It is a term applied to medications used to treat cancer. Chemotherapy is systemic, which means that the chemotherapy reaches most of the body through the bloodstream. If cancer cells are hiding out in different places of the body, chemotherapy can reach most of these areas and kill the cancer cells.

Chemotherapy drugs can’t tell the difference between normal cells and cancer cells. As a result, many of these drugs affect normal cells and cause side effects.

Chemotherapy has to be carefully planned so that it progressively destroys the cancer cells during the course of treatment, but not the normal cells and tissues. It may be given intensively in high doses over a short period, or it may be given in lower doses over a longer period.

Chemotherapy drugs leave the body in body fluids. It is very important for your own protection that you wear gloves when handling body fluids during the time that your child is receiving chemotherapy and for a short while afterwards.

Radiotherapy uses high energy x-rays which destroy cancer cells. Before treatment begins, it is necessary to undergo what is known as ‘planning’.

This allows the radiotherapist to work out the exact position in which to place your child, and ensures that treatment is given to exactly the right place to kill cancer cells each time.

Radiotherapy is painless and usually only takes a few minutes each day. During the treatment the child must lie perfectly still. This is to ensure precise delivery of the radiotherapy. Sometimes an anaesthetic is needed.

Radiotherapy is given daily and the duration of the course of treatment is variable according to your child’s type of cancer. Your radiotherapist will discuss the side effects of radiotherapy prior to your child’s treatment.

Children undergoing treatment for cancer will often require repeated blood tests and insertion of cannulas to enable chemotherapy and other drug treatment to be given. Even though doctors and nurses are very experienced at taking blood and inserting cannulae, it can sometimes hurt and is not a pleasant experience for the child.

Many children therefore have a special device called a central line, which is used to take samples of blood and to administer chemotherapy and other drugs (such as antibiotics). It can also be used to give blood or platelet transfusions.

A central line is a fine plastic tube, which is inserted into a vein in the child’s chest. This procedure is carried out under a general anaesthetic. When inserting the line, the surgeon makes a small cut into a vein in the neck and feeds the line down towards the heart. The other end is then tunnelled under the skin to emerge on the front of the chest as an external line.

Although inserted in a similar fashion, some lines do not come out through the skin. Instead, the line ends in a reservoir or ‘port’ that is buried under the skin As nothing comes out through the skin ports can be easier to look after but they still need to be accessed with a needle.

Central lines can remain in place for many months and are a very good way of avoiding the discomfort of repeated injections. However, the main risk associated with central lines is infection. Anytime a foreign body dwells inside the blood vessel, an increased risk of infection exists. Most of these infections are caused by skin bacteria. Attempts will be made to clear the infection with antibiotics, but sometimes the catheter may have to be removed.

Clotting inside the catheter, or outside around the catheter tip, may cause blockage of the catheter lumen or obstruction of the blood vessel the catheter is in. It may be impossible to draw blood from the catheter, or even to flush it or use it for infusion.

Heparin or urokinase may be tried to clear the blockage. Central lines can also slip out or get dislodged but this becomes less likely the longer the duration from insertion.

Your nurses and doctors will advice you on the care for your child’s central line.

To find out whether cancer cells have passed into the cerebrospinal fluid (CSF) which surrounds the brain and the spinal cord.

This test involves putting a needle into the spine and letting some of the fluid drain out.

Your child will be asked to lie on his/her side and to curl up slightly so that his/her back rounds towards the doctor.

A fine needle is inserted into his/her back between two vertebral bones in the lower spine and a few drops of the fluid are removed. Sometimes drugs are injected into the fluid at the same time as part of the treatment. This test is done under sedation or under local anaethetic (EMLA).

X-rays:

Ultrasound:
Ultrasound waves are sound waves that the human ear cannot hear. Ultrasound scans are completely safe and are used particularly to look at the abdomen and heart.

Bone scan:
If your child has a cancer which has spread to bone, a bone scan will show how much of the bone is affected. Small doses of a radioactive substance can be injected into a vein to show up abnormal areas in the bones.

CT (Computerised Tomography) Scan

A CT (computerised tomography) scanner is a special kind of X-ray machine. It is used for taking pictures of soft body tissue.

Pictures of the part of the body to be scanned are taken from different angles by a camera in a rotating drum instead of sending out a single X-ray through the body as with ordinary X-rays

MRI (Magnetic Resonance Imaging)

MRI scanning builds up a series of cross section pictures of the body. The process is harmless and painless. But the machine is noisy and, looks frightening as your child has to lie in a tunnel.

He / She may be given a sedative or general anaesthetic to make sure that he lies still during the scan.

Nausea and vomiting can range from slight to severe. Your child’s doctors will prescribe anti-emetics (to stop the nausea and vomiting) when he/she is on chemotherapy. Your child may be on more than one type of anti-emetics during chemotherapy. If your child vomits too many times, he/she can get dehydrated.

These suggestions may help your child when he/she is nauseated:

• Do not give his/her favourite foods
• Do not eat fatty, fried, very spicy or very sweet foods
• Eat cooked foods that are at room temperature. The smells from hot foods may make your child’s nausea worse
• Keep your child’s mouth clean; brush at least twice a day
• Do not force your child to eat

Infection is an important problem of cancer treatment. Your child may be at risk for infection due to the cancer itself affecting his/her body’s own defences (leukaemia/lymphoma) or from the side effects of treatment (chemo/RT) affecting the production of white blood cells (WBC).

The body has many ways to protect us from infections. Skin, acid in the stomach and coughing are some ways that the body protects itself. WBC destroy germs after they enter the body.

Neutrophils are the special WBCs that fight infection. When the number of neutrophils (ANC) are <1.0 x 109/l, you are said to be ‘neutropenic’ and very prone to infections. If you are neutropenic for only a few days, the risk of infection is small. If the neutropenia lasts for a week or longer, the risk of infection is very high. Even mild infections can cause life-threatening illness.

Infection cannot be completely prevented. However, there are many things you can do to decrease the risk of infection in your child.

• Avoid large crowds or anyone with signs of infection.
• Avoid contact with people with contagious diseases such as flu, measles or chicken pox
• Keep your child clean by bathing daily and washing hands after using the bathroom.
• Keep your child’s mouth very clean by brushing his/her teeth
• Avoid uncooked vegetables. Fruits need to be washed thoroughly and peeled. Avoid grapes as far as possible as they are difficult to wash and peel
• Avoid constipation and straining to have a bowel movement
• Remove fresh flowers and live plants from the rooms as they may harbour fungus

Cancer and cancer treatment can sometimes cause mucositis (a sore mouth). This may cause your child to have a reduced oral intake and be dehydrated. There are things you can do to help your child’s mouth heal and to make it feel better.

• Examine your child’s mouth at least once daily. Look for any ulcers, sores, red areas, or white patches. Report changes and any mouth pain to your doctor or nurse.
• Keep your child’s mouth clean and moist. Clean your child’s teeth even though it is sore. If it hurts to use a soft brush, use an oral swab.
• Ensure your child rinses his/her mouth frequently with salt water or Sodium Bicarbonate solution (can be obtained from the ward).
• Before meals and as needed for comfort, apply an anaesthetic (a numbing agent), such as ‘Lignocaine’, to sore areas of your child’s mouth. This will numb his/her mouth and make eating easier.
• Eat frequently and in small amounts.

There are other side effects that are specific to the chemotherapy your child is on. This will be explained to you during your treatment.