Paediatric cancer care

Cancer is a disease in which some of the body's cells start to grow in an uncontrolled way. Normally, cells grow, do their job, and are replaced in an orderly fashion. In cancer, that orderly process breaks down and abnormal cells keep multiplying, sometimes forming a lump (a tumour) or, in the case of blood cancers, building up inside the bone marrow and bloodstream.

Paediatric cancer (also called childhood cancer) simply means cancer that develops in a child or teenager. The word paediatric (also spelled pediatric) refers to the medical care of children. Oncology is the branch of medicine that deals with cancer, so a paediatric oncologist is a doctor who specialises in treating cancer in young people.

It is important to know that childhood cancer is rare. The World Health Organization estimates that about 400,000 children and adolescents aged 0 to 19 develop cancer worldwide each year. In the United States, an estimated 14,910 children and adolescents aged 0 to 19 were expected to be diagnosed with cancer in 2024. Cancer in children is also quite different from cancer in adults. It usually starts in different parts of the body, looks different under the microscope, and very often responds differently to treatment.

Childhood cancers are grouped by where they begin in the body and by how the cells look under a microscope. According to the National Cancer Institute and the American Cancer Society, the most common types in children aged 0 to 14 include:

• Leukaemias (also spelled leukemias) — cancers of the blood and bone marrow, the spongy tissue inside bones where blood cells are made. Leukaemia is the most common childhood cancer. Acute lymphoblastic leukaemia (ALL) is the most frequent subtype.
• Brain and other central nervous system (CNS) tumours — growths in the brain or spinal cord. These are the most common solid (lump-forming) tumours in children.
• Lymphomas — cancers of the lymphatic system, part of the body's immune (infection-fighting) defences. These include Hodgkin and non-Hodgkin lymphoma.
• Neuroblastoma — a cancer that begins in early nerve cells, most often in young children.
• Wilms tumour — a kidney cancer usually found in young children, often noticed as swelling or a lump in the tummy.
• Bone cancers such as osteosarcoma and Ewing sarcoma, and soft-tissue sarcomas such as rhabdomyosarcoma (a cancer of muscle-type cells).
• Retinoblastoma — a rare cancer of the eye in very young children.

In teenagers aged 15 to 19, the pattern shifts a little towards cancers that are also seen in adults, such as lymphoma, thyroid cancer, and melanoma (a type of skin cancer). Each of these cancers has its own subtypes, and the exact subtype matters a great deal because it guides which treatments are likely to work best.

One of the most common and painful questions parents ask is, "Did I do something to cause this?" For the vast majority of families, the honest answer is no. Unlike many adult cancers, most childhood cancers do not have a known cause, and very few are linked to lifestyle or to anything a parent did or did not do.

Most childhood cancers are thought to start from changes (called mutations) in the DNA of a cell. DNA is the instruction manual inside cells. These changes often happen early in life, sometimes before birth, simply because cell division is not perfect and errors can occur, especially while a child's body is growing quickly. They usually arise by chance.

A small number of childhood cancers are connected to identifiable factors, including:

• Inherited gene changes. The National Cancer Institute notes that roughly 8% to 10% of childhood cancers are linked to an inherited gene change passed down in a family. Most childhood cancers are not inherited.
• Ionising radiation, such as high doses of radiation.
• Certain chronic infections, such as HIV, Epstein-Barr virus, and malaria, which are more relevant in some parts of the world.
• A weakened immune system (immunosuppression).

Because the causes of most childhood cancers are unknown, there is usually nothing that could have been done to prevent them. This is not a comfort, exactly, but it can lift the heavy and unfair burden of blame from a family's shoulders.

One of the trickiest things about childhood cancer is that its early signs often look just like the everyday illnesses, bumps, and bruises of childhood. There is no single warning sign. Most children with these symptoms do not have cancer — the symptoms are far more often caused by common infections, injuries, or other harmless conditions. Still, it helps to know what to watch for.

The American Cancer Society lists signs that are worth having a doctor check, especially if they do not improve or keep coming back:

• An unusual lump or swelling, for example in the neck, tummy, chest, armpit, or groin
• Unexplained tiredness, paleness, or looking generally unwell
• Easy bruising or bleeding, or small red or purple spots on the skin
• Ongoing pain in one area, or limping or bone pain without a clear cause
• A fever or illness that will not go away
• Frequent headaches, sometimes with vomiting, especially in the morning
• Sudden changes in eyesight, or a white or milky colour seen behind the pupil of the eye (sometimes noticed in photographs)
• Unexplained weight loss

The single most useful rule of thumb is this: if your child has a symptom that is not getting better or going away — even one not on this list — have them seen by a doctor. You know your child best. Trusting your instinct and asking for a check-up is always reasonable, and a good doctor will take your concerns seriously.

