26
Nov

Cancer Therapies

Cancer Therapies

Surgery

The objective of surgery is to completely remove the cancer and a margin of tumor-free tissue; or, if the tumor cannot be totally removed or a clear margin achieved, to eliminate as much of it as possible, so that subsequent measures such as chemotherapy and/or radiation therapy might be more effective.

Radiation therapy

External-beam radiation therapy destroys tumor cells using a narrow beam of high-energy X rays from a special machine.

Chemotherapy

The word chemotherapy literally means “drug therapy,” but it has become synonymous with cancer treatment. Surgery and radiation therapy treat cancer locally; chemotherapy is usually a systemic therapy. Ingested orally or injected, the chemicals hunt down vagrant tumor cells anywhere in the body and stop them from proliferating. Your youngster may be prescribed a single medication, but more likely she’ll receive combination chemotherapy of two, three, perhaps more drugs. One regimen used for advanced lymphoblastic lymphoma consists of no fewer than ten drugs.

Anti-cancer agents owe their effectiveness to the fact that they zero in on rapidly dividing cells. While malignant cells sustain the most damage, normal cells in the lining of the digestive tract, the white blood cells and the hair also happen to be highly active, and they too incur the wrath of the chemo agents. Consequently, symptoms such as nausea, lowered resistance against infection, mouth sores, diarrhea and hair loss may accompany treatments. Radiation also targets rapidly dividing cells, but the adverse effects tend to be confined to the treatment area, or field.

If defined loosely, chemotherapy can be said to include hormonal drugs and immunologic agents. This latter group, long regarded in some quarters as the future of cancer treatment, has been slow in fulfilling its promise. The principle behind immunotherapy is to beef up the body’s immune system against the intruders, or to direct antibodies (with or without a drug attached) to the surface of cancer cells. For the time being, immunologics have yet to assume their place as front-line treatments.

Bone-marrow transplantation (BMT)

Bone-marrow transplantation has two roles in cancer treatment. In leukemia, it may be curative therapy, replacing the diseased marrow with new marrow withdrawn from the hip bone of a family member or a matched unrelated donor, then infused into the patient’s bloodstream.

In other pediatric cancers, BMT makes it possible for youngsters to receive higher-than-normal doses of chemotherapy and/or radiation therapy. The increased amounts of drugs wipe out more cancer cells but also destroy the bone marrow, which then must be replenished with healthy marrow cells—often the patient’s own. You may hear this procedure referred to as high-dose chemotherapy with stem-cell support. Stem cells are the undeveloped cells in the marrow that mature into blood cells. They are also found, in lesser numbers, in the bloodstream. Half the transplants performed in the United States now use peripheral-blood stem cells (PBSCs) in place of bone marrow.

There are two main types of bone-marrow transplants: allogeneic and autologous. In an allogeneic transplant, the stem cells are harvested from another person with genetically compatible cells. A perfect match improves the chances that the body will accept the transplanted marrow, or graft, and that the graft will take to its new home. The most-likely matched donor is a brother or sister, followed by a parent. However, two in three BMT candidates do not have an immediate family member with matching cells. In that event, the patient’s doctor might arrange for him to be registered with the National Marrow Donor Program, which attempts to match patients with volunteer donors from its ever-expanding data base.

In autologous stem-cell transplantation, the patient’s own marrow is aspirated through a needle during a period of remission, frozen, then given back to him later. (If the person never enters remission, the marrow can be treated with chemotherapy in the laboratory until it tests negative for cancer cells.) This technique, which has been used in relapsed Hodgkin’s disease and non-Hodgkin’s lymphomas, and experimentally for several other resistant pediatric cancers, is less dangerous and less costly. It is now the front-line treatment for neuroblastoma. Since the patient is receiving his own stem cells, there is no chance of the body rejecting the graft and avoids the chance that the graft will mistake its old haunt for a foreign invader and go on the attack. Graft-versus-host disease (GVHD), as this is called, is a common and potentially serious side effect of allogeneic BMT and is a particularly severe problem when unrelated donors are used.

Side Effects of Cancer Treatment

If your child should require chemotherapy, radiation therapy and/or bone-marrow transplantation, and so on, her oncologist will undoubtedly discuss with you the possible side effects that may occur during treatment. While it is important to be aware of the possibilities, don’t jump to conclusions that your child is going to be racked with nausea and diarrhea and lose all of her hair. There is no way to predict how a patient’s body will respond to the drugs or the radioactive rays. Some youngsters sail through their treatments, barely missing a day of school.

It is hoped that will be your son’s or daughter’s story too. But it’s wise to be aware of potential problems. One of the first questions to ask the doctor in the wake of a cancer diagnosis is, “What steps can be taken to relieve any symptoms and side effects?” You and your child will probably be heartened by his answer, for some of the most striking progress in cancer care has come in the area of symptom management. For instance, we now have such effective antinausea drugs that many chemotherapy patients never spend a day feeling sick to their stomachs. The key to success is to have the doctor prescribe them prophylactically, to be taken just prior to treatments. This is a point to take up with the pediatric oncologist.

