Childhood Cancer : What About Treatment?

by National Cancer Institute

(Page 5 of 14)

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.

What Are the Different Types of Cancer 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.

Surgery

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.

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