Pediatric malignancies presenting in the head and neck.

OBJECTIVES: Childhood cancer is rare and often difficult to diagnose. In the head and neck region, benign diseases are much more common. The aim of this study was to estimate the proportion of childhood cancer cases with a primary head and neck presentation, to describe symptoms, physical findings, diagnostic interval and tentative diagnoses.

METHODS: Registry-based retrospective cohort study, with patients identified in the Danish Childhood Cancer Registry. Review of medical records, imaging reports and pathology reports. All childhood cancer patients less than 15 years of age with primary disease presentation in the head and neck region from the Central Danish Region in the years 2003-2013. Outcome measures were proportion of patients with a primary head and neck presentation; frequency of physical findings; diagnostic intervals; and frequency of tentative diagnoses.

RESULTS: 85 patients (15% of all childhood cancers) had primary disease presentation in the head & neck region (95% confidence interval [CI]: 12 - 18%). A total of 24% (CI: 21 - 28%) of patients had any symptoms or findings from the head and neck region at presentation. Most common symptoms and findings were a swelling or a tumor, and possibly general symptoms. Diagnostic interval was more than three weeks in three out of four of patients. Primary suspicion was most commonly an infectious disease.

CONCLUSIONS: A substantial proportion of patients with childhood cancer have disease presentation in the head and neck. Worth noting is, that symptoms and findings are easily mistaken for an infectious disease, which probably explains the significant diagnostic interval.