Last Updated 11/21/2015
26
Nov

Chronic Conditions and School

Chronic Conditions and School

My child has a chronic health condition. What do I need to tell the school?

If your child has special health needs, the school should have a written document outlining a health care and emergency plan.

The following information should be in the document:

    • A brief medical history
    • The child’s special needs
    • Medicine or procedures required during the school day
  • Special dietary needs
  • Transportation needs
  • Possible problems, special precautions
  • Pediatrician’s name
  • Emergency plans and procedures (including whom to contact)

Once the school is informed a student has a chronic health condition, a meeting is often scheduled to discuss what services may be needed. The meeting should include parents, the student (if old enough), school health staff, the coordinator of special needs services, student aids, and the child’s primary teacher. Health care providers, such as the child’s pediatrician, also should be invited or asked to provide information in writing.

One goal of this meeting is to develop a written plan that clearly describes the services the student needs. Depending on the child’s needs, this plan may be described as a 504 Plan or an Individualized Education Program (IEP). This legal document outlines exactly what services the child will receive and sets short- and long-term goals for the child. The plan should be reviewed regularly to ensure it continues to meet the child’s needs.

Parent Responsibilities

The following are ways you can help your child receive the education and services he or she needs to succeed in school:

  • Talk to the school. Don’t be afraid to tell the school about your child’s condition. Some parents worry about sharing this information, but the more informed teachers and other school staff are, the better prepared they will be to help your child. If the school staff don’t have all the facts, they may make wrong assumptions about your child’s behavior or performance.
  • Make an emergency plan. Ask your pediatrician to help you write down exactly what the school should do if your child has certain health needs. School staff should know how to reach you or your pediatrician in case there is an emergency. Remember to call the school right away when contact information has changed.
  • Make a health plan. If your child takes medicine at school, ask about the school’s policies for storage and self-usage. Make sure your child is able to take her medicine in a comfortable place, and that the school is provided with an adequate supply. Remember to call the school right away if there are any changes in your child’s condition.
  • Give your consent. You will have to sign a release form that gives the school permission to contact your pediatrician. Also, your pediatrician will need your written permission to discuss your child’s condition with the school. If your child requires medicine or special procedures, the school must receive written instructions from your pediatrician.
  • Plan ahead. Meet with your child’s teachers regularly to talk about how your child is doing at school. Ask if your child’s health condition is affecting her schoolwork or behavior. If your child is missing a lot of school due to illness, talk with her teacher about ways to help her keep up with her work.

Know the Law

By law, your child is entitled to an education that will help her develop to her full potential. Schools may be required to provide additional services that will assist in both in-school programs and after-school events. Federal laws such as the Individuals with Disabilities Education Act (IDEA) and the Americans with Disabilities Act (ADA) state that every child should be allowed to attend school in the “least restrictive” setting possible.

Last Updated 11/21/2015
26
Nov

Treating Cancer in Children

Treating Cancer in Children

Leukemia

Combination chemotherapy, CNS prophylaxis: injecting chemotherapy into the cerebrospinal fluid (intrathecally) as a preventive measure against the leukemia spreading to the central nervous system, Radiation therapy to the head in selected cases, Allogeneic bone-marrow transplantation in first or second remission, depending on the type of leukemia, Investigational therapies

Hodgkin’s Disease

Chemotherapy, Radiation therapy, Investigational therapies

Non-Hodgkin’s Lymphomas

Chemotherapy, CNS prophylaxis: injecting chemotherapy into the cerebrospinal fluid (intrathecally) as a preventive measure against the lymphoma spreading to the central nervous system, Radiation therapy to the chest is sometimes given to shrink a lymphoblastic lymphoma that is obstructing breathing or circulation, Allogeneic bone-marrow transplantation (after relapse), High-dose chemotherapy followed by autologous bonemarrow transplantation (usually after relapse), Investigational therapies

Brain Tumors

Surgery to remove the tumor from the brain, Radiation therapy to the brain (and to the spine, if the cancer is disseminated), Chemotherapy, Investigational therapies

Rhabdomyosarcoma

Surgery to remove the tumor, Chemotherapy, Radiation therapy, High-dose chemotherapy followed by autologous bonemarrow transplantation (usually after relapse), Investigational therapies

Osteosarcoma

Preoperative chemotherapy, Limb-salvage surgery, to preserve the limb, or amputation, Chemotherapy, Surgery to remove any metastatic tumors that remain following chemotherapy, Investigational therapies

Ewing’s Sarcoma

Preoperative chemotherapy, Surgery to remove the tumor, Radiation therapy (if the tumor is not completely resected), Surgery, to remove metastases to the lungs, High-dose chemotherapy followed by autologous bonemarrow transplantation (after relapse) Investigational therapies

Last Updated 11/21/2015
26
Nov

Childhood Cancer: Coping With the Diagnosis

Childhood Cancer: Coping With the Diagnosis

Just the thought of a child getting cancer can be frightening and overwhelming. But while cancer can be life threatening, there’s encouraging news. Over the last few decades, improved therapies have helped childhood cancer survival rise to more than 80%. Many kinds of cancer can now be cured or controlled to help give children a better quality of life into adulthood.

