Childhood Cancer: Types, Symptoms & Treatment Guide

What Is Childhood Cancer?

Childhood cancer is a collective term for cancers that occur in children and adolescents up to 18 years old. Unlike most adult cancers, childhood cancers are rarely linked to lifestyle factors and instead usually arise from random genetic changes during development. The most common types include leukemia, brain tumors, lymphoma, and neuroblastoma.

Cancer occurs when cells in the body begin to grow uncontrollably. In children, this process differs significantly from adult cancers in several important ways. While adult cancers often develop over decades and are frequently linked to environmental exposures or lifestyle choices like smoking, childhood cancers typically develop from cells that are still growing and developing. This means they often arise from embryonic or fetal tissue types, which is why many childhood cancers have names ending in "-blastoma" (like neuroblastoma or retinoblastoma), referring to immature blast cells.

The biology of childhood cancer also differs from adult cancer. Children's cancers tend to grow more rapidly, but paradoxically, they often respond better to treatment. This is partly because the rapidly dividing cancer cells are more vulnerable to chemotherapy, and partly because children's bodies can generally tolerate more intensive treatment than adults. However, this also means that childhood cancers can progress quickly if not detected and treated promptly.

Approximately 300,000 children worldwide are diagnosed with cancer each year. While childhood cancer is relatively rare - accounting for less than 1% of all cancers - it remains the leading cause of disease-related death in children in high-income countries. The good news is that survival rates have improved dramatically over the past 50 years, from less than 30% in the 1960s to more than 80% today in countries with access to modern treatment.

How Common Is Childhood Cancer?

Childhood cancer is thankfully rare compared to adult cancers. In high-income countries, approximately 140-150 children per million under age 15 are diagnosed with cancer each year. To put this in perspective, for every child diagnosed with cancer, more than 100 adults receive the same diagnosis. However, childhood cancer's impact on families and society is profound because it affects the youngest and most vulnerable members of our communities.

The incidence of childhood cancer varies somewhat by age, sex, and ethnicity. Cancer is slightly more common in boys than girls, and certain types of cancer are more common in specific age groups. For example, neuroblastoma typically affects very young children under age 5, while bone cancers and certain lymphomas are more common in adolescents.

What Are the Most Common Types of Childhood Cancer?

The most common childhood cancers are leukemia (about 30% of cases), brain and central nervous system tumors (about 26%), lymphomas (about 8%), neuroblastoma (about 6%), Wilms tumor (kidney cancer, about 5%), and bone cancers. The distribution of cancer types varies significantly by age, with some cancers more common in infants and others in adolescents.

Understanding the different types of childhood cancer helps parents and caregivers recognize warning signs and understand treatment approaches. Each type has unique characteristics, treatment protocols, and prognoses. Modern medicine has made remarkable progress in treating childhood cancers, with some types now having survival rates above 90%.

Leukemia

Leukemia is cancer of the blood-forming cells in the bone marrow and is the most common childhood cancer, accounting for approximately 30% of all pediatric cancer cases. The disease occurs when the bone marrow produces abnormal white blood cells that don't function properly and crowd out healthy blood cells. There are several types of leukemia, but the most common in children is acute lymphoblastic leukemia (ALL), which accounts for about 75% of childhood leukemia cases.

Symptoms of leukemia typically develop because the abnormal cancer cells crowd out the normal blood cells. When there aren't enough healthy red blood cells, children become pale and tired. When there aren't enough platelets, children bruise easily and may have unusual bleeding. When there aren't enough functional white blood cells, children become susceptible to infections and may have persistent fevers. Bone pain can occur when leukemia cells accumulate in the bone marrow.

The prognosis for childhood leukemia has improved dramatically. Today, approximately 90% of children with ALL achieve remission with treatment, and overall survival rates exceed 85% for many subtypes. Treatment typically involves chemotherapy given in phases over 2-3 years, and some children may need stem cell transplantation.

Brain and Central Nervous System Tumors

Brain tumors are the second most common childhood cancer and the most common solid tumor in children. They account for about 26% of all childhood cancers. Brain tumors in children differ significantly from those in adults, both in the types that occur and how they're treated. The most common childhood brain tumors include astrocytomas (including pilocytic astrocytoma), medulloblastomas, ependymomas, and brain stem gliomas.

