PassFinals
Paediatrics

Childhood Cancers

Childhood cancer is uncommon but can present through subtle, non-specific symptoms; a palpable abdominal mass, unexplained enlarged abdominal organ, visible haematuria or an absent fundal red reflex should trigger the appropriate urgent UK referral pathway.

In a nutshell

A childhood abdominal mass is a cancer red flag. NICE recommends very urgent specialist assessment within 48 hours for a palpable abdominal mass or unexplained enlarged abdominal organ when neuroblastoma or Wilms tumour is possible, and for unexplained visible haematuria when Wilms tumour is possible. An absent fundal red reflex needs suspected-cancer-pathway ophthalmology for retinoblastoma. Neuroblastoma often produces systemic or metastatic clues; Wilms tumour is renal; retinoblastoma produces leukocoria. Diagnosis and treatment are specialist and risk-directed.

Classic presentation

A toddler has a painless abdominal mass, or a parent notices a white pupil in a photograph. Ask about haematuria, hypertension, weight loss, fever, bone pain, limp, neurological symptoms and family-predisposition features, then use the appropriate urgent referral pathway.

Key points

  • Palpable abdominal mass or unexplained enlarged abdominal organ: very urgent specialist assessment within 48 hours for neuroblastoma or Wilms tumour.
  • Unexplained visible haematuria in a child: very urgent Wilms-tumour assessment.
  • Absent fundal red reflex: suspected-cancer-pathway ophthalmological assessment for retinoblastoma.
  • Neuroblastoma may cross the midline and cause bone pain or periorbital bruising; Wilms tumour is a renal mass and may cause haematuria or hypertension.
  • Do not arrange a primary-care biopsy for suspected retinoblastoma; diagnosis is by specialist ophthalmic assessment.
  • Risk-directed paediatric oncology treatment and late-effects follow-up are essential.

First-line investigation

Focused examination, blood pressure and urine assessment plus urgent referral; abdominal ultrasound helps define a mass but must not delay the pathway.

Management

Recognise the red flag

  • Palpable abdominal mass, unexplained enlarged abdominal organ, visible haematuria or absent fundal red reflex requires the appropriate urgent pathway.1,2

Assess and stabilise

  • Check blood pressure, urine, hydration, pallor, pain, neurological function and respiratory status; treat acute compromise while arranging specialist transfer.1,2

Stage and treat in specialist care

  • Use tumour-specific imaging, biology and specialist examination to select observation, surgery, chemotherapy, local eye therapy, radiotherapy or immunotherapy; do not invent a regimen.3,4,5

Support survivorship

  • Provide family support, genetics where indicated, relapse surveillance and structured late-effects follow-up for organ function, vision, growth, fertility, cognition and second cancers.3,4,5

Exam traps

  • A Wilms tumour versus neuroblastoma bedside distinction is suggestive, not diagnostic.
  • Do not reassure about a persistent abdominal mass because the child looks well.
  • An absent fundal reflex is not managed with routine community review.
  • Do not biopsy an intraocular mass in primary care.
  • A child with a tumour may present with spinal cord compression, bone pain or visual signs rather than a mass.

Illustrations

LeukocoriaA sourced clinical photograph showing a white pupillary reflex; retain attribution and licence and keep image-quality remediation in the separate image campaign.J Morley-Smith, Wikimedia Commons · Public domain

Key sources

  1. NICE NG12, Suspected cancer: recognition and referral (NICE guideline published 23 June 2015 and current page last updated 15 April 2026; childhood recommendations include very urgent referral for abdominal mass or enlarged organ and suspected-cancer-pathway ophthalmology for absent fundal red reflex)Updated 15 Apr 2026
  2. CCLG Child Cancer Smart, Abdominal tumours (UK professional decision-support tool for children aged 0 to 18 years, based on systematic review and Delphi consensus; current page accessed 4 August 2026)
  3. CCLG, Neuroblastoma in children (UK specialist cancer information covering presentation, staging, risk-directed treatment, high-risk therapy, infant stage MS disease and current UK access caveats for DFMO; current page accessed 4 August 2026)
  4. CCLG, Wilms tumour in children (UK specialist cancer information; content last reviewed July 2022 and accessed 4 August 2026; covers investigation, staging, surgery, chemotherapy, radiotherapy, bilateral disease and follow-up)
  5. CCLG, Retinoblastoma (UK specialist retinoblastoma information; content last reviewed January 2023 and accessed 4 August 2026; covers EUA, imaging, RB1 inheritance, local therapy, chemotherapy, enucleation and follow-up)
  6. NHS, Retinoblastoma: tests and next steps (NHS patient pathway information last reviewed 2 May 2023; supports red-reflex assessment, specialist examination, ultrasound, MRI and genetic testing)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.