Childhood Cancer: Symptoms, Types & Treatment Options

What Is Childhood Cancer?

Childhood cancer refers to cancers that develop in children and adolescents under 18 years of age. Unlike adult cancers, they are rarely caused by lifestyle or environmental factors and instead arise from abnormal cell development. Approximately 400,000 children worldwide are diagnosed with cancer each year, with leukemia, brain tumors, and lymphoma being the most common types.

Cancer in children is fundamentally different from cancer in adults. While adult cancers often develop over decades and are frequently linked to lifestyle factors such as smoking, diet, or sun exposure, childhood cancers typically arise from abnormalities in normal cell development. These cancers can occur at any age from infancy through adolescence, though different types tend to peak at different ages.

Despite being relatively rare—childhood cancers represent less than 1% of all cancer diagnoses worldwide—cancer remains the leading cause of death by disease among children in high-income countries. However, the outlook has improved dramatically over the past several decades. In the 1960s, fewer than 30% of children with cancer survived; today, more than 80% survive five years or more in countries with access to specialized care.

The causes of childhood cancer are largely unknown. Unlike many adult cancers, lifestyle factors and environmental exposures rarely play a role. About 10% of childhood cancers are hereditary, meaning they are caused by genetic mutations passed down from parents. Some inherited conditions, such as retinoblastoma (eye cancer), have a strong genetic component. However, for the vast majority of children who develop cancer, the cause cannot be identified.

How Cancer Develops in Children

Cancer occurs when cells begin to grow and divide uncontrollably. In normal development, cells grow, divide, and eventually die in an orderly process. Cancer cells, however, continue to grow and accumulate, forming tumors or crowding out normal cells in the blood and bone marrow.

In children, cancer often develops from cells that are still growing and developing. This is one reason why childhood cancers can grow very quickly—the cells are naturally programmed to divide rapidly during normal development. However, this rapid growth also often means that childhood cancers respond well to treatment, particularly chemotherapy.

Childhood Cancer Statistics

Understanding the scope of childhood cancer helps put the condition in perspective. Worldwide, approximately 400,000 children and adolescents are diagnosed with cancer each year. In high-income countries, the incidence rate is approximately 140-160 cases per million children per year. While cancer can develop at any age, certain types are more common in specific age groups—leukemia, for example, peaks in children ages 2-5.

What Are the Most Common Types of Childhood Cancer?

The most common childhood cancers are leukemia (30%), brain and central nervous system tumors (25%), and lymphoma (10%). Other types include neuroblastoma, Wilms tumor (kidney cancer), bone cancers (osteosarcoma and Ewing sarcoma), retinoblastoma (eye cancer), and soft tissue sarcomas. Each type requires specific treatment approaches.

Childhood cancers differ significantly from adult cancers in the types that occur most frequently. While adults commonly develop cancers of the breast, lung, colon, and prostate, children are more likely to develop cancers of the blood, brain, and developing tissues. Understanding the different types helps families know what to expect regarding diagnosis, treatment, and prognosis.

Leukemia

Leukemia is cancer of the blood-forming cells in the bone marrow. It is the most common childhood cancer, accounting for about 30% of all cases. The two main types in children are acute lymphoblastic leukemia (ALL), which accounts for about 75% of childhood leukemia cases, and acute myeloid leukemia (AML), which accounts for most of the remainder.

ALL has one of the highest survival rates of any childhood cancer, with more than 90% of children surviving five years or more. This success is the result of decades of clinical trials that have refined treatment protocols. Treatment typically involves chemotherapy given in phases over 2-3 years.

Brain and Central Nervous System Tumors

Brain tumors are the second most common type of childhood cancer and the most common solid tumor in children. They can occur at any age and in various locations within the brain, which affects both symptoms and treatment approaches. Common types include medulloblastoma, glioma, and ependymoma.

Treatment for brain tumors often involves a combination of surgery, radiation therapy, and chemotherapy. The specific approach depends on the tumor type, location, and extent of spread. Some brain tumors are very treatable with excellent outcomes, while others remain challenging.

