Cancer is a group related diseases. In all types of cancer, some of the body's cells begin to divide without stopping and spread into surrounding tissues.

Normally, new cells form as you need them, replacing old cells that die. Sometimes, this process goes wrong. New cells form when you don't need them, and old cells don't die when they should. The extra cells can form a tumor. Tumors can be benign or malignant. Benign tumorsaren't cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body.

Children can get cancer in the same parts of the body as adults, but there are differences. Childhood cancers can occur suddenly, without early symptoms, and have a high rate of cure. The most common children's cancer is leukemia. Other cancers that affect children include brain tumors, lymphoma, and soft tissue sarcoma.

Symptoms and treatment depend on the cancer type and how advanced it is. Treatments include surgery, radiation therapy, chemotherapy, stem cell transplants, and/or targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells.

Although cancer in children and adolescents is rare, it is the leading cause of death by disease past infancy among children in the United States. In 2021, it is estimated that 15,590 children and adolescents ages 0 to 19 will be diagnosed with cancer and 1,780 will die of the disease in the United States. Among children ages 0 to 14 years, it is estimated that in 2021, 10,500 will be diagnosed with cancer and 1,190 will die of the disease. Among adolescents ages 15 to 19 years, about 5,090 will be diagnosed with cancer and about 590 will die of the disease.

Overall, among children and adolescents (ages 0 to 19) in the United States, the most common types of cancer are leukemias, brain and central nervous system (CNS) tumors, and lymphomas.

Among children (ages 0 to 14 years), the most common types of cancer are leukemias, followed by brain and other CNS tumors, lymphomas, neuroblastoma, kidney tumors, and malignant bone tumors.

Among adolescents (ages 15 to 19 years), the most common types of cancer are brain and other CNS tumors and lymphomas, followed by leukemias, thyroid cancer, gonadal (testicular and ovarian) germ cell tumors, and malignant bone tumors.

Different racial and ethnic groups have differences in rates of the most common types of childhood cancer. For example, in 2013–2017, among children ages 0 to 14, Hispanic children had nearly twice the rate of leukemia as Black children. In 2014–2018, rates of brain and other CNS tumors were higher in White children than all other racial and ethnic groups.

As of January 1, 2018 (the most recent date for which data exist), approximately 483,000 survivors of childhood and adolescent cancer (diagnosed at ages 0 to 19 years) were alive in the United States. The number of survivors will continue to increase, given that the incidence of childhood cancer has been rising slightly in recent decades and that survival rates overall are improving.

Cancer occurs more frequently in adolescents and young adults ages 15 to 39 years than in younger children, although incidence in this group is still much lower than in older adults:

• 17.8 cancer diagnoses per 100,000 children ages younger than 15 years
• 77.4 cancer diagnoses per 100,000 adolescents and young adults ages 15 to 39 years
• 548.9 cancer diagnoses per 100,000 adults ages 40 to 64 years

The most frequent cancers diagnosed in adolescents and young adults (AYAs) are cancers that are more common among adults than younger children, such as breast cancer, melanoma, and thyroid cancer. But certain cancers, such as testicular cancer, are more likely to be diagnosed among AYAs than among either younger children or adults. However, the incidence of specific cancer types varies widely across the adolescent and young adult age continuum.

Most cancers in children, like those in adults, have alterations (changes, or mutations) in genes that lead to uncontrolled cell growth and eventually cancer. Genetic changes (or variants) that are passed from parents to their children—known as germline variants—can be associated with an increased risk of cancer. Genetic changes that lead to cancer can also occur spontaneously in cells during development.

About 6% to 8% of all cancers in children overall are caused by an inherited pathogenic variant (harmful alteration) in a cancer predisposition gene, although the percentage varies across cancer types. For example, about 45% of children with retinoblastoma, a cancer of the eye that develops mainly in children, inherited a pathogenic variant in a gene called RB1 from a parent. Children who inherit variants associated with certain familial syndromes, such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, Fanconi anemia, Noonan syndrome, and von Hippel-Lindau syndrome, also have an increased risk of childhood cancer.

