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CHILDREN'S CANCER - Treatment

Surgery
Surgery plays a very important part in the treatment of tumours. Depending on the size and position of the tumour in the body an operation to remove it may be the first part of treatment.

More often though a biopsy of the tumour is taken first to make the diagnosis. (A biopsy involves taking a piece of tissue from the tumour for analysis in the laboratory).

Sometimes, an operation may be dangerous or cause too much damage to tissue because of the size and position of the tumour. In these cases chemotherapy or radiotherapy may be given before an operation to shrink the tumour and make surgery easier.

Radiotherapy
Radiotherapy uses high energy x-rays which destroy cancer cells. It is normally used to treat one (local) area where the tumour was found. Radiotherapy is given each day Monday to Friday with weekends off. How long a course of treatment lasts is variable, but it may be anything up to six weeks.

Before treatment begins it is necessary to undergo what is known as 'planning'. This allows the radiographer to work out the exact position in which to place the child, and ensures that treatment is given to exactly the right place each time.

Radiotherapy is painless and usually only takes a few minutes each day. During the treatment the child must lie perfectly still to ensure precise delivery of the radiotherapy. Sometimes it is necessary to give a sedative to help the child lie still and occasionally an anaesthetic is needed.

Radiotherapy is a very effective treatment against cancer cells but it can cause some damage to healthy cells close to the area being treated. The immediate side effects of radiation are usually very mild. The skin may become sore as if it were sunburnt.

Other potential immediate side effects depend upon the part of the body being treated. For example radiotherapy to the stomach and/or the pelvic area can cause problems such as diarrhoea, feeling sick and loss of appetite. It is important to remember that these side effects, although troublesome, are temporary and can be treated.

Radiotherapy can cause some longer term side effects which will not be instantly apparent. As time goes by the effect of radiation to any growing tissues may become more noticeable. In particular, radiation to the brain can have important effects on growth and development. Your doctor will be able to discuss these with you in more detail.

Chemotherapy
Chemotherapy drugs work by interfering with the ability of a cancer cell to divide and reproduce itself. The cancer cells become damaged and eventually die. As the drugs are carried in the blood, they can reach cancer cells all over the body.

Chemotherapy can be given in different ways, either by mouth or intravenously (by injection into a vein). There are many technical terms used to describe how the drugs are given and you will see these on drug charts and on treatment plans (protocols). The common terms are shown in the following table:

Whichever way the drugs are given, they are absorbed into the blood and carried around the body so they can reach all the cancer cells. This makes chemotherapy particularly useful when cancers have spread.

Chemotherapy has to be carefully planned so that it progressively destroys the cancer during the course of treatment, but not the normal cells and tissues. It may for example be given intensively in high doses over a short period, or it may be given in lower doses over a longer period.

When treatment is given by intravenous injection the drugs are usually diluted into a bag of liquid such as saline (salt water) and given through a 'drip' into a vein in the arm. In this situation a fine tube is inserted into the vein and taped securely to the arm. The tube is called a cannula.

The other way of giving intravenous chemotherapy is through a central line. This is a common way of giving chemotherapy to children.

Most of the drugs have significant and potentially unpleasant short term side effects, such as hair loss and nausea and vomiting. There are, however, effective ways of controlling some of these problems and reducing the distress they may cause.

The main areas of the body that may be affected by chemotherapy are where normal cells rapidly divide and grow: the mouth, digestive system, skin, hair, and bone marrow.

Further information about the potential side effects of cancer treatment can be found at the end of this section.

It is important to be aware that while most side effects are temporary, some treatments may have longer term effects. These may not always be obvious at the time and careful follow up to detect any of these long term effects is needed after treatment has finished. Individual drugs and their side effects are described further on.

Bone marrow and peripheral stem cell transplant
(high dose treatment)

Bone marrow and stem cell transplants are ways of allowing much higher doses of chemotherapy to be given, to improve the chances of completely curing the disease. In children, this type of treatment is usually used for more aggressive types of tumour.

Chemotherapy and radiotherapy interfere with the production of the blood. Usually chemotherapy is given at 3 or 4 week intervals to allow the bone marrow to recover. However, this means that there is a limit to how much chemotherapy can be given, since it may cause permanent damage to the bone marrow.

In transplants, very high doses of chemotherapy (with or without radiotherapy) are given over a few days and bone marrow or stem cells (either the child's own or donated by someone else) are then given back to 'rescue' the child from the effects of high dose treatment. The stem cell procedure is sometimes referred to as bone marrow transplant or peripheral blood stem cell transplant or rescue.

It is important to know that high dose treatment is complicated and generally not the first treatment used. Your doctor will discuss this in detail if appropriate.