Symptoms of brain tumors depend on the tumor's location but commonly include headaches (especially ones that are worse in the morning or wake the child from sleep), nausea and vomiting, vision problems, balance difficulties, personality or behavior changes, and in infants, an enlarging head circumference. Some tumors cause seizures or affect specific neurological functions depending on their location.

Treatment for brain tumors typically involves surgery when possible, followed by radiation therapy and/or chemotherapy depending on the tumor type and the child's age. Younger children may receive chemotherapy instead of radiation to protect the developing brain. Survival rates vary widely depending on the tumor type and location, ranging from above 90% for some low-grade tumors to more challenging prognoses for certain aggressive types.

Lymphomas

Lymphomas are cancers that begin in the lymphatic system, which is part of the body's immune system. They account for about 8% of childhood cancers. There are two main types: Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma is more common in adolescents and young adults, while non-Hodgkin lymphoma can occur at any age during childhood.

The hallmark symptom of lymphoma is swollen lymph nodes, particularly in the neck, armpit, or groin, that persist for more than two weeks and cannot be explained by infection. Other symptoms may include unexplained fever, night sweats, unexplained weight loss, fatigue, and itching. When lymphoma affects the chest, it can cause breathing difficulties or a persistent cough.

Hodgkin lymphoma has one of the highest survival rates of all childhood cancers, exceeding 95% with modern treatment. Non-Hodgkin lymphoma has also seen significant improvements in outcomes, with survival rates typically ranging from 80-90% depending on the subtype. Treatment usually involves chemotherapy, and some cases may require radiation therapy.

Neuroblastoma

Neuroblastoma develops from nerve tissue and is most common in children under age 5, particularly in infants. It accounts for about 6% of childhood cancers but is responsible for a disproportionate number of childhood cancer deaths. The tumor most commonly develops in the adrenal glands (located above the kidneys) but can occur anywhere along the sympathetic nervous system.

Symptoms of neuroblastoma depend on where the tumor develops but may include an abdominal mass or swelling, bone pain, dark circles around the eyes, fever, and irritability. In some cases, the tumor can press on the spinal cord, causing weakness or paralysis. Interestingly, neuroblastoma in very young infants sometimes regresses spontaneously without treatment.

Treatment and prognosis for neuroblastoma depend heavily on the child's age, the tumor's characteristics, and how far the cancer has spread. Low-risk neuroblastoma has an excellent prognosis, with survival rates above 95%. High-risk neuroblastoma is more challenging to treat, but ongoing research continues to improve outcomes through new treatment approaches including immunotherapy.

Wilms Tumor (Kidney Cancer)

Wilms tumor, also called nephroblastoma, is the most common kidney cancer in children, typically affecting children between ages 3 and 4. It accounts for about 5% of childhood cancers. Most cases occur sporadically, but a small percentage are associated with genetic syndromes or inherited mutations.

The most common symptom of Wilms tumor is an abdominal mass or swelling, which is often first noticed by a parent during bathing or dressing. Other symptoms may include blood in the urine, abdominal pain, fever, loss of appetite, and high blood pressure. The tumor is often discovered before it causes significant symptoms.

Wilms tumor is one of the success stories of pediatric oncology, with survival rates exceeding 90% for most children. Treatment typically involves surgical removal of the affected kidney, followed by chemotherapy and sometimes radiation therapy. Even children with advanced disease often have good outcomes with appropriate treatment.

Other Childhood Cancers

Additional childhood cancers include bone cancers (osteosarcoma and Ewing sarcoma, more common in adolescents), retinoblastoma (eye cancer, usually diagnosed before age 3), soft tissue sarcomas (including rhabdomyosarcoma), liver cancer (hepatoblastoma), and germ cell tumors. Each of these has specific characteristics, treatments, and outcomes that pediatric oncology teams are experienced in managing.

What Are the Warning Signs of Childhood Cancer?

Warning signs of childhood cancer include unexplained weight loss, persistent fatigue, recurring fevers, unusual bruising or bleeding, swollen lymph nodes lasting more than 2 weeks, persistent headaches (especially with vomiting), bone or joint pain, abdominal swelling, and changes in vision or balance. While these symptoms usually have other causes, persistent or worsening symptoms warrant medical evaluation.

