Suspected Childhood Cancers Referral Guidanceand Form

Please attach to e-referrals when referring as a Suspected Cancer. The form includes guidance on where and how to refer children presenting with potential cancer symptoms

Referrer Details / Patient Details
Name: / Name: / DoB:
Address: / Address: / Gender:
Hospital No.:
NHS No.:
Tel No: / Tel No. (1): / Please check tel. nos.
Tel No. (2):
Email:
Decision to Refer Date: / Translator Required: Yes  No  Language: / Mobility:
UNWELL CHILD
If a child has presented acutely unwell and may require same-day admission to hospital, please contact the Paediatric Emergency Department to discuss on 0117 3428666.
For children who do not require immediate admission, please follow the guidance below.
SYMPTOMS FOR REFERRAL AS A SUSPECTED PAEDIATRIC CANCER TO UH BRISTOL USING THIS FORM
Unexplained lymphadenopathy with concerning features(please see Lymphadenopathy Guide below for
description of concerning features and when to refer)
Palpable abdominal mass or unexplained enlarged abdominal organ
Unexplained visible haematuria, where UTI has been excluded as a cause
X-ray suggests the possibility of bone sarcoma
Ultrasound scan suggests the possibility of soft tissue sarcoma
Ultrasound findings are uncertain and clinical concern about potential soft tissue sarcoma persists
Unexplained splenomegaly accompanied by at least one of: fever, night sweats, shortness of breath, pruritis or
unexplained weight loss
SYMPTOMS REQUIRING OTHER ACTION
  • Unexplained petechiae, particularly if accompanied by pallor, unexplained bruising, lymphadenopathy, persistent fatigue, fever, unexplained persistent infection, hepatosplenomegaly – Arrange immediate full blood count. If child is acutely unwell, please discuss with Children’s Emergency Department.
  • Neurological symptoms possibly indicating a brain/CNS tumour – please refer to guide below.
If symptoms or signs of raised intracranial pressure, discuss with Paediatric Emergency Department.
If other symptoms or signs raising concern, refer by fax to General Paediatrics (fax 0117 3428684) – referral will be read same or next working day, and triaged for Rapid Access Clinic or routine clinic appointment, based on features described.
  • Unexplained bone swelling or persistent or unexplained bone pain – refer for urgent plain film X-ray, further action according to result.
  • Unexplained soft tissue lump which is increasing in size – refer for urgent ultrasound scan, further action according to result.
  • Absent red reflex –please refer to a paediatric ophthalmologist for assessment
  • Skin lesions suspicious of cancer (note skin cancer exceptionally rare in children) – please refer using the suspected skin cancer referral form (common to adults and children)
  • Persistent parental anxiety about potential cancer, where you do not suspect cancer in your clinical judgement – please make a routine referral to general paediatrics for patient to be examined and appropriate advice and reassurance given

Clinical details of this referral Please detail the following information on the form or in an attached referral letter.
What are the concerning symptoms and signs?
Does the patient have any significant known long term conditions?
Is there any relevant family history e.g. cancer in the wider family?
Has the child had any investigations relevant to this referral? If so, please detail results
Please confirm that the patient/parent is aware that this is a suspected cancer referral: YesNo
Please confirm that the two week wait referral leaflet has been given: YesNo
Date(s) that patient is unable to attend within the next two weeks:
If patient is not available for the next 2 weeks, and aware of nature of referral, consider seeing patient again to reassess symptoms and refer when able and willing to accept an appointment.
For hospital to completeUBRN:
Received date:
LYMPHADENOPATHY GUIDE
Benign reactive lymphadenopathy is very common in childhood, and not of concern. Palpable benign lymph nodes may remain present for many months without regressing completely, which is normal. Characteristics of benign lymphadenopathy are:
-Small, mobile lymph nodes that often ‘wax and wane’ in size with intercurrent infections
-Usually cervical, in anterior or posterior triangle, and/or occipital region
-General well child
-Not associated with any of the listed concerning systemic symptoms below
Consider referral to secondary care for assessment of lymphadenopathy if any of the following:
-Lymphadenopathy of axillae or supra-clavicular regions
-Large nodes >2cm diameter (not small ‘shotty’ ones) in the groins or neck
-Accompanied by concerning symptoms such as unexplained fever, night sweats, shortness of breath (especially when lying flat), pruritis, unexplained back pain, or unexplained weight loss
If a child has potentially concerning lymphadenopathy, please examine the whole body and describe the size and location of the nodes in the ‘clinical details’ section of the referral form, plus any associated symptoms
NEUROLOGICAL SYMPTOMS GUIDE
If you have a high index of suspicion that a child has a possible brain or CNS tumour you should discuss your concerns with Paediatric Emergency Department the same day.
Symptoms of brain tumours can fluctuate in severity - resolution and recurrence does not exclude a brain tumour
A normal neurological examination does not exclude a brain tumour
Presentation, symptoms and signs depend upon the age of the child. Many of the potential symptoms listed are common in children and young people and not associated with a brain or CNS tumour; however a combination of the symptoms is more worrying. Therefore children presenting with one of the symptoms below should be checked for the others.
Signs and Symptoms of a potential brain or CNS tumour
Same day discussion with Paediatric Emergency Department +/- referral for neuroimaging /
  • Signs of raised intracranial pressure:
-Early morning waking with headache on most days over a four week period
-Early morning waking with headache accompanied by vomiting on most days over a two week period
-Bulging fontanelle in a younger child
-Papilloedema
  • persistent unexplained vomiting (occurring on most days over a two week period)
  • reduced level of consciousness
  • new onset cerebellar signs e.g. demonstrable unsteadiness, stumbling/falling more often
  • development of a head tilt, holding the head or neck at an awkward angle or twisted position
  • development of wry neck (difficulty in turning the head)
  • blurred or double vision, or a sudden worsening in vision /eyesight
  • cranial nerve abnormalities
  • new-onset afebrile seizures with focal onset/symptoms
  • symptoms of spinal cord compression (back or neck pain, sensory or motor disturbance, bladder or bowel problems)

Fax to General Paediatrics within 48hrs for triage to most appropriate clinic
(fax 0117 3428684) /
  • visual disturbances (that do not meet the threshold described in the box above)
  • gait abnormalities (that do not meet the threshold described in the box above)
  • motor or sensory signs
  • persistent back pain can be a symptom of a tumour involving the spine and is indication for an examination, investigation with a full blood count and blood film, and consideration of referral
In infants and young children
  • abnormally rapid increase in head size
  • arrest or regression of motor development
  • altered behaviour
  • abnormal eye movements
  • lack of visual following
  • poor feeding/failure to thrive

Other symptoms to consider that could be associated with a brain tumour /
  • Unexplained deteriorating school performance or developmental milestones
  • Unexplained behavioural and/or mood changes
  • Precocious puberty (in girls before the age of 8, in boys before the age of 9), particularly in boys, accompanied by at least one other symptom from the list above
  • Delayed or arrested puberty, accompanied by at least two other symptoms from the list above

A useful resource aimed at both health professionals and the public is the Headsmart website:

PLEASE NOTE: children with suspected cancer should only be referred to UH Bristol, not Weston or NBT.

Published August 2017