Healthy stem cells within the bone marrow mature into three types of blood cell: white, red and platelets.
The aim of a bone marrow transplant (also known as a stem cell transplant) is to replace abnormal bone marrow with healthy marrow so the body can produce normal blood cells again.
There are two main types of transplant:
where your child's own stem cells (bone marrow) are used as a supportive treatment for high-dose chemotherapy or radiotherapy. Stem cells are collected and stored prior to high dose therapy because such intensive doses can damage the bone marrow (both the abnormal and healthy stem cells). Your child's own cells are then re-infused into the damaged bone marrow to encourage the production of healthy blood cells.
Stem cells (bone marrow) are provided by a donor. High doses of chemotherapy are given to remove a child's own marrow and the new marrow from a donor is transplanted. The healthy stem cells are given via the central line. Isolation in a sterile facility is required after this procedure because your child will be exceptionally vulnerable to infection until their body can re-build a healthy bone marrow system.
Both transplant procedures are complex and require extensive discussion about the risks, benefits and side effects.
Surgery will most likely be needed if your child has been diagnosed with a solid tumour.
The tumour will be removed surgically during an operation while your child is under anaesthetic.
If the tumour proves to be benign (non-cancerous) or a small cancerous tumour is removed completely and there is no evidence to suggest the cancer may have travelled to other parts of the body, this may be the only treatment needed.
Our cells are "born to divide" and cancer cells are no exception.
Chemotherapy drugs are also known as "cytotoxic" drugs because they damage or kill dividing cancer cells.
Carried through the bloodstream, these drugs are able to find cancer cells wherever they may be, even those that have spread from the original tumour site. Leukaemias need chemotherapy because, as cancers of the blood, the cancer cells are all through the body.
However, these drugs target our healthy dividing cells too, like those in our mouth and skin and the cells powering our immune system. Chemotherapy treatment must be managed carefully to maximise the damage to dividing cancer cells, minimise harm to our healthy cells and reduce associated side effects. Such management may include using different combinations of drugs, varying the dosages of these drugs and administering the drugs at different times.
Chemotherapy is given in one, or a combination, or three ways:
To minimise the distress of needles and injections, your child may be fitted with a Hickman line, also known as a central line or portacath, to receive chemotherapy and also to have blood samples taken. Your child will have a small operation (under anaesthetic) to insert the line which looks like a small rubber tube or catheter. The line is placed under the skin and enters a central vein in the chest. The end of the tube outside the body is sealed with a cap which can be removed for administration of chemotherapy or for taking blood samples. The line will be cleaned and examined regularly by the medical team and will remain in place for the duration of treatment.
Common side effects are:
The drugs used in chemotherapy are strong and your child may experience side effects. The number of side effects experienced and their duration and intensity varies for each individual but in this section we discuss some of the more common side effects. Your medical team will provide you with complete information and outline medical remedies and general tips for coping with side effects. Remember that most of the side effects will stop when treatment is finished.
Use your Kenzie's Gift Diary to write down appointments for treatment and also to record side effects experienced and their severity. This information is very helpful for the medical team when determining future treatments. If side effects become severe and if you are concerned, call your medical team right away. The Diary has a place for noting down those contact numbers too.
Chemotherapy targets reproducing cells so the production of blood cells can drop. Blood count tests will be conducted during treatment to monitor the effects of chemotherapy on the blood.
The number of red cells will be reduced. This is called anaemia and can cause tiredness and feeling faint or dizzy. Anaemia can be treated with a blood transfusion.
Our white cells help us to combat infection and chemotherapy can reduce their number too. This is known as lowered immunity and if the white cell count becomes too low, chemotherapy may be temporarily stopped to allow the cells time to reproduce. A reduction in white cells means your child may be more susceptible to infections such as a cold so it is important that you contact your medical team if you think your child is unwell. Prompt treatment with antibiotics can prevent the development of a more serious condition.
A low number of platelets can produce a condition known as Thrombocytopenia. Your child may bruise more easily or bleed longer if they cut themselves. If platelets become too low, a platelet transfusion may be needed.
Radiotherapy uses high energy rays on one area of the body to destroy cancer cells (in solid tumours) and minimise harm to healthy cells. All of our cells contain a set of instructions telling them what to do. These instructions are known as DNA. Radiotherapy destroys the DNA within a cancer cell, causing the cell to die and so shrinks the tumour.
Radiotherapy is not painful and each treatment session may last 5-10 minutes. It is similar to having an x-ray taken where your child will be asked to lie very still while the radiotherapy takes place. If your child is unable to remain still, a mild sedative may be given.
Prior to the commencement of treatment, technicians may scan your child either with a CT scanner or simulator to locate the area of the body to be treated. Marks may be drawn on the skin to help the radiographer (technician giving the treatment) locate the area accurately each time.
During treatment, your child is placed on a couch and made comfortable. While treatment is taking place, your child is alone in the room but can speak with the radiographer in the adjoining room. You may sit with the radiographer too and speak with your child. Treatments are usually scheduled daily, Monday through Friday, for a number of weeks, as determined by your specialist.
The side effects of radiotherapy are usually mild but one of the most pronounced is fatigue. Your child may feel very tired during the treatment course and for some weeks afterwards. Loss of appetite is also common.
Radiotherapy can cause a skin reaction around the area being treated, similar to sunburn and the severity of the reaction depends on the area being treated and the type of skin your child has. If you see this reaction on your child, advise the medical team.