Lymphoma

Lymphoma is cancer of the lymphatic system, which is part of the immune system. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma. Lymphoma is more common in older children and teenagers than in young children.

Both types of lymphoma generally respond very well to treatment, with survival rates exceeding 90% for most subtypes. Treatment typically involves chemotherapy, with radiation therapy used in some cases.

Neuroblastoma

Neuroblastoma is a cancer that develops from nerve tissue and is almost exclusively seen in young children, typically under age 5. It most commonly arises in the adrenal glands (located above the kidneys) but can occur anywhere along the sympathetic nervous system.

Neuroblastoma behaves unpredictably—some cases resolve on their own without treatment (especially in infants), while others are aggressive and difficult to treat. Treatment intensity varies based on risk classification.

Wilms Tumor (Nephroblastoma)

Wilms tumor is a kidney cancer that typically affects children between ages 2 and 5. It is named after Max Wilms, the German surgeon who first described it. Wilms tumor often presents as a painless abdominal mass that parents notice while bathing or dressing their child.

Wilms tumor is one of the most successfully treated childhood cancers, with survival rates exceeding 90%. Treatment typically involves surgery to remove the affected kidney, followed by chemotherapy and sometimes radiation therapy.

What Are the Warning Signs of Cancer in Children?

Warning signs of childhood cancer include unexplained weight loss, persistent fatigue, unusual lumps or swelling, frequent headaches (especially with morning vomiting), easy bruising or bleeding, bone or joint pain, and unexplained fevers. These symptoms are usually caused by common childhood illnesses, but persistent symptoms warrant medical evaluation.

Recognizing the potential signs of cancer in children is important for early diagnosis, which can improve treatment outcomes. However, it's equally important to understand that the symptoms of childhood cancer are often similar to those of common, benign childhood illnesses. The key differentiator is usually the persistence of symptoms or the combination of multiple concerning symptoms.

Parents know their children best. If something doesn't seem right or if symptoms persist despite treatment for common conditions, it's appropriate to seek further medical evaluation. Trusting parental instinct while avoiding excessive worry requires a balanced approach—most children with these symptoms will not have cancer, but persistent unexplained symptoms should be investigated.

General Warning Signs

Some symptoms may indicate various types of childhood cancer:

• Unexplained weight loss: Children should be gaining weight as they grow. Significant weight loss without diet changes or increased activity is concerning.
• Persistent fatigue: While children can be tired from busy schedules, ongoing fatigue that doesn't improve with rest may indicate a problem.
• Unexplained fever: Fevers that don't respond to treatment, recur frequently, or persist without an obvious cause should be evaluated.
• Night sweats: Drenching night sweats (not related to room temperature or blankets) can be a sign of lymphoma or leukemia.
• Unusual lumps or swelling: Painless lumps, especially in the neck, armpit, or groin, or swelling in the abdomen should be evaluated.

Symptoms That May Indicate Leukemia

Leukemia affects the blood and bone marrow, leading to specific symptoms:

• Easy bruising or bleeding: Including frequent nosebleeds, bleeding gums, or bruises that appear without trauma
• Frequent infections: The abnormal white blood cells don't fight infection effectively
• Pale skin: Due to anemia (low red blood cell count)
• Bone or joint pain: Caused by abnormal cells crowding the bone marrow
• Swollen lymph nodes: Often in the neck, armpit, or groin

Symptoms That May Indicate Brain Tumors

Brain tumor symptoms depend on the tumor's location but often include:

• Persistent headaches: Especially if worse in the morning or wake the child from sleep
• Morning vomiting: Vomiting that occurs upon waking, often without nausea
• Vision problems: Double vision, vision loss, or abnormal eye movements
• Balance problems: Difficulty walking, coordination issues, or clumsiness
• Personality or behavior changes: Unusual irritability, sleep pattern changes, or developmental regression
• Seizures: Especially new-onset seizures in a child without a history of seizures

How Is Childhood Cancer Diagnosed?

