Chemotherapy

Chemotherapy is a treatment which uses drugs to kill cancer cells.  

There are lots of different types of chemotherapy drugs, and exactly which drugs your child may receive will depend on what type of cancer your child has. Children will often be treated with a combination of different drugs. 

It can be used for different reasons, including to:

• Reduce the size of solid tumours before surgery – known as neoadjuvant chemotherapy
• Kill cancer cells in the body and reduce the chance of the cancer coming back – known as adjuvant chemotherapy
• Alleviate symptoms if a person cannot be cured of their cancer – known as palliative chemotherapy

Cancer is a disease when cells in the body multiply out of control. To do this, each cancer cell splits to form two new cells. Chemotherapy works by interfering with this process, which is known as cell division. 

Each type of chemotherapy drug works in a different way to block cell division, but they all result in the cells being unable to divide normally. This causes the cells to become damaged and die. 

Combinations of drugs are often given together, because by stopping cancer cells dividing in different ways, there’s a better chance of killing them. 

Chemotherapy which is injected into the blood or swallowed can travel through the bloodstream, which means it can reach cancer cells in most of the body. However, many of the normal therapeutic drugs cannot pass the blood-brain barrier which makes brain tumours harder to treat.

The effectiveness of chemotherapy depends on a lot of different factors, such as the type of cancer being treated or whether it has spread to other parts of the body. 

Some types of cancer are often cured by chemotherapy, but for other types it is unlikely that it alone will be able to cure. It may be given with other treatments to make them more effective. 

It’s difficult for anyone to predict exactly how a child’s cancer will respond to chemotherapy, or what will happen in the future after treatment. Your child’s oncologist will be able to give you information about how effective this treatment could be for your child.

Chemotherapy will usually cause unwanted side effects because the drugs affect normal cells as well as cancer cells. In particular, chemotherapy drugs affect parts of the body where cells multiply quickly. These include the lining of the mouth and gut, the bone marrow where blood is produced, and hair follicles. 

There are lots of possible side effects, some of which are more likely to happen than others. The side effects your child may experience depends on the combination of drugs they will receive. If your child is having high doses of chemotherapy, they may also experience more complex side effects.

Your child’s healthcare team can give you more specific information about the side effects your child may experience.

Short-term side effects of chemotherapy

Some side effects occur shortly after chemotherapy has begun and may last only a few weeks or months after treatment has ended. The most common short-term side effects include:

• Tiredness (fatigue) – either feeling tired all the time or tiring easily during normal activities.
• Feeling sick (nausea) and vomiting – caused by the effect that chemotherapy can have on the lining of the gut. Anti-sickness medication can be prescribed to help reduce this.  
• Hair loss – most commonly from the hair on the head, but sometimes children can lose eyebrows, eyelashes, and hair from the arms and legs as well. Their hair will almost always grow back after treatment ends, though it may be a different texture or colour to how it was before. 
• Reduction in the number of blood cells – chemotherapy can affect the bone marrow, where blood is produced. This can lead to side effects such as bruising and bleeding, and being more prone to infections. It may also lead to anaemia – a condition which can leave someone looking pale and feeling tired or short of breath.

Other short-term side effects may include mouth ulcers, changes to taste, sensitive skin, changes to hearing, or a tingling sensation in the hands and feet.

There are many more potential side effects than it is possible to list here. You can ask someone in your child’s healthcare care for more information about possible side effects, or if you or your child are concerned about anything. 

Long-term and late side effects of chemotherapy

Some side effects may last for months or even years after chemotherapy has ended. Other ‘late’ side effects may not appear until long after treatment has ended. These long-term side effects may include:

• Kidney, liver, or heart problems – some chemotherapy drugs may cause damage to these organs. The doctors will do tests to check that the kidneys, liver, and heart are working normally, if needed. 
• Infertility – this treatment can affect the testicles and ovaries, even in young children, which may reduce their fertility later in life. Egg or sperm banking might be advised for some children.
• Second cancers – for some chemotherapy drugs, there’s a very small chance that they may increase the chance that a child develops another type of cancer later in life. 

The healthcare team looking after your child will be able to provide more information about the specific side effects that they might experience, and what can be done to reduce the chance of them happening or reduce their impact.

Chemotherapy can be given to children in lots of different ways. The method will depend on the type of cancer being treated, and which drugs are being used. 

Chemotherapy into the blood

The most common way for chemotherapy to be given is into the blood through a vein (intravenous). This can be done either by injection with a syringe, or by infusion, using a device known as a drip.

To make it easier to give chemotherapy into the blood, your child may have a surgical procedure to put in a device known as a ‘central line’. This is a narrow tube which inserted into a major blood vessel in the chest. Chemotherapy drugs can then be delivered through ports connected to the tube. The central line is removed after the full course is finished. 

If your child is having chemotherapy delivered into the bloodstream, this will usually be done in hospital. The time needed to give the chemotherapy will depend on the type of drug used, but it can be anything up to a few hours. A child may only need to visit for the day, or they may need to stay in hospital for longer if their doctors need to monitor them. 

Chemotherapy is often split up into multiple doses, with a rest period between each dose to allow the body to recover. The number of doses your child needs will vary depending on the type of drug used and the type of cancer they have. Your child’s oncologist will be able to explain more about the exact schedule for the chemotherapy that your child will receive. 

Other ways to give chemotherapy

Chemotherapy may also be taken orally, as tablets or a liquid that is swallowed. These can often be taken at home.

There are other, less common methods for delivering chemotherapy drugs. These include injecting into a muscle (intramuscular), under the skin (subcutaneous), or into the fluid around the spine and brain (intrathecal).