Childhood Cancer: Types, Symptoms & Treatment Options

What Is Childhood Cancer?

Childhood cancer refers to any malignant disease that develops in children and adolescents under 18 years of age. Unlike most adult cancers, childhood cancers are rarely caused by lifestyle factors such as diet, smoking, or environmental exposures. Instead, they typically arise from random genetic mutations during normal cell division or inherited genetic conditions.

Cancer develops when cells in the body begin to grow and divide uncontrollably, eventually forming tumors or, in the case of blood cancers like leukemia, flooding the bone marrow and bloodstream with abnormal cells. In children, these cancerous changes most commonly affect blood cells, the brain and nervous system, lymph nodes, bones, kidneys, and soft tissues. The biological behavior of childhood cancers differs significantly from adult cancers, which is why children are treated by specialized pediatric oncologists at dedicated cancer centers.

Approximately 300,000 children worldwide are diagnosed with cancer each year, according to the World Health Organization. While this represents less than 1% of all cancer diagnoses globally, childhood cancer remains a leading cause of disease-related death among children in many countries. The good news is that treatment outcomes have improved dramatically over the past several decades. In high-income countries with access to modern treatment protocols, the overall five-year survival rate for childhood cancer now exceeds 80%, with some cancer types achieving survival rates above 90%.

The landscape of childhood cancer treatment has been transformed by international collaboration, standardized treatment protocols, and advances in supportive care. Organizations such as the International Society of Paediatric Oncology (SIOP) and the Children's Oncology Group (COG) have developed evidence-based treatment guidelines that are used worldwide. However, significant disparities exist between high-income and low-income countries, where survival rates may be as low as 20-30% due to limited access to diagnosis, treatment, and supportive care.

How Childhood Cancer Differs from Adult Cancer

Understanding the fundamental differences between childhood and adult cancers is essential for appreciating why children require specialized care and why their prognosis is often more favorable:

• Causes: Adult cancers are frequently linked to lifestyle factors such as smoking, obesity, alcohol use, and occupational exposures accumulated over decades. Childhood cancers, in contrast, are almost never caused by such factors. Most arise from spontaneous genetic errors during fetal development or early childhood, or from inherited genetic syndromes.
• Cell types: Childhood cancers typically originate from embryonic or developing cells, which is why they often respond more dramatically to chemotherapy. Adult cancers usually arise from mature, differentiated cells that may be more resistant to treatment.
• Treatment tolerance: Children generally tolerate intensive chemotherapy better than adults because their organs are healthier and have greater regenerative capacity. This allows for more aggressive treatment protocols that can achieve cure in many cases.
• Response to treatment: Many childhood cancers are highly chemosensitive, meaning they respond well to chemotherapy drugs. This is partly because rapidly dividing immature cells are more vulnerable to the effects of these medications.
• Long-term effects: While children often survive cancer, they face unique challenges related to treatment effects on growing bodies, including impacts on growth, fertility, heart function, and cognitive development.

What Are the Most Common Types of Childhood Cancer?

The most common childhood cancers are leukemia (approximately 30% of all cases), brain and central nervous system tumors (26%), lymphomas (8%), neuroblastoma (6%), Wilms tumor (5%), and bone cancers including osteosarcoma and Ewing sarcoma. Each type has distinct characteristics, treatment approaches, and outcomes.

Childhood cancers are classified into numerous specific types and subtypes, each with unique biological characteristics that influence treatment decisions and prognosis. Unlike adult cancers, which are often named by the organ where they originate (lung cancer, breast cancer), childhood cancers are frequently named for the specific cell types involved, reflecting their developmental origins.

Leukemia

Leukemia is the most common cancer in children, accounting for approximately 30% of all childhood cancers. It is a cancer of the blood-forming cells in the bone marrow, leading to the overproduction of abnormal white blood cells that crowd out healthy blood cells. The two main types in children are acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

Acute lymphoblastic leukemia represents about 75% of childhood leukemia cases and has one of the highest cure rates of any childhood cancer, with five-year survival exceeding 90% in many treatment centers. Treatment typically involves multiple phases over 2-3 years, including induction, consolidation, and maintenance chemotherapy. Acute myeloid leukemia is less common but more aggressive, requiring intensive chemotherapy and sometimes 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 encompass a diverse group of tumors including medulloblastoma, gliomas, ependymoma, craniopharyngioma, and many others. The location and type of tumor significantly influence treatment options and outcomes.

