Families & Kids

Types of Treatment

Your child's doctor will suggest a course of treatment depending on what type of cancer your child has. Sometimes, a combination of treatments are needed to kill the cancer. Some common treatments for childhood cancer are:

Surgery

Often, the best course of treatment is to have the tumor surgically removed. If so, this will be done by a pediatric surgeon in the operating room. Your child will be given anesthesia so that he/she sleeps through the procedure. Because surgery may not remove all of the cancer cells, chemotherapy or radiation may also be used to destroy any cancer cells left behind.

Primary surgery is done shortly after the cancer is diagnosed and most, if not all of the tumor is removed. However, depending on the size of the tumor and where it is, it may not be safe to remove the tumor immediately. If this is the case, chemotherapy or radiation may be used first to shrink the tumor prior to surgery.

Supportive care surgery is commonly done to give the child a central venous line that will be used to give the chemotherapy and to draw blood work from. This will cut down the number of "needlesticks" your child must endure. Another example of a supportive surgery would be the placement of a shunt in the head when there is a brain tumor. This will decrease pressure that causes symptoms such as headache and nausea.

Second look surgery is done after treatment to see how well the chemotherapy or radiation has killed the cancer.

Chemotherapy

Chemotherapy is a medicine or combination of medicines given by mouth, into a vein, by injection into a muscle or into the spine to kill the cancer cell or stop it from growing. You will be given specific, written information on the medicine chosen for your child and how often you will need to come to the clinic for treatment. You will also be given information on the possible side effects of taking the chemotherapy and ways you and your health care team can help prevent or treat these symptoms. Some common side effects of chemotherapy are nausea, vomiting, hair loss, lowered blood counts and sores in the mouth.

Biological Therapy

Biological therapy helps your child's immune system fight the cancer. Though it is not certain exactly how biological therapy works, it is thought to stop or slow the growth of cancer cells, makes it easier for your immune system to destroy cancer cells and keep cancer from spreading to other parts of your body.

In most cases, the term "biologics" is used for a class of medications that are produced by means of biological processes involving DNA technology. Two examples of this type of medication would be a monoclonal antibody and erythropoietin, a growth stimulating hormone.

Radiation Therapy

Radiation is the use of high energy x-rays to rapidly kill cancer cells. Different than chemotherapy, radiation does not cause cell damage throughout the body, but damages cells only in the area (field) where the radiation is given. Your child's field of radiation will be carefully measured and marked on your child's body during a 'simulation' appointment prior to beginning the treatment. These markings will remain in place until the treatment is completed.

Radiation can make the skin very sensitive and you will be asked not to use lotions or powders on your child's skin.

Side effects your child may experience depend on the area of the body that is treated and on the amount of radiation received. Some effects of radiation are not seen for many years. Your doctor will talk to you about what symptoms you might expect and how they will be treated if they do occur.

Stem Cell Transplant

Blood stem cell transplantation may help cure cancers such as leukemia, Hodgkin's disease and other lymphomas. Blood stem cell transplant will allow the physician to replace your child's diseased or damaged marrow with healthy blood-forming cells.

Blood cells are made in the bone marrow. Bone marrow is located in the spongy part of bones, especially the hips, breastbone, ribs and legs. The youngest type of blood cell is the stem cell or progenitor cell. As it matures, the stem cell develops into a white blood cell, red blood cell or platelet.

Some patients require high doses of chemotherapy and/or radiation to destroy their cancer cells. Along with the cancer, however, normal cells in the marrow are also destroyed. So after the chemotherapy and radiation are given, the child will then receive an infusion into the bloodstream of healthy donor blood stem cells. The transplanted cells move into the spaces inside the bones to create new marrow, which contains cells with the ability to grow and make healthy new red blood cells, white blood cells, and platelets in a process known as engraftment.