Genomic changes that arise during development of one of the germ cells (sperm or egg) that unite to form the zygote that becomes a child can increase the risk of cancer in that child. Genomic changes can include broken, missing, rearranged, or extra chromosomes as well as gene variants. One such alteration is trisomy 21, or the presence of an extra copy of chromosome 21, which causes Down syndrome. Children with Down syndrome are 10 to 20 times more likely to develop leukemia than children without Down syndrome. However, only a very small proportion of childhood leukemia is linked to Down syndrome.

Genetic changes that sometimes can be associated with cancer can also occur in different cells of the body after birth, as the body is actively growing and developing during early childhood. The extent to which these changes reflect environmental exposures is unclear. In adults, exposure to cancer-causing substances in the environment, such as cigarette smoke, asbestos, and ultraviolet (UV) radiation from the sun is known to cause genetic changes that can lead to cancer. However, environmental causes of childhood cancer have been particularly difficult to identify, partly because cancer in children is rare and partly because it is difficult to determine what children might have been exposed to early in their development.

Nevertheless, several environmental exposures have been linked to childhood or adolescent cancer. For example, one study found that melanoma in children and adolescents (ages 11–20 years) has many genomic similarities to melanoma that occurs in adults, including an enrichment of UV-induced mutations. And ionizing radiation can lead to the development of leukemia and other cancers in children and adolescents. Children and adolescents who were exposed to radiation from the atomic bombs dropped in Japan during the Second World War had an elevated risk of leukemia, and children who were exposed to radiation from the Chernobyl nuclear plant accident had an elevated risk for thyroid cancer.

Exposure of parents to ionizing radiation is also a possible concern in terms of the development of cancer in their future offspring. Children whose mothers had x-rays during pregnancy (that is, children who were exposed before birth) and children exposed after birth to diagnostic medical radiation from computed tomography (CT) scans have been found to have a slight increase in risk of leukemia and brain tumors, and possibly other cancers. However, genomic analysis of children born to people exposed to radiation at Chernobyl indicates that this exposure did not lead to an increase in new genetic changes being passed from parent to child.

Several other environmental exposures have also been associated with childhood cancer. However, because of challenges in studying these associations, such as the difficulty of determining the specific chemical exposures at the relevant period in a child’s development, it is difficult to draw firm conclusions. For some types of childhood leukemia (particularly acute lymphoblastic leukemia), associations have been described for father’s tobacco smoking; for exposure to certain pesticides used in and around the home or by parents at their workplace; for solvents, organic chemicals that are found in some household products; and for outdoor air pollution. Studies of childhood brain tumors have suggested associations with exposures to pesticides in and around the home and maternal consumption of cured meats.

Researchers have also identified factors that may be associated with reduced risk of childhood cancer. For example, maternal consumption of folate has been associated with reduced risks of both leukemia and brain tumors in children. Being breastfed and having been exposed to routine childhood infections are both associated with a lowered risk of developing childhood leukemia.

First- and second-degree relatives of a child diagnosed with cancer may be at increased risk for developing cancer if there is already a family history of cancer—that is, if the child’s cancer is likely due to an inherited genetic disorder. A clinician may advise as to whether a child and family members could benefit from genetic testing or referral to a medical geneticist or cancer genetic counselor for evaluation.

Children and adolescents who have cancer are often treated at a children’s cancer center, which is a hospital or a unit within a hospital that specializes in diagnosing and treating patients through 20 years of age. The health professionals at these centers have specific training and expertise to provide comprehensive care for children and adolescents with cancer, and their families.

Children’s cancer centers also participate in clinical trials. The improvements in survival for children with cancer that have occurred over the past half century have been achieved because of treatment advances that were studied and proven to be effective in clinical trials.

