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Disease & Conditions >>> Chemotherapy Articles & News
Chemotherapy For Childhood CancersChemotherapy is treatment with anticancer drugs. These drugs can be given orally (pills or liquids) or by injection. There are several types of injections: into a muscle (intramuscular, or IM), into a vein (intravenous, or IV), into an artery (intra-arterial), or into a cavity (intracavitary). Doctors also inject anticancer drugs into the spinal fluid (intrathecal, or IT) to treat brain tumors and to prevent central nervous system disease in leukemia. Often, special devices, such as catheters and pumps, are used to help deliver the drugs.
Insertion of the IV needle may be painful and, once in the vein, the drugs may cause an uncomfortable burning sensation. If the drug leaks from the vein, it may severely burn the skin, so care must be taken to make sure the IV line is securely in place, and the nurse or doctor must act immediately if the needle comes out of the vein.
Injections are generally given by physicians or nurses, but pills may be given at home. Taking chemotherapy pills can sometimes be a problem with younger children, but the tablets can be broken into smaller pieces for swallowing or powdered and mixed with apple sauce, jam, or custard. Older children, particularly adolescents, may wish to be responsible for taking and keeping track of their oral medication(s). However, it is still important for parents to be familiar with the medications and check to be sure they are being taken correctly.
Whether you or your child is responsible, you may want to develop a system for keeping track of when medications are taken. Marking a special calendar is one way of doing this.
Chemotherapy and Its Side EffectsOnce in the bloodstream, chemotherapeutic drugs are taken up by cells such as breast cancer that divide rapidly. In the cancer cell, the drugs act by interfering with the duplication and growth of the cell, primarily by preventing it from dividing or depriving it of a substance it requires to function, and the cell is eventually destroyed. Anticancer drugs can affect not only cancer cells but also other rapidly dividing normal cells such as those in the gastrointestinal tract, bone marrow, hair follicles, and reproductive system. Because of this, unwanted side effects of the treatment can and often do occur. Most side effects, however, are temporary.
One common side effect of chemotherapy is the reduction of the bone marrow's ability to produce the normal amount of blood cells. This may put your child at greater risk for anemia (if significantly fewer red blood cells are being produced), bleeding (if production of platelets is down), or infection (if the white cell count, particularly that of the neutrophils, is low). Doctors use colony stimulating factors (CSFs), hormone-like substances that regulate the production and function of blood cells, to promote the growth of infection-fighting white blood cells. Using CSFs lessens the risk of infection in patients with a low white blood cell count as a result of chemotherapy. In general, you or your child should be particularly alert to any signs of infection, bruising, or bleeding and notify your physician if they occur.
Many side effects from anticancer drugs are possible, and the following points are good to keep in mind:
1. Most side effects can be lessened by taking appropriate measures before, during, and after chemotherapy. (See the following section for how to control side effects.)
2. Side effects vary in severity and type from person to person and treatment to treatment. Your child will not necessarily have the same reactions as another child, but it is important for you to be aware of those problems that occur commonly so you can recognize them early.
3. Most side effects are reversible and will improve after the drug is stopped. Some, such as hair loss and bone marrow depression, may lessen or disappear even without discontinuing chemotherapy.
4. Side effects of chemotherapy may be classified as common or uncommon and as acute (immediate) or delayed (days to weeks after chemotherapy).
Common acute side effects:
Nausea and vomiting
Pain and burning at injection site
Less common acute side effects:
Allergic reactions (hives; rash; swelling of eyelids, hands, and feet; shortness of breath)
Drug extravasation (leaking of drug out of vein into skin)
Common delayed side effects:
Mouth soreness and ulcers
Constipation (especially with the drug vincristine)
Bone marrow depression (low blood counts)
Uncommon delayed side effects:
Jaundice (yellow tint to skin and eyes due to liver problems)
Hemorrhagic cystitis (bloody urine due to bladder irritation-especially with the drug cyclophosphamide)
Mental or nervous system changes (lethargy, tiredness, lack of coordination)
Each drug has the potential of producing its own side effects. Your doctor can tell you which ones your child is most likely to experience.
5. Daunorubicin or its chemical cousin, Adriamycin, may cause heart damage if the cumulative dose over time exceeds certain levels. Your physician should keep a careful record of the cumulative dose and should warn you if your child passes the usual limits.
6. Chemotherapy may cause some long-term side effects in several body organs. The physician can tell you more about these in relation to your child's specific care and treatment.
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