Cancer Treatment for Children

How is cancer treated in children?

The group of healthcare providers who work together to find, treat, and care for children with cancer is called the cancer care team. The cancer care team may include any or all of these providers, plus others:

  • Primary healthcare providers

  • Pediatricians

  • Pathologists

  • Hematologists

  • Oncology specialists (medical oncologist, radiation oncologist, surgical oncologist)

  • Surgeons (including surgical specialists such as urologists, gynecologists, and neurosurgeons)

  • Anesthesiologists

  • Nurses

  • Oncology nurse specialists

  • Oncology social workers

  • Pharmacists

  • Pastoral care

  • Respiratory therapists

  • Physical therapists

  • Lab technicians

  • Child life therapists

  • Psychologists

  • Radiation technicians

  • Dietitians

Your child's healthcare provider will decide on treatment for cancer based on:

  • Your child's age, overall health, and health history

  • Type of cancer

  • If the cancer has spread

  • New treatment options

  • How well your child tolerates certain medicines, procedures, or therapies

  • The expected outcome

  • Your opinion or preference

Treatment for certain cancers may include:

  • Chemotherapy

  • Radiation therapy

  • Antibiotics. these medicines prevent and treat infections.

  • Supportive care. This may be used to treat or prevent the side effects of treatment. These include nausea, diarrhea, anemia, and mouth sores.

  • Surgery. This treatment is used to remove an organ or tumor.

  • Placement of a central line. A central line is a thin, flexible tube (catheter). It is placed in a large vein that supplies the circulatory system. A central line may be used 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 types of central lines used in the treatment of cancer. Your child's healthcare provider will talk with you about the benefits.

  • Continual follow-up care. This helps to find out how well treatment is working. It also helps to see if the cancer has come back and to manage the effects of treatment.

  • Biological response modifiers and immunotherapy. These are the latest advances in the fight against cancer. They are colony-stimulating factors, interleukins, monoclonal antibodies, tumor necrosis factor, interferons, cytokines, and other biological response modifiers. Many of them are normally found in the body and help the immune system protect the body against invasion.

Healthcare providers are also using the body's own processes to fight disease. In the near future, there may be treatments 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 kill cancer cells. Chemotherapy has been used for many years. It 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.

Chemotherapy can work quite well in treating certain cancers. But 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 possibly prevent these symptoms from happening.

How does chemotherapy work?

In most cases, chemotherapy works by stopping the cancer cells from growing or reproducing. 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 given?

Chemotherapy can be given:

  • As a pill or liquid to swallow

  • As a shot into the muscle or fat tissue

  • As an IV directly to the bloodstream

  • As a medicine put on the skin (topical)

  • As a shot into the spinal fluid (Intrathecal)

What are the side effects of chemotherapy?

Chemotherapy interferes with fast-growing cancer cells. But it also affects some healthy cells. Before your child gets chemotherapy for treatment of cancer, many tests are done to check how well the heart, kidneys, lungs, eyes, ears, and reproductive organs are working (baseline). Some chemotherapy may affect how these organs work either during treatment or months to years afterward. Some treatment may affect fertility. Other potential side effects are:

  • Bone marrow suppression. Chemotherapy often lowers the number of red blood cells that carry oxygen, white blood cells that fight infection, and platelets that help the blood to clot. 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 digestive tract.

  • Hair loss (alopecia). Chemotherapy affects the cells of the hair and nails. After treatment is done, most children's hair will grow back. Texture of hair and fingernails may change.

What is radiation therapy?

Radiation therapy is also called radiotherapy, irradiation or X-ray therapy. It uses strong waves or particles such as X-rays to kill 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 ease its symptoms.

Each hospital may have specific ways of giving radiation therapy. But it often begins with these procedures:

Simulation process

After a physical exam and a review of your child's health history, the treatment team "maps" out the position your child will be in for each treatment. They figure out the exact area on your child's body (treatment field or port) where the radiation will be given. This is called the simulation process. Sometimes the area on your child's body that needs treatment will be marked to make sure radiation is given the right way. 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 done to help plan how to direct the radiation during treatments.

Treatment plan

Once the simulation process is done, the radiation oncologist will figure out 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. Which one depends on the type of cancer, where it is, and your child's health. Sometimes radiation therapy is used in combination with other treatments. These are two types of radiation therapy:

External radiation (external beam therapy)

With this type of treatment, radiation is given by a large machine that points the energy waves directly at the tumor. The radiation therapist controls the machine. Because radiation is used to kill cancer cells, special shields may be made to protect the tissue around the treatment area. Radiation treatments are painless and usually last a few minutes.

Internal radiation (brachytherapy, implant radiation)

With this type of treatment, your child gets a high dose of radiation inside the body as close to the cancer as possible. The radiation treatment is put through a thin tube (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 for a short time. 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 your child gets radiation therapy for treatment of cancer, many tests are done to check how well the heart, kidneys, lungs, eyes, ears, and reproductive organs are working (baseline). Some radiation may affect how these organs work either during treatment or months to years afterward. Some treatment may affect fertility. The side effects usually relate to the area of the body that is getting the radiation treatments. Potential side effects are:

  • Hair loss (alopecia). Hair loss may happen in the part of the body that gets radiation. After treatment is done, most children's hair will grow back.

  • Bone growth. Bone growth may also be affected, especially with young children who are still having major bone growth. Height and length of arms or legs 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 how to prevent and treat any skin problems related to radiation.

  • Diarrhea, nausea, and vomiting. If radiation therapy of the pelvis or stomach is given, a child may have diarrhea, nausea, vomiting, or a combination of these.

  • Tiredness (fatigue). Extreme tiredness called fatigue is common with radiation therapy. It may get worse as treatment goes on. It can last for months after treatment ends.