More than 90% of children and adolescents who are diagnosed with cancer each year in the United States are cared for at a children’s cancer center that is affiliated with the NCI-supported Children’s Oncology Group (COG). COG is the world’s largest organization that performs clinical research to improve the care and treatment of children and adolescents with cancer. Each year, approximately 4,000 children who are diagnosed with cancer enroll in a COG-sponsored clinical trial. COG trials are sometimes open to older individuals when the type of cancer being studied is one that occurs in children, adolescents, and young adults.

Children’s cancer centers that participate in COG must meet and maintain strict standards of excellence for childhood cancer care. A directory of COG locations is available on their website. Families can ask their pediatrician or family doctor for a referral to a children’s cancer center. Families and health professionals can call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) to learn more about children’s cancer centers that belong to COG.

No. Participation in a clinical trial is voluntary, and it is up to each family in collaboration with their treatment team to decide if clinical trial participation is right for their child.

Children and adolescents with cancer may be eligible to be treated in clinical trials at the NIH Clinical Center in Bethesda, Maryland. Because the NIH Clinical Center is a research hospital, only patients who have a specific type or stage of cancer that is under study can be accepted for treatment. In some cases, patients with conditions that are rare or difficult to diagnose may also be accepted for treatment at the NIH Clinical Center. All patients who are treated at the NIH Clinical Center must be referred by a physician.

NCI’s Pediatric Oncology Branch conducts clinical trials at the NIH Clinical Center for children, adolescents, and young adults with a wide variety of cancers. Patients with newly diagnosed cancer, as well as patients whose cancers have come back after treatment, may be eligible to participate in a clinical trial. Physicians at the Pediatric Oncology Branch can also provide a second opinion on a patient’s diagnosis or treatment plan. To refer a patient to the Pediatric Oncology Branch, the patient’s health care provider should call 301-496-4256 (local) or 1-877-624-4878 (toll-free) weekdays between 8:30 a.m. and 5:00 p.m. ET. Parents can also call these numbers to learn if their child is eligible to participate in a clinical trial.

NCI’s Clinical Genetics Branch conducts long-term observational and clinical studies of genetic susceptibility to cancer, mostly in families with a known or suspected cancer predisposition syndrome, or families that have a higher-than-expected rate of cancer. Although some of these study participants, including children and adolescents, are seen at the NIH Clinical Center, the genetic susceptibility studies do not evaluate treatment or other interventions, as in a clinical trial. Information about active studies that enroll children and adolescents can be obtained by contacting the referral nurse at 1-800-518-8474.

People who have had cancer during childhood or adolescence need follow-up care and enhanced medical surveillance for the rest of their lives because of the risk of complications related to the disease or its treatment that can last for, or arise, many years after they complete treatment for their cancer. Health problems that develop months or years after treatment has ended are known as late effects.

The specific late effects that a person who was treated for childhood cancer might experience depend on the type and location of their cancer, the type of treatment they received, and patient-related factors, such as age at diagnosis. Some people with a history of childhood cancer may need additional follow-up if an inherited genetic alteration is found to be the cause of the cancer.

Children and adolescents who were treated for bone cancer, brain tumors, or Hodgkin lymphoma, or who received radiation to their chest, abdomen, or pelvis, have the highest risk of serious late effects from their cancer treatment, including second cancers, joint replacement, hearing loss, and congestive heart failure.

Long-term follow-up analysis of a cohort of survivors of childhood cancer treated between 1970 and 1986 has shown that these survivors remain at risk of complications and premature death as they age, with more than half of them having experienced a severe or disabling complication or even death by the time they reach age 50 years. Children and adolescents treated in more recent decades may have lower risks of late effects due to modifications in treatment regimens to reduce exposure to radiotherapy and chemotherapy, increased efforts to detect late effects, and improvements in medical care for late effects.

It’s important for people who had cancer during childhood or adolescence to have regular medical follow-up examinations so any health problems can be identified and treated as soon as possible. The Children’s Oncology Group (COG) has developed long-term follow-up guidelines Exit Disclaimer for survivors of childhood, adolescent, and young adult cancers.

