Treatment

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Treatment and care of children with cancer is usually provided by a team of health professionals called a multidisciplinary team. Members of this team are specialists in children’s cancers – they understand the differences between children’s cancer and adult cancer, and each team member brings different skills in managing care to meet the needs of both you and your child.

The team will be led by a childhood cancer specialist (paediatric oncologist). Other members of the team depend on the age of your child and their type of disease, and may change over time as your child’s needs change. A list of team members who might make up the multidisciplinary team can be found in The treatment team.

Treatment for bone tumours depends on the age of your child, the stage of the disease, the biological features of the cancer and other factors identified during diagnosis. Treatment will be tailored to your child’s particular situation, and may involve one or more of the following (see How is cancer treated for more detail).

Surgery

Your child is likely to have surgery at some point in their treatment for a bone tumour.

For bone tumours in the arms or legs, doctors can usually remove the tumour and some of the surrounding healthy tissue, and replace it with a graft or implant – this is called limb-sparing surgery. Most implants can be made longer as your child grows, without needing further surgery. After limb-sparing surgery, your child will have intensive rehabilitation and physical therapy to make sure the limb continues to work normally. If the surgery was on a leg, it can take many months for your child to learn to walk again.

In some cases, doctors may need to remove (amputate) all or part of the arm or leg. Your child will be fitted with an artificial limb or prosthesis, and will have intensive rehabilitation therapy to help them learn to use it.

Tumours in other bones (such as the spine, skull, chest or hips) where surgery might not be possible are usually treated with a combination of chemotherapy and radiation therapy.

Chemotherapy

Chemotherapy uses anti-cancer medicines to destroy cancer cells. It is often given as a combination of medicines to try to prevent the cancer cells from becoming resistant to just one or two medicines.

Chemotherapy medicines are given together in courses, often over a few days. Once the body has recovered from the side effects, the next course is given. Most children receive multiple courses of chemotherapy.

Chemotherapy to treat bone tumours is usually given both before surgery (to shrink the tumour and make it easier to remove) and after surgery (to destroy any remaining cancer cells). Chemotherapy is usually part of treatment for all children with Ewing tumours, and may be given in combination with surgery and radiation therapy.

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy X-rays or other types of radiation to destroy cancer cells or stop them from growing.

Osteosarcoma cells are not easily destroyed by radiation, so this treatment is not used in all cases of osteosarcoma. Radiation therapy might be used to treat osteosarcoma in combination with other treatments such as chemotherapy, or on its own if a small amount of cancer is left after surgery. It might also be used to relieve symptoms of bone tumours (such as pain and swelling) if surgery is not a good option, or if the cancer has come back.

Ewing tumours can be treated with radiation therapy either alone or along with surgery, and usually in combination with chemotherapy.

Radiation therapy can have long-term side effects in children. If radiation therapy is included in your child’s treatment, special care will be taken to reduce these risks.

Targeted therapy

Some medicines can target the specific changes in cancer cells that make them different from normal cells. This means that they work differently from standard chemotherapy, and they usually have fewer side effects, or the side effects are not as severe.

Clinical trials are exploring the use of targeted therapies to treat osteosarcoma and Ewing tumours.

published: Sunday, 23 August, 2015