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If your child has a fever while receiving chemotherapy, go to hospital immediately — at any hour. Infection in a child with low white cells can become life-threatening within hours. Also seek emergency care for unusual drowsiness, persistent vomiting, breathing difficulty or a seizure.

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Childhood cancers: what parents need to know

Cancer in children is different from cancer in adults. The types are different, children tolerate intensive treatment better, and cure rates are substantially higher — provided treatment follows a proper protocol from the start.

The single most important factor in childhood cancer is that treatment follows an established protocol delivered by a paediatric oncology unit. Deviating from protocol, or interrupting treatment partway, materially reduces the chance of cure.

Clinically reviewed by Dr. Annie Varughese, Consultant Medical Oncologist Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Commonest
Leukaemia
Then brain tumours and lymphomas
Cure rates
Substantially higher than adults
With complete protocol-based treatment
Critical factor
Not interrupting treatment
Abandoning treatment partway is the biggest avoidable risk
Time in India
Months, not weeks
Leukaemia protocols run 2 to 3 years, mostly at home
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What childhood cancers are

Acute lymphoblastic leukaemia is the commonest cancer of childhood and, with full protocol treatment, is cured in a high proportion of children. Treatment is long — typically two to three years — but most of it is maintenance therapy given as tablets at home, with only the initial months being intensive.

Brain tumours are the commonest solid tumours in children and vary enormously, from those cured by surgery alone to those requiring surgery, radiotherapy and chemotherapy together. Radiotherapy in very young children is used cautiously because of effects on the developing brain.

Other important groups include lymphomas, neuroblastoma arising from nerve tissue in the abdomen or chest, Wilms tumour of the kidney, bone tumours such as osteosarcoma and Ewing sarcoma, and retinoblastoma of the eye. Many of these have high cure rates with correct treatment.

What unites them is the importance of protocol. Paediatric oncology has achieved its results through carefully designed treatment regimens tested over decades. A child treated on protocol by a paediatric oncology unit has a substantially better chance than one treated ad hoc — and this is the reason it is worth travelling for.

Symptoms

Symptoms and warning signs

Common signs
  • Unusual and persistent tiredness or pallor
  • Unexplained bruising or a rash of tiny red spots
  • Persistent fever without an obvious infection
  • A lump or swelling anywhere, including the abdomen
  • Persistent bone or joint pain, or limping
  • Headaches with vomiting, especially in the morning
  • A white reflection in the pupil seen in photographs, or a squint
Warning signs of an emergency
  • Fever during chemotherapy — always an emergency
  • Unusual drowsiness or difficulty waking
  • Persistent vomiting, particularly with headache
  • Seizure
  • Breathing difficulty or rapid breathing
  • Bleeding that will not stop, or extensive new bruising

Abandoning treatment partway is the greatest avoidable risk

Childhood cancer protocols are long, and treatment interruption is the commonest reason a curable cancer becomes incurable. Families run out of money, travel becomes impossible, or a child appears well and treatment seems unnecessary. Before starting, we will map out the full duration, the total cost, and exactly which phases must be given in India and which can be given at home. Beginning a protocol you cannot finish is worse than not beginning it, and we would rather have that conversation at the outset.

Diagnosis

How it is diagnosed

Diagnosis requires tissue or marrow; imaging establishes the extent.

Initial tests

  • Full blood count and blood film — often the first abnormality found
  • Bone marrow aspirate and biopsy — for leukaemia, and to check for spread in some solid tumours
  • Biopsy of the tumour — for solid tumours, ideally by a surgeon experienced in paediatric oncology
  • Ultrasound — commonly the first imaging for an abdominal mass

The deciding tests

  • Immunophenotyping, cytogenetics and molecular testing — determine the risk group and therefore the intensity of treatment
  • MRI or CT — defining the tumour and, for brain tumours, the whole neuraxis
  • PET-CT or MIBG scan — for staging lymphomas and neuroblastoma respectively
  • Lumbar puncture — checks whether leukaemia has reached the fluid around the brain

Ask which protocol will be followed

This is the most useful question a parent can ask. Paediatric cancers are treated on named, established protocols, and a unit that follows one is telling you their treatment is based on decades of accumulated evidence. Ask which protocol, what the total duration is, and which phases require inpatient admission. Send us whatever documents you have and we will confirm the plan is protocol-based.

Options

Treatment options

Treatment is usually a defined sequence over months to years rather than a single intervention.

Leukaemia

Protocol chemotherapy over two to three years

An intensive induction phase to achieve remission, then consolidation, then a long maintenance phase of daily tablets and periodic clinic visits. Only the early months are intensive; maintenance can frequently be given near home once the protocol is established, with monitoring. Treatment directed at the fluid around the brain is included in all protocols.

