In 2024 alone, about 14,900 American children (0-19 years) heard the words "you have cancer." Yet this staggering number pales in comparison to the global crisis: over 400,000 children die from cancer each year worldwide, a figure that could be even higher due to diagnostic challenges in many countries.

September is childhood cancer awareness month. Occurring months after International Childhood Cancer Day in February, the overarching message of the childhood cancer campaign this year is to bridge gaps and save lives. This awareness day underscores the importance of addressing disparities in childhood cancer care and uniting global efforts to improve access to treatment and support.

What Is Childhood Cancer?

Cancer is the second leading cause of death globally, ranking just behind cardiovascular disease. However, for children and adolescents, it is the leading cause of death. Childhood cancers, also known as pediatric cancers, represent a group of different disorders, mostly of unknown cause. Only a small percentage of childhood cancers are caused by inherited genes that increase a child’s risk.

Main Types of Childhood Cancers

The major types of childhood cancer include a variety of blood, brain, solid, and soft tissue tumors.

1. Leukemia:

A type of cancer that affects the blood and bone marrow, including Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), and Chronic Myeloid Leukemia (CML). Although a rare disease, leukemia is the most common form of childhood cancer in the United States.

2. Brain and Spinal Cord (CNS) Tumors:

Such as Astrocytoma, Medulloblastoma, Ependymoma, Gliomas, and DIPG (Diffuse Intrinsic Pontine Glioma).

4. Lymphomas:

Tumors that originate in the lymphatic system, a part of the immune system. Examples include Hodgkin Lymphoma, Non-Hodgkin Lymphoma (subtypes: lymphoblastic, mature B-cell, anaplastic large cell)

5. Neuroblastoma:

Tumors of the sympathetic nervous system/adrenal gland, including Retinoblastoma, and Eye (retina) cancer.

6. Renal Tumors:

This includes nephroblastoma (Wilms tumor), rhabdoid renal tumor, kidney sarcomas, renal carcinomas, and other unspecified malignant renal tumors.

7. Sarcomas:

Sarcoma is a rare cancer that starts in the body's connective tissues, such as bones, muscles, fat, nerves, and blood vessels. It accounts for about 15% of childhood cancers. Examples include Rhabdomyosarcoma (muscle), Embryonal rhabdomyosarcoma, Alveolar rhabdomyosarcoma, Osteosarcoma (bone), Ewing Sarcoma (bone/soft tissue), Kaposi Sarcoma, and Soft tissue sarcomas (various types).

8. Germ Cell Tumors:

These are tumors that arise from germ cells (often in ovaries/testes).

9. Hepatic Tumors:

Liver tumors in children are rare, but can be benign or malignant, with the most common type of malignant tumor being hepatoblastoma and the second most common one being hepatocellular carcinoma.

10. Other Malignant Epithelial Neoplasms and Melanomas:

These include adrenocortical carcinomas, thyroid carcinomas, nasopharyngeal carcinomas, malignant melanomas, skin carcinomas, and other carcinomas of salivary glands, colon, appendix, lung, thymus, etc.

Childhood Cancer Risk Factors

For most children, the cause of cancer is unknown. In about 5–10% of cases, the disease is tied to inherited genetic changes or new mutations that happen on their own. These include conditions like Li-Fraumeni syndrome, retinoblastoma, and neurofibromatosis, as well as other rare syndromes such as Gorlin and Beckwith-Wiedemann. Some non-inherited factors can also raise risk, like past exposure to radiation or chemotherapy, certain viral infections, and congenital conditions such as Down syndrome or Fanconi anemia. Differences in how a child’s body processes drugs or repairs DNA may also play a role in modifying risk.

Treatment Outlook for Childhood Cancers

Thanks to advances in treatment, more than 80% of children with cancer in developed countries now live at least five years after diagnosis. This progress is mostly due to combinations of chemotherapy, surgery, and more precise radiation, with newer targeted and immune-based therapies also beginning to play a role, though less often in children. But treatments like chemotherapy and radiation can cause serious long-term side effects, including hormone problems, heart and nerve issues, fertility challenges, and even second cancers later in life. The risk of these complications is higher for children treated at a very young age, those who receive more intensive therapy, or those with inherited cancer risks. Survivors, therefore, carry lifelong health risks tied to their treatments.

Childhood Cancer: Global Trends, Incidence, Disparities and Outcomes

Over the past 50 years, childhood cancer cases have been steadily rising worldwide. At the same time, deaths have gone down and survival has improved. Data from the SEER registry between 1975 and 2019 clearly show these trends, along with the disparities that still exist.

Incidence of Childhood Cancers

In the U.S., cases went from 14.2 per 100,000 children in the late 1970s to 18.9 per 100,000 between 2010 and 2019. The biggest increases were seen in leukemias, lymphomas, brain tumors, liver cancers, and germ cell tumors. A few cancers, like neuroblastoma and kidney tumors, have stayed more stable or even declined slightly.

Although not all groups have been affected equally. Rates of new cancer cases rose faster in White and other-race children compared to Black children.

Trends in Childhood Cancer Deaths

The good news is that deaths from childhood cancer have dropped dramatically, from 4.9 per 100,000 in the late 1970s to 2.3 per 100,000 in recent years. Survival has also improved: 5-year survival went from about 63% to 85%, and 10-year survival rose from 59% to 83%. Leukemia survival has nearly doubled, while big gains have also been made in lymphomas, neuroblastoma, liver tumors, Wilms tumor, and medulloblastoma. Still, some cancers, like brain and bone tumors, remain much harder to treat.

Childhood Cancer Disparities

Disparities are a major challenge in childhood cancer. Despite having a lower incidence, Black children consistently have worse survival outcomes compared to White children. Infants and older teens also tend to fare worse than children ages 1–14. And while advances in chemotherapy, stem cell transplants, targeted therapy, and immunotherapy have transformed outcomes for many cancers, progress has been slower for bone and soft-tissue sarcomas. Survivorship also brings its own challenges, as many children face long-term effects of treatment, second cancers, and chronic health conditions. This is particularly the case for low-and middle-income countries(LMICs), which bear the highest burden for childhood cancer cases.

Each year, more than 400,000 children worldwide are diagnosed with cancer, and about 80% of them live in low- and middle-income countries. In these regions, survival rates are much lower; only 10% to 60% of children live at least five years after diagnosis, compared to more than 80% in wealthier countries. This gap is largely due to unequal access to healthcare, including delays in diagnosis, too few trained specialists, limited medicines and equipment, malnutrition, and families stopping treatment because of cost or other barriers. Children in these settings are often diagnosed at later stages and face more complications from both the cancer and its treatment.

Closing this gap will take a global effort. Investing in stronger healthcare systems, better training, and fair access to essential care, along with sustainable programs and policies that support children and families everywhere, will go a long way in reducing geographical disparities.

Reference

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