Leukemia: The Most Common Type of Childhood Cancer

The most common type of childhood cancer is leukemia, a cancer of the blood. Leukemia begins in the bone marrow, the spongy substance inside our bones where blood cells are made. Other childhood cancers include lymphoma (blood cancer that begins in the lymph glands) and solid tumors (abnormal clumps of tissue). Solid tumors may occur throughout the body, such as in the brain, kidney, muscle or bone.

What Causes Childhood Cancer?

The causes of childhood cancer are largely unknown. Childhood cancer can occur suddenly, with no early symptoms, and might get detected during a physical exam.

“If you notice something unusual in your child—unexplained symptoms, not growing properly, belly distended, blood in urine—take your child to the doctor,” says Dr. Nita Seibel, a pediatric oncologist at NIH. If the doctor suspects cancer, a series of tests will help identify the type of cancer, where it’s located and whether it has spread to other parts of the body.

Tips for Parents When Researching the Diagnosis

Cancers in children can be different from adult cancers. When you’re researching the diagnosis, be sure you’re looking at how that cancer affects children. Often, the outcomes may be better for children than for adults with the same type of cancer.

For instance, Seibel says, childhood tumors tend to respond better to treatment than do tumors in adults. Cancer cells tend to grow very swiftly in the types of tumors seen in children. So therapies can be selected to interrupt this rapid growth. Children with leukemia, non-Hodgkin’s lymphoma or certain solid tumors tend to have a good outcome.

Treatment Plans

Doctors design treatment plans specific to each child. Children usually receive one or more of the following treatments:

  • Chemotherapy drugs
  • Radiation
  • Surgery (for solid tumors)
  • Immunotherapy
  • A bone marrow or blood stem cell transplant

Unpleasant side effects are common and can include hair loss, nausea and diarrhea. But side effects tend to fade shortly after treatment ends.

Dr. Stephen Hunger, a pediatric cancer specialist at the University of Colorado, says that most advances in treatment have come from improvements to chemotherapy drugs. For instance, treatment for childhood leukemia 30 years ago often involved radiation to the brain. But radiation can cause health problems later in life. Now, with improvements to chemotherapy, oncologists are using radiation less, if at all, for children with leukemia and some other types of cancer. “This is a good change because of the long-term side effects to thinking and learning, and the risk of later developing brain tumors,” Hunger says.

Clinical Trials for Childhood Cancer

Improvements to treatment are often based on clinical studies of people who have cancer. Children might be eligible to participate in certain clinical studies of cancer shortly after their diagnosis.

“NIH supports clinical trials for most types of childhood cancer,” says Dr. Malcolm Smith, a pediatric oncologist at NIH. For types of cancer that already have good treatments, he says, trials aim to maintain survival while reducing side effects. Other studies evaluate the safety and effectiveness of experimental therapies for cancers that lack good treatment options. When standard therapy fails, some children may be able to participate in clinical trials that test promising new agents.

One NIH-supported cancer research network links thousands of pediatric cancer experts. Together, they conduct clinical research trials for common types of childhood cancers. Another NIH-sponsored research group is testing potential new drugs for pediatric brain tumors at hospitals nationwide.

Coping with Childhood Cancer

When a child is being treated for cancer, family members may find it hard to move forward with everyday life. After chemotherapy or radiation therapy, children may be tired and need more rest. Even so, kids with cancer have the same needs as other young people.

  • Encourage your child to stay in touch with friends. Keeping contact is easier if your child can keep going to school. Contact your child’s teachers and school nurse to discuss the disease, treatment, absences and any needed changes in activity.
  • Children often worry about how their classmates will act toward them, especially if a child has missed a lot of school or has noticeable changes such as hair loss. Let your child know that many people, including kids, are uneasy about serious illness. These people may act differently or say hurtful things. Many kids will be accepting of a child with cancer, but they may have a lot of questions. Talk to your child about ways to answer.
  • Be open with your child about the diagnosis and upcoming treatments. Age-appropriate discussions might help ease stress, fear and uncertainty. Emphasize that cancer isn’t contagious and isn’t anybody’s fault.

If your child is diagnosed with cancer, you may need support as well. You and your family can get help from many sources. 