Treatment for brain tumors typically involves surgery to remove as much tumor as possible, often followed by radiation therapy and chemotherapy. Because the developing brain is particularly vulnerable to radiation damage, treatment protocols for young children often try to delay or minimize radiation exposure. Advances in neurosurgery, targeted therapies, and proton beam radiation have improved outcomes while reducing long-term side effects.

Lymphoma

Lymphomas are cancers that arise from lymphocytes, a type of white blood cell involved in immune function. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma. Together, they account for about 8% of childhood cancers.

Hodgkin lymphoma typically presents with painless swelling of lymph nodes, often in the neck or chest, and has an excellent prognosis with survival rates exceeding 95%. Non-Hodgkin lymphoma in children includes several subtypes, with Burkitt lymphoma being the most common worldwide. Treatment involves chemotherapy, and outcomes have improved significantly with modern treatment protocols.

Neuroblastoma

Neuroblastoma is a cancer of immature nerve cells that most commonly develops in infants and young children under 5 years of age. It typically arises in the adrenal glands or along the sympathetic nerve chain in the abdomen, chest, or neck. Neuroblastoma accounts for about 6% of childhood cancers but causes a disproportionate share of childhood cancer deaths.

The behavior of neuroblastoma varies dramatically based on factors including the child's age, tumor stage, and specific genetic features. Some low-risk tumors, particularly in infants, may spontaneously regress without treatment, while high-risk disease requires intensive multimodal therapy including surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy.

Wilms Tumor (Nephroblastoma)

Wilms tumor is the most common kidney cancer in children, typically diagnosed between ages 3 and 4. It accounts for about 5% of childhood cancers. Most children present with an abdominal mass that is often discovered incidentally by parents or during routine examinations.

Treatment outcomes for Wilms tumor are excellent, with survival rates exceeding 90% for most stages. Treatment typically involves surgical removal of the affected kidney followed by chemotherapy, with radiation therapy added for higher-risk cases. International collaborative studies have refined treatment protocols to maximize cure rates while minimizing long-term side effects.

Bone Cancers

The two main bone cancers in children and adolescents are osteosarcoma and Ewing sarcoma. These tumors most commonly occur during the adolescent growth spurt and frequently affect the long bones of the legs and arms.

Osteosarcoma typically arises near the knee or shoulder and requires intensive chemotherapy combined with surgery. Advances in limb-sparing surgical techniques have reduced the need for amputation in many cases. Ewing sarcoma can occur in bones or soft tissues and is treated with a combination of chemotherapy, surgery, and radiation. Both cancers have five-year survival rates of approximately 60-70% for localized disease.

What Are the Warning Signs of Childhood Cancer?

Warning signs of childhood cancer include persistent unexplained symptoms such as fatigue, weight loss, recurrent fevers, easy bruising or bleeding, swollen lymph nodes, persistent pain, headaches with morning vomiting, vision changes, and unusual lumps or swelling. Because these symptoms can have many causes, persistent or unexplained symptoms warrant medical evaluation.

Recognizing the potential signs of childhood cancer can be challenging because many symptoms overlap with common childhood illnesses. However, certain patterns and persistence of symptoms should prompt medical evaluation. Parents and caregivers play a crucial role in identifying concerning changes because they know their child's normal behavior and health patterns best.

It is important to understand that having one or more of these symptoms does not mean a child has cancer. Most of these symptoms are far more commonly caused by infections, injuries, or other benign conditions. However, when symptoms persist, worsen, or cannot be explained by common causes, seeking medical evaluation is appropriate. Early diagnosis can lead to better treatment outcomes.