Recognizing the warning signs of childhood cancer can be challenging because many symptoms overlap with common childhood illnesses. A child with leukemia might initially seem to have a persistent cold or flu. A child with a brain tumor might complain of headaches that are attributed to stress or needing glasses. This is why it's important for parents and healthcare providers to pay attention to symptoms that persist, worsen, or don't respond to typical treatments.

The key to early detection is awareness and persistence. If your child has symptoms that concern you, trust your instincts and seek medical attention. If initial treatments don't help, don't hesitate to ask for further evaluation or a second opinion. Early diagnosis can significantly improve outcomes for many childhood cancers.

General Warning Signs

Some warning signs can be associated with various types of childhood cancer. These general symptoms occur because cancer affects the body's normal functions and triggers immune responses. Unexplained weight loss, where a child loses weight without dieting or increased activity, is always concerning and warrants investigation. Persistent fatigue that doesn't improve with rest, or a child who suddenly can't keep up with normal activities, should be evaluated.

Recurring fevers without an obvious source, particularly if they come and go over several weeks, may indicate cancer. While most fevers in children are caused by infections, persistent or cyclical fevers deserve attention. Similarly, unusual bruising or bleeding - especially bruises in unusual locations or that appear without known injury - can indicate problems with blood cell production that occur with leukemia or other cancers.

Symptoms Specific to Cancer Types

Different types of cancer cause different symptoms based on which organs or tissues are affected. For leukemia, watch for pale skin, fatigue, frequent infections, easy bruising, bleeding gums, and bone or joint pain. For brain tumors, be alert to headaches (especially ones that are worse in the morning or wake the child from sleep), nausea and vomiting, vision changes, balance problems, or personality changes.

For lymphomas, look for swollen lymph nodes that persist for more than two weeks and can't be explained by infection, night sweats, unexplained fevers, and unexplained weight loss. For abdominal tumors like neuroblastoma or Wilms tumor, watch for abdominal swelling or a lump, constipation, and loss of appetite. For bone cancers, pay attention to bone pain that wakes the child at night or doesn't improve with rest.

What Causes Childhood Cancer?

Most childhood cancers are caused by random genetic mutations that occur during normal cell development, not by inherited genes or environmental factors. Only 5-10% of childhood cancers have a hereditary component. Unlike adult cancers, childhood cancer is rarely linked to lifestyle factors, and parents should not blame themselves for their child's diagnosis.

Understanding the causes of childhood cancer helps families cope with the diagnosis and make informed decisions about their child's care and future family planning. The science of childhood cancer causation has advanced significantly, revealing that these cancers are fundamentally different from most adult cancers in their origins.

The vast majority of childhood cancers arise from random errors that occur when cells divide and copy their DNA. During fetal development and early childhood, cells are dividing rapidly to build the body's tissues and organs. Each time a cell divides, its entire genome - billions of DNA base pairs - must be copied. Despite remarkable accuracy, errors occasionally occur. Most of these errors are harmless or are corrected by the cell's repair mechanisms. However, when errors occur in genes that control cell growth and division, cancer can result.

This understanding has important implications for families. It means that in most cases, nothing the parents did or didn't do caused their child's cancer. The cancer wasn't caused by something the mother ate during pregnancy, by childhood vaccines, by living near power lines, or by letting children use electronic devices. These myths persist but have no scientific support. The random nature of most childhood cancers means they simply cannot be prevented.

Genetic and Hereditary Factors

While most childhood cancers are not inherited, approximately 5-10% are associated with genetic syndromes or inherited mutations. Some cancers have a stronger genetic component than others. Retinoblastoma, for example, is hereditary in about 40% of cases, caused by inherited mutations in the RB1 gene. Children who inherit this mutation have a high risk of developing retinoblastoma and need regular screening from birth.

Several genetic syndromes are associated with increased cancer risk in children. Li-Fraumeni syndrome, caused by mutations in the TP53 gene, increases risk for multiple cancer types including leukemia, brain tumors, and bone cancers. Down syndrome (trisomy 21) increases the risk of leukemia significantly. Neurofibromatosis increases risk of brain tumors and other cancers. Beckwith-Wiedemann syndrome increases risk of Wilms tumor and other cancers.

