Pattern of symptoms and signs of primary intracranial tumours in children and young adults: a record linkage study

Abstract

ObjectiveTo describe the age pattern and temporal evolution of symptoms and signs of intracranial tumours in children and young adults before diagnosis. Design and settingA record linkage study using population-based data from the National Cancer Registry, linked to Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). Patient cohortPatients aged 0-24 years when diagnosed with a primary intracranial tumour between 1989 and 2006 in England. MethodsLinked records of relevant symptoms and signs in primary care and hospitals were extracted from CPRD (1989CPRD ( -2006 and HES (1997HES ( -2006. Temporal and agespecific changes in presentation rates before diagnosis of an intracranial tumour, for each of eight symptom groups, were estimated in generalised additive models. Results All ConclusionsNon-localising symptoms and signs were more than twice as common as focal neurological signs.An intracranial tumour should be considered in patients with relevant symptoms that do not resolve or that progress rapidly.4

Specific and Non-specific Clinical Presentations in the Year Before the Diagnosis of Childhood Leukaemia

“…The cor-responding numbers are listed in Supplementary Appendix I (pp. [12][13][14][15][16][17]. Among the six general presentations examined, the rate of haematological presentations was the earliest to increase significantly and found to increase since the fourth month (91-120 days) before the date of myeloid leukaemia diagnosis ( Fig.…”

Childhood cancer, type 1 diabetes and other immune diseases: healthcare visits in the year before diagnosis in Taiwan

“…The types of presentation-specific healthcare visits varied substantially according to the underlying condition. Organ specificity of recorded presentations was seen across four solid tumours—compared to other presentations, recent increases were seen in apparent injuries (INJ) most strongly shortly before the diagnosis of bone cancer8 (6.6-fold, 95% CI 4.9 to 9.0) and soft tissue cancer (4.1-fold, 95% CI 2.6 to 6.3); recent increases were seen in urogenital problems most strongly shortly before the diagnosis of ovarian cancer (3.5-fold, 95% CI 2.0 to 6.1); and recent increases were seen in neuropsychosocial problems (NEURO 3.4-fold, 95% CI 2.9 to 4.1) most strongly shortly before the diagnosis of brain tumour 1. By contrast, it seemed that urogenital problems and apparent injuries were more commonly seen shortly before the diagnosis of more systematically involved diseases, including the three haematological malignancies, type 1 diabetes, systematic lupus erythematosus, and rheumatoid arthritis.…”

“…Among the 10 conditions which included cancer at seven sites and three immune diseases, recent increases (>threefold) in organ-specific presentations shortly before the diagnosis of bone cancer,8 soft tissue cancer, ovarian cancer,9 and brain tumour,1 and brain tumour, and general presentations of urogenital problems and apparent injuries before the diagnosis of lymphoma,10 acute lymphoid leukaemia,2 and systemic lupus erythematosus,11 were generally in line with known clinical presentations of each condition. This may suggest that children with known presentations were missed at these clinic visits.…”

“…A case-only study on childhood brain tumours in the UK1 and our recent case-control study on childhood leukaemia in Taiwan2 both reported increasing rates of healthcare visits in the months before the diagnosis. To our knowledge there have been no reports for other diseases.…”

Brain tumours in paediatrics: when should they be suspected?

“…The paper by Chu et al 1 presents retrospective case note review data on a large number of patients with brain tumours. The authors used a large-scale number crunching exercise to show brain tumour diagnosis can be delayed and that these children often present with non-specific symptoms making diagnosis more difficult.…”