Pediatric Oncology Overview
Childhood cancers differ from adult cancers.
Cancers in children are different from those in adults: they are usually not lifestyle-related, they tend to be fast-growing but often respond well to treatment, and the most common types are leukemias and brain (CNS) tumors. The general principles from adult oncology still apply — protect against infection and bleeding, and recognize emergencies — but the specific tumors and a few unique nursing points are heavily tested.
Two facts come up again and again: ALL is the most common childhood cancer, and you must never palpate the abdomen of a child with Wilms tumor. Lock those in first.
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Leukemia (ALL)
The most common childhood cancer — a bone marrow problem.
Acute lymphocytic leukemia (ALL) is the most common childhood cancer. Abnormal white cells crowd out the bone marrow, so the child can't make normal blood cells. The signs follow directly from bone marrow failure:
- Anemia — fatigue, pallor
- Neutropenia — frequent infections and fever
- Thrombocytopenia — bruising, petechiae, bleeding
- Bone/joint pain, enlarged lymph nodes, and an enlarged liver/spleen
Treatment: chemotherapy (often in phases); childhood leukemia generally has a good response rate.
If you remember that leukemia crowds out the marrow, you can predict the symptoms: low red cells → anemia, low white cells → infection, low platelets → bleeding. Nursing care centers on neutropenic and bleeding precautions.
Brain Tumors
The most common solid tumors in children — watch for increased ICP.
Brain tumors are the most common solid tumors in children. The symptoms come from increased intracranial pressure (ICP):
- Headache worse in the morning or on waking
- Vomiting (often without nausea, especially in the morning)
- Ataxia (unsteady, wide-based gait), head tilt, vision changes
- Behavioral or personality changes; in infants, an enlarging head and bulging fontanel
A child with a morning headache and vomiting (especially vomiting that brings relief and isn't tied to nausea) should raise concern for increased ICP from a brain tumor. Avoid actions that further raise ICP and report neuro changes promptly.
Wilms Tumor (Nephroblastoma)
A kidney tumor — and the classic "do not palpate" rule.
Wilms tumor is a cancer of the kidney, usually found in young children. It's often discovered as a firm abdominal mass or swelling, frequently noticed by a parent during bathing or dressing. The mass is usually on one side and does not cross the midline.
The single most important nursing point: do not palpate the abdomen of a child with (or suspected to have) Wilms tumor. The tumor is encapsulated, and pressing on it can rupture the capsule and spread cancer cells. A sign is posted at the bedside, and the child is handled gently until surgery (nephrectomy).
Neuroblastoma
A tumor of nerve tissue — often already spread.
- Arises from neural crest (nerve) tissue, most often in the adrenal gland or along the sympathetic chain.
- Often presents as an abdominal mass that crosses the midline (a useful contrast with Wilms tumor).
- Frequently metastatic at diagnosis ("the silent tumor"), since it grows quietly.
Both can be an abdominal mass in a young child. A quick discriminator: Wilms = kidney, stays on one side (don't palpate); neuroblastoma = nerve/adrenal, crosses the midline, often already spread.
Lymphomas
Cancers of the lymphatic system.
- Hodgkin lymphoma — more common in adolescents; classically presents as painless, firm, enlarged lymph nodes (often in the neck), sometimes with fever, night sweats, and weight loss. Generally very treatable.
- Non-Hodgkin lymphoma — more diffuse and faster-growing; can occur in younger children.
A persistent, painless enlarged lymph node in a teen — especially with night sweats and weight loss — points toward Hodgkin lymphoma and warrants evaluation.
Bone Tumors
Most common in adolescents during growth spurts.
- Osteosarcoma — the most common bone cancer in children/teens; typically near the knee (lower femur or upper tibia). Signs: pain and swelling, sometimes after a minor injury.
- Ewing sarcoma — another bone tumor, often in the shaft of long bones or the pelvis.
Treatment: chemotherapy plus surgery (limb-salvage or amputation), so care includes pain control, mobility, and body-image support.
Persistent bone pain and swelling near the knee in an adolescent — especially that doesn't fit a simple injury — should be evaluated for osteosarcoma. Body-image and psychosocial support are big parts of nursing care if amputation is needed.
Nursing Care
Protect, support, and recognize emergencies.
- Infection prevention — neutropenic precautions; a fever of 100.4°F (38°C) or higher is an emergency (blood cultures, prompt antibiotics).
- Bleeding precautions — for thrombocytopenia (soft toothbrush, no rectal temps/IM injections, avoid aspirin).
- Chemo side effects — antiemetics before chemo, oral care for mucositis, monitor for tumor lysis, high-calorie/high-protein nutrition.
- Wilms tumor — do NOT palpate the abdomen.
- Family & psychosocial — support coping, body image (alopecia, amputation), and developmentally appropriate communication with the child.
Match the clue to the cancer: most common = ALL (marrow failure); morning headache + vomiting = brain tumor (↑ICP); abdominal mass, don't palpate = Wilms; mass crossing midline = neuroblastoma; painless node = lymphoma; knee pain in a teen = osteosarcoma. Then apply neutropenic and bleeding precautions.
? A child undergoing chemotherapy develops a fever of 101.2°F (38.4°C). What is the priority action?
Frequently Asked Questions
Common student questions on this topic.
What is the most common childhood cancer?
Why should you not palpate the abdomen of a child with Wilms tumor?
What are the signs of a brain tumor in a child?
What is the difference between Wilms tumor and neuroblastoma?
Why is fever an emergency in a child receiving chemotherapy?
What is osteosarcoma?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Pediatric Oncology Cheatsheet
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