What is chemotherapy?

Chemotherapy is the term given to the treatment of cancer using strong drugs called cytotoxics (meaning cell poisons). Chemotherapy is used as a complimentary tool to eliminate remaining cancer cells in the body. Chemotherapy is used alone or combined with surgery and/or radiotherapy. Chemotherapy drugs injure or kill body cells. Chemotherapy attacks cancer cells but will also affect some normal cells and can cause side effects. These side effects are usually temporary. Different drugs have different side effects and children can react differently to the same cytotoxic drug.

How is chemotherapy given?

Chemotherapy can be given in many ways. How chemotherapy is given depends on the drug and the type of cancer. In children, it is usually given by tablets or by injection into the blood, tissue or spinal fluid. The drugs enter the bloodstream and work to kill cancer in parts of the body to which the cancer has spread. In preparation for chemotherapy, children will have 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 bloodstream for giving the chemotherapy and for taking blood samples, and protects the child from regular injections. There are two types of access most commonly used:

• Central venous catheter (CVC) - a small flexible plastic tube inserted into a large vein through which drugs and fluids can be given and blood specimens taken painlessly. When it is not being used for treatment purposes it is discreetly tucked away close to the skin and protected with a small dressing.
• Port - a central line surgically inserted under the skin, usually the chest wall. It provides quick and easy access to the blood and can be left in place for a long time.

Both are fitted during a small operation using a general anaesthetic.This will remain in place until all the chemotherapy is finished.

Depending on the treatment regime prescribed, the child will either be admitted to the ward for several days every two to three weeks or will receive treatment as a day-case in the day oncology unit. The duration of chemotherapy treatment and type of drugs that are used depend on the type of cancer the child has and his or her response to the drugs. Every child's treatment differs, so a child may receive daily, weekly, or monthly chemotherapy treatments. The doctor may also recommend cycles of treatment, which allow the child's body to rest between periods of chemotherapy treatment.

Side effects of chemotherapy

Many of the medications used in chemotherapy also carry the risk of both short-term and long-term problems. Short-term side effects include nausea, vomiting, hair loss, fatigue, anemia, abnormal bleeding, and increased risk of infection due to destruction of the bone marrow, as well as kidney damage and menstrual irregularities. Some drugs carry a risk of bladder inflammation and bleeding into the urine, hearing loss, and liver damage. Others may cause heart and skin problems. Longer-term effects can include infertility, growth problems, organ damage, or increased risk of other cancers.The medical staff may prescribe other medications to counteract as many of the side effects as possible.

Precautions with chemotherapy

For 2 - 3 days after chemotherapy, small amounts of some drugs are excreted in urine, faeces or vomit. The amount of drugs excreted will vary depending on the drug given.

• Urine, faeces and vomit can be disposed of in the toilet. Double flush with the lid down to avoid splashing.
• Soiled disposable nappies should be placed in a plastic bag and disposed of in the normal way.
• Other soiled items such as cloth nappies, linen and clothing can be washed with lots of detergent and water.
• Good general hygiene is recommended after handling urine, faeces and vomit. Washing hands is the single most important measure.
• Pregnant women should wear gloves when handling waste.

Sometimes chemotherapy can be given at home. Oral chemotherapy is often given at home.