Paediatric malignancies

Paediatric malignancies refer to cancers that occur in children and adolescents. Unlike adult cancers, which often arise from prolonged environmental exposure or lifestyle factors, childhood cancers are usually the result of developmental abnormalities in immature cells. Although they are relatively rare, paediatric cancers tend to grow rapidly, but they are also highly responsive to treatment — making early diagnosis and specialist care essential. With advancements in multimodality treatment, cure rates for childhood cancers have improved significantly over the past few decades.
The biology and distribution of paediatric cancers are different from those seen in adults. The most common malignancies in children include leukemias (such as ALL and AML), brain and central nervous system tumors (like medulloblastoma and glioma), lymphomas (Hodgkin and Non-Hodgkin), solid tumors like neuroblastoma and Wilms’ tumor, and bone and soft tissue sarcomas such as osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma. Each of these cancers requires a distinct therapeutic approach tailored to the age, tumor biology, and growth pattern of the child.
Warning signs of paediatric cancers may be subtle and easily mistaken for common childhood illnesses. Persistent fever, unexplained fatigue, weight loss, prolonged body pains, frequent infections, abnormal bruising, persistent headaches with morning vomiting, swelling in the abdomen, or visible lumps should not be ignored. Early medical evaluation and timely referral to a paediatric oncology specialist can significantly improve treatment outcomes.
Accurate diagnosis begins with a detailed clinical evaluation and supportive investigations such as blood tests, imaging (Ultrasound, CT, MRI, or PET-CT), and biopsy procedures. In many paediatric cancers, bone marrow analysis, cytogenetic testing, and molecular profiling are crucial in determining risk categories and planning personalized treatment protocols. These specialized investigations help clinicians select the most appropriate and least toxic therapy for each child.
Paediatric cancer care is delivered through a multidisciplinary model involving paediatric oncologists, radiation oncologists, paediatric surgeons, radiologists, pathologists, and rehabilitation teams. Treatment typically includes a combination of chemotherapy, surgery, radiation therapy, and advanced therapies such as bone marrow transplantation, targeted therapy, and immunotherapy.

Chemotherapy remains the backbone of treatment for most childhood cancers and is often complemented by surgery for solid tumors. Radiation therapy plays a vital role in managing brain tumors, sarcomas, lymphomas, and high-risk or residual disease. With modern technologies like IMRT, VMAT, IGRT, SRS, and Proton Therapy, clinicians can deliver highly precise radiation while minimizing exposure to healthy growing tissues — an essential consideration in children. For selected high-risk leukemias and relapsed cancers, stem cell transplantation and novel immunotherapies such as CAR-T cells are emerging as powerful treatment options.
Radiation in children must be delivered with exceptional precision to avoid long-term complications affecting growth, cognition, endocrine function, and quality of life. This is where the philosophy of modern radiation oncology resembles other precision-based treatments such as SRS for brain tumors and SBRT for lung and liver lesions — with one major difference: the safety margins and tissue-sparing requirements are even more stringent in paediatrics. Advanced conformal techniques ensure effective tumor control while protecting vital organs, allowing children to lead normal, healthy lives after treatment.
Paediatric malignancies, though emotionally challenging for families, are among the most curable cancers today when treated in specialized centres with a well-coordinated, multi-disciplinary approach. Advances in chemotherapy, targeted therapy, precision radiation, and supportive care have dramatically improved survival rates, offering children the chance not only to survive but to thrive. The ultimate goal in paediatric oncology is not just curing the cancer — but safeguarding the child’s future, development, and quality of life.