Paediatrics Cancer

Services

Cancer Services

The Luton and Dunstable Hospital NHS Foundation Trust's Cancer Unit is part of the Mount Vernon Cancer Network.  The Network covers a geographical area from North London to mid-Bedfordshire, west to Buckinghamshire and east to Hertfordshire, providing services to a population of two million people.  The Mount Vernon Hospital Cancer Centre provides specialist care, including radiotherapy and complex chemotherapy, with the local Cancer Units and the Primary Care Trusts providing routine and on-going care, including chemotherapy.

Oncology services are provided by consultant staff from Mount Vernon, taking part in combined clinics with the Luton and Dunstable hospital staff.

To access the service please visit your GP

Children's cancers at the Luton and Dunstable Hospital are part of the Paediatric Services.  Paediatrics is the medical specialty dealing with the development and care of children and with the diagnosis and treatment of childhood diseases.

The Luton and Dunstable Hospital provides a full range of Acute Paediatric Services with dedicated facilities in a child and parent-friendly environment.

Most children are seen within the Children's Outpatient Department where the staff and surroundings are designed for the comfort and fun of children - and their siblings.

We have seven General Paediatric Consultants, each of whom have special areas of interest.  They are complemented by five Locum Consultants, thus ensuring that there is hands-on Consultant cover 24 hours a day, every day.

Paediatrics - Haematology / Oncology

Dr Dan Thompson (Haematologist) / Dr Stalin Ramprakash . 
Dr Ramprakash runs weekly Oncology Clinics and fortnightly Haematology Outpatient clinics.

If childhood malignancy is suspected, please contact Dr Ramprakash or the Attending Paediatric Consultant (via switchboard or secretary), to arrange an urgent assessment.

The L&D consultants work in partnership with Tertiary Centres, referring on for further investigations and advice, when necessary. Most paediatric problems can be dealt with locally.

The consultant paediatricians are always happy to discuss difficult cases and assess the urgency of referral. Please contact via secretaries or, for the Attending Consultant via the switchboard.

Referrals to L&D Paediatrics:

Paediatric medical GP referrals pass through the PAU for expert assessment, investigation, observation and treatment. Some do not require inpatient stays. Some complex, chronically sick children have open access to contact the PAU for expert advice.

Note: The PCT Paediatric Primary Care filter located in A&E is accessible 9-5 for simple paediatric problems and has reduced some unnecessary visits to the PAU.

Brief Service Description

All children admitted to the Trust are looked after on the Paediatric Unit.

The beds are divided into three wards, all located on the 4th floor unit:

  • Squirrel Ward (17 beds) for children under two.
  • Rabbit Ward (17 beds) for medical and longer stay surgical patients including isolation facilities for paediatric oncology patients, and a small adolescent unit.
  • Hedgehog Ward (15 Beds) a "5 days a week" Paediatric Surgical Unit and Day-Case Investigation Unit. When necessary Hedgehog Ward opens overnight to take acute paediatric admissions.

Admissions:

All children admitted to the hospital are managed on these wards, including children requiring High Dependency care.

Who to Refer

All patients can be referred, particularly those covered by the Mount Vernon Cancer Network area - NHS Bedfordshire residents in South Bedfordshire and NHS Luton residents

Refer children and young people who present with symptoms and signs of cancer to a paediatrician or a specialist children's cancer service, if appropriate.

When making a referral, inform the parents and child or young person about the reason for referral and which service they are going to attend so that they know what to do and what will happen next.  Establish good communication in order to develop the supportive relationship that will be needed if cancer is found.

Consider referral:

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)

Persistent parental anxiety is sufficient reason for referral, even when a begin cause is considered most likely.  Take into account parental insight and knowledge when considering urgent referral.

Urgent referral within 2 weeks (under 2 week rule):

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).

There are associations between Down's syndrome and leukaemia, between neurofibromatosis and CNS tumours, and between other rare symptoms and some cancers.  Be alert to the potential significance of unexplained symptoms in children with such syndromes.

Leukaemia (children of all ages)

Immediate Referral within a few hours or even more quickly if necessary:

Refer immediately children or young people with either:

  • Unexplained petechiae, or
  • Hepatosplenomegaly

Investigations

  • Investigate with full blood count and blood film one or more of the following symptoms and signs:
    • Pallor
    • Fatigue
    • Unexplained irritability
    • Unexplained fever
    • Persistent or recurrent upper respiratory tract infections
    • Generalised lymphadenopathy
    • Persistent or unexplained bone pain
    • Unexplained bruising

If the blood film or full blood count indicates leukaemia, make an urgent referral

Lymphomas

Immediate Referral within a few hours or even more quickly if necessary:

Refer immediately children or young people with either:

  • Hepatosplenomegaly, or
  • Mediastinal or hilar mass on chest X-ray

Urgent referral within 2 weeks (under 2 week rule):

Refer urgently children or young people:

