Treatment at specialist centres
Most children diagnosed with cancer in the UK will immediately be referred to one of 21 hospitals that are specialist centres for treating children’s cancer.
Doctors at the specialist centre will confirm the diagnosis and plan the child’s treatment. Some of the later treatment may be given at the family’s local hospital under the guidance of the specialist centre – this is known as shared care.
The child’s treatment will usually be planned by a multidisciplinary team of specialists. Led by a consultant oncologist/haematologist, the team may also include a clinical oncologist (specialising in chemotherapy and radiotherapy), a surgeon, a nurse specialist and a pharmacist as well as other healthcare professionals such as dieticians, psychologists, physiotherapists and occupational therapists. The team will work together to provide treatment and care for the child.
Many children have their treatment as part of a clinical research trial.
Trials aim to improve our understanding of the best way to treat childhood cancers – they usually compare the standard treatment with a new or modified version of the standard treatment. Information gathered from successive trials has been one of the most important factors in the increasing survival rates for childhood cancer.
Taking part in a clinical trial is entirely voluntary; the medical team will provide detailed information and you will be given plenty of time to decide whether it is right for your child. Children who do not take part will receive the current standard treatment.
Types of treatment
The types of treatment used most often to treat cancer are surgery, radiotherapy, chemotherapy, immunotherapy, bone marrow or peripheral blood stem cell transplantation. Depending on the type of cancer, children may have one kind of treatment or a combination of treatments. Most children receive a combination of treatments, called combination therapy.
Surgery plays a very important part in the treatment of cancer. Surgery aims to remove the tumour during an operation. Tissue around the tumour and nearby lymph nodes may also be removed during the operation. Sometimes, surgery may be dangerous or cause too much damage because of the size and position of the tumour. In these situations, chemotherapy or radiotherapy may first be used to shrink the tumour.
Your child is likely to have many worries about surgery. Your child may ask:
- What is it like to be put to sleep?
- Will it hurt?
- How will I feel about my body after the operation?
- Will my parents be with me when I wake up?Find out all you can about your child’s operation so that you can give clear and honest answers to your child’s questions. Your child needs to trust you. Try to get your child to talk about all their concerns before the surgery.
Common side effects of surgery include pain, headaches, nausea, and constipation. Side effects from surgery depend on the location of the tumor, the type of operation and the child’s general health.
Chemotherapy is the use of “anticancer drugs”, the drugs flow through the bloodstream around the body to kill cancer cells wherever they may be. Because some anticancer drugs work better together than alone, chemotherapy may consist of more than one drug. This approach is called combination chemotherapy.
Depending on the type of cancer your child has and which drugs are used, chemotherapy may be given in one or more of these ways:
- By mouth (oral medication) – The drugs are swallowed in liquid or pill form. (You may crush and mix them with food that your child likes)
- Intravenously (IV) – The drugs are injected by needle into a vein or into an IV line (Hickman Line *)
- Intrathecal injection (IT) – The drugs are injected by needle into the spinal fluid
- Intramuscular injection (IM) – The drugs are injected by needle into the muscle
- Subcutaneous injection (SC) – The drugs are injected by needle just below the skin.
* Under general anesthetic the Hickman Line is put into a large vein in the chest. The plastic tube extends outside the body.
Depending on the medicine, your child may need to stay in the hospital, perhaps overnight or longer.
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells in one area of the body, while doing as little harm as possible to healthy cells. It works by destroying the DNA inside cancer cells – this prevents them from reproducing and therefore shrinks the tumour. The treatment is usually given as a series of short daily sessions over a few weeks and may be combined with other treatments such as surgery or chemotherapy. It is also used post surgery to make sure all the cancer cells are destroyed.
Radiotherapy is also used in children who require a stem cell (bone marrow) transplant. Common side effects include tiredness, weakness, sore skin and loss of hair in the treatment area.
Proton beam therapy
This is an advanced form of radiotherapy that uses a precision high-energy beam of particles to destroy cancer cells. Because it is so much more precise than conventional radiotherapy, it can deliver a high-dose of radiation to the tumour whilst sparing surrounding healthy tissue, so reducing the risk of harmful side effects.
There are currently no proton beam therapy facilities available in the UK and a number of patients are sent abroad for treatment. The first facilities are due to open in the UK in 2015.
A new type of treatment known as immunotherapy is beginning to be used in the treatment of some cancers and is the subject of a great deal of research effort.
Immunotherapy harnesses the power of the patient’s own immune system to attack the cancer. This can be achieved in a number of different ways.
A type of immunotherapy known as anti-GD2 therapy is currently being tested for children with high-risk neuroblastoma. Early results are promising but the treatment has unpleasant side-effects and is still undergoing trial.
Stem cell transplantation
A stem cell – or bone marrow – transplant allows children to have much higher doses of chemotherapy than they could otherwise tolerate. This high dose chemotherapy improves the chances of curing their cancer but has more side effects.
Very high doses of chemotherapy destroy the blood stem cells in bone marrow, so after high-dose chemotherapy a child will be given stem cells as a drip. These make their way to the bone marrow and start producing blood cells again.
Stem cell transplants can also bring about an important curative effect in leukaemia patients, known as graft versus leukaemia.
Side effects and complications
Treatments for cancer involve high doses of toxic drugs and/or radiation. These therapies are effective in killing the deadly cancerous cells but unfortunately they can also damage normal, healthy cells, putting the child at risk of harmful side-effects.
Short-term side effects such as hair loss, nausea and anaemia are common but temporary problems. With good supportive care, they can be kept to a minimum.
Some children may experience more serious long-term effects, which persist for months or years after treatment, or ‘late’ effects which do not develop or become apparent until years after treatment ends. The risk of these effects varies from child to child, depending on the treatments used and the age and developmental stage of the child.
A major consideration in the development of new treatments is how to minimise the risk of harmful effects.
Complementary therapies are thought to be used by up to a third of cancer sufferers. These therapies may be used alongside the conventional treatments such as chemotherapy, radiotherapy and surgery, not as an alternative to these treatments.
Complementary therapies are generally used to help with the symptoms of disease and the side effects of treatment. Side effects such as nausea, vomiting, fatigue and pain are well known but depression and anxiety are also very common and complementary therapies can help reduce anxiety and promote relaxation.
Some cancer centres offer complementary therapies directly. Some patients will need to seek independent practitioners; in all cases it is advisable to seek advice from your child’s doctor. Some complementary therapies may actually interfere with conventional treatments.
Practitioners are referred to as complementary therapists, alternative therapists or holistic healers.
‘Alternative Medicine’: often referred to as an alternative to conventional medical treatment.
‘Complementary medicine’: often referred to as any therapy that can compliment conventional medicine, i.e. Diet, Aromatherapy, Naturopathy.
Whilst there are many qualified and enthusiastic therapists, we have decided to only list therapists that have attained the highest qualifications available in their chosen field. Please use the complimentary therapies tab at the top of this page.