When a hereditary cancer syndrome is suspected, genetic counseling and testing can help families understand their risks and make informed decisions about screening and prevention. If your child is diagnosed with cancer, the medical team will evaluate whether genetic testing is appropriate based on the cancer type, family history, and any associated features.

Environmental Factors

Unlike adult cancers, very few childhood cancers are linked to environmental exposures. High-dose radiation exposure, such as from atomic bomb exposure or therapeutic radiation, is one of the few proven environmental causes. Previous chemotherapy treatment can also increase the risk of secondary cancers later in life.

Research has investigated many potential environmental factors but has found little evidence linking common exposures to childhood cancer. Studies have not found consistent associations between childhood cancer and factors like household chemicals, pesticides, electromagnetic fields, cell phones, living near nuclear facilities, or parental smoking (though parental smoking has other serious health effects and should be avoided).

How Is Childhood Cancer Diagnosed?

Childhood cancer is diagnosed through a combination of physical examination, blood tests, imaging studies (X-rays, CT scans, MRI), and tissue biopsy. The specific tests depend on the suspected cancer type. Diagnosis is made at specialized pediatric cancer centers where teams have expertise in childhood cancers and can accurately determine the cancer type, stage, and appropriate treatment.

The diagnostic process for childhood cancer begins when a parent, child, or healthcare provider notices concerning symptoms. The journey from initial concern to diagnosis can feel overwhelming for families, but understanding the process can help reduce anxiety and prepare for what's ahead.

Initial evaluation typically includes a thorough physical examination and medical history. The healthcare provider will ask about symptoms, their duration, and their progression. They'll examine the child for signs like swollen lymph nodes, abdominal masses, or neurological changes. Based on this evaluation, initial tests are ordered.

Blood Tests

Blood tests are often among the first tests performed when cancer is suspected. A complete blood count (CBC) can reveal abnormalities in red blood cells, white blood cells, and platelets that might indicate leukemia or other conditions affecting the bone marrow. Blood chemistry tests evaluate organ function and can detect tumor markers - substances produced by certain cancers that appear in the blood.

Specific tumor markers are associated with particular cancers. Alpha-fetoprotein (AFP) can be elevated in liver cancer and certain germ cell tumors. Lactate dehydrogenase (LDH) may be elevated in various cancers. Catecholamines and their metabolites can indicate neuroblastoma. These markers help with diagnosis and are also used to monitor treatment response.

Imaging Studies

Imaging tests create pictures of the inside of the body and are essential for locating tumors, determining their size, and assessing whether cancer has spread. Different imaging techniques have different strengths. X-rays can show bone abnormalities and some tumors. Ultrasound uses sound waves to create images and is particularly useful for examining abdominal organs like the kidneys and liver.

CT (computed tomography) scans use X-rays to create detailed cross-sectional images and can show tumors throughout the body. MRI (magnetic resonance imaging) uses magnetic fields and provides excellent detail, particularly for brain tumors and soft tissue masses. PET (positron emission tomography) scans show metabolic activity and can help identify areas of active cancer throughout the body.

Biopsy and Tissue Diagnosis

In most cases, a biopsy is needed to definitively diagnose cancer. A biopsy involves removing a small sample of tissue, which is then examined by a pathologist under a microscope. For leukemia, the biopsy involves taking a bone marrow sample (bone marrow aspiration and biopsy). For solid tumors, surgical techniques are used to obtain tissue samples.

Modern pathology goes beyond simply identifying cancer cells. Specialized tests analyze the cancer's specific characteristics, including genetic and molecular features that influence treatment decisions. These analyses help determine the cancer subtype, predict how aggressive it might be, and identify targets for specific therapies. This precision medicine approach has significantly improved outcomes for many childhood cancers.

How Is Childhood Cancer Treated?

Childhood cancer treatment typically combines chemotherapy, surgery, and/or radiation therapy, with the specific approach depending on the cancer type and stage. Treatment is provided at specialized pediatric cancer centers by multidisciplinary teams including pediatric oncologists, surgeons, radiation therapists, nurses, and support staff experienced in caring for children. Newer treatments like immunotherapy and targeted therapy are increasingly being used.

Treatment for childhood cancer has advanced remarkably over the past decades, transforming once-fatal diagnoses into highly curable conditions. The success of childhood cancer treatment stems from a combination of factors: international cooperation in clinical trials, treatment protocols refined over decades, and the dedication of specialized pediatric oncology teams.