  • With one or more of the following (particularly if there is no evidence of local infection):
    • Non-tender, firm or hard lymph nodes
    • Lymph nodes greater than 2cm in size
    • Lymph nodes progressively enlarging
    • Other features of general ill-health, fever or weight loss
    • Axillary node involvement (in the absence of local infection or dermatitis)
    • Supraclavicular node involvement
  • With shortness of breath and unexplained petechiae or hepatospenomegaly (particularly if not responding to bronchodilators)

Brain and Central Nervous System Tumours

Immediate Referral within a few hours or even more quickly if necessary:

Refer immediately children or young people with:

  • A reduced level of consciousness
  • Headache and vomiting that cause early morning waking or occur on waking as there are classical signs of raised intracranial pressure

Refer immediately children aged younger than 2 years with any of the following symptoms:

  • New-onset seizures
  • Bulging fontanelle
  • Extensor attacks
  • Persistent vomiting

Refer urgently or immediately children with any of the following neurological symptoms and signs:

  • New-onset seizures
  • Cranial nerve abnormalities
  • Visual disturbances
  • Gait abnormalities
  • Motor or sensory signs
  • Unexplained deteriorating school performance or developmental milestones
  • Unexplained behavioural and/or mood changes

Urgent referral within 2 weeks (under 2 week rule):

Refer urgently children aged 2 years and older, and young people, with:

  • A persistent headache where you cannot carry out an adequate neurological examination in  primary care

Refer urgently children aged younger than 2 years with:

  • Any of the following symptoms suggestive of CNS cancer:
    • Abnormal increase in head size
    • Arrest or regression of motor development
    • Altered behaviour
    • Abnormal eye movements
    • Lack of visual following
    • Poor feeding/failure to thrive
    • Squint, urgency dependant on other factors

Neuroblastoma (all ages)

Most children and young people with neuroblastoma have symptoms of metastatic disease which may be general in nature (malaise, pallor, bone pain, irritability, fever or respiratory symptoms), and may resemble those of acute leukaemia.

Investigations

  • Investigate with a full blood count any of the following symptoms and signs:
    • Persistent or unexplained bone pain (X-ray also needed)
    • Pallor
    • Fatigue
    • Unexplained irritability
    • Unexplained fever
    • Persistent or recurrent upper respiratory tract infections
    • Generalised lymphadenopathy
    • Unexplained bruising
  • If neuroblastoma is suspected carry out an abdominal examination (and/or ultrasound), and consider chest X-ray and full blood count.  If any mass is found refer urgently
  • Infants aged younger than 1 year may have localised abdominal or thoracic massesm and in infants younger than 6 months of age there may also be rapidly progressive intra-abdominal disease.  Some babies present with skin nodules.  If any such mass is identified, refer immediately

Urgent referral within 2 weeks (under 2 week rule):

Refer urgently children with:

  • Proptosis
  • Unexplained back pain
  • Leg weakness
  • Unexplained urinary retention

Wilms' Tumour (all ages)

Wilms' tumour most commonly presents with a painless abdominal mass.

Investigations

Persistent or progressive abdominal distension should prompt abdominal examination

  • If a mass is found, refer immediately
  • If the child or young person is uncooperative and abdominal examination is not possible, consider referral for an urgent abdominal ultrasound

Urgent referral within 2 weeks (under 2 week rule):

  • Refer urgently a child or young person presenting with haematuria

Soft Tissue Sarcoma (all ages)

  • A soft tissue mass in an unusual location may give rise to misleading local and persistent unexplained symptoms and signs and sarcoma should be considered. These include:
    • Head and neck:
      • Proptosis
      • Persistent unexplained unilateral nasal obstruction with or without discharge and/or bleeding
      • Aural polyps/discharge
    • Genitourinary tract:
      • Urinary retention
      • Scrotal swelling
      • Bloodstained vaginal discharge

Urgent referral within 2 weeks (under 2 week rule):

  • Refer urgently a child or young person presenting with an unexplained mass at almost any site that has one or more of the following features.  The mass is:
    • Deep to the fascia
    • Non-tender
    • Progressively enlarging
    • Associated with a regional lymph node that is enlarging
    • Greater than 2cm in diameter in size

Bone Sarcomas (osteosarcoma and Ewing's sarcoma) (all ages)

History of an injury should not be assumed to exclude the possibility of a bone sarcoma.

