What About Treatment?
Surgery Chemotherapy Radiation Therapy Immunotherapy Bone Marrow and Peripheral Blood Stem Cell Transplants Complementary and Alternative Medicine Hospitalization
To plan the best treatment, the doctor and treatment team will look at your
child's general health, type of cancer, stage of the disease, age, and many
other factors. Based on this information, the doctor will prepare a treatment
plan that outlines the exact type of treatment, how often your child will
receive treatment, and how long it will last. Each child with cancer has a
treatment plan that is chosen just for that child; even children with the same
type of cancer may receive different treatments. Depending on how your child
responds to treatment, the doctor may decide to change the treatment plan or
choose another plan.
Before treatment begins, your child's doctor will discuss the treatment plan
with you, including the benefits, risks, and side effects. Then you and the
treatment team will need to talk with your child about the treatment. After the
doctor fully explains the treatment and answers your questions, you will be
asked to give your written consent to go ahead with treatment. Depending on
your child's age and hospital policy, your child may also be asked to give
consent before treatment.
The treatment plan may seem complicated at first. But the doctor and treatment
team will explain each step, and you and your child will soon become used to
the routine. Many parents find it helpful to get a copy of the treatment plan
to refer to as the treatment proceeds. It also helps them in arranging their
own schedules. Do not be afraid to ask questions or speak up if you feel
something is not going right. Your child's doctor is often the best person to
answer your questions, but other members of the treatment team can give you
information, too. If you feel as though you need extra time with the doctor,
schedule a meeting or phone call. Remember, you are part of the treatment team
and should be involved in your child's treatment.
The types of treatment used most often to treat cancer are
surgery,
chemotherapy,
radiation therapy,
immunotherapy, and
bone marrow or
peripheral blood stem cell transplantation . Doctors use these
treatments to destroy cancer cells. Depending on the type of cancer, children
may have one kind of treatment or a combination of treatments. Most children
receive a combination of treatments, called
combination therapy.
Treatments for cancer often cause unwanted or unpleasant side effects such as
nausea, hair loss, and diarrhea. Side effects occur because cancer treatment
that kills cancer cells can hurt some normal cells, too. As your child begins
treatment, you may want to keep the following in mind.
-
The kinds of side effects and how bad they will be depend on the kind of drug,
the dosage, and the way your child's body reacts.
-
The doctor plans treatment so that your child has as few side effects as
possible.
-
The doctor and treatment team have ways to lessen your child's side effects.
Talk with them about things that can be done before, during, and after
treatment to make your child comfortable.
-
Lowering the treatment dosage slightly to eliminate unpleasant side effects
usually will not make the treatment less able to destroy cancer cells or hurt
your child's chances of recovery.
-
Most side effects go away soon after treatment ends.
Remember that not every child gets every side effect, and some children get
few, if any. Also, how serious the side effects are varies from child to child,
even among children who are receiving the same treatment. The doctor or
treatment team can tell you which, if any, side effects your child is likely to
have and how to handle them. If you know what side effects can occur, you can
recognize them early.
For many solid tumors, surgery is an essential part of the treatment. Surgery
is a local therapy to remove the tumor. Tissue around the tumor and nearby
lymph nodes may also be removed during the operation. Sometimes radiation or
chemotherapy is used first to shrink the tumor before it is removed. Shrinking
the tumor makes the surgery easier.
|
Helping Your Child Face Fears About Surgery
Your child is likely to have many worries about surgery. Your child may ask:
-
What is it like to be put to sleep?
-
Will I feel a lot of pain?
-
Will my body be changed?
-
How will I feel about my body after the operation?
-
Will my parents be with me when I wake up?
Here are some suggestions that might help your child face surgery:
-
Give honest answers to your child's questions.
Your child may lose trust in you if what you say does not match what really
happens. Your child needs to trust you.
-
Learn as much as you can about your child's operation.
To give the correct answers to your child's questions, you will need to find
out as much as possible about what will happen. The doctors and other members
of the treatment team can give you the facts you need to prepare your child.
-
Visit the operating and recovery rooms before the surgery.
To help children get ready for surgery, many hospitals encourage them to visit
the rooms where they will be during surgery and recovery. They can meet and
talk with the people who will be there. For instance, young children may be
shown a surgical mask and given one to try on or to put on a toy or another
person.
-
Talk with your child about feelings and concerns.
Above all, try to get your child to talk about any feelings or concerns he or
she has about the surgery.
Possible Side Effects of Surgery
Side effects from surgery depend on the location of the tumor, the type of
operation, the child's general health, and other factors. Common side effects
include pain, headaches, nausea, and constipation. These effects may be from
the surgery, pain medicine, or lack of exercise. The doctor will give your
child medicine, as needed, to help ease these side effects and other symptoms.
