Scottish referral guidelines for suspected cancer: quick reference guide

Children's Tumours

Abnormal blood count

• If reported as requiring urgent further investigation.

Petechiae/Purpura

• Always an indication for urgent investigation.

Fatigue in a previously healthy child and associated:

• Generalised lymphadenopathy.
• Hepatosplenomegaly.

Bone Pain especially if:

• Diffuse or involves the back.
• Persistently localised at any site.
• Requiring analgesia.
• Limiting activity.

Lymphadenopathy if any of the following:

• Non tender, firm/hard and >3 cms in maximum diameter.
• Progressively enlarging.
• Associated with other signs of general ill health, fever, weight loss.
• Involves axillary nodes (no local infection or dermatitis) or supraclavicular nodes.
• Mediastinal or hilar mass on CXR.

Headache if any following:

• Increasing in severity or frequency.
• Worse in the morning or causing early wakening.
• Associated with vomiting.
• Associated with neurological signs (e.g. squint, ataxia).
• Associated with behavioural change or deterioration in school performance.

Soft Tissue Mass if any of the following:

• Shows rapid or progressive growth.
• Size >3 cms in maximum diameter.
• Fixed or deep to fascia.
• Associated with regional lymph node enlargement.