Last Updated 11/21/2015
26
Nov

Benefits of a Pediatric Cancer Program

Benefits of a Pediatric Cancer Program

Both the American Academy of Pediatrics (AAP) and the National Cancer Institute recommend that children and adolescents receive diagnosis, staging and treatment at one of the more than two hundred medical centers that specialize in pediatric cancers. According to several studies, young patients’ survival rates are 20 to 40 percent higher when their care is coordinated by pediatric oncologists and is carried out at comprehensive, multidisciplinary cancer centers.

The term multidisciplinary means that although your child will have one or possibly two attending physicians orchestrating her care, her case will be reviewed by specialists in various treatment disciplines. In this comprehensive approach, the health-care team might consist of a pediatric surgeon; a pediatric oncologist, or chemotherapist; a radiation oncologist; a pathologist; and other specialists as needed.

Increasingly, cancer therapy incorporates several modalities, in an effort to improve not only the cure rates but patients’ quality of life. It is now routine to follow many surgeries with chemotherapy or radiation therapy—sometimes both—to treat any remaining tumor cells (whether visible or not) and seek to prevent a future return of the disease, or relapse. Another trend in cancer medicine is to administer these treatments preoperatively; perhaps to whittle a previously inoperable tumor to a surgically resectable size or to spare a patient from having to undergo an amputation or other mutilating surgery. With so many variables in terms of sequencing treatment, it is essential that all the specialists be assembled at the time of diagnosis. This occurs in a multidisciplinary cancer center. A team of specialists reaches a consensus on what it believes is the most appropriate course of treatment, or protocol, for your child.

What Are Clinical Trials?

For all the progress made in cancer treatment, there is still a long way to go. It is through conducting clinical trials that new drugs, improved methods of delivering radiation, and multimodality protocols find their way into practice. About seven in ten children who are treated at pediatric cancer centers participate in investigational studies. They receive treatments that earlier studies have found to be effective and that researchers believe will prove superior to existing therapies. These are usually modifications of standard treatments, so there is little risk of receiving inferior therapy. In what’s called a phase 2 clinical trial, the new treatment is given to a large group of similarly diagnosed patients (the study group), while another large group with the same disease (the control group) receives the current standard treatment. The National Cancer Institute is involved with these drugs at all levels of development, before approval is given.

One other consideration when deciding on a treatment center: As parents of a child with a potentially life-threatening illness, you’re seeking not only medical expertise but experience in treating young cancer patients. Dr. Gerald Gilchrist, a pediatric hematologist-oncologist at the Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota, observes, “With teenagers, the emotional and developmental issues that come up in the course of a catastrophic disease are very different from the issues adults often face. The average internist or oncologist is not trained to deal with these issues and may not be comfortable dealing with them.”

At a multidisciplinary pediatric cancer center, it is understood that quality cancer care encompasses the whole patient; maintaining his sense of wellbeing as well as his physical health. The medical team routinely includes an oncology social worker sensitive to the concerns and anxieties of adolescents diagnosed with cancer.

Last Updated 11/21/2015
26
Nov

Accommodating Children with Cancer in Child Care or School

Accommodating Children with Cancer in Child Care or School

Children may come to school or child care as cancer survivors, or they may be diagnosed with cancer while enrolled. If children who have cancer are well enough during therapy or between rounds of therapy, they may attend child care or school.

What adaptations may be needed?

Medications

Some children may be on low-dose antibiotics to prevent infection, but they are usually given at home.

Dietary considerations

There usually is no special diet, but children who are recovering from weight loss from chemotherapy may be on high-calorie foods or shakes.

Physical environment

  • Good hygiene such as hand washing and avoiding infectious diseases. See Preventing the Spread of Illness in Child Care or School.
  • Follow any guidance in the child’s care plan about physical activity, but usually children who are well enough to attend child care or school will be able to participate in most activities.

How teachers can help:

  • Schedule a meeting with parents/guardians to go over the specifics of the child’s condition because each case is unique.
  • Have the child make a brief visit before the first full day returning to child care or school to meet with his teachers and classmates.
  • The child’s care plan will probably need to be updated frequently for a child who is still getting cancer treatments.
  • Make sure the child’s care plans are updated after each hospitalization or change in therapy.
  • Explain to the other children about the child’s condition, especially if the child’s appearance has changed.
  • Children sometimes feel guilty that they somehow caused their condition and may need reassurance that this isn’t so.
  • Immediately after chemotherapy or radiation, the child may be more tired or need to rest, but that will resolve over a few weeks.
  • The child may have frequent absences for medical tests and treatments. Often child life specialists in the hospital help children adapt and keep up with any lessons they may miss.

Benefits of being with peers:

Being with groups of children can provide a routine and the chance to interact with friends, which can be a welcome break from a hospital setting.

Last Updated 11/21/2015