Children and Amputations
In the past, amputations were often necessary to remove bone tumors in the arms
and legs. Depending on the type of tumor, however, doctors more and more can
use procedures that spare the limb and make amputation unnecessary. Fewer
children suffer the loss of a limb. Your child's treatment team will explain
the options available to you.
For some children, however, amputation remains the best choice. These children
have special concerns. They wonder what it will be like not to have an arm or
leg. Will they be able to do everyday things? How will they do them? How will
others act toward them? They may feel a lack of wholeness after surgery.
Sometimes it is more difficult for parents than for children to adjust to an
amputation. Generally, younger children adjust more quickly. Adolescents have
special concerns. They may be more sensitive about the way they look to others.
They also may worry about how the amputation will affect developing and keeping
relationships, participating in sports activities, getting married, and having
children.
It may be helpful for your child to see how others have adjusted to an
amputation. Meeting other children who have had amputations and who are doing
well can be very helpful. Your child will learn that he or she can have a full
and active life - most children can participate in the same activities they did
before having an amputation. They can still walk, run, ride a bicycle, ski,
swim, and even mountain-climb. It may also help for the treatment team to show
your child an artificial limb, or
prosthesis, and other devices or aids that will help with movement.
After surgery, your child will be aware of a bulky dressing or bandage at the
site of the surgery. Your child may feel "phantom pain," an eerie but common
feeling. Sensations such as cold, itching, and pain are felt in the limb as if
it were still part of the body. Doctors do not know what causes phantom pain.
The best explanation is that the brain has been accustomed to receiving
messages from the nerves in the limb that has been amputated. It takes time for
the brain to get used to the nerve fibers that remain and the new messages from
the stump. Sometimes a light massage and changing the position of the stump
will offer some relief. The doctor will usually start medication ahead of time
to ease your child's pain and can also order some medicine to treat the phantom
pain when it happens.
As part of the rehabilitation, a physical therapist will help your child with
exercises to strengthen the muscles needed to support a temporary prosthesis.
These exercises are often hard and can be painful, so your child needs to be
encouraged and supported during this time. Once the muscles become stronger,
the doctor may order a temporary prosthesis for your child. The prosthesis is
made by a prosthetist, a person skilled in making artificial limbs. The
temporary prosthesis will be bulkier and heavier than the permanent one. The
way it looks may be disappointing, but the added heaviness will further
strengthen the stump and the bulkiness will protect it. Once the stump is fully
healed, and your child is able to move the limb well with the temporary
prosthesis, fitting for the permanent prosthesis will begin.
Health professionals will be available to help your child and family throughout
the entire process - from making treatment choices to adjusting to the
permanent prosthesis. Drawing upon the strength and comfort of family members
and joining a support group may also help you cope.
Chemotherapy is the use of "anticancer drugs" to treat cancer. Chemotherapy is
systemic therapy, which means that the drugs flow through the
bloodstream to nearly every part of the body to kill cancer cells wherever they
may be. Because some anticancer drugs work better together than alone,
chemotherapy may consist of more than one drug. This approach is called
combination chemotherapy.
|
Depending on the type of cancer your child has and which drugs are used,
chemotherapy may be given in one or more of these ways:
-
By mouth (oral medication) - The drugs are swallowed in liquid or pill
form. If your child has trouble swallowing pills, you can break the pills into
smaller pieces, or you may crush and mix them with applesauce, jam, pudding, or
other food that your child likes.
-
Intravenously (IV) - The drugs are injected by needle into a vein or
into an IV line.
-
Intramuscular injection (IM) - The drugs are injected by needle into the
muscle. Your child will know it as a "shot."
-
Subcutaneous injection (SC) - The drugs are injected by needle just
below the skin. Your child will also know this as a "shot."
-
Intrathecal injection (IT) - The drugs are injected by needle into the
spinal fluid
Although your child may be able to receive chemotherapy treatments at home, he
or she will probably need to go to the hospital or doctor's office to receive
IV drugs or injections. Depending on the medicine, your child may need to stay
in the hospital, perhaps overnight or longer.
Oral Chemotherapy
When possible, involve your child in this treatment. For example, you may want
to keep a special calendar to help your child track when medicine should be
taken. Older children, particularly adolescents, may want to be responsible for
taking and keeping track of their medication. Even so, you still need to make
sure that the medicine is being taken as ordered. Be sure to notify the doctor
if your child misses any doses of medication or if he or she vomits them up.
