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Medical procedures, chemotherapy, and radiation
As cancer kid parents, we become well versed in a number of medical procedures and become familiar with the names of many chemotherapy drugs. The intention of this section is to provide an overview of these procedures and drugs, detailed information in some cases, and links to sources of more information when appropriate.
Diagnostic scans are in a separate section (see the navigation link to the right).
Note: This section has health/medical information. It was not written by a health care professional. The medical references are: the web sites listed in the text below at the individual topics, the author's personal experience as well as that of members of the online ALL discussion list, a booklet that Children's Hosptial sent home with the author's family, and the book:
- Childhood Leukemia: A Guide for Families, Friends, and Caregivers, 4th ed., by Nancy Keene, 2010.
The procedures below are common for many childhood cancers. Since they can be painful, please also see the section on pain control section.
A good reference for the following medical procedures: Duke's reference page on cancer tests and procedures.
A podcast: "Preparing Your Child for Medical Procedures" on the cancer.net website.
Spinal is a short cut term for spinal tap, and is also called LP (for lumbar puncture) or intrathecal (IT). Spinals are performed both to check the CNS fluid for cancer cells and to treat the CNS with chemotherapy.
In a spinal, the patient has a needle inserted into the spinal fluid, in the middle of the back just below the waist. A spinal can be painful, and the patient must hold very still during the procedure. After the procedure, they must lie flat for 30 minutes (to prevent a headache). Different patients tolerate spinals to different degrees.
Bone marrow aspirations, or BMA
Bone marrow aspirations (and bone marrow biopsies, below) are performed to check for cancer cells in the bone marrow. They are ordered periodically in the treatment of the leukemias. They are also ordered if something unusual is going on with a child's blood counts.
Bone marrow aspirations hurt more than spinals. In a BMA, a small sample of bone marrow is suctioned, usually from the hip, through a needle for examination under a microscope. BMA is removal of liquid marrow, as opposed to BMB which is removal of tissue. See:
Bone marrow biopsy, or BMB
A special needle is used to remove a small amount of tissue - a tiny "bone chip" - from the bone marrow for examination under a microscope. It can be done immediately following a BMA. BMB give a larger volume of sample to test.
Complete blood counts, or CBCs, are routine during treatment for childhood cancers. Blood counts are ordered to monitor a child's response to treatment and, in the leukemias, to make sure that there are no cancer cells in the peripheral blood. Blood counts are discussed on a separate page:
CT, MRI, and nuclear imaging are discussed on a separate ped-onc page:
Chemo drugs are administered in several ways: IV, IM, SQ, LP, or PO. IV drugs are usually given via a central line, discussed in a separate section on ports. Don't miss the link at the end of this section on how the doses are calculated from body surface area.
IV, or intravenous
IV means that something is administered directly into a vein. Patients with cancer can require frequent IV treatments, either chemo, transfusions, or antibiotics. Many children have central lines or ports, both to save them from frequent needle sticks and to prevent damage to veins.
IM, or intramuscular
These are shots given with an ordinary syringe directly into the tissue of a muscle (like, straight down into the top of the thigh).
These shots are given just under the skin.
LP, IT, or spinals
Shots that are administered into the spinal fluid. Please see the paragraphs on LPs in the medical procedures section.
This is: pills. A good way to remember PO is P stands for "by" and O stands for "mouth". (It's Latin: per os ) Similarly, NPO is when the patient can't have anything by mouth. Nothing to drink or eat, not even a sip! This would be before a procedure such as bone marrow aspiration, when an anesthetic is used.
How to get kids to take oral meds: The parents' views on the subject!!
Drug doses in protocols are often listed as an amount per BSA, or Body Surface Area. Here is a link to a page that calculates Body Surface Area and descriptive statistics plus medication doses.
The list of chemotherapy drugs used in childhood cancers is long. Usually, your oncologist will give you an information sheet on each drug that is given to your child.
Below are three sections, one that links to pages written by your author on ALL drugs and a second that contains annotated links to external web sites with good chemo drug information. The third section has links to web sites that might have information on new chemo drugs.
Patty's chemo drug pages
For the chemotherapy drugs used in the treatment of first-remission ALL in the late 1990s, your author prepared a treatise on the mode of action and possible side effects for each, using her expertise as a biochemist. Included on this non-ped-onc web site are:
- anthracyclines and dexrazoxane or Zinecard® as a heart protectant during anthracycline treatment
- 6-mercaptopurine and 6-TG
- prednisone and dexamethazone - steroids
- ara C - cytarabine also see the "Sea to Ara C" essay by Patty
- methotrexate also includes a summary of parents comments on experience with this drug (this is on this ped-onc site)
Links to other web sites that have chemo drug information
- MedlinePlus is a service of the US National Library of Medicine and NIH. The coverage is similar to the drug sheets given to you by the doctors. Although another site, cancerpage.com, takes you to the same drug sheets, it's nice because only cancer drugs are listed.
- Medscape is presented by WebMD. The drug info is a supplement to doctor's information; a good feature is the easy-to-find adverse drug-drug interactions.
- CancerBackup is a non-profit UK site for cancer patients. The drug info pages are informative; a good feature is the reference section for each drug.
- The Internet Drug Index, or RxList, gives some information about chemo drugs. The site is noteworthy because through the advanced search you to look up drug from imprint code on tablet. (If you find a pill and do not know what it is, you can look it up using the drug ID.)
- Pill Identifier Search by imprint, shape, or color.
- Chemocare.com. Scott Hamilton, the Olympic ice skater, started this after his dx with cancer. I like the site because it has good information and also a few paragraphs on how the drugs work.
- The Access Project Drug Index has only brief descriptions of each drug, but I am including it because it was one of the first sites that had drug info on the 'net. (The Access Project is a clearninghouse for AIDS issues.)
- HealthTouch Online
Links to web sites with information on new drugs
- Compassionate use section - On this ped-onc site.
The following links provide excellent information on radiation therapy.
- University of Pennsylvania. This is a pictorial view of the pediatric patient's flow through the Department of Radiation Oncology at the University of Pennsylvania. While this document is directed at children undergoing radiotherapy at the Hospital of the University of Pennsylvania, many of the procedures are very similar for other institutions.
- Cancer.gov fact sheets: A self-help guide and questions and answers.
Antibiotics are often prescribed throughout a child's cancer treatment to prevent a particular type of pneumonia. These antibiotics, how they work, why they are needed, when they should be taken, alternatives, and parents' comments about them are given on a ped-onc site:
These pages are intended for informational purposes only and are not intended to render medical advice. The information provided on Ped Onc Resource Center should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you suspect your child has a health problem, you should consult your health care provider.