General Warning Signs

Several symptoms may indicate underlying cancer regardless of the specific type:

• Unexplained weight loss: Losing weight without trying, especially when combined with decreased appetite, can be a sign of various cancers. This occurs because cancer cells consume energy and can affect metabolism and appetite.
• Persistent fatigue: While children often have variable energy levels, fatigue that persists for weeks, interferes with normal activities, and does not improve with rest deserves evaluation.
• Recurrent or persistent fever: Fevers without an obvious infectious cause, or fevers that keep returning, may indicate leukemia or lymphoma. Cancer can cause fever by affecting the immune system or through tumor-related inflammation.
• Easy bruising or bleeding: Unusual bruising, frequent nosebleeds, bleeding gums, or tiny red spots on the skin (petechiae) can indicate problems with blood cell production, as seen in leukemia.
• Swollen lymph nodes: While swollen lymph nodes are common with infections, nodes that are painless, continue to grow, do not improve over several weeks, or are located in unusual places (such as above the collarbone) should be evaluated.

Location-Specific Symptoms

Some symptoms are more specific to certain cancer types based on where the cancer develops:

• Headaches with morning vomiting: Brain tumors can cause increased pressure inside the skull, leading to headaches that are worst upon waking and may be accompanied by vomiting. Changes in balance, coordination, or personality may also occur.
• Vision changes: A white reflection in the pupil (leukocoria), crossed eyes, or vision problems can indicate retinoblastoma or certain brain tumors. Any persistent visual abnormality should be evaluated promptly.
• Abdominal swelling or mass: A noticeable lump or swelling in the abdomen may indicate Wilms tumor, neuroblastoma, or other abdominal cancers. Parents often notice this during bathing or dressing.
• Bone or joint pain: Persistent pain in bones or joints, especially pain that wakes a child at night or does not respond to typical treatments, may indicate leukemia or bone cancer.
• Limping or movement changes: Unexplained limping, refusal to walk, or changes in coordination can indicate bone tumors or neurological involvement.

How Is Childhood Cancer Diagnosed?

Diagnosis of childhood cancer involves a combination of physical examination, blood tests, imaging studies (X-rays, CT, MRI, ultrasound, PET scans), and tissue biopsy. The specific tests depend on the suspected cancer type. Accurate diagnosis is essential for determining the most appropriate treatment approach and predicting outcomes.

The diagnostic process for childhood cancer typically begins when concerning symptoms prompt a visit to a primary care provider or pediatrician. If initial evaluation raises suspicion of cancer, the child is usually referred to a pediatric oncologist at a specialized cancer center for further testing. The diagnostic workup aims to confirm the presence of cancer, identify the specific type and subtype, determine how far it has spread (staging), and identify biological features that influence treatment decisions.

Initial Evaluation

The diagnostic process begins with a thorough medical history and physical examination. The healthcare provider will ask about symptoms, their duration and progression, family medical history, and any relevant developmental or health concerns. Physical examination looks for signs such as swollen lymph nodes, abdominal masses, abnormal bruising, or neurological changes.

Blood Tests

Blood tests provide important information about blood cell counts, organ function, and sometimes tumor markers. A complete blood count (CBC) can reveal abnormalities in white blood cells, red blood cells, or platelets that may indicate leukemia. Blood chemistry tests assess kidney and liver function. Some cancers produce specific proteins or markers that can be detected in blood, such as alpha-fetoprotein (AFP) in certain liver and germ cell tumors, or catecholamines in neuroblastoma.

Imaging Studies

Various imaging techniques help visualize tumors and determine their extent:

• X-rays: Provide initial images of bones and the chest to identify tumors or abnormalities.
• Ultrasound: Uses sound waves to create images of soft tissues, particularly useful for abdominal tumors and for guiding biopsies.
• CT (Computed Tomography): Creates detailed cross-sectional images using X-rays, helpful for evaluating tumors throughout the body.
• MRI (Magnetic Resonance Imaging): Produces highly detailed images without radiation, particularly valuable for brain and spinal cord tumors and for soft tissue assessment.
• PET (Positron Emission Tomography): Uses radioactive tracers to identify metabolically active cancer cells, useful for staging lymphoma and other cancers.
• Nuclear medicine scans: Specialized scans using radioactive tracers, such as MIBG scans for neuroblastoma or bone scans for bone tumors.

