Cancer is a large group of diseases characterized by the development of an abnormal cell that does not carry on the normal activities of the original cell. Many of these abnormal cells have an unlimited life span, allowing them to make many copies of themselves; they may have the capability of spreading to other areas of the body. Cancers can have many complications that can ultimately cause the body’s organs to stop functioning properly, leading to serious consequences and death.
Acute Lymphocytic Leukemia (ALL), the most common malignant disease in children, is a cancer of the bone marrow, where blood cells (white cells that fight off infections, red cells that carry oxygen and platelets that prevent bleeding) are produced. When leukemia develops, the bone marrow is replaced with abnormal cells, preventing the production of normal blood cells and resulting in serious infections, fatigue and bleeding. Untreated, the disease is lethal. With the advent of powerful drugs (chemotherapy) that can destroy the abnormal cells, most children with leukemia are cured.
“Remission” implies that the child’s disease has been controlled and there is significant improvement. “Complete remission” implies that there is no obvious sign of the disease. This is not the same as “cure,” which is a term usually used only after a very long period of remission following the completion of all treatment.
This depends on the type of cancer. Between 75-80 percent of all children with cancer are cured — a percentage far better than with adult cancers. Each disease has its own prognosis, which depends on the presentation and biologic nature of the cancerous cell. Your doctor will be able to talk to you about your child’s illness and course of treatment.
Side effects depend on many factors, including the intensity of treatment, the medications used, the type and location of the cancer, the need for surgery or radiation therapy, and the duration of treatment. Generally, the more aggressive the disease, the greater the need for more intense therapy and the greater likelihood of side effects. Common side effects include hair loss, infections, bleeding, mouth sores, gastrointestinal complaints (such as abdominal pain, diarrhea or constipation), fatigue, nausea and vomiting.
It is always advisable to prepare each child for the required treatment before it is provided. The more the child knows and understands about what to expect, the better he/she is able to deal with the treatment and alleviate any fears. Most treatments are not painful and, when explained properly to a child, can help the therapy proceed smoothly.
Most children who receive chemotherapy experience some degree of hair loss. The amount of hair loss can be minimal, but many children lose all of their scalp hair, as well as some hair in other areas of the body. This side effect of chemotherapy is nearly always temporary, with most children re-growing their hair while still in treatment. Within a few months of completing all therapy, the hair usually grows back to normal. Radiation therapy can cause more long-lasting hair loss, depending on the site of radiation and the total number of treatments.
Most of the dramatic progress made in the treatment of childhood cancer has occurred because of cooperation among many national and international pediatric cancer centers. When a new, promising medication or treatment regimen is developed, the Children’s Oncology Group (COG) institutes a clinical trial, which is a scientific study comparing the new treatment with the current best therapy. This way, the science of treating childhood cancer is advanced, and we can determine what changes we can make to further enhance our cure rate. With the consent of the family, most children are entered into clinical trials because participation has many advantages, but it is not mandatory, and every child is treated with the best therapy available.
A protocol is the structured treatment, divided into several phases of therapy. Treatments often alternate between more intense therapy with more potential side effects, and easier treatments that allow the child to recover. These protocols are nearly always constructed at the national level as the most effective therapy with the fewest long term complications.
Your child’s pediatrician plays a critical role in the treatment team. While chemotherapy and its complications are usually managed by the Center’s specialists, the pediatrician can often help with physical exams and blood counts to save you a trip into our office. The pediatrician’s input is invaluable, and he/she is always kept abreast of the patient’s progress through letters detailing all treatments, exams, and complications.