Children are not simply “small adults.” The problems facing children with cancer and their families are increasingly complex and require new strategies. Cancer in childhood has epidemiologic differences from that of adults. Nevertheless, it is the second leading cause of death in childhood (second only to accidents and trauma among children less than 15 years of age). More importantly, childhood cancers have a considerably higher cure rate with chemotherapy and radiation. Advances in surgery allow for more complete resection of certain malignancies. A major feature of childhood cancer is the frequent necessity for brief, noxious diagnostic and therapeutic procedures. These procedures produce great fear and anxiety in the child. The anesthesiologist may assist in many facets of the patient's treatment and recovery, from initial assessment to chronic pain therapy. It is important to form an alliance with pediatric oncologists, surgeons, nursing staff, and the patient's family. This article covers the role of the anesthesiologist in the care of pediatric cancer patients.