Biopsy

A biopsy, which involves obtaining a sample of the suspected tumor tissue, is usually necessary for definitive diagnosis. The tissue is examined under a microscope by a pathologist who specializes in diagnosing cancer. Modern diagnosis also involves molecular and genetic testing of tumor tissue to identify specific mutations and characteristics that influence treatment decisions and prognosis.

For leukemia, diagnosis is typically made through bone marrow aspiration and biopsy, where a sample of bone marrow is obtained from the hip bone. This allows detailed analysis of the leukemic cells, including their type, genetic features, and how they respond to initial treatment.

How Is Childhood Cancer Treated?

Childhood cancer treatment typically involves combinations of chemotherapy, surgery, radiation therapy, and increasingly, targeted therapies and immunotherapy. Treatment is tailored to the specific cancer type, stage, and biological features. Most children are treated according to clinical trial protocols that represent the current best evidence for optimal outcomes.

Treatment of childhood cancer requires a coordinated, multidisciplinary approach involving specialists from various fields working together to develop and implement individualized treatment plans. Treatment protocols are based on decades of clinical research and are continuously refined through ongoing clinical trials. The specific treatment approach depends on the type of cancer, its location and stage, genetic features, and the child's overall health.

Chemotherapy

Chemotherapy uses powerful medications to kill cancer cells or stop them from dividing. It remains the cornerstone of treatment for most childhood cancers. Because chemotherapy travels throughout the body via the bloodstream, it can reach cancer cells wherever they may be, making it particularly effective for cancers that have spread or for blood cancers like leukemia.

Chemotherapy regimens for children are carefully designed based on extensive research. Treatment is typically given in cycles, with periods of treatment followed by rest periods to allow the body to recover. The specific drugs, doses, and schedules vary depending on the cancer type and treatment protocol. Side effects are carefully managed with supportive care medications and close monitoring.

Surgery

Surgery plays a crucial role in treating many solid tumors. The goals of surgery may include complete removal of the tumor when possible, obtaining tissue for diagnosis through biopsy, relieving symptoms caused by tumor pressure, or debulking (removing as much tumor as possible) before other treatments. Advances in surgical techniques, including minimally invasive approaches and sophisticated imaging guidance, have improved outcomes while reducing complications.

Radiation Therapy

Radiation therapy uses high-energy beams to destroy cancer cells. It may be used as part of initial treatment, to treat remaining cancer after surgery, or to target cancer that has spread. Because radiation can affect normal developing tissues, its use in children requires careful consideration of benefits and risks. Newer techniques such as proton beam therapy allow more precise targeting of tumors while minimizing radiation exposure to surrounding healthy tissues, which is particularly important for brain tumors and tumors near critical structures.

Targeted Therapy and Immunotherapy

Advances in understanding cancer biology have led to development of targeted therapies that attack specific molecular features of cancer cells. These treatments can be more effective and less toxic than traditional chemotherapy for some cancers. Immunotherapy harnesses the body's immune system to fight cancer and has shown remarkable success in some childhood cancers, including certain types of leukemia and neuroblastoma.

Stem Cell Transplantation

Stem cell transplantation (also called bone marrow transplantation) allows delivery of very high doses of chemotherapy that would otherwise be lethal by replacing the destroyed bone marrow with healthy stem cells. This approach is used for certain high-risk leukemias, relapsed cancers, and some solid tumors. Stem cells may come from the patient themselves (autologous transplant) or from a matched donor (allogeneic transplant).

Clinical Trials

The remarkable improvement in childhood cancer survival over the past decades is largely due to systematic clinical research. Most children with cancer are treated on clinical trials, which are carefully designed studies that test new treatments or new combinations of existing treatments. Participation in clinical trials provides access to the most current treatment approaches while contributing to knowledge that will benefit future patients.

What Are the Survival Rates for Childhood Cancer?

Overall five-year survival rates for childhood cancer have improved to approximately 85% in high-income countries. Rates vary significantly by cancer type, with some cancers like acute lymphoblastic leukemia achieving 90% or higher survival, while others remain more challenging. Early diagnosis, specialized treatment, and access to clinical trials significantly impact outcomes.

The prognosis for childhood cancer has improved dramatically over the past 50 years. In the 1960s, childhood cancer was almost uniformly fatal, with survival rates below 30%. Today, thanks to advances in treatment protocols, supportive care, and research, more than four in five children diagnosed with cancer in high-income countries will survive at least five years, with many achieving long-term cure.

