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«Usually, two or all three types of treatment are used in a combined way, which requires very careful overall plan. Using this method, even very ...»

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Types of Treatment

There are three main types of treatment used for cancer. These

are:

• Surgery

• Chemotherapy (drug treatment) and

• Radiotherapy (x-ray treatment)

Usually, two or all three types of treatment are used in a combined

way, which requires very careful overall plan. Using this method,

even very advanced tumours, which would have been quite

untreatable, can be controlled or cured.

Surgery

Most children with a cancer lump (tumour) will require surgery in order to make a diagnosis. This operation is called a biopsy, which may involve an open operation, or sometimes a core of tumour tissue is removed with a thick needle under a general anaesthetic.

The piece of tumour removed is then looked at in the laboratory to find out the exact tumour type. This is very important because different types of tumours require different forms of treatment.

Some tumours can be removed by surgery, but this treatment alone is rarely curative and usually needs to be combined with one or more forms of treatment. Sometimes an exploratory operation is undertaken with multiple samples taken from various sites to work out the extent of the tumour spread. A biopsy can be quite a small procedure, or it may be a big operation depending on the site. The time when the surgery is done will depend on the child’s treatment plan and on the tumour type and it is likely that your child will be nursed in the surgical area.

In some tumours, surgery is the first type of treatment used, but in others it may be delayed for weeks or months to allow drug therapy and/or radiation to shrink the tumour and allow for a curative operation. The timing and extent of the surgical procedure will depend on the site of the tumour in the body and the degree of spread.

Section 5 - Treatment -1- Chemotherapy What is chemotherapy?

Chemotherapy, or chemical therapy, is one form of cancer treatment that involves giving patients anti-cancer drugs. Most of these drugs are known as cytotoxic drugs, which literally means cell (cyto) killing (toxic). Most children who have chemotherapy will receive a number of different drugs that work together to fight the cancer.

Cancer treatment may include chemotherapy, radiotherapy or surgery, and in many cases a combination of these may be used.

When chemotherapy is used in conjunction with other types of treatment, it is called adjuvant therapy.

How do the drugs work?

The body is made up of cells and these cells go through cycles of resting, growing and dividing. Different types of cells spend different amounts of time doing these tasks. Cells that grow and divide quickly are more susceptible to chemotherapy. It is during the process of growing and dividing that cytotoxic drugs get into cells and change their make-up so they cannot multiply. As chemotherapy affects cells that divide quickly, it can effect healthy cells too.

Different drugs act at different times of the cycle – some in the growing phase and others in the dividing phase – so for this reason a combination of two or more drugs is usually given.

Does chemotherapy have side effects?

Chemotherapy cannot tell the difference between good cells and bad cells, it simply effects all cells that divide rapidly. Damage to normal cells may lead to side effects.

The normal cells most often affected by chemotherapy include those in the –

• bone marrow (where blood is produced) causing low blood counts

• digestive system (mouth, stomach, bowels or intestines, rectum) which may cause nausea, vomiting or mouth/gut ulcers Section 5 - Treatment -2 hair follicles (hair loss)

• reproductive system (impaired fertility- discuss this with your doctor) Normal cells repair themselves much more effectively than cancer cells; therefore the side effects caused by damaging healthy cells are almost always temporary.

Different chemotherapy drugs cause different side effects. Also, people respond to chemotherapy differently, some people will have few problems, others more. You will be given specific information pamphlets on all the chemotherapy drugs your child will receive.

This information includes how the drug is given, side effects and precautions.

Most of the side effects can be easily managed but it is important for you to let your doctor or nurse know if you notice any side effects.

It is not possible to resolve all side effects of chemotherapy;

however, we will do our best to make your child comfortable.

Who decides what type of chemotherapy and how it will be given?

Soon after your child has been diagnosed with cancer, your doctor will provide you with a detailed outline of the planned treatment and a general timeframe of what will happen and when. This is referred to as the treatment protocol.

–  –  –

When will my child have chemotherapy?

Chemotherapy is given according to the treatment protocol. Most chemotherapy is given in cycles where your child will have a course of treatment followed by a rest period.

The rest periods allow the body to recover from the side effects of the drugs.

Will chemotherapy hurt?

Oral chemotherapy is just like taking any other medication orally – it does not hurt but some children do not like medicines so the oncology team will give you some helpful hints for taking medicines.





Injections may be part of your child’s treatment plan and to help reduce the pain we use local anaesthetic cream prior to giving needles. Other measures like ice packs may be helpful for IM injections.

Most children diagnosed with cancer have some form of a central line inserted. (There is a chapter explaining these in detail included in the folder) These central venous access devices allow us to give chemotherapy and other medications directly into a vein.

If your child becomes very distressed a referral to the psychologist may be helpful. Some children have found hypnotherapy very helpful.

Section 5 - Treatment -4Will my child be admitted to hospital?

Some chemotherapy is given on an outpatient basis at the Ronald McDonald Children’s Clinic. This may be either a quick push of medication or it may be given over 1-6 hours.

When chemotherapy is given over a longer period of time or requires extra fluid to be given at the same time your child will be admitted to hospital. When this occurs on the treatment protocol your doctor will explain this to you.

When your child is receiving oral chemotherapy at home you will be given information on how and when to administer this.

How long will treatment last?

The length of treatment will depend on the protocol and how well your child’s disease responds to the drugs. The doctor will plan the treatment for a certain length of time known to be effective for children with similar types of cancer.

Bone Marrow Rescue Procedures Some protocols use such high doses of chemotherapy that the body’s own bone marrow would be permanently damaged or recover too slowly to allow the treatment to be undertaken safely.