Referral

Refer children or young people with:

  • Rest pain, back pain and unexplained limp (a discussion with a paediatrician or X-ray should be considered before or as well as referral)
  • Persistent localised bone pain and/or swelling, and X-ray showing signs of cancer.  In this case refer urgently

Retinoblastoma (mostly children less than 2 years)

Urgent referral within 2 weeks (under 2 week rule):

Refer urgently children with:

  • A white papillary reflex (leukocoria).  Pay attention to parents reporting an odd appearance in their child's eye
  • A new squint or change in visuals acuity if cancer is suspected.  (Refer non-urgently if cancer is not suspected)
  • A family history if retinoblastoma and visual problems.  (Screening should be offered soon after birth)

Investigations

  • Imaging may be best done by a paediatrician, following referral
  • Any of the following symptoms and signs required a full blood count:
    • Pallor
    • Fatigue
    • Irritability
    • Unexplained fever
    • Persistent or recurrent upper respiratory tract infections
    • Generalised lymphadenopathy
    • Persistent or unexplained bone pain (X-ray also needed)
    • Unexplained bruising

Macmillan Cancer Support Rapid Referral Guidelines

Macmillan Cancer Support Rapid Referral Guidelines

Who not to Refer

Patients outside of the Mount Vernon Cancer Network area are usually referred to Hospitals within their Cancer Network area. 

NHS Bedfordshire residents not living in South Bedfordshire, patients not resident in NHS Luton area and North & East Bedfordshire patients are included under the Anglia Cancer Network and are usually referred via Bedford Hospital.

Resources

Map of Medicine Patient Pathway

Map of Medicine Patient Pathway - Suspected Acute Leukaemia

NICE Guidelines:

CG27 Referral for suspected cancer: full guideline
http://guidance.nice.org.uk/CG27/Guidance

CG27 Referral for suspected cancer: quick reference guide
http://guidance.nice.org.uk/CG27/QuickRefGuide/pdf/English

CG27 Referral for suspected cancer: information for the public
http://guidance.nice.org.uk/CG27/PublicInfo/pdf/English

CG27 Referral for suspected cancer: NICE guideline
http://guidance.nice.org.uk/CG27/NICEGuidance/pdf/English

NICE Guidance - Improving Outcomes in children and young people with Cancer - Manual Update - Full Guidance
http://guidance.nice.org.uk/CSGCYP/Guidance/pdf/English

NICE Guidance - Healthcare Services for children and young people with Cancer - Information for the Public
http://guidance.nice.org.uk/CSGCYP/PublicInfo/pdf/English

Website Resources:

Leukaemia:

Macmillan Cancer Support - Acute Myeloid Leukaemia in Children:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Acutemyeloidleukaemia.aspx

Macmillan Cancer Support - Acute Lymphoblastic Leukaemia in Children:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Acutelymphoblasticleukaemia.aspx

Lymphomas:

Macmillan Cancer Support - Hodgkin Lymphoma in Children:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Hodgkinlymphoma.aspx

Macmillan Cancer Support - Non-Hodgkin Lymphoma in Children:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Non-Hodgkinlymphoma.aspx

Brain and CNS Tumours:

Brain Tumours - NHS Choices:
http://www.nhs.uk/conditions/brain-tumours/Pages/Introduction.aspx

Samantha Dickson Brain Tumour Trust:
http://braintumourtrust.co.uk/

Macmillan Cancer Support - Brain Tumours in Children:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Braintumours.aspx

Neuroblastoma:

Neuroblastoma NHS Choices:
http://www.nhs.uk/conditions/neuroblastoma/pages/introduction.aspx

The Neuroblastoma Society:
http://www.nsoc.co.uk/

Action for Sick Children:
http://www.actionforsickchildren.org/

Cancer Research UK - Neuroblastoma:
http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/neuroblastoma

Macmillan Cancer Support - Neuroblastoma:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Neuroblastoma.aspx

Wilms' Tumour:

Macmillan Cancer Support:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Wilmstumour.aspxNHS

Soft Tissue Sarcoma:

Macmillan Cancer Support - Rhabdomyosarcoma in children
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Rhabdomyosarcoma.aspx

Bone Sarcoma (osteosarcoma and Ewing's sarcoma):

Bone Cancer (sarcoma) - NHS Choices:
http://www.nhs.uk/conditions/cancer-of-the-bone/pages/introduction.aspx

Bone Cancer Research Trust:
http://www.bcrt.org.uk/

Teen Info on Cancer:
http://www.click4tic.org.uk/understandit/typesofcancer/bonecancer

Teenage Cancer Trust
http://www.teenagecancertrust.org/

Health Talk Online - Teenage Cancer
http://www.youthhealthtalk.org/Teenage_Cancer/People/Interview/1171/Category/130

Macmillan Cancer Support - Osteosarcoma
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Osteosarcoma.aspx

Macmillan Cancer support - Ewing's Sarcoma:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Ewingssarcoma.aspx

Retinoblastoma:

Retinoblastoma NHS Choices:
http://www.nhs.uk/conditions/retinoblastoma/pages/introduction.aspx

Childhood Eye Cancer Trust:
http://www.chect.org.uk/cms/

Macmillan Cancer Support - Retinoblastoma:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Retinoblastoma.aspx

Cancer Network

Mount Vernon Cancer Network - for residents of Hertfordshire and South Bedfordshire
http://www.mountvernoncancernetwork.nhs.uk/

Patient Information Leaflets

Patient information leaflet - 2 Week Wait

Macmillan Cancer Support - Luton



Last updated: 20/06/2013

Update due: 20/06/2014