It is also important to keep a record of the details of the cancer diagnosis and the treatment that was received. This record should include:

• the type and stage of cancer
• date of cancer diagnosis and dates of any relapses
• genetic testing for inherited variants and somatic (tumor) variants
• types and dates of imaging tests
• contact information for the hospitals and doctors who provided treatment
• names and total doses of all chemotherapy drugs used in treatment
• the parts of the body that were treated with radiation and the total doses of radiation that were given
• types and dates of all surgeries
• any other cancer treatments received
• any serious complications that occurred during treatment and how those complications were treated
• the date that cancer treatment was completed

The record should be kept in a safe place, and copies of the record should be given to all doctors or other health care providers who are involved with the child’s follow-up care, even as the child grows into adulthood.

Many children’s cancer centers have clinics where survivors of childhood cancer can go for follow-up care until they reach their early 20s. Some cancer centers are now creating clinics dedicated to follow-up care for long-term survivors of pediatric and adolescent cancers.

Many cancer centers also include programs to help families navigate long-term survivor care, including both the physical and emotional issues they may face after treatment. In addition, many adolescent and young adult (AYA) cancer programs have been created to address some of the more unique needs of teens and young adults. Areas of focus include discussing and preserving future fertility, peer support, and psychosocial support that addresses personal issues such as finances, education, occupational impacts, and transition to independence.

The overall outlook for children and adolescents with cancer has improved greatly over the last half-century. In the mid-1970s, 58% of children (ages 0 to 14 years) and 68% of adolescents (ages 15 to 19 years) diagnosed with cancer survived at least 5 years. In 2011–2017, 84.7% of children and 85.9% of adolescents diagnosed with cancer survived at least 5 years.

Although survival rates for most childhood cancers have improved in recent decades, the improvement has been especially dramatic for a few cancers, particularly acute lymphoblastic leukemia, the most common childhood cancer. Improved treatments introduced beginning in the 1960s and 1970s raised the 5-year survival rate for children diagnosed with acute lymphoblastic leukemia at ages 0 to 14 years from 57% in 1975 to 92% in 2012. The 5-year survival rate for children diagnosed with non-Hodgkin lymphoma at ages 0 to 14 years also increased dramatically, from 43% in 1975 to 91% in 2012.

Because of these survival improvements, brain cancer has replaced leukemia as the leading cause of cancer death among children. During 2001–2018, death rates among children from brain and other nervous system cancers were stable while death rates from leukemia declined an average of 2.9% per year.

In contrast, survival rates remain poor for some cancer types, for some age groups, and for some cancers within a site. For example:

• Half of children with diffuse intrinsic pontine glioma (a rare type of brain tumor) survive less than 1 year from diagnosis, and only 10% survive 2 years from diagnosis.
• Among children with Wilms tumor (a type of kidney cancer), older children (those diagnosed between ages 10 and 16 years) have lower 5-year survival rates than younger children.
• For soft tissue sarcomas, 5-year survival rates in 2011–2017 among children and adolescents ages 0 to 19 years ranged from 66% (rhabdomyosarcoma) to 73.7% (soft tissue and other extraosseous sarcomas).
• In 2011–2017 the 5-year survival rate for lymphoid leukemia (mostly acute lymphoblastic leukemia) was 91.5% for children younger than 15 years, compared with 76% for adolescents ages 15 to 19 years.

Evidence suggests that adolescents and young adults with acute lymphoblastic leukemia may have better outcomes if they are treated with pediatric treatment regimens than if they receive adult treatment regimens. Recent improvements in 5-year survival rates for adolescents and younger adults with acute lymphoblastic leukemia may reflect greater use of these pediatric treatment regimens.

The cancer mortality rate—the number of deaths due to cancer per 100,000 people per year—among children and adolescents ages 0 to 19 years declined by more than 50% from 1975 to 2018. Specifically, the mortality rate was 5.1 per 100,000 children and adolescents in 1975 and 2.2 per 100,000 children and adolescents in 2018. However, despite the overall decrease in mortality, approximately 1,800 children and adolescents still die of cancer each year in the United States, indicating that new advances and continued research to identify effective treatments are required to further reduce childhood cancer mortality.

