The Global Initiative for Childhood Cancer (GICC) of the World Health Organisation (WHO) aims to improve childhood cancer survival globally to 60%. An important focus is targeting childhood cancer through universal childhood registry development. Locally, there is a need to better capture and report childhood cancer rates.

The CHOC Childhood Cancer Foundation South Africa reports that it is now estimated that one in 408 children worldwide will be diagnosed with cancer before the age of 15 years. In 2021, a total of 1 378 cancers were diagnosed in children and teens younger than 20 years of age, as documented and reported by the South African National Cancer Registry (NCR). This equated to an overall age-standardised rate of 63.5 cases per million children. This number is low compared to the United Kingdom, where 140 to 160 children per million (aged < 15years) are diagnosed with cancer annually.

Some childhood cancers appear to be diagnosed more often than in the past. However, the increase is largely due to improved detection and diagnostic methods, explains Dr Liezl du Plessis, paediatric oncologist at Life Eugene Marais Hospital.

“Diagnosing cancer accurately in children and teenagers is only the first step. Equally important is ensuring they are supported safely throughout treatment, while working to reduce long-term side effects for those who survive into adulthood,” says Dr du Plessis. Unfortunately, some children are diagnosed at a later stage, when the disease is more advanced and harder to cure. “In other cases, symptoms may be missed or mistaken for other illnesses, leading to delays in diagnosis and treatment,” she explains.

Why early response matters

The Cancer Association of South Africa (CANSA) estimates that 800 to 1 000 children are newly diagnosed every year, but at least the same amount may never be formally diagnosed. With awareness and seeking medical care timeously, more children can receive the treatment they need, which can improve the outcomes of their treatment.

Seeking medical help when a child’s symptoms persist is crucial. Parents, families, and caregivers play a vital role in noticing when something doesn’t seem right and advocating for further assessment. At the same time, ongoing awareness among healthcare providers about the warning signs of childhood cancer is equally important. “Early recognition and referral can make a real difference,” explains Dr du Plessis. “We need strong awareness of the red flags of childhood cancer, not only among families, but across the healthcare system.”

Dr du Plessis also advocates for clear referral pathways, which are essential so that when concerning signs are identified, children can be urgently referred to a paediatric cancer unit. This allows specialist teams to complete the necessary diagnostic tests as quickly and safely as possible. Importantly, children do not need to have a confirmed tissue (histological) diagnosis before being seen by a paediatric oncology team. “We want to be involved early in the diagnostic process,” she says. “By working alongside other specialists, we can help plan the timing and location of biopsies, surgeries, and the start of treatment in the safest and most effective way.”

Many childhood cancers respond very well to chemotherapy. In some cases, early treatment can reduce the need for extensive surgery or delay it until it is safer to perform. Wherever possible, doctors also aim to avoid radiation therapy, as it can have significant long-term side effects for growing children. The goal of treatment is not only to cure the cancer, but to do so with the least possible impact on a child’s future health. “We aim to cure where we can,” Dr du Plessis explains, “but just as importantly, we aim to cure with the minimum long-term effects of treatment.”

For this reason, most children who have been treated for cancer are followed up closely for many years after treatment ends, and, in some cases, for life. This long-term care helps monitor their health, manage any late effects of therapy, and support them as they grow into adulthood.

What childhood cancer looks like 

Understanding which cancers most commonly affect children can help parents recognise early warning signs. Some of the most prevalent childhood cancers in South Africa and globally are outlined below.

1. Haematological (blood and bone marrow) cancers

a. Leukaemia

Affects the blood and bone marrow, and is the most frequently diagnosed childhood cancer in South Africa. It often announces itself through symptoms that many parents might initially dismiss: aching bones, joints or persistent backache; easy bruising or unexplained bleeding; prolonged fevers that won't break; or a pale, fatigued child who seems to have lost their usual energy. These signs can easily be confused with growing pains or viral infections, making vigilance crucial.

b. Lymphoma

Hodgkin and non-Hodgkin lymphoma affect the lymphatic system. While Hodgkin lymphoma often develops more slowly, non-Hodgkin lymphoma in children can be very aggressive, sometimes progressing within days to weeks. For this reason, prompt investigation is essential. Lymph node biopsies should not be delayed,, sometimes progressing within days to weeks. For this reason, prompt investigation is essential. Lymph node biopsies should not be delayed and results are ideally available within two to three days so that chemotherapy can be started as soon as possible. Warning signs can overlap with leukaemia and include persistent swelling of lymph nodes, fever, weight loss or fatigue. Parents might notice lumps in the neck, armpits or groin, often accompanied by unexplained fevers, drenching night sweats or gradual weight loss that can't be explained by diet or activity changes.