Intravenous Chemotherapy
Your child will get the drug through a thin needle put into a vein, usually on
the hand or in the arm. In babies and very small children, the needle may be
placed in a vein in the scalp. Although getting chemotherapy usually does not
hurt, it may be painful when the IV needle is put in, and the drugs may cause a
burning feeling. If the drug leaks from the vein, it may burn the skin, so care
must be taken to make sure the IV line is firmly in place. The nurse or doctor
must act right away if the needle comes out of the vein.
Another way to give IV chemotherapy is through a
catheter. The catheter remains in place during the course of treatment so that drugs
can be given without having to place a needle into the vein over and over
again. The most commonly used are central venous catheters. While the child is
under general or local anesthesia, the catheter is usually put into a large
vein in the chest by making a small incision (cut) near the collarbone. Two
types of central venous catheters are commonly used.
-
One type of catheter is an external venous catheter (for example, a Broviac or
Hickman catheter). In this type of catheter, the plastic tube extends outside
the body.
-
The second type (for example, a Port-a-Cath catheter) is placed under the skin
and needs to have a needle placed into it each time it is used. This type of
catheter may be more appealing to adolescents or for families who cannot take
care of a catheter that needs special daily care.
In addition to chemotherapy, pain medicine and blood transfusions can be given
through the catheter, and blood can be drawn from the body through the
catheter.
Side Effects of Chemotherapy
Side effects can occur when the anticancer drugs affect not only the cancer
cells but healthy cells as well. Different drugs produce different side
effects. Ask your doctor or nurse what side effects your child is most likely
to have and when they are likely to occur. Side effects are either acute (they
happen right away) or delayed (they happen days, weeks, or years after
chemotherapy). The most common side effects of chemotherapy are listed in the
following chart.
You may also find these NCI materials useful:
You can receive copies from the NCI-supported Cancer Information Service (CIS)
by calling 1-800-4-CANCER (1-800-422-6237) or TTY at 1-800-332-8615. Also, many
NCI publications may be viewed or ordered
online.
Side Effects of Chemotherapy:
DIGESTIVE TRACT PROBLEMS
Side Effect |
What You Can Do |
|
Nausea and Vomiting |
-
Ask your child's doctor about medicines to control nausea and vomiting and/or
sedatives to help your child sleep through nausea.
-
Ask your doctor if it is alright to give your child milk or antacids before
taking oral anticancer drugs. Certain oral anticancer drugs should not be taken
with milk.
-
Feed your child light foods 3-4 hours before treatment.
-
Encourage your child to eat small amounts of food often and slowly.
-
Avoid serving sweet, greasy, and spicy foods or foods that have strong odors.
-
Serve your child cold meals, such as sandwiches, instead of hot foods.
-
Encourage your child to take liquids first, and then wait 30-60 minutes before
eating solids. Most children tolerate liquids better than solids.
-
Have your child rest after meals.
-
If your child is vomiting, do not give anything to eat or drink until it is
under control. Once the vomiting is under control, give small amounts of clear
liquids (for example, water, broth, milk-free ices, and gelatin desserts).
Begin with 1 teaspoon every 10 minutes; gradually increase the amount to 1
tablespoon every 20 minutes; and, finally, try 2 tablespoonfuls every 30
minutes. When your child can keep down clear liquids, try denser liquids (for
example, strained cereal, pudding, yogurt, milkshakes, cream soups). Give small
amounts as often as your child can keep them down. Gradually work up to solid
foods.
|
Diarrhea |
-
Contact your doctor if your child's diarrhea is severe; that is, more than
three loose stools per day.
-
Avoid giving your child fatty foods.
-
Try serving foods that are high in proteins and calories but low in fiber, such
as plain or vanilla yogurt, rice with broth, or noodles.
-
Serve your child foods and liquids that are high in sodium and potassium. Foods
high in potassium that do not cause diarrhea are bananas, peach and apricot
juices, and boiled or mashed potatoes.
|
Constipation |
-
Call your doctor if your child goes more than 2 days without having a bowel
movement.
-
Encourage your child to drink more fluids, such as apple juice.
-
Make sure your child gets some exercise.
-
Serve your child high-fiber foods, such as wholegrain breads and cereals; brown
rice; dried fruits, such as raisins and prunes; and raw fresh vegetables.
|
Heartburn or stomach ache |
-
Ask your child's doctor about giving your child an antacid.
-
Avoid serving your child
foods that are
fried, greasy or very spicy.
|
|
MOUTH PROBLEMS
Side Effect |
What You Can Do |
|
Sore mouth or throat, mouth sores |
-
Ask your child's doctor for medicine (sprays, special mouthwashes, and
lozenges) for your child's mouth.
-
Give your child a sponge toothbrush or cotton swab to brush his or her teeth.