From 1997 through 2017, the cancer death rate dropped the most for 15- to 19-year-olds (a 1.7% drop each year on average), followed by that for 0- to-4-year-olds (a 1.4% drop each year), 10- to 14-year-olds (a 1.2% drop each year), and 5- to 9-year-olds (a 1.1% drop each year).

While the completion of your child’s cancer treatment is something to celebrate, it may also bring new challenges. You may worry that the cancer will return. Your child may struggle to get used to new routines. Some families enter this new phase feeling stronger, whereas others are more fragile. Many families are surprised by anxious feelings that arise during this long-awaited time, when they expected to feel only relief. Instead of this being a time to go back to life as it used to be, it may be a time of continued adjustment, as you leave the security of the people on your child’s health care team. Some said the transition to life after treatment took longer and was more challenging than they thought it would be.

Follow-Up Care after Cancer Treatment

Get a written copy of your child's treatment summary and survivorship care plan. Ask for recommendations to hospitals that offer the type of follow-up or survivorship care that your child needs.

Treatment Summary

The treatment summary includes both diagnostic and treatment information, such as:

• Type of cancer, severity (stage, grade, or risk group), date of diagnosis, and pathology report
• Type(s) of treatment received, including the names and doses of all medications, as well as the total amounts and sites of any radiation therapy received
• Treatment dates
• Key reports and scans, such as CT scans and MRIs
• Side effects and/or complications experienced during treatment
• Supportive care received (also called palliative care)—such as counseling or physical therapy
• Identifying number and title of the clinical trial, if your child was in a clinical trial
• Names and contact information of key people on your child’s health care team

Survivorship Care Plan

A survivorship care plan (also called a follow-up care plan) is developed for each child. Survivorship care plans are based on the type of cancer and treatment your child received. For example, some children may need to return for visits each month for the first year after they have completed treatment. Others may not need to return as often. Here is the type of information that’s included in follow-up care plans for children who have been treated for cancer, as outlined in the Institute of Medicine's Cancer Survivorship Care Planning Exit Disclaimerfact sheet:

• Exams and tests/procedures to check for the recurrence or metastasis of cancer, and a schedule of when they are needed
• Care and support to manage any long-term side effects and check for late effects
• Psychosocial support or counseling, and referrals as needed
• Referrals for legal aid or financial support, as needed
• Referrals to, and coordination with, specialists such as cardiologists, education specialist, endocrinologists, physical therapists, and psychologists and to appropriate treatments, clinical studies, and rehabilitation specialists
• Recommendations for healthy behaviors, such as advice regarding nutrition and physical exercise
• Family-based care, education, and outreach to your child and family

Follow-Up Care Clinics/Survivorship Clinics

Places that specialize in follow-up care for children who have been treated for cancer are called follow-up care clinics or survivorship clinics. At these clinics, your child will see specialists (in cardiology, endocrinology, fertility, nutrition, psychology, and/or pulmonology, for example) who will monitor your child’s health. These clinics are usually found within hospitals.

Long-Term and Late Effects

Although many side effects go away once treatment has ended, long-term side effects, such as fatigue, may take some time to go away. Other side effects, called late effects, may not occur until months or even years after treatment.

Whether or not your child may have late effects of treatment depends on the type of cancer your child had and how it was treated, as well as personal factors, such as:

• Cancer-related factors such as the type of cancer, where it was in the body, and how it affected tissues and organs
• Treatment-related factors such as the type and dose of treatment(s) or the type of surgery
• Patient-related factors such as your child’s gender, age at diagnosis, length of time since diagnosis/treatment, personal and family health history, and health habits

Types of Late Effects

Late effects may be physical, emotional, or cognitive. Knowing what symptoms to be aware of and when they may occur can help you plan for the needs of your child. Not knowing what to expect can cause anxiety for some parents. However, for other parents, knowing about late effects that may or may not happen to their child in the future can be overwhelming. Many parents find it helpful to ask their child’s doctor what to focus on at each step of their child’s recovery.

