The article focuses on the analysis of current issues and challenges facing pediatric oncology and hematology. Data on cancer incidence in children at the level of economic development of the state, relative to the healthcare model are provided. The main characteristics of oncological care systems in economically developed countries and in developing countries around the world are identified, and the features of the Russian model are emphasized. Particular attention is paid to recent technologies and development vectors of molecular-targeted, cell therapy, precision surgery. The role of information technology and digital transformations in increasing the efficiency of healthcare models for providing oncological care to children in Russia is shown. National and foreign experience convincingly proves that a breakthrough in pediatric oncology is possible only with a systematic approach combining scientific innovations with access to medical care. Russia, being at a unique stage of development, demonstrates both significant successes in the field of high technologies and persistent structural problems. Thus, the key vector of development is not only the introduction of individual innovations but also solving fundamental tasks of standardization, overcoming regional inequality, and developing personnel potential, which will allow fully realizing the accumulated scientific and clinical potential.