Treating childhood cancer


smiling boy
The outlook for children with cancer has improved dramatically over the last fifty years.

In the early 1960s, three quarters of children diagnosed with cancer died. Today, more than three quarters of children survive.

However this high overall survival rate masks wide variation between different types of cancer.

Retinoblastoma, a cancer of the eye, can now be cured in almost every young patient. Neuroblastoma has the worst overall survival of the 10 main diagnostic groups – at 67 per cent. Within the main diagnostic groups, there are some rare sub-types of cancer that still have appallingly low survival rates. High grade astrocytoma, a type of brain tumour, kills more than 80 per cent of young patients within five years.

The treatments used for childhood cancer are toxic, unpleasant and uncertain. As well as finding new ways to treat those forms of cancer which still have a poor outlook, a major challenge facing doctors today is how to make treatments safer and minimise the risk of treatment-related harm in young patients.

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.

Clinical trials

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

There are several different types of treatment used for childhood cancer including surgery, chemotherapy, radiotherapy, immunotherapy and stem cell transplantation. Often a combination of these treatments is used.

Surgery

Surgery plays a very important part in the treatment of cancer. Surgery aims to remove the tumour during an operation.

Depending on the size and position of the tumour in the body, surgery may be the first part of treatment. 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.

Chemotherapy

Chemotherapy is the term used to describe the drugs that a child is given to kill the cancer cells.

These drugs may be taken orally (by mouth), intravenously (injected directly into a vein), intramuscularly (injected directly into the muscle) or intrathecally (directly into the spinal fluid)

Radiotherapy

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. The treatment is usually given as a series of short daily sessions over a few weeks.

Radiotherapy is also used in children who require a stem cell (bone marrow) transplant. Radiotherapy is used to destroy their existing bone marrow prior to transplantation.

Proton beam therapy 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 will open in the UK in 2015.

Immunotherapy

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.

Read more: Stem cell transplantation

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.

Read more: Side effects of treatment | Long-term and late effects of treatment

Complementary therapy

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.

Read more: Complementary therapy

Further information

For information on how specific childhood cancers are treated, visit the individual Types of childhood cancer pages. 

Read more: Information on cancer types | Commonly used terms in treatment

Chemo to the Rescue – a children's book on leukaemia

Macmillan Cancer Support – for detailed information on childhood cancers and their treatment

Children’s Cancer and Leukaemia Group – for a range of useful publications on childhood cancer
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