In accordance with the Basic Plan to Promote Cancer Control Programs, a medical setting for providing patients with pediatric cancers sufficient medical treatments and supports has been assigned as one of the central issues in Japan. The Japanese Ministry of Health, Labour and Welfare designated 15 Pediatric Cancer Core Hospitals, and National Center for Child Health and Development as a central center in February 2013. A medical setting for pediatric cancers has been progressed to achieve the consolidation of patients who need specialized therapies and equalization of patients who need standard therapies for cure. Pediatric cancers are typical rare cancers in terms of the disease frequency. Therefore, there is a limitation to conduct systemic clinical studies in a few centers. To overcome this situation, JCCG(Japanese Children's Cancer Group)and JPLSG(Japanese Pediatric Leukemia/Lymphoma Study Group)were organized to conduct more than 30 clinical studies nationwide in each disease of pediatric solid tumors and hematological malignancies, respectively. They contributed to better outcome achieving more than 80% overall survival rates. While clinical trials to reduce therapeutic intensity in patients with better prognosis, molecular targeted therapies based on comprehensive genetic analysis and CAR-T therapy have been provided as effective therapeutic options in patients with refractory diseases. However, we still have limitations to provide patients such new therapeutic agents without delay covered by health insurance. Comprehensive supportive care for the patients and their family members by multi-disciplinary medical stuffs are required for their better quality of life. Long-term follow-ups for cancer survivors, learning supporting system for high school students, cares for their siblings, supports for the generation of adolescent and young adults (AYA) and fertility preservation have been provided in each hospital. In this paper, I summarized these current status and future perspective for medical settings of pediatric cancers in Japan.