Physical Late Effects

Physical late effects involve changes to organs, tissues, and/or body functions. They may affect your child’s growth and development. Some children who have been treated for cancer have many physical late effects, whereas others have relatively few.

Emotional Late Effects

Emotional late effects include changes to your child’s mood, feelings, and actions. Many children are very resilient after cancer treatment. Others experience social and/or emotional problems. If your child is not sleeping well and no longer enjoys activities that he once did, it is important to talk with your child’s doctor about having your child evaluated for depression.

Some children develop post-traumatic stress disorder (PTSD). This anxiety disorder arises in reaction to physical injury or severe mental or emotional distress. Symptoms of PTSD may include having flashbacks about diagnosis or treatment, avoiding places that are reminders of the experience, and being fearful, irritable, unable to sleep, or having difficulty concentrating. Ask your child’s health care team to suggest resources for mental health support in your area.

Cognitive Late Effects

Cognitive late effects include changes in your child’s ability to memorize, learn, and think. These types of late effects are more likely to occur in children who’ve had certain cancers such as brain and spinal cord tumors, head and neck cancers, and some types of leukemia, such as ALL. Treatments such as radiation therapy to the head and certain types of chemotherapy also increase the risk of cognitive late effects. These late effects are also more likely in children who were very young during treatment, who received very high doses of treatment, and whose treatment lasted for a long time.

Children with cognitive late effects may have a more difficult time:

• Memorizing or remembering
• Learning (handwriting, spelling, reading, vocabulary, and/or math may be particularly challenging)
• Thinking (including concentrating, completing work on time, doing work that involves multiple steps, problem solving, and planning)

Questions to Ask Your Child's Health Care Team

As you talk with your child's doctor, here are some questions to consider:

About treatment

• Who should we talk with to get a comprehensive record of treatment(s) and medications that our child received during treatment?

About practical steps to take at home

• What health problems in our child should we be aware of?
• Who should I contact if health problems occur?
• Does my child need to continue taking any medicine(s)? If so, for how long?
• What types of activities may help my child? Are any activities not recommended?
• What vaccines should my child receive? When should they be given?

About follow-up care (plan and schedule)

• Who should I talk with to get a follow-up care plan and schedule for my child?
• What medical experts should my child see for follow-up care?
• What tests will be done during follow-up care visits? How often and for what reason?
• Where should my child go for follow-up care visits?
• What is the schedule for these visits?

About possible long-term and/or late side effects

• Is my child at increased risk of having long-term side effects? If so, which ones and how can they be managed?
• Is my child at increased risk of developing late effects later in life? If so, which ones? How likely are these to occur? How long after treatment might they occur?
• What types of specialists should my child see to manage these effects?

About support and coping

• What survivor support groups are available for my child? For our family?
• What are the benefits to my child of receiving professional counseling? Is this something you recommend for my child? Why or why not?

This guide is divided into five sections:

Diagnosis

• Types of Childhood Cancers
• Diagnosing and Staging Cancer
• Talking with Your Child

Treatment

• Hospitals That Specialize in Treating Children with Cancer
• Clinical Trials
• Cancer Treatments and Side Effects
• Common Health Problems (infection, nutrition, stress and pain)

Support

• Finding Ways to Cope and Stay Strong
• Helping Your Child to Cope
• Helping Brother and Sisters
• Getting Organized

Life After

• Survivorship and Follow-up Care
• If Treatments Aren’t Working
• Looking Forward

Resources

• Practices That Help Children: Integrative Medicine Approaches
• Medical Tests and Procedures

Each section also has quotes from parents, related resources, and questions to help you get more in-depth and personalized information. This guide is designed to be used as a tool in consultation with your child’s health care team.