Chemotherapy (chemo) is the use of medicines to treat cancer or kill cancer cells. Chemotherapy has been used for many years. It's one of the most common treatments for many types of cancer. The groups of cancer therapy medicines work in different ways to fight cancer cells. For example, some interfere with the ability of cancer cells to grow or reproduce. It's common for cancer to be treated with more than one medicine at a time. Chemo may be used alone or used with other treatments, such as radiation or surgery.

Your child may need chemo to:

• Treat a certain type of cancer
• Decrease the size of a tumor before surgery
• Help other treatment work better, such as radiation
• Reduce pain, or other symptoms, and improve quality of life

Chemo can work very well to treat cancer. But while these medicines kill cancer cells, they can also damage healthy cells. The damage to healthy cells causes side effects. Your child's cancer doctor (oncologist) will keep track of your child very closely for side effects. They will prescribe medicines or other treatments and give you instructions to help reduce the side effects.

There are many chemo medicines. Some are used more often to treat cancer in children. Side effects of chemo vary by the dosage and medicine used. There will be more side effects if more than one chemo medicine is given. Ask your child's doctor what side effects you can expect, when to report to them, and how to manage them.

Side effects of busulfan (given by mouth or I.V.) can include:

• Abnormal heartbeat, heart failure
• Confusion, dizziness, headache, fever, feeling tired, seizures
• Hair loss (alopecia), acne, rash, itchiness
• Belly (abdominal) pain, nausea, vomiting, diarrhea, liver problems
• Decrease in blood cell counts (myelosuppression)
• Joint and muscle pain
• Trouble breathing, bleeding, asthma, collapsed lung
• Allergic reaction
• Infections

Side effects of carboplatin (given by I.V.) can include:

• Damage to nervous system (neurotoxicity)
• Damage to hearing (ototoxicity)
• Hair loss (alopecia)
• Belly (abdominal pain), diarrhea, nausea, vomiting, mouth inflammation (mucositis)
• Decrease in blood cell counts (myelosuppression) or bleeding
• Severe allergic-type reaction
• Infection

Side effects of cisplatin (given by I.V.) can include:

• Damage to nervous system (neurotoxicity)
• Damage to hearing (ototoxicity)
• Nausea and vomiting
• Decrease in blood cell counts (myelosuppression)
• Severe damage to kidneys (renal toxicity)
• Severe allergic-type reaction

Side effects of cyclophosphamide (given by mouth or I.V.) can include:

• Feeling tired
• Hair loss (alopecia)
• Belly (abdominal) pain, nausea, vomiting, diarrhea, mouth inflammation (mucositis)
• Decrease in blood cell counts (myelosuppression)
• Bladder damage (bladder toxicity)
• Reproductive hormone changes
• Infections

Side effects of cytarabine (given by I.V. or into the spinal canal) can include:

• Infection of sac surrounding heart (pericarditis)
• Damage to nervous system (neurotoxicity)
• Eye inflammation (conjunctivitis)
• Fever, headache, tiredness
• Hair loss (alopecia), rash, skin ulcers, itchiness
• Belly (abdominal) pain, nausea, vomiting, and diarrhea
• Mouth sores
• Liver problems
• Decrease in blood cell counts (myelosuppression)
• Kidney problems
• Trouble breathing (dyspnea)
• Severe allergic-type reaction
• Severe infection (sepsis)

Side effects of daunorubicin or doxorubicin (given by I.V.) can include:

• Damage to heart muscle (myocardial toxicity)
• Heart failure
• Feeling tired
• Severe local tissue injury
• Decreased blood supply to tissue (necrosis) at I.V. site
• Hair loss (alopecia)
• Belly (abdominal) pain, nausea, vomiting, diarrhea, mouth inflammation (mucositis)
• Decrease in blood cell counts (myelosuppression)
• Other cancers

Side effects of etoposide or teniposide (given by I.V.) can include:

• Low blood pressure (hypotension)
• Problems with the nerves in the arms and legs (peripheral neuropathy)
• Feeling tired
• Hair loss (alopecia)
• Belly (abdominal) pain, nausea, vomiting, diarrhea, inflammation in mouth (mucositis)
• Damage to liver (hepatotoxicity)
• Severe decrease in blood cell counts (myelosuppression)
• Severe allergic-type reaction

Side effects of hydroxyurea (given by mouth) can include:

• Dizziness
• Feeling tired
• Headache
• Seizures
• Hair loss (alopecia)
• Skin ulcers, nail changes, redness (erythema), death of tissue (gangrene)
• Nausea, vomiting, diarrhea, inflammation in mouth (mucositis)
• Liver failure
• Decrease in blood cell counts (myelosuppression)
• Cancer affecting white blood cells (leukemia)
• Asthma
• Trouble breathing (dyspnea)

Side effects of L-asparaginase (given by I.V. or as an injection) can include:

• Pain, swelling, or redness
• I.V. may cause itchiness, rash
• Trouble breathing (dyspnea)
• Tightening of airway (bronchospasm)
• Severe allergic-type reaction

Side effects of mercaptopurine (given by mouth) can include:

