Pediatric Cancer Services

Treating pediatric cancer

Inpatient care
Infants and children who are recovering from surgery or need more intensive cancer treatment may be admitted as inpatients to the 7th floor of the Children's Hospital. Adolescents are admitted to the 7th floor Adolescent unit.

Outpatient care at the Pediatric Specialty Center
Most cancer treatments are delivered in an outpatient setting.

Types of treatment
The exact type of treatment a child receives depends on the type of cancer. Most children with cancer receive surgery, radiation therapy, chemotherapy or a combination of the three.

Surgery
The goal of surgery is to remove the cancerous tumor. Surgery is usually done on an inpatient basis by a pediatric surgeon. Recovery depends on the extent of the surgery. The surgeon will provide details of the surgery before the operation. Depending on the location and size of the tumor, the surgery may be followed by radiation therapy and/or chemotherapy. Alternatively, these treatments may be used before surgery to shrink tumors and make them easier to remove.

Radiation therapy
Radiation therapy can be used alone or in combination with other therapies. This type of therapy, which is done on an outpatient basis, uses high energy X-rays to destroy cancer cells while minimizing damage to healthy tissues.

Before radiation therapy begins, a radiation oncologist will meet with the patient and family to explain the details of treatment, which may take several weeks to complete at Hunter Radiation Therapy. A special dye will be placed on the skin of the area to be treated. It acts as a guide for aiming the radiation and should not be washed off until all treatment is completed.

Side effects from radiation depend on where the radiation is aimed. Always discuss any side effects that with the child's doctor. Side effects may include:

	Damage to the skin, so treated areas should be protected from sunlight and irritation.
	Sore mouth (if the head and neck area is treated).
	Temporary hair loss from the area receiving radiation.
	Diarrhea, nausea, vomiting or headaches. Medicines given before or following treatment can alleviate some of these side effects. Small meals eaten three to four hours before treatment can sometimes lessen nausea. Over-the-counter medications can help with diarrhea.

Chemotherapy
Chemotherapy involves the use of special medicines to stop the growth of cancer cells. Because each medicine kills cancer cells in different ways, sometimes several medicines are given in combinations that have been proven to be the most effective in the treatment of a particular type of cancer.

Chemotherapy can be given orally as a pill to be chewed or a liquid to be swallowed, as an injection under the skin, via an intravenous needle directly into blood or into the spinal fluid during a lumbar puncture.

Chemotherapy can produce side effects. Just as chemotherapy kills cancer cells, it also kills other normal cells in the body, such as bone marrow cells that normally mature into blood cells. Chemotherapy can reduce the numbers of blood cells in the body. The three types of blood cells are white blood cells, which fight infection; red blood cells that carry oxygen in the blood; and platelets, which help blood clot.

Children who receive chemotherapy must be watched for signs of infection (see When to call the doctor.) Also, because the numbers of red blood cells and platelets are reduced, sometimes blood transfusions are necessary to boost the number of these cells.

Other side effects may include:

	Nausea and vomiting. New medicines given before chemotherapy is administered can prevent the majority of nausea and vomiting in children.
	Mouth sores
	Hair loss

Stem cell treatment
Stem cell therapy is a very promising form of cancer treatment. See the explanation provided by the National Cancer Institute for bone marrow transplant and peripheral blood stem cell transplantation.

Central lines
Central lines provide an easy access for intravenous medications, blood, nutrition and chemotherapy and are helpful in long-term therapy. To place a central line, the patient undergoes a surgical procedure in the operating room while under general anesthesia. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy, blood transfusions and intravenous medications.

There are two types of central lines commonly used for children diagnosed with cancer:

	Broviac (or Hickman) catheter.
	Port-A-Cath (PACs).

Both go to the large vein near the heart. Hickman and Broviac catheters come all the way out through the skin. The Port-A-Cath ends in a rubber dome just under the skin. To use it, nurses must place a needle through the skin and rubber dome.

When to call the doctor
Children undergoing chemotherapy often feel tired and weak. Other symptoms may be normal side effects of treatment. Ask your doctor or nurse about any side effects your child experiences after treatment. Much can now be done to prevent or control these side effects.

While your child is undergoing chemotherapy, you should be watchful for any signs of infection or other problems. Call your doctor at any time if your child has:

	A fever greater than 101°F.
	Shaking chills.
	Severe cough or rapid breathing.
	Headache or stiff neck.
	Blisters, rashes, sores or redness at IV or finger stick site.
	Ear ache.
	Sore throat.
	Pain during bowel movements or urination.
	No bowel movement for two days or signs of constipation, including hard stool, abdominal pain, swelling or firmness and lack of appetite.
	Infected hangnails.
	Exposure to chicken pox or measles.
	Pale skin or lack of energy.
	Yellowish color to skin or whites of eyes.
	Easy bleeding, bruising, nosebleeds or blood in stool or urine.
	Excessive thirst or urination, especially while on steroids.
	A need for any dental cleaning, treatment, procedure or vaccination.

Learn more
• YNHH Health Library: Cancer treatment: Index

Last revised: Jan. 8, 2008 (dh)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.