Childhood cancer is diagnosed through a combination of physical examination, blood tests, imaging studies (MRI, CT, ultrasound, PET), and biopsy. For leukemia, bone marrow aspiration is essential. Diagnosis is made at specialized pediatric cancer centers by teams experienced in identifying and classifying childhood cancers accurately.

Diagnosing cancer in children requires a systematic approach that begins with recognizing concerning symptoms and progresses through increasingly specific tests. The diagnostic process aims to confirm whether cancer is present, determine the exact type of cancer, understand how far it has spread (staging), and identify characteristics that guide treatment decisions.

Most children with suspected cancer are referred to specialized pediatric cancer centers for diagnosis and treatment. These centers have teams of experts including pediatric oncologists, surgeons, radiologists, and pathologists who specialize in childhood cancers. This expertise is crucial for accurate diagnosis and optimal treatment planning.

Initial Evaluation

The diagnostic process typically begins with a thorough medical history and physical examination. The doctor will ask about symptoms, their duration, and any family history of cancer or genetic conditions. The physical exam checks for masses, enlarged lymph nodes, enlarged liver or spleen, and other abnormalities.

Blood Tests

Blood tests provide important initial information:

• Complete blood count (CBC): Shows the numbers and types of blood cells, which can be abnormal in leukemia and some other cancers
• Blood chemistry tests: Measure substances in the blood that can indicate how organs are functioning or suggest the presence of certain cancers
• Tumor markers: Some cancers produce specific proteins that can be detected in the blood

Imaging Studies

Various imaging techniques help visualize tumors and determine their extent:

• Ultrasound: Often the first imaging test for abdominal masses; uses sound waves and is non-invasive
• CT (computed tomography) scan: Provides detailed cross-sectional images of the body
• MRI (magnetic resonance imaging): Particularly useful for brain tumors and soft tissue masses; no radiation exposure
• PET (positron emission tomography) scan: Shows areas of high metabolic activity, helping identify cancer spread
• Bone scan: Detects cancer that has spread to bones

Biopsy

A biopsy—removing a sample of tissue for examination—is usually essential for confirming a cancer diagnosis. The tissue sample is examined by a pathologist who specializes in diagnosing cancers. Modern techniques can identify the specific type of cancer, genetic mutations, and other characteristics that guide treatment.

For leukemia, a bone marrow aspiration and biopsy is the key diagnostic test. This involves inserting a needle into the hip bone to remove a sample of bone marrow, where blood cells are made. This test shows whether cancer cells are present and provides information about the specific type of leukemia.

How Is Childhood Cancer Treated?

Childhood cancer treatment typically includes chemotherapy, surgery, and/or radiation therapy, depending on the cancer type and stage. Newer treatments include immunotherapy and targeted therapy. Treatment is delivered at specialized pediatric cancer centers by multidisciplinary teams and often lasts months to years. Most protocols are based on clinical trial evidence.

The treatment of childhood cancer has advanced remarkably over the past several decades, with survival rates improving from less than 30% in the 1960s to over 80% today. This progress is largely due to the systematic conduct of clinical trials that have refined treatment protocols and identified the most effective therapies for each type of cancer.

Treatment is delivered at specialized pediatric cancer centers where multidisciplinary teams work together to provide comprehensive care. These teams include pediatric oncologists, surgeons, radiation oncologists, nurses, pharmacists, social workers, psychologists, and many other specialists. This team approach ensures that all aspects of the child's care—medical, emotional, and practical—are addressed.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. It is the backbone of treatment for most childhood cancers, including leukemia, lymphoma, and many solid tumors. Chemotherapy can be given in various ways:

• Intravenously (IV): Through a vein, often via a central line (a special catheter placed for long-term use)
• Orally: Pills or liquid taken by mouth
• Intrathecally: Injected directly into the spinal fluid (for cancers that may spread to the brain)

Chemotherapy is typically given in cycles, with treatment periods followed by recovery periods. The total duration of treatment varies widely—from a few months for some cancers to 2-3 years for acute lymphoblastic leukemia.