-
Have your child rinse his or her mouth every 2-3 hours and after meals, using
baking soda solution or water.
-
Avoid serving very cold, hot, spicy, or acidic foods.
-
Try serving soft foods.
-
Contact your child's doctor if your child has mouth sores, painful areas, or
patches of red or white in the mouth.
|
Change in taste - foods have less
taste or a bitter metallic taste |
Try well-seasoned foods or tart foods such as oranges,
lemonade, or lemon tart. (Do not try these foods if your child has a sore
mouth, throat, or gums.) Pizza and taco chips frequently become children's
favorite foods.
|
|
SKIN AND HAIR PROBLEMS
Side Effect |
What You Can Do |
|
Hair loss |
-
Use a mild shampoo.
-
Cut your child's hair short.
-
Avoid using hair dryers and electric curlers.
-
Use a wide-tooth comb.
-
If you are planning to have your child wear a wig, select it before all your
child's hair comes out.
-
If you want to cover your child's head, try a variety of hats and scarves.
-
Protect your child's scalp from sun and cold.
|
Redness of skin |
Call your doctor if redness, pain, or swelling occurs.
|
Dry, itching skin |
Use mild soap and moisturizers. (If the child is receiving
radiation therapy, check with your child's doctor before using moisturizer.)
|
Moist skin |
Wash your child's skin 2-3 times each day. Pat dry with a
clean towel and lightly powder with cornstarch. |
Rashes |
Call your child's doctor, who may order medication.
|
Sun sensitivity |
-
Avoid sun exposure.
-
Use an SPF 30 or higher sun-blocking lotion.
|
Swelling, redness, or pain at the
needle site where chemotherapy drugs are given |
Certain drugs given intravenously can cause burns and sores
on your child's skin if they leak out of the vein. Tell your doctor or nurse
right away if leaking occurs.
|
|
KIDNEY AND BLADDER PROBLEMS
Side Effect |
What You Can Do |
|
Bladder irritation and infection |
-
Give your child plenty of fluids, especially on the day of treatment and on
days before and after treatment. The amount of fluids depends on your child's
size, so discuss this with your child's doctor.
-
Avoid giving drinks with caffeine.
-
Report to the doctor if your child has pain or burning when urinating, frequent
urination, a feeling of having to urinate right away, reddish or bloody urine,
or if he or she is not able to urinate.
|
Change in urine color and strong
urine odor |
Some drugs cause the urine to turn orange, red, or bright
yellow and to have a strong odor. Ask the doctor if a change in urine color is
likely.
|
|
NERVE PROBLEMS
Side Effect |
What You Can Do |
|
Damage to nerves |
Certain chemotherapy can damage nerves, causing difficulties
with walking and talking or jaw pain. Call the doctor if any of these problems
occurs.
|
|
BONE PROBLEMS
Side Effect |
What You Can Do |
|
Stress fractures |
Some chemotherapy can weaken bones and cause stress
fractures. Notify the doctor if your child develops pain in the arms or legs or
if your child develops a limp.
|
|
SYSTEMIC PROBLEMS (involving the entire body)
Side Effect |
What You Can Do |
|
Fever |
Call the doctor if your child's temperature goes over
100.4°F or 38°C. Do not give your child any over-the-counter
medications to reduce the fever unless told to do so by the doctor.
|
Flu-like symptoms |
Call the doctor. Symptoms may occur a few hours to a few days
after chemotherapy. They include muscle aches, headache, tiredness, slight
fever, chills, and poor appetite. These symptoms also may be from either an
infection or the cancer.
|
Infection |
Many anticancer drugs lower the number of white blood cells,
making it harder for the body to fight infection. Here is what you can do:
-
When possible, avoid taking your child into crowds. Also, avoid being around
people with colds, flu, or any other contagious diseases, or anyone who has had
a recent immunization with a vaccine containing live viruses (regular measles;
German measles, or rubella; mumps; polio; and chickenpox).
-
Call the doctor if your child is exposed to known infectious illnesses (for
example, measles or chickenpox).
-
If the white blood count falls too low, the doctor may postpone the next
treatment or give a lower dose of drugs for a while.
|
Anemia/fatigue |
Chemotherapy can lower the bone marrow's ability to make
red blood cells, causing anemia. Here is what you can do:
-
Look for weakness, tiredness, dizziness, chills, or shortness of breath.
-
Call the doctor if your child develops any of these symptoms.
|
Blood clotting problems (bleeding) |
Chemotherapy can affect the body's ability to make
platelets, the blood cells that help the blood to clot. Without enough
platelets, your child may bleed or bruise more easily than usual; a blood
transfusion may be needed. Here is what you can do:
-
Look for bruises, small red or purple spots under the skin, bleeding from the
gums or nose, reddish or pinkish urine, or black or bloody bowel movements.