However, survival statistics represent averages and do not predict the outcome for any individual child. Many factors influence prognosis, including the specific cancer type and subtype, the stage at diagnosis, biological and genetic features of the tumor, the child's age and overall health, and response to treatment. Your child's oncology team can provide information about prognosis specific to your child's situation.

Despite overall improvements, significant disparities exist. Children in low- and middle-income countries often face much poorer outcomes due to delayed diagnosis, limited access to specialized care, incomplete treatment courses, and higher rates of treatment abandonment. The World Health Organization's Global Initiative for Childhood Cancer aims to increase survival rates worldwide by improving access to quality care.

What Support Is Available for Families?

Families of children with cancer can access comprehensive support including psychological counseling, social work services, educational support, financial assistance programs, parent and sibling support groups, palliative care when needed, and long-term survivorship programs. Pediatric cancer centers coordinate these multidisciplinary support services.

A childhood cancer diagnosis affects the entire family, not just the child with cancer. Parents face immense stress as they navigate complex medical decisions, manage treatment schedules, and cope with fears about their child's health. Siblings may experience confusion, fear, guilt, or feel neglected as parental attention focuses on the sick child. Grandparents, extended family, and friends are also affected. Comprehensive support for the whole family is an essential component of childhood cancer care.

Psychological Support

Pediatric cancer centers employ psychologists, social workers, and child life specialists who help families cope with the emotional challenges of cancer. Services may include individual counseling for parents or children, family therapy, support groups, and interventions to help children understand and cope with their diagnosis and treatment. Child life specialists use play, preparation, and education to help children cope with medical procedures and hospitalization.

Educational Support

Children with cancer often miss significant amounts of school during treatment. Hospital schools, tutoring services, and coordination with regular schools help children continue their education during treatment and facilitate return to school when possible. Special education services and accommodations may be needed for children who experience learning difficulties as a result of their disease or treatment.

Financial Assistance

Cancer treatment can create significant financial burden for families. Social workers can help identify sources of financial assistance, including government programs, nonprofit organizations, and hospital financial aid. Some organizations provide help with non-medical expenses such as transportation, lodging, and lost wages.

Sibling Support

Siblings of children with cancer have unique needs that deserve attention. They may feel scared, confused, angry, or guilty. Sibling support programs, including camps and support groups specifically for siblings, help these children process their emotions and connect with others who understand their experience.

Long-Term Survivorship

Children who survive cancer require ongoing follow-up care throughout their lives to monitor for late effects of treatment and ensure early detection of any problems. Survivorship programs provide comprehensive long-term care, health education, and support as survivors transition from pediatric to adult healthcare. Survivors benefit from personalized survivorship care plans that document their treatment history and guide ongoing surveillance.

When Should You Seek Medical Care?

Seek medical evaluation if your child has persistent unexplained symptoms lasting more than two weeks, including fatigue, fever, weight loss, pain, or any unusual lump or swelling. Trust your instincts as a parent if something seems wrong. Early evaluation leads to earlier diagnosis and better outcomes if cancer is present.

As a parent or caregiver, you know your child better than anyone. If you notice changes in your child's health, behavior, or appearance that concern you, do not hesitate to seek medical evaluation. While most childhood symptoms are caused by common illnesses, persistent or unusual symptoms deserve attention.

Contact your healthcare provider if your child experiences any of the following:

• Symptoms that persist for more than two weeks without improvement
• Unexplained weight loss or decreased appetite
• Persistent fatigue that interferes with normal activities
• Recurrent fevers without obvious cause
• Easy bruising, bleeding, or petechiae (small red spots on skin)
• Swollen lymph nodes that persist or continue to grow
• Headaches, especially with vomiting or vision changes
• Any unusual lump or swelling
• Persistent bone or joint pain
• Changes in balance, coordination, or behavior

If initial evaluation suggests a possible cancer diagnosis, your child will be referred to specialists for further testing. While waiting for appointments and test results can be anxiety-provoking, the diagnostic process is designed to provide accurate information as quickly as possible so that appropriate treatment can begin.