Treatment
How is cancer treated?
There is no ‘one fits all’ therapy for treating cancer. A child's individual treatment plan is based upon:
• their condition
• stage of their illness
• general health
The plan may consist of a combination of treatments - for example surgery and chemotherapy.
Before treatment
The doctor will outline the benefits, risks and potential side-effects of the treatment. The doctor will also be happy to answer any questions and will repeat information as many times as is needed. The three main ways to treat cancer are through surgery, chemotherapy and radiotherapy.
When a child is receiving treatment it is best not to give them any other medicines without first talking to their Consultant.
SURGERY
If a child has been diagnosed with a solid tumour, it is likely they will need surgery. Treating a tumour surgically means removing it with an operation. Some tissue surrounding the tumour may also be removed. Usually, before the operation a sample of the tumour will be taken to decide whether the tumour is malignant or benign. This is known as a biopsy. If a tumour is removed completely by surgery and is diagnosed as benign this may be the only treatment necessary. If a tumour is removed completely by surgery and is diagnosed as malignant then the child may have a course of chemotherapy to “mop up” any cancer cells that may be elsewhere in the body. Depending upon the size of the tumour, surgery may be the first stage of treatment. However, if the tumour is large, or if removing it could damage any surrounding tissue, chemotherapy or radiotherapy may be given first to try and shrink the tumour to make surgery more successful.
RADIOTHERAPY
The word ‘Radiotherapy’ comes from two words:
• Radio 'radiation’
• Therapy ‘treatment’
Radiotherapy treats cancer by using high energy rays which destroy the abnormal cells, whilst doing as little harm as possible to normal cells. Only some children will receive this type of treatment as its use depends upon the type of cancer they have and where it is in the body. When treating brain tumours for example, radiotherapy is now avoided - if at all possible - for children under three to help minimise any long term side-effects.
How does radiotherapy work?
All human cells contain DNA – the instruction code which tells the cell what it is and what it is to do. Radiotherapy (or the radiation it contains) destroys this DNA within the cancer cell. This causes the cell to die and shrinks the size of the tumour. The treatment is not painful and lasts a few minutes. The procedure is a bit like having an X-ray taken and the child has to lie very still. The length of treatment will vary from child to child. The treatment is planned carefully and may involve a scan or X-ray to accurately pinpoint which areas is to be treated. A mark is drawn on the child’s skin so that the treatment is given to the same spot each time.
It is vital that the child stays still during treatment. Because of this, the doctor may give a young child a sedative or even general anaesthetic to help them relax or sleep. A clear plastic mould will be made to immobilise the area that is to be treated. These moulds are known as “immobilisation devices” and are for the head and body. These devices, also known as masks or shells have to be made for each individual child to use use during treatment. The child lies on the treatment table and the mask or shell fixes over them and onto the treatment table. This stops them moving. A specialist nurse or play therapist can help explain the procedure and prepare a child for it.
Side-effects
The short term side-effects associated with radiotherapy are usually mild. Some children develop a skin reaction to the radiotherapy after a few weeks. The area of skin that is exposed to the radiotherapy can become sore, red and itchy. The radiotherapist will be looking for signs of this reaction (which can look like sunburn). Radiotherapy can sometimes cause some long-term side effects. These do not happen to every child and vary in how severe they are.
CHEMOTHERAPY
Chemotherapy is one of the three main ways to treat cancer. The word chemotherapy comes from two words:
• Chemo 'chemical’
• Therapy ‘treatment’
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells.
How does chemotherapy work?
Chemotherapy drugs are known as “cytotoxic drugs”. They work by trying to stop the growth of rapidly dividing cells. Because – by their nature – cancer cells are rapidly dividing, it is hoped that they will become damaged and die. However, the body also contains healthy rapidly dividing cells (that grow in the mouth, stomach or bone marrow for example.) These can also be affected by the chemotherapy drugs, causing side-effects. There is more about this in our side-effects section. The chemotherapy drugs are carried through the body in the bloodstream, so they can reach cells wherever they find them, including those that may have broken away and spread. Some cancers, such as leukaemia, need chemotherapy because the cancer cells are in the blood and therefore all over the body. When a solid tumour is removed with surgery, doctors may also prescribe chemotherapy to try and “mop up" any cancer cells that remain in the body.
Chemotherapy has to be planned carefully so that it harms the rapidly dividing unhealthy (cancerous) cells but creates the minimum amount of harm to the healthy rapidly dividing cells in the body. Because of this doctors may use a combination of chemotherapy drugs, at high or low doses and at different times, creating an individual treatment plan for each child. The aim of this is to eliminate the cancer and minimise side-effects associated with the drugs.
How is chemotherapy given?