For many adult cancers, there are routine screening programmes — tests done on people who feel well, to catch cancer early. Examples include mammograms for breast cancer or stool tests for bowel cancer.

For children, the situation is different. Because childhood cancer is rare, there are no recommended screening tests for children at average risk, and the World Health Organization notes that childhood cancer generally cannot be prevented or found through screening. There simply is no test that would do more good than harm when applied to all healthy children.

There is an important exception. A small number of children are born with an inherited condition or gene change that raises their risk of certain cancers. For these specific children, a specialist may recommend regular monitoring — for example, periodic scans or examinations — and the family may be offered genetic counselling, which is a conversation with a trained professional about inherited risk. This is tailored to the individual child and is decided together with a doctor.

For everyone else, "early detection" mostly means paying attention to symptoms that do not settle and seeking medical advice promptly. Early diagnosis matters: the WHO points out that when cancer is found early, it tends to respond better to treatment.

Reaching a diagnosis usually takes several steps, and it is normal for this to feel slow and stressful. Doctors work carefully because the exact type of cancer determines the right treatment.

The process often begins with a medical history (questions about the child's health and symptoms) and a physical examination. From there, doctors may use:

• Blood tests — to check blood cells and organ function. In leukaemia, for example, the blood count is often abnormal.
• Imaging tests — pictures of the inside of the body. These can include X-rays, ultrasound (which uses sound waves), CT scans, MRI scans (which use magnets and radio waves), and sometimes PET scans. They show the size and location of any tumour.
• A biopsy — the removal of a small sample of tissue so it can be examined under a microscope. A biopsy is usually the only way to be certain whether a lump is cancer and, if so, exactly which type. For suspected leukaemia, a bone marrow test (taking a small sample of marrow, usually from the hip bone) is used.

Once cancer is confirmed, the team works out the stage — how big the cancer is and whether it has spread to other parts of the body. For leukaemias and some other cancers, doctors instead describe the risk group based on features of the disease. Staging and risk grouping are not about predicting one child's future; they are practical tools that help the team choose the most suitable treatment plan.

Childhood cancer is treated by a multidisciplinary team — a group of specialists who plan care together. This team typically includes paediatric oncologists, surgeons, radiation specialists, specialist nurses, pharmacists, dietitians, physiotherapists, psychologists, social workers, and play specialists who help children cope. Children with cancer in high-income countries are usually cared for at dedicated children's cancer centres; in the United States, for example, more than 90% are treated at such centres.

The main types of treatment, often used in combination, include:

• Chemotherapy — medicines that kill cancer cells or stop them growing. This is a cornerstone of treatment for many childhood cancers, especially leukaemia.
• Surgery — an operation to remove a tumour, used mainly for solid tumours such as Wilms tumour or some sarcomas.
• Radiation therapy (radiotherapy) — high-energy beams that target cancer cells. In children it is used carefully because growing bodies are more sensitive to it.
• Stem cell (bone marrow) transplant — a procedure that restores the blood-forming cells after very high doses of chemotherapy or radiation.
• Immunotherapy and targeted therapy — newer treatments that help the immune system fight the cancer or that act on specific features of the cancer cells. One example is CAR T-cell therapy, used for certain leukaemias that have not responded to other treatment.

Alongside treatment that targets the cancer, supportive care is essential. This includes managing pain, nausea, and infections, providing good nutrition, and supporting the child's emotional wellbeing and schooling. Palliative care — care focused on comfort and quality of life — can be helpful at any stage, not only at the end of life, and works alongside cancer treatment.

There is genuine reason for hope. Treatment for childhood cancer has improved dramatically over the past half-century. The World Health Organization reports that in high-income countries more than 80% of children with cancer are cured, while in many low- and middle-income countries fewer than 30% are cured — a gap driven largely by access to timely diagnosis and treatment rather than by the disease itself.

To give a sense of scale, the National Cancer Institute reports that for children diagnosed in 2013 to 2019, five-year survival was 83.2% for those younger than one year and 87.3% for adolescents aged 15 to 19. For acute lymphoblastic leukaemia, the most common childhood cancer, five-year survival improved from about 57% in 1975 to 92.3% in 2014 to 2020.

These figures are population-level averages. They describe large groups of children diagnosed in the past and treated with the methods of their time. They are not a prediction for any individual child. Outcomes depend heavily on the specific cancer type, its stage or risk group, how it responds to treatment, and many personal factors. The only person who can give you a meaningful picture of your own child's situation is the specialist caring for them. It is always reasonable to ask the team to explain what the outlook means in your child's case.