• Fever
• Feeling tired
• Hair loss (alopecia)
• Rash
• Belly (abdominal) pain
• Inflammation in mouth (mucositis)
• Liver damage (hepatotoxicity)
• Gallbladder and pancreas problems
• Damage to kidneys (renal toxicity)
• Decrease in blood cell counts (myelosuppression)
• Damage to lungs (pulmonary fibrosis)
• Infections

Side effects of methotrexate (given by mouth, I.V., injection, or into the spinal canal) can include:

• Blood clots (thromboses)
• Fluid around heart (pericardial effusion)
• Infection of sac surrounding heart (pericarditis)
• Severe damage to nervous system (neurotoxicity)
• Dizziness, feeling tired, headache
• Hair loss (alopecia), acne, rash, ulcers, itchiness
• Inflammation of bowel (enteritis), bleeding, nausea, vomiting, inflammation of mouth (mucositis)
• Liver failure, cirrhosis of liver
• Decrease in blood cell counts (myelosuppression)
• Severe kidney disease, renal failure
• Blood in urine (hematuria)
• Pain with or trouble urinating (dysuria)
• Fertility problems
• Bleeding
• Joint and muscle pain
• Severe allergic-type reaction
• Cancer of lymphatic system (lymphoma), infections, eye problems

Side effects of thioguanine (given by mouth) can include:

• Nausea, vomiting
• Decreased blood supply to intestines (intestinal necrosis), hole in intestines (intestinal perforation)
• Decreased blood supply to liver (hepatic necrosis)
• Damage to liver (hepatotoxicity)
• Decrease in blood cell counts (myelosuppression)
• Infections

Side effects of thiotepa (given by I.V.) can include:

• Dizziness, feeling tired, fever, headache
• Hair loss (alopecia), rash, skin inflammation (dermatitis), pain at site of I.V.
• Belly (abdominal) pain, nausea, vomiting, diarrhea
• Decrease in blood cell counts (myelosuppression), bleeding
• Pain with or trouble urinating (dysuria)
• Asthma
• Bleeding
• Severe allergic-like reaction

Side effects of topotecan (given by mouth or I.V.) can include:

• Feeling tired
• Fever, headache, pain
• Hair loss (alopecia), rash
• Belly (abdominal) pain, nausea, vomiting, diarrhea
• Decrease in blood cell counts (myelosuppression)
• Trouble breathing (dyspnea), pneumonia
• Severe allergic-like reaction
• Infections

Side effects of vincristine or vinblastine (given by I.V.) can include:

• High blood pressure (hypertension)
• Feeling tired
• Hair loss (alopecia)
• Trouble having bowel movements (constipation)
• Decrease in blood cell counts (myelosuppression)
• Bone and jaw pain
• Tumor pain
• Problems with nerves in the hands and feet (peripheral neuropathy)

Before starting treatment, your child may have blood and imaging tests. They may have minor surgery to place a catheter or port. The catheter or port is used to deliver the chemotherapy medicines, other medicines, and to take blood samples. It prevents your child from having repeated needle sticks.

Getting your child ready for chemo depends on their age and developmental level. Try to:

• Talk with your child with help from books and websites, such as the American Cancer Society.
• Answer your child's questions honestly.
• Get support from your child's oncologist or nurse, or an expert in working with children and their families (child life specialist).

Your child may have chemotherapy at a hospital (inpatient or outpatient), the oncologist's office, a cancer center or clinic, infusion center, or home. Your child may have treatment every day, every week, or every few weeks for a period of time. Treatment is given in cycles. This gives your child time to rest and recover between treatments.

Chemo can be given in different ways. The most common ones are:

• Orally. This means it's taken by mouth as a pill or liquid to swallow.
• Into a vein by I.V. (intravenously). If your child doesn't have a catheter or port, the nurse or technician will put a needle into one of your child's veins with each treatment. It is removed after the treatment. The treatment may take a few hours.
• As a shot (injection). The shot is given into a muscle or under the skin.
• Intrathecal injection. This means the treatment will be injected into the fluid-filled space that is located between thin layers of tissue that cover the brain and spinal cord. Only specific medicines can be given this way.

When having chemotherapy:

• Your child will be checked before, during, and after each treatment.
• Your child's vital signs, such as body temperature and blood pressure will be checked. Blood tests may also be done.
• Your child may be given medicines and fluids to help prevent side effects.

After treatment, your child may stay in the hospital to keep track of and manage side effects. Or your child may be able to go home. The nurse and doctor will make sure there are no serious side effects or reactions. Your child may be able to take part in normal activities, such as school. Or they may not be able to do so, due to tiredness or other side effects. Make sure you're aware of and prepared for possible side effects. Call your child's doctor if your child has new or worse symptoms.

Before you agree to the treatment, test, or procedure for your child make sure you know:

• The name of the treatment, test, or procedure
• The reason your child is having the treatment, test, or procedure
• What results to expect and what they mean
• The risks and benefits of the treatment, test, or procedure
• When and where your child is to have the treatment, test, or procedure
• Who will do the procedure and what that person's qualifications are
• What would happen if your child did not have the treatment, test, or procedure
• Any alternative treatments, tests, or procedures to think about
• When and how will you get the results
• Who to call after the treatment, test, or procedure if you have questions or your child has problems
• If there is a different number to call after office hours or on weekends and holidays
• How much will you have to pay for the treatment, test, or procedure