Chemotheraphy can be given by one, or a combination of the following ways:
• By mouth - in the form of liquid or tablets
• By injection - into the muscle or under the skin
• Intravenously - where the drug is diluted in fluid and given straight into the vein, via a drip.
The 'central line' A 'central line' – such as a Hickman ® line is another way for a child to receive chemotherapy. It is a rubber tube or catheter which is placed under the skin and attached to a central vein in the chest. The end of the tube is on the outside of the chest and is sealed with a cap. When chemotherapy is given, the cap is removed and the drugs are injected into the line. The line can stay in place for the period of treatment. The advantages of such a line are that the child does not have to have needles injected into the skin each time treatment is due. It also gives doctors easy access when taking blood samples. The child will need a small operation to fit the line and special care to make sure the line does not become blocked or infected.
The drugs used for chemotherapy are very powerful and can cause certain side-effects.
BONE MARROW TRANSPLANT
Bone marrow is the spongy substance found inside large bones and is the ‘factory’ which produces the body’s blood cells. The bone marrow makes three different types of blood cell – red, white and platelet. Stem cells are ‘mother’ blood cells that will develop into one of the three types of blood cell. Stem cells are found within the bone marrow, but can also be harvested from the peripheral blood. If bone marrow is used, the procedure is called a bone marrow transplant (BMT). If cells are harvested from the blood, the procedure is called a peripheral blood stem cell transplant (PBSCT)
The aim behind a bone marrow or stem cell transplant is to replace diseased bone marrow with a new healthy system so that the body can produce healthy blood cells once more. They are used in many, sometimes highly individual circumstances so the information on this page is meant to be a general guide only. Parents can speak to their child’s Consultant about any aspects of these transplants and why their child may need one.
Why a transplant?
Transplants can be given as a treatment for certain types or stages of leukaemia– for example when they are in remission or have had a relapse. Stem cells from donor bone marrow, umbilical or peripheral blood are used. High does of chemotherapy are given to remove the child’s own diseased bone marrow and the new marrow is given as a transplant. This is known as an allogenic transplant because the bone marrow is donated from another person.
Stem cells are also used as a supportive treatment when very high-doses of chemotherapy or radiotherapy have been needed to treat a particular type cancer. Stem cells from the child are collected and frozen before high dose therapy (chemotherapy or radiotherapy) is given. The high dose therapy can cause damage to the bone marrow (as well as the cancer cells) so the child’s own cells are then given (or re-infused) to ‘rescue’ the damaged bone marrow. This is a autologous transplant (as the stem cells are the child’s own) and is sometimes referred to as ‘high-dose therapy with stem-cell support’.
What happens?
The bone marrow or stem cells are given to the child via their central line and they will need special care after the procedure including antibiotics and - for some transplants - time in an isolation room. This is because the child will be very susceptible to infection whilst their body is without a healthy bone marrow system. Painkillers and some nutritional supportmay also be needed. Parents can ask their child’s Consultant about care needed after a transplant. It is hoped that the bone marrow or stem cells will travel to the cavities within the bones and ‘graft’ and begin to produce healthy blood cells again.
Bone marrow and stem cell transplants can be complicated procedures. Parents can talk to their child’s Consultant about the risks and side-effects involved.
CLINICAL TRIALS
What is a clinical trial?
When the treatment plan is being written for a child, parents may be asked if they would like their child to take part in a clinical trial. Clinical trials are research projects that aim to find better treatments for childhood cancer. Please note that any new drug used in a clinical trial will have been thoroughly tested beforehand and will have shown that it may be an improvement on the standard, or already used, treatment.
These trials test new treatments to see if they are more effective in treating cancer than the standard treatment available. They are often carried out in a number of hospitals and are co-ordinated by members of the CCLG. (Children’s Cancer and Leukaemia Group formally known as the United Kingdom Children’s Cancer Study Group)
As an example, one trial may consist of a group of children receiving the best known treatment available and another group receiving a new form, or combination of treatment. This treatment may or may not be better than the standard treatment available. The trial is the last stage of testing and children involved in trails are not being used as “guinea-pigs” for something that is totally unknown. Previous tests will have shown that the drug may potentially be more effective than the standard treatment available. “Better” or “more effective” in terms of a clinical trial can mean that the drug treats cancer successfully. It can also mean that the drug produces less side-effects.
Informed consent
Parents have to give their informed consent for their child to take part in a clinical trial - this means they need to understand what the trial is for and how their child will be involved. All children on clinical trials are monitored closely during the trial and parents can they withdraw them at any time. For further information about clinical trials, visit the website of the CCLG.
