Children with cancer are usually treated at specialist pediatric oncology centers/units. The treatment given will depend on the type of cancer, how far it has spread and other individual factors. Many children with cancer will be treated with chemotherapy (drugs). Depending on the type of cancer surgery and/or radiotherapy may also be required. Some children may also need a bone marrow transplant.
Chemotherapy is the treatment of diseases such as cancer with drug therapy. Since the 1960's the development and use of drugs has significantly improved the prognosis for some types of cancer. Chemo means chemicals, for most types of cancer chemotherapy will consist of a number of different drugs, this is known as combination chemotherapy. Chemotherapy may be given in a variety of ways; Intravenously (IV) - into a vein is the most common, Intramuscularly (IM) -injection into a muscle, Orally -by mouth, Subcutaneously (SC) -injection under the skin, Intralesionally (IL) directly into a cancerous area, Intrathecally (IT) - into the fluid around the spine, or Topically -medication will be applied onto the skin.
Surgery is the main treatment for many types of solid tumor, especially when the cancer has not spread to other parts of the body. This involves surgical removal of all or part of the cancer. Sometimes surgery may be used in conjunction with chemotherapy and/or radiotherapy. The type of operation will depend on the location of the main tumor, its size and other factors.
Radiotherapy is the treatment of cancer and other diseases with high energy (ionizing) radiation. Ionizing radiation damages or destroys cells in the area being treated making it impossible for the cancer cells to continue to grow and multiply. Most radiotherapy is delivered from the outside of the body (external beam radiotherapy) usually in the form of high energy X-rays or sometimes as Gamma rays. For certain cancers a radioactive implant can be placed next to the tumor inside the body (internal radiotherapy). As radiotherapy can damage normal cells as well as cancer cells there can be potential side effects, these may depend on the radiotherapy dose, sites of treatment, age and other factors.
Bone Marrow and Stem Cell Transplants
There are many different types of blood cell, but they all develop from stem cells. Most of these stem cells are found in the bone marrow (the soft inside part of the bone), although some are found in the blood (peripheral blood stem cells).
Chemotherapy and/or radiotherapy damages normal cells as well as cancer cells. At high doses the bone marrow may be damaged or destroyed, and the patient may not be able to produce the necessary blood cells. In a Bone marrow transplant (BMT), marrow containing healthy stem cells is infused to replace those damaged by the high dose therapy, so that the patient can produce blood cells again.
Alternatively a peripheral blood stem cell transplant (PBSCT) may be given. While blood is not as rich in stem cells as bone marrow advances in transplantation mean that PBSCT ("stem cell rescue") is increasingly being used in the treatment of certain cancers.
There are 3 types of transplant:
1. Allogenic transplants are where marrow is donated by another person
2. Autologous transplants involve cells being taken from the patient, stored, and then reinfused following high-dose therapy
3. Syngenic transplants are where the donor is an identical twin
BMT may be given for certain types of cancer, and only under specific circumstances. BMT has been widely used to treat specific cancers in children such as leukemia, lymphoma, and neuroblastoma. It is still being evaluated for the treatment of some other types of cancer. There are various potential side effects associated with transplantation, these will largely depend on how well matched the donor's cells are to the patient's cells.
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