In this section we will cover those side effects most commonly associated with chemotherapy and radiotherapy treatments. It is important to remember that your child may experience some side effects and not others, or perhaps all but at different times with varying degrees of severity. The Kenzie's Gift Diary can be used to record side effects i.e. what they are, how bad they become and when they occur (for example, immediately after treatment or perhaps a day or two later). Recording this information will help you and your team manage the side effects and make your child more comfortable.
Your child may receive more than one chemotherapy drug. Different drugs have different effects so be sure your specialist tells you which drugs your child will receive and describes the side effects normally associated with them. Responses to the drugs may vary depending on the individual but it is good to be prepared and have an idea of what to expect.
Chemotherapy and radiotherapy target diseased cells but healthy cells are also affected. If you notice any of the following symptoms becoming pronounced or worse, contact your medical team:
Temperature above 38 degrees, chills, muscle aches (could signal infection)
Weakness, feeling faint, difficulty breathing (could indicate anaemia)
Extensive bruising, bleeding gums, blood in urine or stools (indications that the blood is not clotting properly)
Feeling sick - Chemotherapy and radiotherapy can make your child feel sick and also be sick. If your child feels sick, see if they can sip liquids or nibble on dry toast or plain biscuits. Avoid foods and drinks that are spicy, acid, sweet, salty or hot in temperature and try for foods that are bland and cold. If your child has been sick, then keep the fluids coming as best you can, small amounts at a time (even a teaspoon-full) until your child can manage more liquids and a little solid food. It can be helpful to read to your child, listen to music or watch television together because distraction can help. Encourage your child to drink plenty of fluids. Little and often may work best. Regular intake of fluids will reduce the likelihood of dehydration and also help the body cope with the medications. Cubes of ice or a fruit ice block can also help when your child finds drinking difficult. Keep some on hand in the freezer. Encourage small snacks during the day rather than large meals.
Mouth ulcers - Be sure to let your medical team know if your child develops mouth ulcers as they could become infected. Clean teeth gently and encourage your child to drink to keep the mouth moist. Avoid spicy foods or acidic/fizzy drinks which could irritate the mouth.
Constipation and Diarrhoea - Chemotherapy and pain killing drugs, lack of fluids and less activity than normal can all contribute to constipation and/or diarrhoea so encourage your child to drink plenty of fluids (warm water can be helpful). For constipation, serve foods that are higher in fibre such as raw vegetables, whole grain bread and dried fruits (for example raisins) and encourage your child to move about as much as possible or undertake some gentle exercise with you.
Skin irritations - Both chemotherapy and radiotherapy can cause rashes, redness, itching and general skin sensitivity so, in general, keep your child out of the sun and use a good high factor sunscreen, hats and clothing to cover exposed skin on arms and legs. Speak with your medical team about appropriate moisturisers and creams this is important because most readily available creams and applications contain perfumes and other chemicals which could cause further irritation.
Hair loss - A discussion with your child about hair loss may help you decide how best to manage this common side effect. Some younger children may choose funky hats and head scarves whilst older children may prefer to wear a wig. Be sure to provide hats outside in the sunshine and a warm beanie at night and during the day, if needed, as your child will feel colder. It is always best to decide how to approach the hair loss before it happens and sometimes cutting the hair short before it begins to fall can help your child adjust and feel more in control.
Some long term health issues have been linked to cancer treatments but it is important to remember that most children will not experience any of these problems. Your child will be monitored during follow up consultations and this can help to identify and manage any long term side effects.The likelihood of long term side effects depends on the type of cancer and treatment given, the duration of treatment and the child. Here we list some potential long term side effects but discuss these in detail with your specialist to see if they might apply to your child.
Puberty and fertility/infertility - Certain treatments may affect or delay the onset of puberty and affect fertility, specifically, some chemotherapy drugs and radiotherapy treatment to the brain, abdomen or pelvis (including testicles or ovaries). If your child has reached puberty at the time of treatment, tests can be conducted to determine any potential problems. Some treatments can affect your child's ability to have children of their own and this is difficult to determine until puberty. If your child has reached puberty, tests can be done to identify any problems. It can be very distressing to think that your child may not be able to have children and this knowledge will be difficult for your child too, as he or she moves towards adulthood. Having open and full discussions with your specialist will help.
Growth and development - Radiotherapy can have an adverse impact on your child's growth in two ways:
Intellectual development - Most children recover fully after treatment and return to school with no learning problems at all. Lengthy periods of time away from school during treatment may cause catching up difficulties but with some extra help, your child should be fine. Some children who have received treatment for brain tumours may develop learning difficulties as a result and will need special help at school. Seek advice from your medical team about arranging this help for your child.
Heart, lungs, kidney function - Both chemotherapy and radiotherapy can have effects on the efficiency of the heart and lungs and these effects may not become apparent until some time after treatment has finished. If your child is at risk, close monitoring during follow ups will reveal potential issues. Some types of chemotherapy drugs can cause problems for the kidneys but these are usually not severe or long lasting.
Development of a second cancer - It is possible, but extremely rare, for a child to develop a second cancer later in life as a result of treatment for the first. There are two main risk factors for this: A family may have an inherited risk factor for cancer (very rare) Some cancer treatments may increase the risk of other cancers Your specialist will discuss this with you.