-
Call the doctor if your child develops any of these symptoms.
|
Swelling/fluid retention |
-
Call the doctor if you notice swelling or puffiness in your child's face,
hands, feet, or abdomen.
-
Your child's doctor may recommend limiting table salt and salty foods and/or
order medicine to get rid of the extra fluid.
|
Allergic reaction |
-
Look for fever, fainting, rash, difficulty breathing.
-
Call the doctor immediately. This side effect can be serious, but it is not
common.
|
|
Long-term Side Effects of Chemotherapy
Ask your child's doctor and treatment team about health problems that may occur
later as a result of the chemotherapy. A few chemotherapy drugs can cause
lasting damage to the body's organs. For example, heart problems sometimes show
up years after treatment, and children who have been treated with these drugs
may need regular checkups by a cardiologist. Your child's later ability to have
children may also be affected by chemotherapy. Finally, depending on the
specific chemotherapy your child received, your child may be at risk of
developing a second cancer.
Radiation therapy is treatment with high-energy rays to damage or
destroy cancer cells. Like surgery, radiation therapy is a local therapy. The
rays are aimed at the part of the body that has cancer, and the treatment
destroys cancer cells in the treated area. Doctors may use radiation therapy
before surgery to shrink a tumor. After surgery, radiation therapy may be used
to stop the growth of cancer cells that remain.
|
How Does Radiation Therapy Work?
All human body cells, including cancer cells, contain a substance called DNA.
DNA tells the cells how to form and grow. In radiation therapy, the radiation
harms the DNA inside the cancer cells, causing them to die before more cells
are made. Tumors will shrink as the cancer cells die.
Getting Ready for Radiation Therapy
Before treatment begins, a doctor who specializes in radiation therapy will
talk with you and your child about treatment. The doctor also will mark the
exact area on your child where the radiation will be given. Marking ensures
that the treatment is given in the same place each time. These marks, or small
tattoos, are not painful to receive - the skin is only pricked - and they need
to stay in place all during treatment. Although the skin may become tender
during radiation, it is important to avoid using any soaps or lotions near the
markings or the part of the body receiving the radiation without the approval
of the radiation team. Lotions are often okay if removed hours before
treatment.
Because you would be exposed to radiation, you will not be allowed to stay in
the room with your child during the treatment. Your child will not be
radioactive during or after radiation therapy, so no one need fear being close
to your child.
What Will Happen During Radiation Therapy?
Radiation therapy does not cause pain. It is much like having a regular x-ray
taken, except that your child needs to hold still longer. Because some young
children are often unable to be still, the doctor may give a young child
medicine to help him or her relax or to put him or her to sleep. The parts of
your child's body that are not being treated will be covered by special shields
made of lead to protect those body parts from the radiation.
Lessening Your Child's Fears
Some children may find the machines scary. Most radiation departments will give
you and your child a tour of the area before the first treatment, so both of
you can see what the machines look like. Younger children may be afraid of
being left alone in the room. You can tell your child that you will be right
outside. In some hospitals, you may be able to see your child receive treatment
through closed-circuit television or viewing windows; your child may feel
better just knowing that you are watching.
Side Effects of Radiation Therapy
The high doses of radiation that kill cancer cells can also hurt normal cells.
When this happens, side effects occur. With radiation therapy, the side effects
depend on the treatment dose and the part of the body being treated.
The following chart gives information on the most common side effects of
radiation therapy.
Side Effects of Radiation Therapy:
ALL RADIATION SITES
Side Effect |
What May Help |
|
Tiredness/fatigue |
Make sure your child gets extra sleep and rest. |
Redness. blistering of skin |
-
Leave the irritated skin open to the air.
-
Clean your child's skin as directed.
-
Use ointments only if the doctors approve.
-
Keep your child out of the sun as much as possible.
-
Use at least an SPF 30 sun-blocking lotion.
|
Hair loss (occurs only in the area
being treated) |
-
Your child's hair should grow back within weeks to 3 months after treatment
ends, but some areas receiving higher doses may not grow back.
-
Use a mild shampoo.
-
Cut your child's hair short.
-
Avoid hair dryers and electric curlers.
-
Protect your child's scalp from cold and sun.
-
Use a wide-tooth comb.
-
If you plan to have your child wear a wig, select it before all your child's
hair comes out.
-
If you want to cover your child's head, try different hats and scarves.
-
Ask your child's doctor for medicine
|
|
HEAD AND NECK RADIATION SITES
Side Effect |
What You Can Do |
|
Sore mouth |
(sprays, mouthwashes, and lozenges) for your child's mouth.
