Approximately 12,000 children are diagnosed with malignancies in the USA each year. Cancer is the second leading cause of death in children in the USA. Acute leukemias are the most common type of cancer, 26% of all cancer diagnosis. Brain tumors and lymphomas are the next most common categories of neoplasm in children.
Initial symptoms in children who are diagnosed with cancer often mimic those of other, more common childhood illnesses; fever, vomiting, weight loss, fatigue, and malaise. Particular attention should be paid to the patient who makes repeated visits for a persistent complaint that has not been fully evaluated.
Back pain is a rare complaint in children and should especially concern the ED physician to consider some common childhood tumors i.e. Wilms, Neuroblasoma, Osteosarcoma and Ewing sarcoma, Leukemia and/or Lymphoma
Findings which should prompt further work-up in the ED are: pallor, bleeding: petechiae, purpura, bone pain, limp, painless lymphadenopathy, gingival hyperplasia, abdominal mass, night sweats, pruritis, and unintended weight loss
Labs to obtain: CBC with manual differential, peripheral smear, CMP, uric acid, LDH, coagulation profile, and chest radiograph