Treatment

When a child is diagnosed with cancer, an individualised treatment program is designed to suit their situation. The aim of the treatment program is to provide the best possible chance of cure, whilst minimising any side effects of treatment.

Although specific anticancer treatments (such as chemotherapy) are central to curing cancer in children, supportive and psychosocial care of the child and family are also extremely important. Click here for information on coping.

The three main types of anticancer treatments used for childhood cancers are:

1. Chemotherapy
2. Radiotherapy
3. Surgery

Chemotherapy

• Chemotherapy refers to a group of drugs or medications that kill cancer cells.

• Chemotherapy can be given by mouth (tablets/syrup), intravenous injection (into a vein or via a Central Venous Access Device – CVAD, under the skin (subcutaneously), into the muscle (intramuscularly) or into the spinal fluid (intrathecally).

• Most treatment programs use combinations of different chemotherapy medications. This is done to improve effectiveness of the treatment, minimise the chance of the cancer becoming resistant to treatment and to reduce side effects that may result from high doses of any one single chemotherapy medication.

• Some chemotherapy medications work by affecting the growth of cancer cells, whilst others work by causing damage to the genetic material (DNA) inside the cells.

• Unfortunately, the medications currently available are not selective to cancer cells – that is, they not only damage cancer cells but also damage normal healthy cells. It is this damage to normal cells that causes the unwanted toxic side effects.

Radiotherapy

• Radiotherapy is the use of high-energy (ionising) radiation to treat cancer and it works by damaging the DNA of cancer cells which prevents them from reproducing and they gradually die.

• Normal cells repair and recover more efficiently than most cancer cells following each dose of radiation. This is why a typical course of radiation consists of multiple treatments given daily or twice daily over several days or weeks so that after each treatment, a greater proportion of cancer cells are inactivated while more of the normal cells are allowed to recover.

• With careful planning of radiotherapy treatments, most of the effects will be confined to the tumour and any damage to normal healthy cells will be minimised.

What happens during radiotherapy?

• Each course of radiotherapy is planned individually before the treatment can begin. To take accurate measurements of the part of the body that requires radiotherapy, a machine called a simulator is used. Temporary ink marks are placed on the skin to use as reference lines for each treatment to allow quick and accurate set-up each day.

• The linear accelerator is the machine that actually delivers each treatment. Each treatment session lasts around 3-5 minutes. During this time your child will not feel anything and will need to lie still. If lying still is not possible, your child may require sedation or anaesthetic.

• While the actual radiation beam is being delivered, your child is the only person allowed in the treatment room. Your child can be seen at all times on the television monitor by the radiotherapist and the two of them will be in constant voice contact throughout the treatment.

Surgery

Surgery was the original therapy for childhood cancers and remains one of the mainstays of treatment. The surgeon has a number of important roles to play within the multidisciplinary team:

• Diagnosis and staging of tumours – an operation may be necessary to do a biopsy and assess the size and degree of spread of the tumour. This allows for accurate diagnosis and management.

• Decision making on the timing and type of any operation required – Surgery may be done to remove all of the tumour or most of the tumour (debulking) to allow other treatments to be more successful. Sometimes chemotherapy may be given first to ‘shrink’ the tumour and make the operation less risky and potentially more successful. In some cases surgery may be the only treatment necessary.  Your oncologist and surgeon will discuss these options with you.

• Alleviating/relieving symptoms – Sometimes a surgical procedure may help to relieve distressing symptoms. The surgeon may be asked to assess your child if he/she develops worrying symptoms that may relate to a surgical problem.

• Providing intravenous access – it is common for the child being treated for cancer to require a Central Venous Access Device. This will allow direct access for administering chemotherapy and other medications and fluids, and requires an operation under general anaesthetic performed by a surgeon.