-
Give your child a sponge toothbrush or cotton swab to brush his or her teeth.
-
Have your child rinse his or her mouth every 2-3 hours and after meals using
baking soda solution or water.
-
Avoid mouthwashes that have a high alcohol content, which may irritate mouth
sores.
-
Avoid serving very cold, hot, spicy, or acidic foods.
-
Try serving soft foods.
-
Contact the doctor if your child has mouth sores, painful areas, or patches of
red or white in the mouth.
|
Dry mouth |
-
Drink plenty of water.
-
Suck on sugar-free hard candy or ice pops, or chew sugar-free gum.
-
Rinse with a mouthwash recommended by the doctor.
-
Serve foods with sauces, gravies, and salad dressings to make them moist and
easier to swallow.
-
Drink liquids with meals.
|
|
STOMACH AND ABDOMEN RADIATION SITES
Side Effect |
What You Can Do |
|
Nausea and vomiting |
-
Ask your child's doctor about medicines to control nausea and vomiting and/or
sedatives to help your child sleep through the nausea.
-
Feed your child light foods 3-4 hours before treatment.
-
Encourage your child to eat small amounts of food often and slowly.
-
Avoid serving sweet, greasy, and spicy foods and foods with strong odors.
-
Serve your child cold meals, such as sandwiches, instead of hot foods.
-
Encourage your child to take liquids first, and then wait 30-60 minutes before
eating solids. Most children tolerate liquids better than solids.
-
Have your child rest after meals.
-
If your child is vomiting, do not give anything to eat or drink until it is
under control. Once the vomiting is under control, give small amounts of clear
liquids (for example, water, broth, milk-free ices, and gelatin desserts).
Begin with 1 teaspoon every 10 minutes; gradually increase the amount to 1
tablespoon every 20 minutes; and finally, try 2 tablespoonfuls every 30
minutes. When your child can keep down clear liquids, try denser liquids (for
example, strained cereal, pudding, yogurt, milkshakes, cream soups). Give small
amounts as often as your child can keep them down. Gradually work up to solid
foods.
|
Diarrhea |
-
Contact your doctor if your child's diarrhea is severe, that is, more than
three loose stools per day.
-
Avoid giving your child apple juice.
-
Avoid giving your child fatty foods.
-
Try foods high in proteins and calories but low in fiber, such as plain or
vanilla yogurt, rice with broth, or noodles.
-
Serve your child foods and liquids high in sodium and potassium. Foods high in
potassium that do not cause diarrhea are bananas, peach and apricot juices, and
boiled or mashed potatoes.
-
Make sure your child drinks plenty of liquids.
|
|
Long-Term Side Effects of Radiation Therapy
Radiation therapy also may affect your child in the future. For example,
radiation to the brain may cause learning and coordination problems, especially
in very young children. Thus, it may be helpful to consider neuropsychological
testing following treatment. Radiation therapy may also affect your child's
growth or may cause a second cancer to form in the treated area years after
treatment. Therefore, the doctor may delay radiation therapy or, if possible,
choose another treatment, such as chemotherapy. Your child's treatment team has
no way to know exactly what, if any, long-term effects your child may have, but
they can help you know what the possible effects might be.
The immune system - the body's system for defending itself - knows when
substances that should not be there, such as bacteria and viruses, are in the
body and then attacks them. The system also knows when cells have changed, such
as when cells become cancerous, and then attacks them.
Immunotherapy, also known as
biological therapy, was developed to take advantage of the body's own ability to fight disease.
In immunotherapy, substances called
biological response modifiers (BRMs)
are given to cancer patients. BRMs are substances that are normally made by the
body to fight cancer and other diseases. Scientists can make large amounts of
BRMs to use in cancer treatment. These BRMs destroy cancer cells and change the
way the body reacts to a tumor. They may also help the body replace
noncancerous cells destroyed by chemotherapy.
Several types of BRMs are used to treat cancer. Four are discussed here:
cytokines,
interleukins,
colony-stimulating factors, and
monoclonal antibodies.
-
Cytokines are proteins formed in small amounts by all human cells to help
control the working of cells.
Interferon, one type of cytokine, helps the immune system slow the
rate of growth and division of cancer cells, causing them to become sluggish
and die. In children who have cancer, these agents have been tested against
leukemia, osteosarcoma, brain tumors, and neuroblastoma.
-
Interleukins, another type of cytokine, are made by lymphocytes. Interleukin-2,
one of the most studied interleukins, causes certain kinds of white blood cells
to grow and destroy tumors.
-
Colony-stimulating factors are proteins that cause bone marrow cells to develop
platelets, red blood cells, and white blood cells.
