Childhood cancer: warning signs easy to miss

When doctors told Lauren Lewis that her four-month-old daughter, Aaliyah, had stage 4 neuroblastoma — an aggressive cancer of the adrenal glands and nervous system — the words barely registered. Then came the flood of questions every mother dreads: how could this be my child? What did I do wrong?

The Cape Town mother of two remembers the moment her world shifted.

“I kept asking myself how it could be my child and whether I had done something wrong during my pregnancy,” she said.

Lewis first noticed something was wrong when Aaliyah’s stomach began to swell. “She would cry whenever I touched her tummy. I took her to the clinic. From there we were sent to Swartland Public Hospital in Malmesbury. They did a sonar and found a tumour. We were referred to Tygerberg Hospital for further tests.”

Those tests confirmed stage 4 neuroblastoma.

“I couldn’t cry,” Lewis said. “I prepared myself for the worst. I prepared myself to lose her.”

Childhood cancer symptoms frequently resemble common illnesses, so children are treated repeatedly for infections before cancer is considered. Many never reach a specialist centre in time, and some are lost entirely from the system

—  Jennifer Geel, Wits University

Aaliyah endured months of intensive chemotherapy, surgery, radiotherapy and nutritional support. Last December, she rang the copper bell at Tygerberg Hospital’s paediatric oncology ward, marking the end of her treatment — a milestone celebrated by families navigating childhood cancer.

Aaliyah’s story is not unique.

According to the Western Cape health department, about 100 children under the age of 15 are diagnosed with cancer each year in the Cape Town metro. While overall childhood cancer rates remain relatively stable, case numbers are rising in line with population growth.

Nationally, the Cancer Association of South Africa (Cansa) estimates that between 800 and 1,000 children are diagnosed with cancer each year. However, experts warn that as many as half of the cases go undiagnosed, leading to delayed treatment and preventable deaths.

Jennifer Geel, adjunct professor in the department of paediatrics and child health at the University of the Witwatersrand and head of paediatric oncology at Charlotte Maxeke Johannesburg Academic Hospital, says the warning signs are often missed.

“Childhood cancer symptoms frequently resemble common illnesses, so children are treated repeatedly for infections before cancer is considered,” she said. “Many never reach a specialist centre in time, and some are lost entirely from the system.”

More than 400 different types of cancers affect children, said Geel.

“It is not appropriate to expect communities to know these medical details. The deficit is within the medical system. Doctors and nurses often do not recognise the early warning signs of childhood cancer. Delays are usually not the fault of parents,” she said.

Anina Meiring, Cansa’s service manager for childhood cancer, said a lack of awareness among parents and caregivers also contributes to missed diagnoses.

“Childhood cancers often mimic common illnesses, leading to misdiagnosis. Stigma and myths about cancer discourage families from seeking help, and limited access to diagnostic facilities — especially in rural areas — worsens the situation,” she said.

Prof Alan Davidson, head of haematology and oncology at Red Cross War Memorial Children’s Hospital, stressed the importance of vigilance.

Parents should seek medical advice if their children experience persistent symptoms, such as:

• pallor;
• easy bruising or bleeding;
• bone or joint pain;
• persistently enlarged lymph nodes;
• unexplained lumps in the abdomen or limbs;
• white spots in the eyes;
• new squints;
• bulging eyes;
• deterioration in balance or speech; or
• prolonged headaches.

“While some of these symptoms may resemble common childhood illnesses, persistent signs require urgent investigation. Early recognition allows for quicker diagnosis and better outcomes.”

Government funding and policy frameworks remain inadequate for childhood cancer. While treatment is available at major public hospitals, systemic issues — including medicine access and infrastructure gaps — mean NGOs and private initiatives carry much of the burden,

—  Anina Meiring, Cansa’s service manager for childhood cancer

Meiring said systemic challenges continue to undermine progress. Many primary health-care workers lack specialised training to distinguish cancer symptoms from common childhood conditions. Families face long travel distances to specialist centres, financial strain, and a limited number of paediatric oncology units nationwide.

“These barriers often mean children present with advanced-stage cancer, reducing survival chances. Late treatment increases complications, lowers quality of life and requires more aggressive therapy,” she said.

Rural families face the greatest burden.

Meiring called for strengthened training for primary health-care workers, expanded paediatric oncology services in underserved regions, improved referral systems and transport support, and increased government funding.

“Government funding and policy frameworks remain inadequate for childhood cancer. While treatment is available at major public hospitals, systemic issues — including medicine access and infrastructure gaps — mean NGOs and private initiatives carry much of the burden,” she said.

Meiring said strengthening the national cancer strategic framework to explicitly include childhood cancer, improving medicine procurement and expanding support services are among the most urgent policy needs.