There are some investigations that your child may require during their stay – certainly at the time when we are trying to establish a diagnosis, and later to establish whether the treatment is working. Some of the more common procedures are listed below: Blood Tests This is when staff take a sample of your child's blood, usually via a finger prick. Looking at your child's blood allows us to see what support they might need, for example a blood transfusion or supplements. Blood tests also help us to diagnose what is wrong with your child and identify the best way to treat them. Bone Marrow Aspirate Under anaesthetic one of our doctors will place a needle into a large bone where there is lots of bone marrow (where blood cells are made). They are able to draw back some of the marrow and that is sent to the laboratory. It will be looked at see what kind of cells are in there – most types of leukaemia can be diagnosed from this and some solid tumours if they have spread to this area. Lumbar Puncture Under anaesthetic one of our doctors will place a needle between two vertebrae in the back to get some cerebrospinal fluid (fluid that is all around the brain and spinal cord). Leukaemia can be present in the cerebrospinal fluid so it is tested to see what cells it has in it. Throughout treatment for leukaemia and some other forms of childhood cancer, lumbar punctures are done to give medications into the cerebrospinal fluid and to check for any disease. Scans There are many types of scans that we use to see how big a child’s tumour is and if it has spread. These include ultrasound scans, CT scans, MRI scans, Bone scans, MiBG scans as well as normal X-rays. If your child needs one of these, the procedure will be discussed with you and any other important considerations. Sometimes children need to drink a special fluid first (referred to as contrast), other times they have to fast. Some children will need sedation or a general anaesthetic for the scan. Once the diagnosis is established you will meet with various specialists to talk about what treatment options are available and the benefits and risks of those treatments as well as what the diagnosis means. It is a good idea to have a support person with you for these consultations as a lot of information is often given and it can be hard to take it all in. It is a good idea to write down a list of questions you might want to ask.

Treatments Most children will need some type of treatment for their cancer. For most children this will be chemotherapy – medicines that kill cancer cells. Some may also have radiotherapy – strong X-ray treatment that also kills cancer cells in a specific area. Surgery to cut out the area of cancer may also occur for some types of cancer. For more information on these different treatments, please see below. In New Zealand we belong to various groups of other paediatric hospitals that look after children with cancer – some in America, some in the UK, some in Australia and so on. All of these groups do studies to decide which is the best form of treatment for different types of childhood cancer. So the treatment your child gets is the combination of all that shared knowledge and what is considered the best in the world at the present time. Central Lines Many children will need to have a special tube inserted through their chest into one of the larger blood vessels so that they can receive all the treatment they will need. There are two main kinds – a Hickman line where you end up with one or two tubes coming out of your body, and a Portacath which is device that is placed under the skin and is accessed by a special needle when it is needed. These devices mean that children are not constantly having IV lines put in and they are put into very big veins which minimises the risk of problems with them. If your child is going to need one of these, it will be discussed fully with you and the advantages and disadvantages spelled out.

Chemotherapy is the use of medicines to kill or reduce the spread of cancer cells. Chemotherapy is given as cycles and may be given once a day, once a week or even once a month. This depends on the type of cancer and the best regimen (course) as determined by research. Chemotherapy, unlike radiation (which treats only the part of the body exposed to the radiation), treats the entire body. As a result, any cells that may have escaped from where the cancer originated are treated. A doctor who prescribes chemotherapy is known as a medical oncologist. Depending on what type of cancer you have and whether it has spread, your doctor may use chemotherapy to: Eliminate all cancer cells in your body, even when cancer is widespread Prolong your life by controlling cancer growth and spread or Relieve symptoms and improve your quality of life. Most chemotherapy drugs are given in one of the following ways: You might take a tablet or medicine orally (swallow) It may be given intravenously as an injection over a short period of time or as an infusion over a longer period of time. For these treatments you come into the Department usually for part of the day. Chemotherapy may also be given into a muscle or into the fat. Side effects Some people have no side effects at all from chemotherapy. Sometimes, however, chemotherapy will make you feel sick. As each type of chemotherapy has different side effects they will be discussed with you prior to starting any treatment so you know what to expect. Chemotherapy targets cells that are quickly dividing, whether it's a cancer cell or not. Therefore, some non-cancer cells that divide quickly are also damaged. The following is a list of some normal cells that divide quickly in the body and may be susceptible to the effects of chemotherapy: Cells in your hair (can cause hair loss) Cells of the skin and mouth (can cause sores in your mouth and dry skin) Cells in your stomach and intestines (can cause you to feel sick, vomit or have diarrhoea) Cells in your bone marrow. This is where your red and white blood cells are made. White blood cells fight infections, so temporarily you are very prone to these and they can become serious. You are also prone to viral and fungal infections. Loss of red blood cells can make you anaemic and tired. There are many medicines you can take to reduce or lessen these unwanted effects of chemotherapy. In some cases, chemotherapy may be the only treatment you need. More often, it's used in conjunction with other treatments, such as surgery or radiation, to improve results. For example, you may receive: Neoadjuvant chemotherapy. The goal of neoadjuvant therapy is to reduce the size of a tumour with chemotherapy before surgery or radiation therapy. Adjuvant chemotherapy. Given after surgery or radiation, the goal of adjuvant chemotherapy is to eliminate any cancer cells that might linger in your body following earlier treatments.

Radiation therapy uses special equipment to deliver high doses of radiation (beam of x-rays) to cancerous tumours, to kill or damage them so they cannot grow or spread. Normal cells may be affected by radiation, but most appear to recover fully from the effects of the treatment. Radiation therapy affects only the tumour and the surrounding area. Some cancers are very sensitive to radiation but not all. Radiotherapy is usually given in small doses over a period of time; this is known as a course. A doctor who manages your radiotherapy is called a radiation oncologist. Some common side effects of radiation treatment include: Fatigue or tiredness During the first 2 weeks of treatment, a faint and short lasting redness may occur on your skin. Dryness and peeling of the skin may occur in 3 to 4 weeks. The skin over the treatment area may become darker. Mucositis (inflammation of the lining of the mouth) is a temporary side effect that may happen when radiation is given to the head and neck area. Radiation to the head and neck area can increase your chances of getting cavities. Before starting radiation therapy, notify your dentist and plan for a complete check-up. When radiation treatments include the chest area, the lungs can be affected and you may experience shortness of breath or cough. Radiation to the abdomen may result in swelling and inflammation to the oesophagus (tube from throat to stomach) or intestines, causing nausea, vomiting, or diarrhoea.

Surgery is the oldest form of treatment for cancer. Surgery offers the greatest chance for cure for many types of cancer, especially those cancers that have not yet spread to other parts of the body. People often see just a surgeon for the surgical treatment of cancer and are then referred to an oncologist if other treatments are thought to add benefit. Preparing for surgery Both you and your doctor need to prepare before surgery to make sure you have the best chance for a good outcome. For your part, this involves knowing what to expect (as much as possible) and being comfortable that the decision you’ve made is the best one for you. Knowing as much as you can about your care plan can help reduce your level of stress. Informed consent is one of the most important parts of your preparation for surgery. It is a process during which you give your written permission for your doctor to perform surgery, after you have been informed of all aspects of the treatment.

It is very common for people with cancer to want to try other non-medical treatments such as diet or alternative/complementary medicines offered by other practitioners. It is helpful for your oncology team to know what other therapies you might be taking as sometimes there can be interactions with their treatment.