG12 · Children’s Cancer and Leukaemia Group
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