-
Monoclonal antibodies recognize specific
antigens, substances that the body senses do not belong or regards
as "outsiders," on the surface of cancer cells. These antibodies can be
directed against a certain cell type. They can be used to attack and damage or
destroy cancer cells. They may also be used to deliver anticancer drugs or
radiation directly to specific cancer cells. This technique is still being
developed and is used only in clinical trials.
Side Effects of Immunotherapy
Depending on the exact type of treatment, immunotherapy often causes flu-like
symptoms such as chills, fever, muscle aches, weakness, loss of appetite,
nausea, vomiting, diarrhea, and, at times, a rash. Sometimes the patient will
bleed or bruise easily. Depending on how serious these problems are,
hospitalization may be needed during treatment. These side effects usually go
away after treatment ends. Ask your child's doctor about coping with the side
effects.
Some children who have leukemia or other types of cancer may need a bone marrow
transplant (BMT) or a peripheral blood stem cell transplant (PBSCT). In these
treatments, the blood cells in the diseased or damaged bone marrow - the spongy
material that fills the inside of bones and makes blood cells - are replaced
with healthy cells (stem cells), which will grow new healthy cells.
Stem cells are immature cells that produce the three types of blood cells:
-
white blood cells, which fight infection
-
red blood cells, which carry oxygen to and remove waste products from organs
and tissues
-
platelets, which enable the blood to clot.
Most stem cells are found in the bone marrow, but some - called peripheral
blood stem cells (PBSCs) - are collected from the bloodstream. Umbilical cord
blood also contains stem cells. If your doctor proposes a stem cell transplant
for your child, the stem cells may come from a donor's bone marrow,
bloodstream, or umbilical cord blood or from your child's own bone marrow or
bloodstream.
Healthy stem cells grow in two ways:
-
They divide to form more stem cells.
-
They mature into white cells, red cells, and platelets.
When transplanted into a cancer patient, stem cells can rescue the damaged
blood-forming system.
Two circumstances create the need for a transplant. The first is when the
cancer itself has injured the bone marrow. BMT and PBSCT are commonly used in
the treatment of leukemia and lymphoma. The second circumstance is when a
treatment requires such large doses of chemotherapy or radiation therapy that
the child's bone marrow is damaged during treatment. Chemotherapy and radiation
therapy target all cells that divide rapidly. Cancer cells divide more rapidly
than most healthy cells and so are destroyed by the therapies. Bone marrow
cells, however, also divide more rapidly than other healthy cells, so
high-dosage treatment can have a damaging effect on them as well.
A BMT or PBSCT can be done in three ways: as an autologous transplant, an
allogeneic transplant, or a syngeneic transplant.
-
Autologous transplant - The child's own stem cells or PBSCs cells are
used. They can be obtained from the bone marrow or from blood, using the
apheresis procedure. Stem cells are collected while the child is in
remission. To make sure that any cancer cells that remain are
destroyed, the marrow may be treated with anticancer drugs. After the marrow or
PBSCs are collected, the child receives high-dose chemotherapy, usually over 2
to 6 days, and, frequently, total body irradiation, during which the whole body
is radiated, in one dose or in many doses over several days, to get rid of the
cancer. The collected marrow or PBSCs are then returned to the child through a
vein, as in a blood transfusion.
-
Allogeneic transplant
- The marrow or PBSCs from a sibling, parent, or someone not related to the
child are used for the transplant. The transplant material must be as closely
matched to the patient's blood cells as possible. Cord blood transplant is
allogeneic.
-
Syngeneic transplant
- The perfectly matched marrow or PBSCs from an identical twin are used for the
transplant.
Before the transplant, a catheter is usually inserted into a large vein in the
chest for transplanting the marrow or PBSCs, as well as for giving blood,
antibiotics, and other drugs and for drawing blood. The child is given high
doses of anticancer drugs and/or radiation. When the cancer cells - along with
some healthy bone marrow cells - are destroyed, the new, healthy marrow or
PBSCs can be given. The healthy marrow or PBSCs are given through the catheter
and travel through the bloodstream to the bone marrow where they start to make
red and white blood cells and platelets.
It usually takes 14 to 30 days after the transplant for the transplanted stem
cells to make enough white blood cells to fight infection and to make other
blood cells. During this time, your child will be at higher risk for
infections, anemia, and bleeding. Complete recovery of your child's immune
system can take 1 to 2 years after an autologous, allogeneic, or syngeneic
transplant. Your child may need to remain in a hospital room that is kept as
free as possible from anything that may cause an infection. Supportive care,
which includes receiving blood transfusions and antibiotics, will be given.