Going through cancer treatment affects the whole family. Children may miss school, feel unwell from treatment, or struggle with the changes to their routine and appearance. Brothers and sisters can feel frightened or left out, and parents often carry exhaustion and worry. None of this is a sign of weakness. Many cancer centres offer psychological support, social work, and practical help, and connecting with other families can ease the sense of isolation.

After active treatment ends, children move into follow-up care. Regular check-ups allow the team to watch for any sign that the cancer has returned and to monitor the child's growth and development.

An important part of follow-up is watching for late effects — health problems that can appear months or years after treatment ends. The National Cancer Institute explains that children treated for bone cancer, brain tumours, or Hodgkin lymphoma, or who received radiation to the chest, abdomen, or pelvis, have the highest risk of serious late effects. These can include effects on the heart, hearing, fertility, growth, learning, or a small risk of a second cancer later in life. Long-term follow-up is designed to catch and manage such problems early. Keeping a clear record of exactly which treatments your child received — sometimes called a survivorship care plan — is valuable for the rest of their life.

Some families consider seeking paediatric cancer care in another country, whether for access to a specialist team, specific treatments, or shorter waiting times. If you are exploring care abroad, it helps to understand what shapes the overall cost so you can plan realistically. We do not quote prices here, because every child's situation is genuinely different; instead, here are the factors that matter.

The main things that influence cost include:

• The exact diagnosis, type, and stage or risk group of the cancer
• The treatment plan — for example chemotherapy, surgery, radiotherapy, a stem cell transplant, or a combination, and how many cycles are needed
• The length of stay and whether intensive care or isolation is required
• Diagnostic tests such as scans, biopsies, and laboratory work, including any specialised genetic testing
• Supportive care, medicines, follow-up visits, and the needs of an accompanying parent

To prepare, gather your child's medical records in one place: the diagnosis and pathology (biopsy) reports, blood test results, imaging scans and their reports, a summary of treatments already given, and a current list of medicines. Translated copies are helpful. Organised records let a specialist team give you accurate guidance more quickly. Because the variables are so individual, the most reliable way to understand likely costs is to request a personalised estimate after a specialist reviews your child's records. A free consultation is a sensible first step, and there is no obligation attached to asking.

Turkiye (Turkey) has become a well-known destination for medical care, with a number of large hospitals that treat international patients and offer paediatric services. Modern facilities, experienced specialists, and good travel connections are among the reasons families consider it. As with care anywhere in the world, what matters most is choosing the right centre for your child — not the country alone.

When assessing any paediatric oncology centre, in Turkiye or elsewhere, it is reasonable to verify the following:

• Accreditation. Look for recognised quality accreditation such as Joint Commission International (JCI). JCI accreditation involves an independent evaluation of patient safety and quality of care, renewed every few years. It is a useful signal that a hospital meets international standards.
• A dedicated paediatric oncology team. Children should be treated by specialists in childhood cancer, with a full multidisciplinary team and facilities designed for children, including paediatric intensive care.
• Experience with the specific cancer. Ask how often the centre treats your child's type of cancer and whether they handle the planned treatment, such as stem cell transplant, on site.
• Clear communication. Confirm that interpreters are available and that the team will share a written treatment plan and reports you can take to your home doctors.
• Follow-up arrangements. Ask how follow-up and late-effects monitoring will be handled once you return home.

Be cautious of any clinic that promises a cure, uses superlative marketing language, or pressures you to decide quickly. Trustworthy teams give honest, balanced information and welcome a second opinion. A reputable concierge service can help arrange records review, second opinions, travel, and translation, but the medical decisions always rest with you and the treating specialists.

Because most childhood cancers cannot be prevented, the focus for families is less on prevention and more on getting the best possible care and information. Two avenues are worth understanding.

First, clinical trials. A clinical trial is a carefully designed research study that tests whether a new treatment, or a new way of using existing treatments, is safe and effective. The National Cancer Institute notes that the major improvements in childhood cancer survival over the past 50 years came from treatments studied and proven in clinical trials. In the United States, around 4,000 children diagnosed with cancer enrol in a trial run by the Children's Oncology Group each year. Taking part is always voluntary, and it is a decision each family makes together with their treatment team. Trials are not a last resort; for some children they offer access to promising approaches.

Second, second opinions. Seeking another specialist's view on the diagnosis or treatment plan is a normal, accepted part of cancer care. It can confirm the plan, suggest alternatives, or simply give you confidence. A good medical team will support your wish for a second opinion rather than discourage it.

Finally, look after yourselves. Caring for a child with cancer is a marathon. Accept help, lean on support services and other families, and remember that asking questions — as many as you need — is your right and your team's job to answer.