Children with cancer should be treated at dedicated pediatric cancer centers, not general hospitals. These specialized centers have the expertise, equipment, and support services needed for optimal outcomes. They participate in clinical trials and follow standardized treatment protocols that represent the best current evidence. The staff - from oncologists to nurses to child life specialists - are experienced in working with children of all ages and helping families navigate treatment.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells and is the backbone of treatment for most childhood cancers. Children generally tolerate chemotherapy better than adults, allowing for more intensive treatment regimens. Chemotherapy may be given in different ways: intravenously (into a vein), orally (by mouth), intrathecally (into the spinal fluid for certain cancers that can spread to the central nervous system), or by injection.

Chemotherapy is typically given in cycles, with treatment periods followed by rest periods that allow the body to recover. The drugs, doses, and schedules are carefully determined based on the specific cancer type and the child's individual characteristics. Side effects like nausea, hair loss, and increased infection risk are common but manageable with supportive care. Most chemotherapy side effects are temporary and resolve after treatment ends.

Surgery

Surgery plays an important role in treating many solid tumors in children. The goal of surgery may be to completely remove the tumor (when possible), to remove as much tumor as possible before or after other treatments, or to obtain tissue for diagnosis. The extent of surgery depends on the tumor's location, size, and relationship to vital structures.

Advances in surgical techniques, including minimally invasive approaches, have reduced recovery times and complications. Pediatric surgeons who specialize in oncology have expertise in removing tumors while preserving function and minimizing long-term effects on growing children. In some cases, surgery may be delayed until chemotherapy shrinks a tumor, making removal safer and more complete.

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells and is an important part of treatment for some childhood cancers. Modern radiation techniques allow precise targeting of tumors while minimizing exposure to surrounding healthy tissue. This is particularly important in children, whose developing tissues are more sensitive to radiation's effects.

Because of concerns about long-term effects on growing children, radiation therapy is used more selectively in pediatric oncology than in adult cancer treatment. When radiation is necessary, advanced techniques like intensity-modulated radiation therapy (IMRT) and proton beam therapy can reduce exposure to normal tissues. Proton therapy is particularly valuable for childhood cancers because protons can be precisely controlled to stop within the tumor, reducing radiation to healthy tissue beyond the tumor.

Newer Treatments

Research continues to bring new treatment options for childhood cancer. Immunotherapy harnesses the body's immune system to fight cancer. One form, CAR-T cell therapy, has shown remarkable results for certain children with leukemia who haven't responded to other treatments. The treatment involves genetically modifying the child's own immune cells to recognize and attack cancer cells.

Targeted therapies are drugs designed to attack specific features of cancer cells while sparing normal cells. As researchers identify the genetic and molecular abnormalities driving specific cancers, they can develop drugs that target these abnormalities. These targeted approaches often have fewer side effects than traditional chemotherapy and are increasingly being incorporated into treatment protocols.

What Are the Long-Term Effects of Childhood Cancer Treatment?

About two-thirds of childhood cancer survivors experience at least one late effect from their disease or treatment. These can include effects on growth, fertility, heart health, cognitive function, and risk of secondary cancers. Long-term follow-up throughout life is essential to detect and manage these effects. Many late effects can be prevented or minimized with proper monitoring and intervention.

As survival rates for childhood cancer have improved, increasing attention has been focused on the long-term health of survivors. The treatments that save children's lives - chemotherapy, radiation, and surgery - can also have lasting effects on growing bodies. Understanding these potential late effects helps survivors and their families plan for appropriate monitoring and care.

The specific late effects a survivor might experience depend on the cancer type, treatments received, doses, age at treatment, and individual factors. Not all survivors experience late effects, and many who do have mild, manageable conditions. However, awareness and monitoring are essential to catch problems early when they're most treatable.

Growth and Development

Cancer treatment during childhood can affect growth and development in various ways. Radiation to the brain can affect the pituitary gland, which produces hormones controlling growth and puberty. Some chemotherapy drugs can affect bone growth. Surgery may affect specific organs' function or development. Regular monitoring of growth and development allows early intervention when problems occur.

