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 these providers, plus others:

• Primary healthcare provider. This is the main provider a person usually sees for their medical care.

• Pediatrician. This is a healthcare provider who specializes in the care of children.

• Pathologist. This is a healthcare provider who diagnoses and classifies disease using lab tests.

• Hematologist. This is a healthcare provider who specializes in blood disorders, including blood cancers.

• Pediatric oncologist. This is a healthcare provider who specializes in cancer in children.

• Medical oncologist. This is a healthcare provider who treats cancer using chemotherapy or other medicines.

• Radiation oncologist. This is a healthcare provider who treats cancer using radiation.

• Surgical oncologist. This is a healthcare provider who treats cancer using surgery.

• Surgeons, including surgical specialists such as urologists, gynecologists, and neurosurgeons. These are healthcare providers who use surgery to treat medical conditions, such as removing a tumor to treat cancer.

• Anesthesiologist. This is a healthcare provider who uses medicine (anesthesia) to help you sleep and not feel pain during surgery. A nurse anesthetist is a nurse with advanced training who can also provide anesthesia.

• Nurse. They take care of your child at the bedside. They teach and give support to your child and family.

• Oncology nurse specialist. This is a nurse with special training in caring for patients with cancer.

• Social worker. This is a professional trained to help with the complex social, emotional, and money challenges that occur when a family member is ill.

• Pharmacist. This is a specialist trained to prepare and give out medicine.

• Chaplain. This person provides spiritual or religious support to patients or families.

• Respiratory therapist. This professional works with people who have breathing problems.

• Physical therapist. This professional examines, tests, and treats the body’s strength, mobility, and function. They may use exercises to help a person maintain or build function.

• Occupational therapist. This person helps your child develop and improve the skills they need for daily living.

• Child life specialist. This person is trained in child development. They study how children react to illness and hospitalization. This team member helps you and your child cope while your child is in the hospital.

• Psychologist, psychiatrist, and other mental health specialists. This person assesses and treats emotional and mental health problems.

• Radiation technician. This person gives radiation treatment.

• Dietitian. This is an expert in nutrition. They can help assess your child's nutritional needs and help you know what to feed your child.

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 treatments

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

• The expected outcome

• Your opinion or preference

Treatment for certain cancers may include:

• Chemotherapy. This uses medicines to kill cancer cells.

• Radiation therapy. This uses radiation to kill cancer cells.

• Surgery. This treatment is used to remove a tumor.

• Targeted therapy. This uses medicines or other substances to identify and attack cancer cells.

• Immunotherapy. This treatment boosts your body’s own immune system to help it recognize and attack cancer cells. It uses substances that are either made in the body or in a lab. These substances either boost the immune system overall or help it better target cancer cells.

• Bone marrow transplant. This treatment replaces damaged or diseased bone marrow with new, healthy cells.

• 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.

• 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.

• Clinical trials. More than half of children being treated for cancer are enrolled in clinical trials. Clinical trials help healthcare providers learn while giving patients the most updated testing, treatment, and procedures. Your healthcare provider will discuss all the risks and benefits for any available clinical trials if a clinical trial is a good choice for your child.

The most common forms of treatment for cancer are chemotherapy, surgery, 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 the ability to have children (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.

Be sure you know what chemotherapy side effects to watch for and when to call your child's healthcare team. If fertility is a concern, talk with your child's healthcare team about your child's choices before starting treatment.

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. There are 2 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. But the radioactive substance loses its radiation within a short period of time. Your child's healthcare provider will explain any precautions your child needs to take. 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. Some radiation may affect how these organs work either during treatment or months to years afterward. Some treatment may affect fertility depending on where the radiation beam is directed. 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.

Be sure you know what radiation side effects to watch for and when to call your child's healthcare team. If fertility is a concern, talk with your child's healthcare team about your child's choices before starting treatment.