What are the different types of cancer treatments?

Once it is established what type of cancer your child is diagnosed with, the consultant oncologist will decide the type of treatment that is required. There are three main types of treatments: chemotherapy (drug therapy), radiation therapy, and surgery. Not all children will require all these; your consultant will discuss the treatment needed to treat your child’s cancer.

Chemotherapy

Chemotherapy is treatment with drugs. Chemotherapy is used alone or combined with surgery and/or radiotherapy. Chemotherapy drugs (also called cytotoxic drugs) injure or kill body cells. Chemotherapy attacks cancer cells but will also affect some normal cells and this causes side effects. These side effects are usually temporary.

Different drugs have different side effects and children can react differently to the same chemotherapy drug.

Chemotherapy can be given in many ways. In children, it is usually given by tablets or by injection into the blood, tissue or spinal fluid. Chemotherapy can be given over different periods of time, in hospital or at home as an outpatient. How chemotherapy is given depends on the drug and the type of cancer.

Precautions with chemotherapy

After receiving chemotherapy, small amounts of drugs are sometimes excreted in your child’s body fluids including blood, urine, faeces or vomit. The amount will vary greatly depending on the drug given.

Urine, faeces and vomit can be disposed of in the toilet. Double flush with the lid down to avoid splashing
Soiled disposable nappies should be placed in a plastic bag and disposed of in the normal way
Other soiled items such as cloth nappies, linen and clothing can be washed with lots of detergent and water
Good general hygiene is recommended after handling urine, faeces and vomit. Washing hands is the single most important measure
Pregnant and/or breastfeeding women should wear gloves when handling waste.

Sometimes chemotherapy can be given at home. Oral chemotherapy is often given at home. If this is an option, the nursing staff or pharmacist will teach you all about this.

Radiotherapy

Radiotherapy is the use of high energy radiation, usually x-rays or gamma rays, to kill cancer cells or injure them so they cannot grow and multiply. Radiotherapy is used alone, or with chemotherapy and/or surgery.

Radiotherapy is painless and usually takes a few minutes each time. Radiotherapy is usually given each day, over 4 – 6 weeks. Before radiotherapy begins, the radiotherapy scientist / technician does ‘planning’ – working out the exact position in which to place your child. This allows the radiotherapy to be given at the right place each time.

If radiotherapy is part of your child’s treatment, the radiotherapy healthcare team at Peter Mac will arrange your child’s appointments and give you information about the treatment, possible side effects and how to manage them.

Radiotherapy is a very effective treatment for cancer but it can damage some healthy cells close to the area being treated. This can cause short term and long term side effects. The side effects will depend on how much radiation is used and the part of the body that is being treated. Not all children will have all of the possible side effects. Your radiation oncologist and healthcare team will ensure your child is followed up to identify and manage, if necessary, any side effects from radiotherapy.

The radiation oncologist or registrar will see your child at least once a week while your child is having radiotherapy. You can ask any questions and discuss your child’s treatment and side effects.

Surgery

Many children with cancer will have surgery during their treatment. Surgery is used to biopsy a suspicious mass or lump at diagnosis, stage a disease, insert a central line, remove and / or debulk (reduce the size of) a tumour. Surgery may be an important part of the treatment for children with solid tumours or brain tumours. The general surgeon, orthopaedic surgeon or neurosurgeon will be part of a team of people involved in your child’s care.

Resection of a primary tumour

The surgical removal of the primary tumour may happen before or after chemotherapy. In a few cases complete resection (removal) of the tumour may be the only treatment needed, however most children will require additional chemotherapy and / or radiotherapy. Resection of a primary tumour involves major surgery being performed under a general anaesthetic. The exact nature of the surgery will be explained by the surgical team.

Debulking a tumour

Sometimes a tumour is too large to be removed safely. Debulking the mass (removing as much as possible without removing it entirely) can be beneficial as it may make the child more comfortable, particularly if the mass is large.

Chemotherapy and radiotherapy may then be more effective on a smaller tumour.

Second look procedures

Some children with solid tumours and brain tumours may have a ‘second look’ procedure, 3 – 6 months after the initial debulking. Treatment – radiotherapy and /or chemotherapy, may have shrunk the tumour and it may now be easier to remove surgically. Alternatively, the surgeon may check the area for recurrence and may biopsy the surrounding tissue.

Amputation and enucleation

For some children with retinoblastoma and sarcoma, surgery includes the removal of all or a portion of a body part. Advances in childhood cancer treatment mean that amputation or removal of the cancer mass are needed less often. Surgery for bone tumours can often be complex, involving bone grafts and limb salvage. For accurate, individual information it is best to talk with your child’s orthopaedic surgeon or opthalmologist.

Oral medications

It is a good idea for you to help to give your child’s medicines in hospital. It may make medicine-taking easier if your child needs to continue treatment at home. Many children don’t like taking any sort of medicine.

Hints to help your child take medicine:

Rewards are more helpful than threats. Use an incentive like a Star Chart
Re-direct your child’s attention by playing a game
It might be easier to give medicines with a syringe instead of a spoon. Your nurse will show you how to do this
You might need to hold your child firmly. Your nurse will help show you the best way if needed
If the medication is missed out, you need to tell your child’s team
Some medicines / tablets must be taken at specific times. Make sure you know when your child’s medicine should be taken and always check the expiry dates.

Before giving any medication that has not been ordered by your child’s consultant oncologist, check with your child’s team whether it is okay to give the medication.

Never give aspirin or drugs that contain aspirin.

Taking tablets

Some children have trouble swallowing tablets. If you are having problems with your child taking tablets ask your nurse coordinator or pharmacist for the written information about taking tablets.

Hints to help your child take tablets:

Crush tablets and add to a teaspoon of jam, ice-cream or juice, but take care not to put your child off something he / she likes. A tablet crusher can be obtained. NOTE: Some tablets shouldn’t be crushed. Check with the pharmacy first
Break large tablets into halves or quarters. Tablet cutters can be purchased from a pharmacy
Try this: Put the tablet on the back of the tongue, take a big mouthful of water, tip head back and swallow
Tablets that taste horrible can be put inside a gelatine capsule – available from the pharmacy
When taking capsules, take a mouthful of water first to wet the mouth.

Vomiting tablets

If vomiting happens after taking tablets, talk to the oncology pharmacist, nurse coordinator or the ward. The pharmacist can tell you what to do and can supply replacement tablets or capsules if necessary
If vomiting always happens with tablet taking, tell your consultant oncologist.

La Fondation La Roche-Posay and CCI make every effort to ensure that information provided is accurate and up-to-date at time of printing. We do not accept responsibility for information provided by third parties, including those referred to or signposted to in this publication. Information in this publication should be used to supplement appropriate professional or other advice specific to your circumstances.