Source: www.clicsargent.org.uk
There is no ‘one fits all’ therapy for treating cancer. A child's individual treatment plan is based upon:
• their condition
• stage of their illness
• general health
The plan may consist of a combination of treatments - for example surgery and chemotherapy.
Before treatment
The doctor will outline the benefits, risks and potential side-effects of the treatment. The doctor will also be happy to answer any questions and will repeat information as many times as is needed. The three main ways to treat cancer are through surgery, chemotherapy and radiotherapy.
When a child is receiving treatment it is best not to give them any other medicines without first talking to their Consultant.
SURGERY
If a child has been diagnosed with a solid tumour, it is likely they will need surgery. Treating a tumour surgically means removing it with an operation. Some tissue surrounding the tumour may also be removed. Usually, before the operation a sample of the tumour will be taken to decide whether the tumour is malignant or benign. This is known as a biopsy. If a tumour is removed completely by surgery and is diagnosed as benign this may be the only treatment necessary. If a tumour is removed completely by surgery and is diagnosed as malignant then the child may have a course of chemotherapy to “mop up” any cancer cells that may be elsewhere in the body. Depending upon the size of the tumour, surgery may be the first stage of treatment. However, if the tumour is large, or if removing it could damage any surrounding tissue, chemotherapy or radiotherapy may be given first to try and shrink the tumour to make surgery more successful.
RADIOTHERAPY
The word ‘Radiotherapy’ comes from two words:
• Radio 'radiation’
• Therapy ‘treatment’
Radiotherapy treats cancer by using high energy rays which destroy the abnormal cells, whilst doing as little harm as possible to normal cells. Only some children will receive this type of treatment as its use depends upon the type of cancer they have and where it is in the body. When treating brain tumours for example, radiotherapy is now avoided - if at all possible - for children under three to help minimise any long term side-effects.
How does radiotherapy work?
All human cells contain DNA – the instruction code which tells the cell what it is and what it is to do. Radiotherapy (or the radiation it contains) destroys this DNA within the cancer cell. This causes the cell to die and shrinks the size of the tumour. The treatment is not painful and lasts a few minutes. The procedure is a bit like having an X-ray taken and the child has to lie very still. The length of treatment will vary from child to child. The treatment is planned carefully and may involve a scan or X-ray to accurately pinpoint which areas is to be treated. A mark is drawn on the child’s skin so that the treatment is given to the same spot each time.
It is vital that the child stays still during treatment. Because of this, the doctor may give a young child a sedative or even general anaesthetic to help them relax or sleep. A clear plastic mould will be made to immobilise the area that is to be treated. These moulds are known as “immobilisation devices” and are for the head and body. These devices, also known as masks or shells have to be made for each individual child to use use during treatment. The child lies on the treatment table and the mask or shell fixes over them and onto the treatment table. This stops them moving. A specialist nurse or play therapist can help explain the procedure and prepare a child for it.
Side-effects
The short term side-effects associated with radiotherapy are usually mild. Some children develop a skin reaction to the radiotherapy after a few weeks. The area of skin that is exposed to the radiotherapy can become sore, red and itchy. The radiotherapist will be looking for signs of this reaction (which can look like sunburn). Radiotherapy can sometimes cause some long-term side effects. These do not happen to every child and vary in how severe they are.
CHEMOTHERAPY
Chemotherapy is one of the three main ways to treat cancer. The word chemotherapy comes from two words:
• Chemo 'chemical’
• Therapy ‘treatment’
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells.
How does chemotherapy work?
Chemotherapy drugs are known as “cytotoxic drugs”. They work by trying to stop the growth of rapidly dividing cells. Because – by their nature – cancer cells are rapidly dividing, it is hoped that they will become damaged and die. However, the body also contains healthy rapidly dividing cells (that grow in the mouth, stomach or bone marrow for example.) These can also be affected by the chemotherapy drugs, causing side-effects. There is more about this in our side-effects section. The chemotherapy drugs are carried through the body in the bloodstream, so they can reach cells wherever they find them, including those that may have broken away and spread. Some cancers, such as leukaemia, need chemotherapy because the cancer cells are in the blood and therefore all over the body. When a solid tumour is removed with surgery, doctors may also prescribe chemotherapy to try and “mop up" any cancer cells that remain in the body.
Chemotherapy has to be planned carefully so that it harms the rapidly dividing unhealthy (cancerous) cells but creates the minimum amount of harm to the healthy rapidly dividing cells in the body. Because of this doctors may use a combination of chemotherapy drugs, at high or low doses and at different times, creating an individual treatment plan for each child. The aim of this is to eliminate the cancer and minimise side-effects associated with the drugs.
How is chemotherapy given?