The body's ability to produce enough white blood cells to regenerate the immune system and prevent infections is vital for a successful transplantation. To aid this process, granulocyte colony stimulating factor (G-CSF) is given. G-CSF is a naturally occurring protein that encourages the bone marrow to produce more white blood cells.

It is possible for your child to receive a blood stem cell infusion in one of two ways: using his own stem cells (autologous transplantation), or those from a donor (allogeneic transplantation) which uses cells obtained from a family member or an unrelated individual whose tissue type closely matches the child's.

Autologous transplants

When patients give their own stem cells back to themselves, the procedure is called an autologous stem cell transplant. How can a sick person be his/her own donor and then get healthy again? It helps to think of this kind of transplant as a rescue. The autologous transplant isn't necessarily performed because there's something wrong with the bone marrow or stem cell production. It's performed because the dosage of chemotherapy and radiation needed to kill the disease is so high that it will destroy the patient's existing bone marrow. Without the stem cells in the marrow, there is no blood cell production or immune system, and life is not sustainable. The patient's own stem cells, collected prior to the chemotherapy/radiation, are reinfused, like a blood transfusion, and blood cell production and the immune system are re-established.

Allogenic transplants

Related and unrelated allogeneic transplants are most commonly used in persons with diseases affecting bone marrow, such as leukemia, aplastic anemia, and some lymphomas. The idea is to replace unhealthy marrow with healthy marrow. Sometimes a disease, such as leukemia, interferes with the stem cell growth, causing cells to stop developing and/or become defective. Eventually these abnormal or immature cells enter the bloodstream causing serious illness. A stem cell transplant provides healthy stem cells to patients whose marrow is diseased. The transplant is actually the transfer of healthy stem cells from a donor to a recipient.

Types of Stem Cell Collection

Bone Marrow Stem Cell Transplant

Stem cells are collected from the child's or donor's bone marrow. This is the "traditional" transplant and requires general anesthesia in an operating room. Stem cells are collected from the hip bone. When stem cells are collected from the bone marrow, a large needle is inserted into the back of the hipbone and marrow is withdrawn. The hip bones in the pelvis are marrow-rich bones. Since this procedure is performed under anesthesia, the donor doesn't feel anything during the marrow collection but may experience some discomfort in the back area for a few days afterward. About 5–10% of the donor's marrow is withdrawn, an amount that the body easily replenishes within just a few weeks. This process is known as bone marrow retrieval (sometimes referred to as a "harvest") and is done in an outpatient surgery center.

Peripheral Blood Stem Cell Transplant

When stem cells are taken from the circulating blood, the procedure is more like a blood donation. The stem cells in the circulating blood are called peripheral blood stem cells (PBSC). Like the stem cells in the bone marrow, they are able to divide and produce red cells, white cells and platelets. The concentration of peripheral blood stem cells in the blood, however, is very low. In order to collect them, medications known as colony stimulating factors or growth factors are given to the donor to stimulate the bone marrow to produce more stem cells, which are then released into the blood stream. The growth factors are administered as injections under the skin daily for a maximum of five days duration. Once they are in the blood, these stem cells are collected in one or more sessions normally taking four to six hours each. Stem cell collections are performed as outpatient procedures. Donors should plan to spend most of the day in the hospital on the day of collection. In this procedure, which is called apheresis, the blood circulates through a machine called a cell separator that removes the peripheral stem cells and returns the rest of the blood to the body. The stem cells are then stored and frozen until the time of the transplant for autologous bone marrow transplants. If the stem cells are collected from a related or unrelated donor, they are given immediately.

Cord Blood Transplant

At present cord blood transplant is only offered as a treatment option on some clinical trials. It is mainly offered to children or young adults who meet the criteria for enrollment in these clinical trials. There are far-reaching applications for the use of umbilical cord blood stem cells for transplant. The advantages are many. It can be frozen, stored, and readily available. Cord blood also poses a lower risk of graft-versus-host disease (GVHD) and when GVHD does occur, it seems to be milder

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