Surgery

Surgery plays an important role in treating many solid tumors. The goal is typically to remove as much of the tumor as possible while preserving normal function. In some cases, surgery may be performed before chemotherapy to remove the bulk of the tumor; in others, chemotherapy is given first to shrink the tumor and make surgery easier.

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells. It is particularly important in treating brain tumors and some other solid tumors. Modern techniques allow radiation to be targeted precisely at the tumor while minimizing exposure to surrounding healthy tissue.

Because radiation can affect the developing brain and other tissues, doctors carefully weigh the benefits against potential long-term effects. In young children, chemotherapy may be used instead of or to reduce the dose of radiation whenever possible.

Newer Treatments

Recent advances have introduced new treatment options:

• Immunotherapy: Treatments that help the immune system recognize and fight cancer cells. CAR T-cell therapy, which engineers a patient's own immune cells to attack cancer, has shown remarkable results in some cases of relapsed leukemia.
• Targeted therapy: Drugs that target specific abnormalities in cancer cells, often causing fewer side effects than traditional chemotherapy.
• Stem cell transplant: Used for some leukemias and other cancers; involves replacing diseased bone marrow with healthy stem cells.

Supportive Care

In addition to cancer-directed treatment, comprehensive supportive care is essential. This includes:

• Management of treatment side effects (nausea, infection prevention, pain control)
• Nutritional support
• Blood product transfusions when needed
• Psychological support for the child and family
• Educational support to maintain schooling during treatment

Why Is Long-Term Follow-Up Important?

Long-term follow-up is essential because two-thirds of childhood cancer survivors experience at least one late effect from their treatment. These may include heart problems, fertility issues, hormone imbalances, growth delays, and a small increased risk of secondary cancers. Follow-up continues into adulthood at specialized survivorship clinics.

The success in treating childhood cancer means that there are now millions of childhood cancer survivors worldwide. While this is cause for celebration, it also brings responsibility for long-term monitoring. The treatments that cure cancer can sometimes cause problems that appear months or years later—these are called "late effects."

Research shows that about two-thirds of childhood cancer survivors will experience at least one late effect from their disease or treatment. The risk of late effects depends on several factors:

• The type of cancer and its location
• The treatments received (chemotherapy drugs, radiation dose and location, surgeries)
• The age at treatment (younger children may be more vulnerable to certain effects)

Types of Late Effects

Late effects can affect virtually any organ system:

• Heart problems: Some chemotherapy drugs and chest radiation can affect heart function
• Kidney issues: Certain treatments can reduce kidney function
• Fertility: Some treatments affect the ability to have children in the future; fertility preservation options should be discussed before treatment when appropriate
• Hormone imbalances: Treatment can affect growth hormone, thyroid function, and other hormones
• Growth and development: Radiation and some chemotherapy can affect growth, particularly if given at young ages
• Cognitive effects: Brain radiation and some chemotherapy can affect learning and memory
• Secondary cancers: A small increased risk of developing a new cancer later in life

Survivorship Care

As children complete treatment, they transition from active treatment to survivorship care. Initially, follow-up visits are frequent—often every few months—to watch for recurrence. Over time, visits become less frequent but continue indefinitely.

Around age 18, survivors typically transition from pediatric to adult care. Many specialized survivorship clinics have been established to provide ongoing care for adults who had cancer as children. These clinics provide:

• Monitoring for late effects based on the individual's treatment history
• Screening tests tailored to the survivor's specific risks
• Counseling about healthy lifestyle choices
• Coordination of care with other specialists

How Can Families Cope with a Childhood Cancer Diagnosis?

Coping with childhood cancer requires emotional support for the entire family. Parents often experience shock, fear, and grief; children react based on their age and understanding; siblings may feel neglected or scared. Pediatric cancer centers provide social workers, psychologists, and support resources. Maintaining routines and open communication helps families adapt.

A childhood cancer diagnosis affects the entire family. Parents, the child with cancer, siblings, and extended family members all experience emotional reactions and must adapt to significant changes in daily life. Understanding common reactions and knowing what support is available can help families navigate this challenging time.