Chemotheraphy can be given by one, or a combination of the following ways:
• By mouth - in the form of liquid or tablets
• By injection - into the muscle or under the skin
• Intravenously - where the drug is diluted in fluid and given straight into the vein, via a drip.
The 'central line' A 'central line' – such as a Hickman ® line is another way for a child to receive chemotherapy. It is a rubber tube or catheter which is placed under the skin and attached to a central vein in the chest. The end of the tube is on the outside of the chest and is sealed with a cap. When chemotherapy is given, the cap is removed and the drugs are injected into the line. The line can stay in place for the period of treatment. The advantages of such a line are that the child does not have to have needles injected into the skin each time treatment is due. It also gives doctors easy access when taking blood samples. The child will need a small operation to fit the line and special care to make sure the line does not become blocked or infected.
The drugs used for chemotherapy are very powerful and can cause certain side-effects.
BONE MARROW TRANSPLANT
Bone marrow is the spongy substance found inside large bones and is the ‘factory’ which produces the body’s blood cells. The bone marrow makes three different types of blood cell – red, white and platelet. Stem cells are ‘mother’ blood cells that will develop into one of the three types of blood cell. Stem cells are found within the bone marrow, but can also be harvested from the peripheral blood. If bone marrow is used, the procedure is called a bone marrow transplant (BMT). If cells are harvested from the blood, the procedure is called a peripheral blood stem cell transplant (PBSCT)
The aim behind a bone marrow or stem cell transplant is to replace diseased bone marrow with a new healthy system so that the body can produce healthy blood cells once more. They are used in many, sometimes highly individual circumstances so the information on this page is meant to be a general guide only. Parents can speak to their child’s Consultant about any aspects of these transplants and why their child may need one.
Why a transplant?
Transplants can be given as a treatment for certain types or stages of leukaemia– for example when they are in remission or have had a relapse. Stem cells from donor bone marrow, umbilical or peripheral blood are used. High does of chemotherapy are given to remove the child’s own diseased bone marrow and the new marrow is given as a transplant. This is known as an allogenic transplant because the bone marrow is donated from another person.
Stem cells are also used as a supportive treatment when very high-doses of chemotherapy or radiotherapy have been needed to treat a particular type cancer. Stem cells from the child are collected and frozen before high dose therapy (chemotherapy or radiotherapy) is given. The high dose therapy can cause damage to the bone marrow (as well as the cancer cells) so the child’s own cells are then given (or re-infused) to ‘rescue’ the damaged bone marrow. This is a autologous transplant (as the stem cells are the child’s own) and is sometimes referred to as ‘high-dose therapy with stem-cell support’.
What happens?
The bone marrow or stem cells are given to the child via their central line and they will need special care after the procedure including antibiotics and - for some transplants - time in an isolation room. This is because the child will be very susceptible to infection whilst their body is without a healthy bone marrow system. Painkillers and some nutritional supportmay also be needed. Parents can ask their child’s Consultant about care needed after a transplant. It is hoped that the bone marrow or stem cells will travel to the cavities within the bones and ‘graft’ and begin to produce healthy blood cells again.
Bone marrow and stem cell transplants can be complicated procedures. Parents can talk to their child’s Consultant about the risks and side-effects involved.
CLINICAL TRIALS
What is a clinical trial?
When the treatment plan is being written for a child, parents may be asked if they would like their child to take part in a clinical trial. Clinical trials are research projects that aim to find better treatments for childhood cancer. Please note that any new drug used in a clinical trial will have been thoroughly tested beforehand and will have shown that it may be an improvement on the standard, or already used, treatment.
These trials test new treatments to see if they are more effective in treating cancer than the standard treatment available. They are often carried out in a number of hospitals and are co-ordinated by members of the CCLG. (Children’s Cancer and Leukaemia Group formally known as the United Kingdom Children’s Cancer Study Group)
As an example, one trial may consist of a group of children receiving the best known treatment available and another group receiving a new form, or combination of treatment. This treatment may or may not be better than the standard treatment available. The trial is the last stage of testing and children involved in trails are not being used as “guinea-pigs” for something that is totally unknown. Previous tests will have shown that the drug may potentially be more effective than the standard treatment available. “Better” or “more effective” in terms of a clinical trial can mean that the drug treats cancer successfully. It can also mean that the drug produces less side-effects.
Informed consent
Parents have to give their informed consent for their child to take part in a clinical trial - this means they need to understand what the trial is for and how their child will be involved. All children on clinical trials are monitored closely during the trial and parents can they withdraw them at any time. For further information about clinical trials, visit the website of the CCLG.
Source: www.clicsargent.org.uk
IMPORTANT: The information on this page is intended to back up the information you get from a doctor, not to replace medical advice from a consultant.
