Chemotherapy in childhood

This page explains about chemotherapy in childhood what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this treatment.

Chemotherapy is a treatment regime that involves the use of a group of strong drugs, called cytotoxic drugs.

These drugs are used to treat serious diseases such as cancer. They work by destroying rapidly growing cancer cells in the body.

There have been tremendous advances in chemotherapy in recent years. Fifty years ago a child diagnosed with leukaemia, the most common childhood cancer that affects the bone marrow and blood, usually died within a few weeks. But today, four out of five children make a complete recovery.

Many children who receive chemotherapy will recover from their cancer without suffering any long-term side effects. However, other children who need to have chemotherapy do suffer from serious, and sometimes lasting, side-effects from the powerful drugs that are needed to save their lives.

Normally, the body’s cells divide and function in a smoothly co-ordinated way. But when a child has cancer, the cancer cells divide rapidly.

Cytotoxic drugs are designed to target these rapidly dividing cancer cells, interfering with the way that they multiply. Normal cells are also affected by chemotherapy but they are able to recover more quickly than the cancer cells and therefore damage to them is short term.

Chemotherapy can be given in different ways, depending on the type of cancer a child has and the type of drugs that are going to be used.

The most common ways to administer chemotherapy are orally (by mouth) as either tablets or liquid, or by injection directly into the bloodstream.

In preparation for chemotherapy, a child will often have a central line inserted. This involves a small surgical procedure to insert a long-term narrow tube, which is threaded into a major blood vessel. This provides easy access to the blood system for giving chemotherapy and for taking blood samples, and protects the child from regular injections.

Initially, treatment is usually given at a specialist centre. There are around 20 specialist children’s cancer centres in the UK. The specialist team caring for a child will follow a treatment protocol according to the form of cancer a child has. Later, treatment may be given in partnership with a local hospital.

While killing off cancer cells, chemotherapy does unavoidably cause damage to other healthy cells in the body. The healthy cells which naturally divide most rapidly are most likely to be affected. These are the cells that line the bowel, hair-producing cells, the sex glands and also the cells in the bone marrow that produce blood.

Side-effects vary from child to child depending on the type of cancer they have, the dose of chemotherapy they have and the type of treatment regime that receive.

The most common are:

• Nausea and vomiting: Usually occurs when the drugs are given, and for a few days afterwards. Anti-sickness medications are very effective and can be given to minimise the effects.

• Hair loss: Usually affects the hair on the head, but can also affect the eyebrows (and in older children pubic hair). Hair usually falls out a week or two after treatment, then grows back within a few months of treatment finishing.

• Bone marrow suppression: chemotherapy affects the number of blood cells produced in the bone marrow. The three main groups of cells that are produced are red cells (which carry oxygen), white cells (which fight infection) and platelets (which play an important role in blood clotting). A fall in the number of red cells results in anaemia, and means a child looks pale and feels more tired than usual. A low white cell count can increase child’s risk of suffering from infections. And a lack of platelets can result in a child bruising more easily than usual.

Depending on the type and intensity of cytotoxic drugs needed, there may be other side effects too which can be longer lasting. These can include kidney problems and hearing problems, and an impact on a child’s future fertility.

It is important to speak to the doctors, nurses and pharmacists involved in your child’s care for more detailed advice on these issues.

Much research is currently underway which aims not only to improve children’s survival rates from cancers still further, but also to reduce the impact and severity of the side effects of chemotherapy.