Synopsis
Recognise site-specific and developmental warning signs of childhood solid tumours, use the correct very urgent investigation or referral rather than repeated reassurance, stabilise mass-effect emergencies, and preserve safe specialist imaging and tissue diagnosis.
- Childhood solid tumours present by anatomy and developmental stage: brain and eye change, abdominal mass or haematuria, bone pain or swelling, and an enlarging soft-tissue lump are key patterns.
- First-line action is not a generic cancer blood panel; use the site-specific urgent examination, imaging or referral route and do not let normal blood tests delay it.
- New abnormal cerebellar or central neurological function requires very urgent specialist assessment within 48 hours under NICE NG12.
- Persistent vomiting, abnormal eye movements, balance change, seizure, head tilt or increasing head circumference can be more informative than headache in a young child.
- An absent fundal reflex uses the suspected-cancer ophthalmology pathway; absent reflex with a new squint requires immediate ophthalmology assessment.
- Palpable abdominal mass or unexplained organ enlargement warrants very urgent referral; urgent ultrasound can define anatomy but must not delay specialist review.
- Unexplained bone pain or swelling needs a very urgent plain radiograph, followed by specialist referral within 48 hours if the film suggests sarcoma.
- An unexplained soft-tissue lump that is increasing in size needs very urgent direct-access ultrasound; persistent concern after uncertain imaging still warrants referral.
- Reference-standard diagnosis usually integrates specialist MRI or CT and properly planned tissue histology and molecular analysis; retinoblastoma is diagnosed without routine intraocular biopsy.
- Take parental concern and repeat attendance seriously, record an explicit review interval, and reassess function, growth and examination rather than recycling a benign label.
Key red flags
Persistent or recurrent vomiting, progressive headache, new seizure, abnormal eye movement, visual loss, head tilt, increasing head circumference or loss of balance suggests a brain tumour pathway.
A white pupil or absent fundal reflex requires urgent ophthalmology assessment; new squint with loss of reflex requires immediate referral.
A palpable abdominal mass, unexplained enlarged organ or visible haematuria requires very urgent specialist assessment for neuroblastoma or Wilms tumour.
Persistent or night-waking bone pain, unexplained bony swelling, progressive limp or reduced movement needs very urgent radiography and referral if suspicious.
An unexplained soft-tissue lump increasing in size needs very urgent direct-access ultrasound; uncertain or suspicious imaging with persisting concern needs specialist assessment within 48 hours.
Back pain with weakness, altered gait, saddle symptoms or bladder, bowel or erectile dysfunction suggests spinal cord compression and is an emergency.
Investigation priorities
Localise the process and identify neurological, visual, spinal, vascular or organ emergencies.
Identify organ of origin, urinary obstruction, vascular relationships and a solid or cystic mass.
Management branches
Progressive brain-tumour symptoms, abnormal central function or fundal-reflex loss is present.
- Use emergency assessment for reduced consciousness, papilloedema, acute deficit or spinal cord signs.
- Use very urgent specialist assessment for new cerebellar or other central neurological dysfunction.
- Refer abnormal fundal reflex urgently and new squint plus absent reflex immediately to ophthalmology.
- Arrange specialist imaging without unsafe delay or unplanned sedation.