Parents' Reactions

Receiving a cancer diagnosis for your child is one of life's most devastating experiences. Parents commonly experience:

• Shock and disbelief: The diagnosis often comes unexpectedly, and it may take time to process
• Fear and anxiety: About treatment, prognosis, and the future
• Guilt: Wondering if something could have been done differently
• Grief: For the loss of normal childhood experiences
• Overwhelm: From medical information, decisions, and changes to daily life

If possible, both parents or caregivers should receive the diagnosis together, even if they don't live together. This ensures both have accurate information and can support each other and the child.

Children's Reactions

How a child reacts to a cancer diagnosis depends largely on their age and developmental stage:

• Young children: May not fully understand the illness but sense their parents' distress. They live in the moment and are often more concerned about immediate experiences (procedures, being in the hospital) than the future.
• School-age children: Have more understanding and may have questions and fears about treatment and what will happen to them. They may worry about missing school and activities.
• Teenagers: Often find the diagnosis particularly challenging. They may resent the loss of independence and being different from their peers just when fitting in feels most important.

Supporting Siblings

Siblings often feel overlooked when a brother or sister has cancer. Parents' attention necessarily focuses on the ill child, and normal family routines are disrupted. Siblings may experience:

• Worry about their sibling
• Jealousy of the attention the sick child receives
• Fear that they might also get cancer
• Guilt about their own health or about feeling resentful

It's important to include siblings in information sharing at an age-appropriate level, maintain their routines as much as possible, and ensure they have adults (family members, friends, or support group leaders) who pay attention to their needs.

Getting Support

Pediatric cancer centers have support resources for families:

• Social workers: Help with practical issues, emotional support, and connecting with resources
• Psychologists: Provide counseling for children and family members
• Child life specialists: Help children understand and cope with medical experiences
• Support groups: Connect families with others going through similar experiences
• Financial counselors: Help navigate insurance and financial assistance

What Is Life Like After Childhood Cancer?

Many childhood cancer survivors go on to live full, healthy lives. However, adjusting to life after treatment takes time. Survivors may experience physical and emotional challenges, need ongoing medical follow-up, and find new perspectives on life. With appropriate support and monitoring, most survivors thrive as adults.

Completing cancer treatment is a major milestone, but it doesn't mean immediate return to "normal." The transition from active treatment to survivorship brings its own adjustments. Families often describe mixed emotions—relief that treatment is over combined with anxiety about the future.

For parents, the close connection with the medical team that provided security during treatment may feel like a loss. Regular check-ups continue, but the intensity decreases over time. It can take time to trust that the cancer is truly gone.

For children and teenagers who've completed treatment, reintegrating into normal life—school, activities, friendships—may be challenging. They may look or feel different than before treatment, have missed shared experiences with peers, or struggle with the emotional aftermath of what they've been through.

Physical Recovery

Physical recovery varies depending on the type of cancer and treatment received. Some children bounce back quickly, while others need more time. Common issues during recovery include:

• Fatigue that improves gradually over months
• Return of hair (if lost during treatment)
• Rebuilding strength and endurance
• Catching up on growth if treatment affected development

Emotional Adjustment

Emotional recovery is equally important. Children and families may experience:

• Anxiety about cancer returning, especially around follow-up appointments
• Difficulty talking about the cancer experience
• Changed perspective on life and priorities
• Post-traumatic stress symptoms in some cases
• A sense of purpose or resilience that comes from surviving a serious illness

Professional support from psychologists or counselors who understand cancer survivorship can be helpful during this transition.

Long-Term Outlook

The long-term outlook for childhood cancer survivors is generally positive. Many go on to complete education, pursue careers, have families, and lead fulfilling lives. With appropriate follow-up care to monitor for and manage late effects, most survivors maintain good quality of life.

Research continues to improve both treatment effectiveness and quality of life for survivors. Today's treatment protocols increasingly aim to cure cancer while minimizing long-term effects, and new approaches are being developed to prevent or treat late effects.