Supportive Care
Children having a BMT or PBSCT usually stay in the hospital for 1 to 2 months
(sometimes longer), although outpatient BMT can be done for children who have
brain tumors. Children receiving BMT or PBSCT may need
supportive care.
For more information on side effects from chemotherapy and radiation therapy,
see the charts in those sections.
Graft-Versus-Host Disease
Graft-versus-host disease (GVHD) may occur in patients who receive bone marrow
or peripheral stem cells from a donor. In GVHD, donated stem cells realize they
are in a different body, so they may attack the patient's tissues, such as the
liver, skin, or digestive tract. GVHD can be mild or very severe and can occur
any time after the transplant - even years later. The doctor may give drugs to
reduce the risk of GVHD and to treat the problem if it occurs.
Supportive Care for BMT and PBSCT
Problem |
Supportive Care Provided |
|
Low counts of all types of blood cells |
-
Isolation from people with infectious diseases
-
Transfusion with blood products, including platelets and red blood cells
-
Treatment with proteins that increase the number of white blood cells
|
Infections |
-
Intravenous antibiotics
-
Isolation from other people
|
Gastrointestinal Infections |
-
Low-bacteria diet
-
Mouth care
-
Liquid antibiotics
|
Difficulty eating enough food |
Intravenous nutrition-giving nutrients through a vein |
|
Complementary and alternative medicine (CAM) includes a broad range of healing
philosophies, approaches, and therapies. A therapy is generally called
complementary when it is used in addition to conventional treatments; it is
often called alternative when it is used instead of conventional treatment.
(Conventional treatments are those that are widely accepted and practiced by
the mainstream medical community.)
It is important that the same scientific evaluation used to assess conventional
treatments be used to evaluate complementary and alternative therapies.
Conventional cancer treatments have generally been studied for safety and
effectiveness through clinical trials, which are research studies with people.
Some complementary and alternative therapies have not been studied in clinical
trials.
Questions to Ask Your Child's Health Care Provider About Complementary and
Alternative Therapies
-
What benefits can be expected from this therapy?
-
What are the risks associated with this therapy?
-
Do the known benefits outweigh the risks?
-
What side effects can be expected?
-
Will the therapy interfere with conventional treatment?
-
Is this therapy part of a clinical trial? If so, who is sponsoring the trial?
-
Will the therapy be covered by health insurance?
|
Others, which once were not accepted by the mainstream medical community, are
gaining acceptance in cancer therapy - not as cures, but as complementary
therapies that may help patients feel better and recover faster. One example is
acupuncture. Other therapies, such as laetrile, have been studied and found to
be ineffective and potentially harmful.
If you have questions about complementary or alternative therapies, discuss
them with your child's doctor or treatment team.
Being in the hospital is often scary for any child, especially at first. It is
a whole new world to learn about - new people and strange machines, procedures,
and routines. Adding a touch of home by having pictures of family members and
friends, drawings, and other personal things in your child's room can help make
the hospital a less scary place. These homey touches can help start a
conversation between the hospital staff and your child.
One of the scariest things for many children is being separated from their
parents and siblings. Many hospitals and treatment centers help your family and
your child spend as much time together as possible by allowing you to visit
anytime and having beds for parents in the child's room or bedrooms nearby. If
the hospital does not have beds for you, you might ask to sleep in a chair near
your child's bed.
Most hospitals have playrooms for children who are patients. Playrooms often
have toys, games, arts and crafts supplies, and tape players, giving children a
chance to play and talk with each other in much the same way that they do with
their friends at home or in school. The playroom setting allows children to
relax and become more comfortable in the hospital. Playroom staff, trained in
working with children who have serious illnesses, can talk to parents and other
members of the treatment team about the fears or concerns a child may share
through play.
If your child cannot get out of bed to go to the playroom, child-life workers -
trained staff who help coordinate play, schoolwork, and other activities for
the child - may make bedside visits.
For older children who are trying to separate themselves from you and be more
on their own, being in the hospital may thwart their drive for independence. At
a time when young people are normally doing more on their own, cancer makes
them rely on you more. As a result, adolescents may make it known, loudly and
often, that they are unhappy. They may refuse treatment, break hospital rules,
miss outpatient appointments, and rebel in other ways.
Children of any age will often cooperate more if given treatment choices that
do not cause problems with their care. Parents can help children become more
independent by allowing them to share the responsibility for their care. Some
hospitals also make a special effort to help children cope with illness and
being in the hospital, such as allowing teenagers to dress in street clothes
whenever possible and to have friends visit. Some hospitals have equipment that
allows the child to interact with his or her classmates in their classroom.
Back to Top
< Previous Section | Next Section > |