Pediatric Chemotherapy

What is chemotherapy?

Chemotherapy (often called chemo) uses powerful drugs to kill cancer cells. Most chemotherapy medicines travel via the bloodstream and can target cancer cells all over the body.

Chemotherapy may be used to:

• Cure cancer or stop or slow its growth
• Prevent cancer from coming back after treatment
• Shrink tumors that are causing pain or other symptoms

Chemotherapy may be given on its own or combined with other cancer treatments. Sometimes patients receive chemotherapy before surgery or radiation therapy to shrink tumors so they're easier to remove or destroy. This is called neoadjuvant therapy. Chemotherapy can also be given after other treatments to kill any remaining cancer cells and prevent cancer from coming back. This approach is called adjuvant therapy.

Which cancers are treated with chemotherapy?

Chemotherapy is used to treat many types of cancer, including childhood cancers that begin in the following areas:

• Blood
• Kidneys
• Brain or other parts of the nervous system
• Ovaries or testicles
• Muscles
• Bones
• Liver
• Eyes
• Lymph nodes or other parts of the immune system

When determining whether chemotherapy is the best treatment option for your child, the care team will consider a number of factors. These include the type of cancer your child has, how advanced it is and your child's overall health.

What should I expect during my child's chemotherapy treatment?

Your child may receive chemotherapy in a hospital, clinic or even at home. There are many ways to give chemotherapy medicines:

• Oral. The patient is given a capsule, pill or liquid to swallow.
• Intravenous (IV). Chemotherapy is infused into a vein through a small needle or a thin, flexible tube called a catheter. In some cases, the care team sets up a catheter or port (a device placed under the skin and connected to a catheter) that can remain in place for a long period of time. This allows your child to receive chemotherapy without the need for repeated needle sticks.
• Injection. Your child receives a chemotherapy shot into the muscle or under the skin.
• Topical. A cream form of chemotherapy is applied to the skin.
• Intrathecal. Chemotherapy is injected into the tissues that cover the brain or spinal cord.
• Intraperitoneal. Chemotherapy medicines are put into the peritoneal cavity, the fluid-filled space that holds the stomach, intestines and liver.

Oral and intravenous chemotherapy are the most common methods.

Chemotherapy is often given in cycles. For example, your child may receive chemotherapy every day for a week and then have three weeks of rest. These four weeks are one cycle, and the cycle is repeated a set number of times. The rest periods give the body time to recover.

What are the side effects of chemotherapy?

Chemotherapy medicines work by targeting cells that grow and divide quickly. Cancer cells do this, but some healthy cells – such as the cells lining the mouth and intestines and those that make hair grow – do this as well. Chemotherapy may damage these healthy fast-growing cells. It may also destroy or slow the growth of the bone marrow cells that make blood cells.

Damage to healthy cells can cause a range of side effects. Your child may have many, some or no side effects, depending on the type and amount of chemotherapy drugs they receive and how their body reacts. Having side effects is not related to whether the chemotherapy is working.

Common side effects of chemotherapy are:

• Tiredness
• Nausea and vomiting
• Diarrhea
• Mouth sores
• Hair loss
• Increased risk of infections

There are ways to prevent and relieve many side effects, so let the care team know if your child is having them.

Side effects usually disappear or fade away when the child finishes chemotherapy. However, some children develop what are called late effects: Health problems caused by cancer treatment (or the cancer itself) that emerge months or even years later.

Late affects may involve:

• Tissues, organs and body functions
• Growth and development
• Thinking, learning and memory
• Mood and emotions
• Second cancers

Your child's risk of developing late effects depends on the type of cancer they had; how it was treated; and personal factors, such as their age at diagnosis and their health habits. It's a good idea to ask the care team about possible late effects from your child's treatment.

Late effects are one reason why childhood cancer survivors should have expert follow-up care. At UCSF Benioff Children's Hospitals, we offer this through our Pediatric Survivorship Program, where kids who went through cancer treatment receive medical monitoring, long-term specialized care, and health education.