SECTION I: INITIAL CARE OF THE CHILD WITH NEW OR RECURRENT CANCER Childhood cancer can present with nonspecific signs and symptoms that can overlap with those of many childhood illnesses ( Table 98.2 ) Even when the chief complaint is a localized symptom, disseminated disease may be present Once the diagnosis of cancer is suspected, the child should be referred to a center skilled in the management of childhood malignancies However, supportive care for lifethreatening complications may need to be initiated prior to referral After stabilization, the specific workup, including obtaining tissue for diagnosis, should be carried out under the direction of a pediatric oncologist so that optimal information can be obtained No patient should be discharged from the ED without a specific plan for definitive diagnosis and management The possibility of a cancer diagnosis usually causes fear and distress and requires empathic care and support from the health care team in the ED The emergency clinician should describe the findings and concern about possible cancer to the patient and family It is appropriate to reassure them that most childhood cancer is curable Specific details about diagnosis, treatment, and prognosis are best deferred to the pediatric oncologist once definitive information is available LEUKEMIA Goals of Treatment The primary goal of emergency management of these patients is rapid assessment and correction of hematologic, metabolic, infectious, and cardiorespiratory complications After a patient has been stabilized, further diagnostic evaluations can be performed