Hormone replacement therapy can address many endocrine effects. Growth hormone therapy can help children who have growth hormone deficiency after treatment. Thyroid hormone replacement is common for survivors who received radiation that affected the thyroid. Regular endocrine screening helps identify problems early.

Fertility

Cancer treatment can affect fertility in both boys and girls. Certain chemotherapy drugs and radiation to the pelvic area carry higher risks. Before treatment begins, the medical team should discuss fertility preservation options. For adolescent boys, sperm banking may be possible. For adolescent girls, egg or ovarian tissue preservation may be options. For younger children, ovarian or testicular tissue preservation is an active area of research.

Many childhood cancer survivors go on to have biological children, but fertility monitoring and counseling should be part of survivorship care. If fertility is affected, assisted reproductive technologies or other options for building families can be discussed.

Heart and Organ Health

Certain chemotherapy drugs, particularly anthracyclines like doxorubicin, can affect heart function. The risk increases with higher cumulative doses. Regular cardiac monitoring, including echocardiograms, is recommended for survivors who received these drugs. Early detection of cardiac problems allows intervention before significant symptoms develop.

Other organs can also be affected. Kidney function may be monitored in survivors who received certain drugs or kidney radiation. Hearing should be checked after treatment with platinum-based chemotherapy. Lung function may be affected by certain drugs or chest radiation. A comprehensive survivorship care plan addresses monitoring for all relevant organ systems.

Secondary Cancers

Childhood cancer survivors have an increased risk of developing new cancers later in life. This risk is related to genetic factors, radiation exposure, and certain chemotherapy drugs. Regular screening and healthy lifestyle choices can help detect secondary cancers early or reduce risk.

Survivors should avoid tobacco and limit alcohol, maintain a healthy weight, stay physically active, and limit sun exposure. They should follow recommended cancer screening guidelines and discuss with their doctors whether additional screening is appropriate based on their treatment history.

How Can Families Get Support?

Families affected by childhood cancer need comprehensive support including medical care, emotional support, practical assistance, and financial resources. Pediatric cancer centers provide social workers, child life specialists, psychologists, and support groups. Organizations worldwide offer resources for families including financial assistance, housing during treatment, and peer support programs.

A childhood cancer diagnosis affects the entire family - parents, siblings, grandparents, and extended family. The emotional, practical, and financial challenges can feel overwhelming. However, comprehensive support is available, and connecting with resources early can make the journey more manageable.

Hospital-Based Support

Pediatric cancer centers provide extensive support services beyond medical treatment. Social workers help families navigate the healthcare system, understand insurance coverage, access financial assistance, and coordinate resources. Child life specialists help children cope with hospitalization and treatment through play, education, and preparation for procedures. Psychologists and counselors provide emotional support for children and family members.

Many centers have specialized programs for siblings, recognizing that brothers and sisters also need support and attention. Educational specialists help children maintain their schoolwork during treatment. Palliative care teams focus on quality of life and symptom management throughout treatment. Chaplains provide spiritual support for families of all faiths or no faith.

Practical Support

Organizations provide practical help that makes daily life more manageable during treatment. Many offer housing near treatment centers for families who must travel for care. Meal programs help families focus on their child rather than cooking. Transportation assistance helps families get to appointments. Some organizations provide housecleaning, lawn care, or other practical services.

Financial assistance programs help with treatment costs, living expenses, and lost wages. Insurance navigation services help families understand and maximize their coverage. Legal aid organizations can help with employment issues, insurance problems, and other legal challenges families may face.

Emotional and Peer Support

Connecting with other families going through similar experiences can provide invaluable emotional support. Parent support groups, both in-person and online, allow parents to share experiences, exchange information, and support each other. Camp programs for children with cancer and their siblings provide normalcy and connection with peers who understand their experiences.

Individual and family counseling helps process the emotional impact of diagnosis and treatment. Many families find that their relationships strengthen through the experience, but counseling can help address challenges that arise. Bereavement support is available for families who lose a child to cancer.

Life After Treatment

The end of treatment brings relief but also new challenges. Many families experience anxiety about the cancer returning. Children may struggle with re-entering school and peer relationships. Physical and emotional late effects may become apparent. Long-term follow-up programs help survivors transition from active treatment to survivorship care, addressing medical monitoring, psychosocial needs, and healthy lifestyle promotion.