By: Dr. Brian Gannon
My child has a knot in her neck. Is it cancer, or am I overreacting? Many parents have these fears, and understandably. Cancer is scary, and we have all heard of people who were diagnosed “too late” for treatment. What are some early warning signs and reasons to see your doctor?
Cancer in children tends to fall into three broad categories: unexplained masses, enlarged lymph nodes or leukemia. Here are some things to look for and discuss with your doctor if you are concerned.
1. Any swelling or mass that does not make sense for your child should be evaluated by the doctor. This could include swelling in one leg not related to an injury; mass in the belly without any symptoms; or even a white spot in the eye noted on family photos. These may seem clear, but when a child lives with you, it is easy to explain things away for a long time, or until there are symptoms of something pushing on neighboring organs.
2. Enlarged lymph nodes are extremely common in children, especially toddlers and teenagers. Luckily toddlers rarely get tumors in the lymph nodes, but adolescents definitely do. The vast majority of children seen in the office for this complaint will have an innocent explanation: a cold, a bug bite or a toothache. The signs of an innocent lymph node (usually a mild infection or inflammation fighting off other illness) would be tenderness, size less than 1 inch, rubbery texture, and clear margins, meaning you can easily find all the edges and get your fingers around the lump.
Reactive nodes (which is what we call them) will grow quickly, over a few days to a week, then stabilize and shrink very slowly over 6-8 weeks. If the node is larger, rock-hard, with unclear margins or fixed to underlying bone, non-tender or lasting more than two months and still growing, then your doctor should see it. It still may not be a tumor or lymphoma, but it certainly justifies a visit to the office.
3. Leukemia is scary. The problem is that most children do not show any specific symptom that says, “I have leukemia.” We hear about easy bleeding or bruising, or pale skin. Sure, these could be signs of a problem, but they are not usually what lead to diagnosis. Most kids with leukemia are diagnosed by accident, when we do lab work for some other reason. I have seen teenagers with crazy white counts when we did screening labs to start acne medicine!
4. If you are worried about cancer of any type in your child, especially if your concern is related to a family history of cancer or leukemia, then please mention it to your pediatrician directly. If we do not understand your agenda, we may not be able to address our concerns adequately, even if you are just a “worried parent.” The take-home message is that your concerns are still valid, simply because they are your concerns. Our job is to address those concerns on some level. If it turns out that there is no medical issue to explain your anxieties, then so be it. At least the pediatrician did the appropriate testing and listened to you as a parent.
5. I would like to close with a message of hope. Over the past 50 years, amazing advances have reduced the likelihood of death in many childhood cancers, notably certain types of leukemia, genetically-determined tumors and retinoblastoma. We have great treatments available and children are wonderfully resilient in dealing with both the medical and emotional trauma of a chronic illness. Not all cancer is curable, but the news is getting more positive every day.
Once again, remember that you as a parent know your child better than anyone on this earth. If you think something is wrong, tell your child’s doctor. The more he understands the reasons for your concern, the better he can develop a plan to figure out the answer to the question you are asking. If you think it’s an infection, tell us. If you think it’s arthritis because your mom had lupus, tell us. And by all means, if your grandfather had leukemia before St. Jude’s came up with a cure, please let us know. We want to help you and hear you, but the best we can do is answer the questions presented by you and your child’s symptoms.