Childhood cancer warning signs and diagnostic pathways: Viva

This is a branching oral built to probe the reasoning that holds the persistent-progressive principle at the centre, and to expose the candidate who has memorised the tumour list without the discipline of the duration threshold. The questions escalate from the framing to the red flags, the front-line management, and the prevention of the delay, with deliberate probes into the leucocoria, the abdominal mass, and the cancer predisposition syndrome. ^[1]

Opening question: framing the problem

The examiner opens with the limp and the mass and asks how you frame this problem in a single sentence, and what the first question is that you ask of the history. ^[1]

A strong answer names the bone or the soft-tissue tumour cluster, and states that the first question is whether the symptom has crossed the line from a self-limiting into a persistent or a progressive course. The growing pains are bilateral, evening and free of daytime findings, and a unilateral, progressive, night pain that wakes the child, with a firm mass, is never a growing pain. ^[1]

Model answer. This boy has six weeks of unilateral, progressive, night-time leg pain with a firm thigh mass, which is a bone or a soft-tissue sarcoma until proven otherwise. My first question is whether the course is persistent and progressive, because the growing pains that this was attributed to are bilateral and free of daytime findings, and this presentation is not. ^[1]

Probe one: the five red-flag clusters