2. Brain tumours

These tumours can cause some of the most distinctive – yet often overlooked – symptoms because early signs are usually subtle. Symptoms may start gradually and can be easy to miss at first. Children may develop new seizures, a head tilt, or slow changes in how their nervous system works, such as losing skills they previously had, like the ability to walk or sit, or becoming increasingly off balance or unsteady. Persistent headaches, particularly those that strike in the morning and come with vomiting, should always raise concern. In younger children, an enlarging head circumference can signal increased pressure within the skull.

3. Nephroblastoma/Wilms’ tumour

Parents often discover this childhood kidney cancer when they notice an abdominal lump or swelling, sometimes spotted during bath time or dressing. Blood in the urine or unexplained abdominal pain may accompany the mass.

4. Bone and soft-tissue sarcomas

Appear as unexplained lumps in the limbs, head, neck or pelvis. Unlike the harmless bumps children often acquire through active play, these lumps tend to grow steadily. They may cause pain or, in severe cases, lead to easy fractures in affected bones. There are several types of these cancers, including Ewings sarcoma (read Kaylan Botha’s journey of courage, care and community with this disease) and osteosarcoma. Osteosarcoma is more common in teens, often originating close to the growth plate during a growth spurt. Parents and children often attribute symptoms and signs to sports injuries, which may delay a diagnosis significantly. Outcome of bone and soft tissue tumours is strongly influenced by whether they are localised or have already spread at the time of diagnosis.

When to seek medical advice and care

While the common symptoms of childhood cancer may resemble many childhood illnesses, they become concerning when they are unexplained, persistent or combined. CANSA urges parents to:

• seek medical help for prolonged symptoms
• return to healthcare providers if symptoms don’t go away after treatment
• seek help again if symptoms return after disappearing

Parents play a powerful role in their child’s health journey. Trusting your instincts and speaking up when something feels “not quite right” is important. “If you feel your concerns haven’t been fully heard, it’s absolutely okay to seek another opinion, ask for blood tests, or request a referral to a specialist,” urges Dr du Plessis. She highlights that empowering parents with knowledge helps them advocate effectively for their child’s care. And there is real hope: according to CANSA and supported by WHO data, survival rates for many childhood cancers can exceed 70% in well‑resourced settings, showing what’s possible when children receive timely, appropriate treatment. “In high income countries, survival rates for childhood cancer can be closer to 80%. In South Africa, outcomes differ depending on access to healthcare.”

On confirming a diagnosis, Dr du Plessis urges healthcare practitioners and parents to follow the correct referral pathways for childhood cancer. “When cancer is suspected, it’s important not to wait for a confirmed diagnosis before seeking specialist input,” she adds. “Early consultation and referral allow us to help guide a timely diagnosis.”

Supporting your child (and yourself) through their cancer diagnosis and journey

If your child faces a cancer diagnosis, your approach requires both strength and tenderness. Every situation is unique and will involve a team of experts to support you and your child. “As well as navigating the treatment path, psychosocial, nutritional, physical therapy, occupational therapy and even spiritual support are typically required,” adds Dr du Plessis.

The following three tips offer a starting point for comforting and reassuring your child:

1. Communication is key. Use age-appropriate language to discuss the illness honestly, validating your child's fears while making space for questions and feelings. Children often sense when adults are hiding the truth, while honesty, delivered with love, helps them to process their reality.
2. Create islands of comfort in the storm. Surround your child with familiar favourites like beloved toys, music and photo albums. Cuddling and handholding provide security that words cannot, as do impromptu play sessions, gentle routines and stories.
3. Managing your own well-being is equally important. Seek support from the treating team of experts, as well as family and friends. You may also want to consider counsellors or parent groups through organisations like CHOC or CANSA. Practise mindfulness and prioritise rest and nutrition, even when it feels impossible; your well-being directly impacts your ability to care for your child.

Facing a cancer diagnosis in a child or teenager can feel overwhelming, but it’s important to remember that many childhood cancers can be successfully treated, and cure is often possible. Treatment may involve intensive therapy and periods of hospital care, but families will have a team of healthcare professionals to walk the journey with them. “A multidisciplinary healthcare team works closely with each child and family, offering medical care, guidance and support at every step. Plans are tailored to each child’s needs, recognising that every family’s journey is different, and adjustments are made along the way to achieve the best possible outcome.”

 Dr du Plessis concludes by encouraging parents to “trust your instincts, watch for persistent symptoms and don’t wait to seek medical advice”.

 For more information about our oncology services or to download our Support for cancer patient caregivers guide, visit the Life Oncology webpage.

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