urgent referral guidance for suspected childrens cancer

Last edited 12/2022 and last reviewed 02/2023

General guidance:

• consider referral when a child or young person presents with persistent back pain (an examination is needed and a full blood count and blood film)
  • prsistent parental anxiety is sufficient reason for referral, even where a benign cause is considered most likely
  • take into account parental insight and knowledge when considering urgent referral.
• refer urgently when a child or young person presents:
  • several times (for example, three or more times) with the same problem, but with no clear diagnosis (investigations should also be carried out)

Note that there are associations between Down’s syndrome and leukaemia, between neurofibromatosis and CNS tumours, and between other rare syndromes and some cancers. Clinicians should be alert to the potential significance of unexplained symptoms in children with such syndromes

See linked items for guidance for:

• referral for suspected childhood leukaemia
• referral for suspected lymphoma
• referral for suspected brain cancer or CNS tumour
• referral for child or young person presenting with haematuria
• referral for suspected sarcoma or bone cancer
• referral for suspected retinoblastoma

The Childhood Cancer Guidelines are linked below:

https://www.cclg.org.uk/Referral-guidance

This guidance is specific to children as it is recognised that there are a number of differences in the presentation, referral pathways and care of children with cancer compared with those of adults.

There are some factsheets for general practitioners:

• Childhood cancer: Care and treatment: https://www.cclg.org.uk/write/MediaUploads/Publications/PDFs/Childhood_cancer_-_care_and_treatment_(GP)_2018.pdf
  
  
• Childhood cancer: End of life care: https://www.cclg.org.uk/write/MediaUploads/Publications/PDFs/Childhood_cancer_-_end_of_life_care_(GP)_2018.pdf
  
  
• Childhood cancer: Health of survivors in adulthood - https://www.cclg.org.uk/write/MediaUploads/Publications/PDFs/Childhood_cancer_-_health_of_survivors_(GP)_2018.pdf

 Reference:

1. NICE (June 2005). Referral Guidelines for Suspected Cancer
2. NICE (June 2015). Suspected cancer: recognition and referral.