For a bone marrow rescue procedure to occur your child will have previously had a bone marrow or blood stem cell harvest. This is a procedure in which cells from bone marrow or blood are collected from the patient or close relative. Once the chemotherapy is given, some of these cells are given back to the patient. These cells then grow and multiply in the patient’s bone marrow. More information regarding this procedure will be given to you if required.

–  –  –

Chemotherapy cannot tell the difference between good cells and bad cells, it simply effects all cells that rapidly divide. Damage to normal cells may lead to side effects.

1. Bone marrow suppression Bone marrow suppression is the most common side effect of most chemotherapy drugs. Bone marrow suppression can limit the dose of chemotherapy that can be given and the time between courses.

The bone marrow, which is found in the hollow centres of most bones, is the factory where blood is made.

Blood is made up of fluid and cells. There are three main types:

• Red cells contain the pigment haemoglobin, which carries oxygen around the body. Lack of red cells and haemoglobin is called anaemia and causes paleness and tiredness.

–  –  –

Contact the hospital if you notice any of the above symptoms.

Anaemia can occur at any time on treatment. The following could help you manage the symptoms until the anaemia resolves or you

have a blood transfusion:

• Arrange child’s activities to have time to rest

• Eat a well balanced diet and drink lots of fluids. (refer to the nutrition section for advice)

• Rise slowly after sitting or lying to prevent dizziness.

To correct anaemia a blood transfusion is given as a drip over a few hours and can usually be done on an outpatient basis. White blood cells are removed by filtering, and all blood products are now irradiated before use to help reduce the risk of reaction. Despite these precautions there is a very small risk of reactions or infections from blood.

Bleeding Platelet numbers may fall low enough to cause minor and major bleeding problems during treatment. This is called thrombocytopenia. If the platelet count falls to a very low level a platelet transfusion will be given to prevent possible bleeding. The ability of platelets to help blood clot is severely affected by even small doses of aspirin. This drug should not be given during chemotherapy. Paracetamoll is a safe and equally effective Section 5 - Treatment -8substitute. There is a list included in the home care section showing the medications that contain aspirin. The following steps

will help minimise the chance of bleeding:

• Use a soft toothbrush – unless bleeding or sore mouth (refer to the mouthcare section)

• Use a lip balm to keep lips moist and prevent cracking

• Blow nose gently

• Caution with physical activity when platelets are low.

If your child has bleeding from the nose, gums and /or mouth or unexplained bruising please contact the hospital. Bleeding can also occur in the bowel which, would show as red streaks in a bowel action or black bowel actions. If urine is pink or vomit is red or a coffee colour then this may be a sign of bleeding and you will need to contact the hospital.

Infections Fever Chemotherapy affects the numbers of white cells and this reduces the child’s resistance to infection. Any fever over 38.5°C or two fevers over 38°C that develops during treatment must be taken seriously and medical advice sought from the specialist or local doctor. (You will need to use a thermometer to take your child’s temperature, if you do not have a thermometer, parents have reported that digital thermometers are much more effective than the expensive tympanic thermometers.) Normal temperature is between 36 – 37.5 °C.

If your child has a temperature greater than 38.5 °C with a neutrophil count of less than 0.5 they will require admission to hospital for several days and be treated with intravenous antibiotics. While your child is in hospital your child will be isolated in a single room. If your child has a bacterial infection they may become very ill without prompt medical attention.

There may be times when you are admitted to another ward, if this were to happen then you will be seen by the oncology team when they do there rounds and they will assist the staff with any questions they may have regarding your child’s care.

Chicken pox and Measles Some of the common childhood diseases such as measles, chicken pox or shingles are dangerous to children receiving Section 5 - Treatment -9chemotherapy. These can result in a very serious infection, which can very rarely be fatal. It is very important for parents to contact their doctor as soon as the child comes into contact with somebody suffering from one of these diseases. Contact needs to be direct or close, that is person to person contact. It is important to have the diagnosis of the contact person (the person with the disease) confirmed by a doctor if possible.

Chicken pox and measles are both infectious before the rash appears. For this reason it is very important that parents establish a good communication network amongst their relatives, friends and schoolteachers so that they are notified immediately if someone with whom their child has been in contact, whether in play or at school, develops chicken pox or measles.

The infectious period for these two illnesses is shown below:

–  –  –

Shingles, which is a re-activation of the chicken pox virus in people who have already been infected with the virus in the past, is also potentially infectious and children have been known to catch chicken pox from grandparents with shingles. The infectious period for shingles is the same as for chicken pox and shingles may occur more than once.

Parents and siblings who have already had chicken pox and measles cannot pass the illnesses on from an infected contact to the child receiving treatment for cancer.

Section 5 - Treatment - 10 If your child has come into contact with someone with chicken pox preventative treatment of an antibody is given by injection. This must be given within three days (72 hours) of a contact if it is to be effective, and even then it will only give protection for about 2 to 3 months.

Some parents have found it helpful to send a letter to other parents at childcare or to have information circulated in the school newsletter.

Mumps and German Measles Mumps and German measles (Rubella) are not considered to be dangerous, and no special precautions are required.

Common Conditions Common conditions such as colds and tonsillitis do not usually present any real problems.

–  –  –

Vaccines containing live viruses, such as measles vaccine, are potentially dangerous, because of the risk of producing an overwhelming infection with the modified virus. Live virus vaccines must not be given to children receiving chemotherapy. It is safe to give live virus vaccines to siblings except in the case of oral polio vaccine. As this can be spread through faeces, you should request an inactivated polio vaccine for your other children.



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