Cancer Treatment for Children
How is cancer treated?
The group of healthcare professionals who work together to find, treat, and care for people with cancer is called the cancer care team. The cancer care team may include any or all of the following healthcare providers, in addition to others:
Primary healthcare providers
Oncology specialists (medical oncologist, radiation oncologist, surgical oncologist)
Surgeons (including surgical specialists such as urologists, gynecologists, and neurosurgeons)
Oncology nurse specialists
Oncology social workers
Child life therapists
Specific treatment for cancer will be determined by your child's healthcare provider based on:
Your child's age, overall health, and medical history
Type of cancer
Extent of disease
Development of new treatment options
Your child's tolerance for specific medicines, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment for certain types of cancer may include:
Antibiotics (to prevent and treat infections)
Supportive care (to treat or prevent the side effects of treatment, such as nausea, diarrhea, anemia, and mouth sores)
Surgery (for organ or tumor removal)
Placement of a central line. A central line is a thin, flexible tube called a catheter that is placed in a large vein that supplies the circulatory system. A central line is needed to give your child medicines and blood products. It also provides a site where blood samples can be easily taken without causing pain. There are several different types of central lines that are used in the treatment of cancer. Your child's healthcare provider will explain the benefits of the available central lines.
Continual follow-up care (to determine response to treatment, detect recurrence of disease, and manage the effects of treatment)
Biological response modifiers and immunotherapy (colony-stimulating factors, interleukins, monoclonal antibodies, tumor necrosis factor, interferons, cytokines, and the development of other biological response modifiers are the latest advances in the fight against cancer. Many of these modifiers are normally found in the body and assist with the immune system's ability to protect the body against invasion.)
In addition, healthcare providers are using the body's own processes to fight disease. In the near future, there may be a development that can make our bodies recognize cancer cells and destroy them or simply filter them out like common viruses.
The two most common forms of treatment for cancer are chemotherapy and radiation therapy.
What is chemotherapy?
Chemotherapy is the use of anticancer medicines to destroy cancerous cells. Chemotherapy has been used for many years and is one of the most common treatments for cancer. Different groups of medicines work in different ways to fight cancer cells. Chemotherapy may be used alone for some types of cancer or in combination with other treatments, such as radiation or surgery. Certain chemotherapy medicines may be given in a specific order depending on the type of cancer it is being used to treat.
While chemotherapy can be quite effective in treating certain cancers, the medicines reach all parts of the body, not just the cancer cells. Because of this, there may be many side effects during treatment. Being able to anticipate these side effects can help you and your child's caregivers prepare and, in some cases, prevent these symptoms from happening.
How does chemotherapy work?
In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of medicines work in different ways to destroy cancer cells. Often a combination of chemotherapy medicines is used to fight a specific cancer.
How is chemotherapy administered?
Chemotherapy can be given:
As a pill or liquid to swallow
As an injection into the muscle or fat tissue
Intravenously (directly to the bloodstream; also called IV)
Topically (applied to the skin)
Intrathecal (delivered into the spinal fluid)
What are the side effects of chemotherapy?
Chemotherapy interferes with fast-growing cancer cells, but it also affects some healthy cells. Before receiving chemotherapy for treatment of cancer, many tests are performed to evaluate the baseline (pretreatment) function of heart, kidneys, lungs, eyes, ears, and reproductive organs. Some chemotherapy may affect the function of these organs either during treatment or months to years after treatment. Some treatment may affect fertility. Other potential side effects may include, but are not limited to, the following:
Bone marrow suppression. Red blood cells that carry oxygen, white blood cells that fight infection, and platelets that help the blood to clot are usually lowered with chemotherapy use. Risk for anemia, fatigue, infection, and bleeding are increased with bone marrow suppression.
Mouth sores, skin changes, nausea, vomiting, and diarrhea. Chemotherapy affects the fast-growing cells of the mouth, skin, and gastrointestinal (GI) tract.
Hair loss (also called alopecia). Chemotherapy affects the cells of the hair and nails. After treatment is completed, most children's hair will grow back. Texture of hair and fingernails may change.
What is radiation therapy?
Radiation therapy (also called radiotherapy, irradiation or X-ray therapy) uses high energy waves or particles (such as X-rays) to destroy or damage cancer cells. Radiation therapy may be used in several ways depending on the type and location of the cancer. Certain levels of radiation work to destroy cancer cells or prevent cells from growing or reproducing. This treatment may provide a cure for cancer, control the disease, or help relieve its symptoms.
Although each hospital may have specific protocols, radiation therapy usually begins with these procedures:
Simulation process. After a physical exam and a review of your child's medical history, the treatment team "maps" out the position your child will be in for each treatment and the exact location on your child's body (referred to as treatment field or port) where the radiation will be given (the simulation process). Sometimes, the area on your child's body that needs treatment will be marked to make sure radiation is given properly. The treatment team may also make molds, headrests, or other devices that help to position your child during your treatment. Imaging studies may also be performed during the simulation process to help plan how to direct the radiation during treatments.
Treatment plan. Once the simulation process is completed, the radiation oncologist will determine your child's treatment plan. This will include the type of machine to use, the amount of radiation that is needed, and the number of treatments that will be given.
What are the different types of radiation therapy?
Radiation therapy is given through different methods, depending on the type of cancer, the location of the cancer, and the patient's health. Sometimes, radiation therapy is used in combination with other treatments. The following are some of the different types of radiation therapy with brief explanations of their goals:
External radiation (external beam therapy). With external radiation (external beam therapy), radiation is given by a large machine that points the energy waves directly at the tumor. The radiation therapist controls the machine. Since radiation is used to kill cancer cells, special shields may be made to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
Internal radiation (brachytherapy, implant radiation). With internal radiation (brachytherapy, implant radiation), a high dose of radiation is given inside the body as close to the cancer as possible. The radiation treatment is inserted through a thin tube called a catheter. Some of the radioactive implants are called seeds or capsules. Internal radiation involves giving a higher dose of radiation in a shorter time span when compared with external radiation. Some internal radiation treatments stay in the body temporarily; other internal treatments stay in the body permanently, although the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.
What are the side effects of radiation therapy?
The side effects of radiation depend on the dose and location, and if it is internal or external. Before receiving radiation for treatment of cancer, many tests may be performed to evaluate the baseline (pretreatment) function of heart, kidneys, lungs, eyes, ears and reproductive organs. Some radiation may affect the function of these organs either during treatment or months to years after treatment. Some treatment may affect fertility. The side effects usually relate to the area of the body that is receiving the radiation treatments. Potential side effects may include the following:
Hair loss (also called alopecia). Hair loss may happen if radiation therapy of the head is given. After treatment is completed, most children's hair will grow back.
Bone growth. Bone growth may also be affected, especially with young children who are still having significant bone growth. Height stature and/or limbs may be shortened because of the effect of radiation.
Skin changes. The skin may be more sensitive, reddened, or irritated after having radiation. Skin care is an important part of radiation treatment. Skin changes are short-term effects of radiation. Your child's healthcare provider will explain the necessary prevention and treatment of any skin problems related to radiation.
Diarrhea, nausea, and vomiting. If radiation therapy of the pelvis or stomach is given, a child may experience diarrhea, nausea, and/or vomiting.
Fatigue. Extreme tiredness called fatigue is common with radiation therapy. It may get worse as treatment goes on and can last for months after treatment ends.
March 21, 2017
Levy, Adam S., MD,Sather, Rita, RN