Usually appropriate whenAcute lymphoblastic leukaemia, with intensity adjusted according to risk group and response.
Solid tumours

Surgery, chemotherapy and radiotherapy in sequence

For Wilms tumour, neuroblastoma, bone tumours and others, the sequence typically involves chemotherapy to shrink the tumour, surgery to remove it, and further chemotherapy, with radiotherapy in selected cases. The order is defined by the protocol and should not be improvised.

Usually appropriate whenSolid tumours of childhood, according to type, stage and risk group.
Brain tumours

Surgery, with radiotherapy and chemotherapy as indicated

Maximal safe removal is the first step for most, performed by a paediatric neurosurgeon. Some low-grade tumours need nothing further. Others require radiotherapy and chemotherapy, with radiotherapy used cautiously in very young children because of effects on brain development.

Usually appropriate whenAccording to tumour type, location and the child's age.
Transplant

Bone marrow transplant for selected children

Used in high-risk or relapsed leukaemia, and in high-risk neuroblastoma as an autologous transplant. Requires weeks in protective isolation and a matched donor for allogeneic transplant — a sibling, a half-matched parent, or an unrelated donor.

Usually appropriate whenRisk category or relapse indicates it. HLA typing of siblings should be arranged early where it may be needed.
The decision

How the choice is made

Exact diagnosis and risk group

Cytogenetics and molecular testing place a child in a risk group, and that determines how intensive treatment needs to be. Undertreating a high-risk child and overtreating a low-risk one are both harmful.

Whether the full protocol can be completed

This is a practical question as much as a medical one, and it deserves an honest answer before treatment begins rather than in month eight.

The unit's paediatric oncology capability

A dedicated paediatric oncology unit with paediatric-trained nursing, isolation facilities and blood bank support. Adult oncology units are not a substitute.

We will give you the full expected duration and cost before anything starts, including the parts that can be given at home. Nobody should begin a two-year protocol without knowing what it involves.

Urgency

How urgent is your case

Usually safe to plan travel
  • Child stable between cycles with no fever
  • Diagnosis confirmed locally, planning protocol treatment
  • In maintenance phase, well and growing
  • Seeking second opinion on a proposed plan
Needs local assessment before travel
  • Fever during chemotherapy — always
  • Drowsiness, persistent vomiting or seizure
  • Breathing difficulty
  • Uncontrolled bleeding
  • Severe pain not responding to medication

We will tell you which column you are in

Newly diagnosed acute leukaemia in a child should be treated where you are, immediately. Once remission is achieved, transferring care or arranging transplant becomes safe and sensible.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Bone marrow or tumour biopsy report
  • Immunophenotyping, cytogenetics and molecular results
  • Imaging reports — ultrasound, CT, MRI or PET
  • Your child's age and current weight

Also helpful

  • Full blood counts over time
  • Details of any treatment already given, with protocol name if known
  • Whether your child has siblings, and their ages
  • Any previous discharge summaries
Send my reports for review See published cost ranges
Questions

Questions patients ask

Many are, and cure rates are substantially higher than for adult cancers. Acute lymphoblastic leukaemia, Hodgkin lymphoma, Wilms tumour and retinoblastoma all have high cure rates with complete protocol-based treatment. The decisive factors are accurate diagnosis, correct risk stratification, and finishing the treatment.

For acute lymphoblastic leukaemia, the long maintenance phase is what prevents relapse. The intensive phase lasts months; the remainder is largely daily tablets and periodic clinic visits, during which most children return to school and normal activity. Shortening it materially increases the risk of the leukaemia returning.

No, and for leukaemia you should not. The intensive phases are worth doing where the expertise is, but maintenance can usually be given near home under local supervision with the protocol written out clearly. We will map which phases require you to be here before anything starts.

Tell us before treatment begins rather than partway through. Starting a protocol that cannot be completed is worse than not starting, because an interrupted course loses most of its benefit. We will give you the full cost upfront, and where the numbers do not work, we will say so honestly and help you look at what is achievable near home.

Some treatments affect future fertility, and this depends on the drugs, the doses and whether radiotherapy is involved. For older children and adolescents, fertility preservation can sometimes be discussed before treatment begins. Raise it early — once treatment has started, options narrow.

Yes. Children frequently look and feel well during maintenance treatment, and that is a sign the treatment is working rather than a sign it is no longer needed. Stopping early because a child appears healthy is the commonest route by which a curable childhood cancer relapses.

RelatedOn this site
Cancer treatment in IndiaRead → Blood cancersRead → Bone marrow transplantRead → Cancer treatment costRead → Medical visa guidesRead →
Contact

Send us your reports

Send the biopsy or bone marrow report with cytogenetics, plus imaging and your child's age and weight. Tell us what treatment has already been given and under which protocol.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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