Tuesday 7 June 2011

Understanding Pediatric Cancer (2): Treatment

Now that you have learnt about the types of childhood cancers, we shall move on to the types of medical treatment for cancer.

*Note: The following information had been adapted from my own research and was therefore not written by a medical professional. The terms 'child' or 'children' refer to individuals below the age of 21 years old.

Lesson 2: Treatment for Childhood Cancer

Delivered by a complex team of medical professionals, who looks after the needs of the child and their families, treatment for pediatric cancer include chemotherapy, radiotherapy, bone-marrow or stem-cell transplantation and surgery. Depending on the type of cancer and its severity, treatment may entail a combination of two or more of the above therapies that are administered either concurrently or one after another.


Chemotherapy, the most common form of cancer treatment, is the administration of cytotoxic drugs that kill cancer cells and interfere with their growth. The aim of chemotherapy is to completely destroy all the cancer cells; hence, the patient is given the maximum dosage of drugs that is tolerated by the body.

The drug is administered through a central venous line, which is inserted into a large vein under the collarbone. This thin plastic tube stays in the patient’s body for many months so that subsequent blood tests and drug administrations can be done without repeatedly pricking the child and causing him/her distress.

Photo credit: curesearch.org

Chemotherapy requires the patient to spend significant amounts of time in the hospital. There are also many side effects associated with the drugs and complications like infections and bleeding may occur.

Chemotherapy is also the main form of treatment used to treat lymphomas as the tumor is very responsive to it.


Photo credit: interview with the illustrator

Radiotherapy uses ionizing radiation to target and cause cell damage to the cancer. The treatment requires that the patient be hospitalized daily for 4-6 weeks and common side effects of treatment include hair loss and soreness of the mouth and skin.

Recent research has shown that children are generally more responsive to chemotherapy than radiotherapy, which is why the former is used more frequently. The only exception is brain tumors, which require both chemotherapy and radiotherapy (and sometimes surgery).


Photo credit: kaahe.org
There are two purposes for conducting surgery on a child with cancer:
A) to obtain tissue sample for analysis and diagnosis;
B) to remove all or part of the tumor from the affected site.

Although surgery is risky, the level of surgical risks can be reduced if the medical team is skilled and able to make sound decisions.

Surgery, together with chemotherapy, is often used to treat bone tumors such as osteosarcoma and Ewing’s sarcoma. In more severe cases, the limb may be amputated and an artificial prosthesis inserted.


Photo credit: placidway

Transplantation is performed when oncologists deem it necessary to administer a high and potentially lethal dosage of drugs to the patient, which could overly suppress the bone marrow. Bone marrow or stem cells are then transplanted to counter this suppression.

As with any surgical procedure, transplantation procedures are very risky. There are also many acute and chronic complications that are associated with this form of treatment. Hence, transplants are only performed in patients who have a high-risk type of cancer and are unresponsive to regular chemotherapy.

Treatment for Acute Lymphoblastic Leukemia (ALL)

The treatment of the most common form of childhood cancer, ALL, consists of a combination of chemotherapy and radiotherapy with the aim of achieving complete remission as soon as possible. Treatment targets all parts of the body and is more intensive than that of adults. The initial period is the most intensive where hospitalization is required, after which subsequent treatment is administered in the outpatient clinic. Treatment then continues for about 24 to 36 months.

Children with ALL are usually placed on clinical trial protocols where treatment is commonly divided into 4 main phases:

I. Remission induction = aims to eradicate leukemia cells rapidly from the bone marrow and circulatory system
II. CNS preventive therapy
III. Consolidation = phase where therapy is intensified following induction
IV. Maintenance = as presence of undetectable levels of leukemia still have the capacity to be fatal, maintenance is necessary to ensure complete eradication of leukemia cells.

A child is considered to be in remission when the signs and symptoms of cancer has disappeared but as the cancer may return, the child is not declared a survivor until he/she is three to five years in remission.

Dixon-Woods, M., Young, B. & Heney, D. (2005). Rethinking experiences of childhood cancer: A multidisciplinary approach to chronic childhood illness. Open University Press: Maidenhead

Eiser, C. (2004). Children with Cancer: The Quality of Life. Lawrence Erlbaum Associates: United States of America.

Continue to >> Understanding Pediatric Cancer (3): Side Effects of Treatment
<< Back to Understanding Pediatric Cancer (1): Types of Childhood Cancers

UPDATE: If you'll like to find out the results of my research, my complete thesis can be found on the NUS Scholar Bank (Part 1 & Part 2) =)

This post is part of my series on My Pediatric Cancer Research
Read on to learn more about childhood cancer and its impact.
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