How Pediatric Cancers Are Treated

Surgery

There are several different types of surgery performed at Memorial Sloan-Kettering, and almost every patient who comes to the hospital typically will undergo at least one type of surgery. The three main types of surgery are biopsies, line placements or removals, and the actual surgical removal of the tumor.

Biopsies

A biopsy is usually necessary for diagnosis. There are different types of biopsies including surgical biopsy.

A surgical biopsy may be excisional, incisional, or needle. In an excisional biopsy, the surgeon removes the entire tumor, along with some surrounding healthy tissue in order to compare the different types of tissue and determine whether the tumor cells have been completely removed. During an incisional biopsy, a portion of the tumor is removed. If cancer is present, the entire tumor may be removed immediately or during another operation. A fine needle aspiration (FNA) is when a small sample of a tumor is aspirated (removed) with a fine needle, and the contents are sent to the pathology lab for diagnosis.

Line and Port Placements

Another common type of surgery performed is the insertion or removal of a long catheter that is set into a large vein to deliver medicine or take blood samples; external lines, such as either the Broviac or the Hickman catheter, are positioned outside the skin. While internal lines such as a Port-a-Cath or Mediport are placed under the skin.

Surgery for the insertion or removal of these catheters is always done while the patient is under anesthesia.

Usually, before a patient begins treatment, a central line is inserted. Many patients are happy to have central lines because it eliminates the need for doctors and nurses to access their veins, which can become painful. When the catheter is accessed, the procedure is usually not painful. At the completion of treatment, the central line is removed from the patient.

Tumor Removal

When a surgeon removes the tumor, he may also remove some of the surrounding tissue and lymph nodes close to the tumor. All surgeries are done while the patient is under anesthesia.

Chemotherapy

Chemotherapy is the use of medications to treat cancer. These drugs are sometimes given orally, sometimes through a vein, or sometimes by injection. Chemotherapy may consist of just one drug, or a combination of drugs, whichever method is the treatment standard and will kill the cancer cells in the most effective way.

Chemotherapy is usually given in cycles: a treatment period (one or more days when treatment is given) followed by a recovery period (several days or weeks), then another treatment period, and so on.

However, sometimes chemotherapy is given intrathecally. In this treatment approach, the anticancer drugs enter the spinal fluid through a needle placed in the spinal column or a device placed under the scalp. These procedures are done while the patient is under anesthesia.

Monoclonal Antibody Therapy

Monoclonal antibody therapy is another way to treat cancer, specifically, neuroblastoma. A person's immune system makes antibodies to attack germs such as bacteria or viruses, but it will not attack neuroblastoma because the tumor is part of our own bodies. An antibody that attaches to neuroblastoma can be made in a laboratory and then given intravenously to a patient. This antibody will circulate in the bloodstream until it finds and attaches to a neuroblastoma cell. And then the patient's own immune system will attack and kill that neuroblastoma cell.

Radiation Therapy

Radiation therapy uses high-energy particles or waves, such as x-rays, to destroy or damage cancer cells. This form of therapy can be used at various phases of cancer treatment. In early stage cancers, radiation therapy may be used to attempt to cure or control the disease. It can also be used before surgery to shrink a tumor, or following surgery to prevent the cancer from returning. In advanced cancer, radiation therapy may be used to treat symptoms that are caused by the cancer, such as pain.

Immunotherapy

Immunotherapy stimulates or supports the body's immune system to fight cancer and can protect the body from certain side effects of cancer treatment.

Transplant

The main agents of the body's immune system are red blood cells, white blood cells, and platelets. Stem cells are blood cells that have not differentiated to become a specific kind of blood cell. All blood cells begin as undifferentiated stem cells. Many of these remain in the bone marrow where they can become any type of blood cell the body needs, but some go into general circulation through the blood vessels.

If you have a type of cancer that responds to high doses of chemotherapy, radiation, or both, one of the side effects of treatment is that your bone marrow will be suppressed. To help bone marrow cells recover from these intense treatments, bone marrow transplants are performed. There are two common types of transplants: autologous and allogenic.

In an autologous stem cell transplant, stem cells are harvested from your own bone marrow, and then later infused back into your bone marrow, after treatment with high doses of chemotherapy and/or radiation. These stem cells rescue your immune system, which has been destroyed by the cancer treatments you received.

During an allogenic stem cell transplant, stem cells are obtained from the marrow of a donor (while he or she is under general anesthesia), and then the stem cells are transplanted into your bone marrow. This occurs after you receive high doses of chemotherapy and/or radiation.