Childhood Cancer : Chemotherapy, Radiation Therapy

by National Cancer Institute

(Page 6 of 14)

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:

• Chemotherapy and You: A Guide to Self-Help During Treatment 6 discusses side effects from chemotherapy and ways to cope with them

• Eating Hints for Cancer Patients 7 provides suggestions for how to eat well during cancer treatment.

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

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.

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.

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