Children treated at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center receive the combined strengths of two internationally renowned Harvard teaching hospitals. A single team of experts delivers care at a Boston campus connected by pedestrian bridges, with inpatients treated at Boston Children's Hospital and outpatients at the Jimmy Fund Clinic at Dana-Farber Cancer Institute.
We base every child's specific course of treatment on several factors, including:
- age, overall health and medical history
- type, location and size of the tumor
- genetic changes, for some tumors
- extent of the disease
- tolerance for specific medications, procedures or therapies
- how your child's doctors expects the disease to progress
There are a number of treatments we may recommend. Some may help to treat the tumor while others are intended to address complications of the disease or side effects of the treatment.
Surgery has multiple roles in the diagnosis and treatment of some types of pediatric cancers, including biopsy, tumor removal and placement of long-term intravenous lines.
Tumor specimens are examined by our pathologists to determine the exact diagnosis.
When possible, it’s best to completely remove the entire tumor. In general, the more of the tumor that is removed, the greater the chance for survival.
Using the latest molecular profiling techniques, some tumors (including brain tumors) are now processed to identify abnormal genes within the tumor.
Our doctors use precisely targeted and dosed radiation to kill cancer cells and control the growth of the tumor. Depending on the type of the cancer, some patients are treated with targeted focal radiation therapy. In those tumors that may have spread, radiation therapy can sometimes be delivered to larger areas of the body.
Chemotherapy (or chemo) refers to a group of drugs that interfere with the cancer cell’s ability to grow or reproduce.
- Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
- Often, a combination of chemotherapy drugs is used.
- Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. It may be given:
- orally, as a pill to swallow
- intramuscularly (IM), as an injection into the muscle or fat tissue
- intravenously (IV), directly to the bloodstream
- intrathecally, with a needle directly into the fluid surrounding the spine
Chemotherapy also refers to the use of drugs that are made to specifically inhibit a genetic pathway required to keep the tumor going. These drugs are often referred to as “targeted” therapy. Rather than the standard side effects associated with radiation and chemotherapy (loss of hair, nausea and vomiting, damage of the blood producing cells), targeted drugs tend to be better tolerated.
Side effects of chemotherapy and radiation therapy
While chemotherapy can be quite effective in treating certain cancers, the drugs affect both cancerous and non-cancerous cells. In the same way, while radiotherapy can be quite effective in treating certain cancers, the radiation damages both cancerous and non-cancerous cells. Because of this, there can be many undesirable side effects during treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and in some cases prevent these symptoms from occurring.
Stem cell transplant
A stem cell (bone marrow) transplant is an infusion of healthy blood forming stem cells by IV (through a needle into a vein) to treat certain types of cancer, blood disorders and other conditions. Blood forming stem cells are a special type of cell found in the bone marrow that can form any type of blood cell: red blood cells, white blood cells and platelets. This is different from embryonic stem cells, which can form any type of cell in the body.
The cells for a stem cell transplant (also called a bone marrow transplant) can come from a related donor—usually a sibling, an unrelated donor—or the patient himself. The stem cells are infused into the bloodstream and travel to the bone marrow where they begin to make new blood cells.
A stem cell transplant can be used to:
- replace diseased, non-functional bone marrow with healthy functioning bone marrow (for conditions such as aplastic anemia and sickle cell disease)
- replace bone marrow and restore its normal function after high doses of chemotherapy or radiation (for diseases such as leukemia, lymphoma and neuroblastoma)
- replace bone marrow with healthy functioning bone marrow to prevent further damage from a genetic disease (such as Hurler's syndrome and adrenoleukodystrophy)
Stem cell transplantation has risks involved, some of which are life threatening. The risks and benefits must be weighed and thoroughly discussed with your child’s stem cell transplant team prior to the procedure.
Children receiving a stem cell transplant are treated through our Stem Cell Transplant Center, one of the largest and most experienced stem cell transplant programs in the United States.
Will my child be OK?
Today, the five-year survival rate is 84 percent for all childhood cancers combined. However, it’s important to understand that your child’s short-term health and long-term survival varies greatly depending on the specific type of cancer. Prompt medical attention and intensive therapy are very important, as is continuous follow-up care. (Read Five Things Parents of Children Should Know.)
Your child’s prognosis greatly depends on:
- the type of cancer
- the extent of the disease
- size and location of the tumor(s)
- presence or absence of metastasis (spread to other areas in the body)
- the cancer’s response to therapy
- your child’s age and overall health
- your child’s tolerance of specific medications, procedures or therapies
- new developments in treatment
New methods are continually being discovered to improve treatment and to decrease side effects.
What kind of long-term follow-up care should my child get?
Some children who are treated for pediatric cancer will experience significant long-term problems as a result of their treatment. Children require ongoing specialized care to monitor for signs that the cancer may have returned and manage side effects of treatment.
Because of the possible long-term problems and the risk of a cancer returning, a child usually returns to us for care for years after she is initially treated for cancer.
One of the major goals of the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is to maximize your child’s long-term health. We do this in many ways, including attending to your child’s:
- intellectual function and school performance
- endocrine evaluation and treatment
- neurologic assessment
- psychosocial care
- hearing and vision
To monitor for recurrence and address short and long-term side effects of treatment, children treated for pediatric cancer receive follow-up care at our cancer survivorship clinics.
The long-term outcome for children with pediatric cancer is improving. How well each child does depends on various factors, including the type of tumor and whether the disease has spread to other parts of the body (metastasized) by the time of diagnosis. Our research continues to help us understand the causes of cancer so we can develop more targeted, effective therapies.
David B. Perini Quality of Life Clinic
To assist the many children successfully treated for malignant tumors, we have an established multidisciplinary, long-term follow-up program through Dana-Farber Cancer Institute's David B. Perini Quality of Life Clinic.
This program helps survivors of all ages address the medical, psychological and social consequences of their diagnosis and subsequent treatments. Childhood cancer survivors of any age are invited to visit our clinic, regardless of where they were initially treated.
Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic
For survivors of childhood brain tumors, we have established the Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic at Dana-Farber Cancer Institute. Through this service, your child will be able to meet with his neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit:
- Our pediatric brain tumor survivorship clinic is held weekly.
- In addition to meeting with your pediatric neuro-oncologists, neurologist and neurosurgeon, your child also may see one of our endocrinologists and/or alternative/complementary therapy specialists.
- School liaisons and psychosocial personnel from the pediatric brain tumor team are also available.
- If your child needs rehabilitation, he also may meet with speech, physical and occupational therapists during and after treatments.
Supportive and palliative care
When necessary, our Pediatric Advanced Care Team (PACT) is available to provide supportive treatments intended to optimize the quality of life and promote healing and comfort for children with life-threatening illness. In addition, PACT can provide psychosocial support and help arrange end-of-life care, should that be necessary.
Resources and support
In addition to providing medical care, we strive to also meet all of your family’s emotional and quality-of-life needs. Our patient and family support services will help address many of your needs and concerns. Read about our resources and support services here.