Childhood Cancer Awareness Month

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer answers features the
00:12 --> 00:13latest information on cancer
00:13 --> 00:15care by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week, it's a conversation about
00:21 --> 00:23childhood cancer with Doctor Mary Jane Hogan.
00:23 --> 00:26Dr Hogan is an associate professor of
00:26 --> 00:27clinical Pediatrics and hematology
00:27 --> 00:30oncology at the Yale School of Medicine,
00:30 --> 00:32where Doctor Chagpar is a professor
00:32 --> 00:33of surgical oncology.
00:35 --> 00:36So, Doctor Hogan, maybe we can start
00:36 --> 00:39off by you telling us a little bit more
00:39 --> 00:41about yourself and what it is you do.
00:41 --> 00:44Sure. I am currently working in
00:44 --> 00:48our Smilow cancer clinic in New Haven,
00:48 --> 00:50as well as our clinics located
00:50 --> 00:54in Trumbull and Greenwich, CT.
00:54 --> 00:58I've come by way of a lot of different
00:58 --> 01:02avenues. My research initially has focused on
01:02 --> 01:04treating brain tumors in
01:04 --> 01:07mice in the laboratory,
01:07 --> 01:10but more recently have done more research
01:10 --> 01:13in childhood cancer survivorship issues.
01:13 --> 01:17And currently am also doing
01:17 --> 01:19the clinical education issues
01:19 --> 01:21for colleagues and trainees,
01:21 --> 01:24as well as helping families and
01:24 --> 01:27patients with learning about cancer.
01:28 --> 01:31Terrific, NOTE Confidence: 0.806416672
01:31 --> 01:33we're talking here about childhood
01:33 --> 01:35cancers and that's something that
01:35 --> 01:37everyone always finds really distressing,
01:37 --> 01:40the fact that children can get cancer.
01:40 --> 01:43So can you tell us a little bit more about
01:43 --> 01:45the epidemiology of childhood cancers?
01:45 --> 01:48I mean, how many children in the US get
01:48 --> 01:51diagnosed with cancer every year and
01:51 --> 01:54how common is it and what kinds of
01:54 --> 01:58cancers are we talking about here?
01:58 --> 02:02Well, childhood cancers are more
02:02 --> 02:05rare compared to adult cancers.
02:05 --> 02:07There are approximately 2,000,000
02:07 --> 02:09adults every year diagnosed with
02:09 --> 02:11cancer in the United States,
02:11 --> 02:14and this is compared to about
02:14 --> 02:1715,000 children and teens in the
02:17 --> 02:20United States diagnosed every year.
02:20 --> 02:23And cancer, I'll just sort of describe
02:23 --> 02:26it a little bit here, is an abnormal
02:26 --> 02:29increase in cells in the body of
02:29 --> 02:31abnormal cells that don't function
02:31 --> 02:35or don't work in the body and they
02:35 --> 02:38take up space and this doesn't
02:38 --> 02:41allow the regular body organs to
02:41 --> 02:45do their job and keep us healthy.
02:45 --> 02:50And so the most common cancers in children
02:50 --> 02:51are leukemia,
02:51 --> 02:53and this is an abnormal
02:53 --> 02:55accumulation of white blood cells.
02:55 --> 02:57White blood cells typically fight infection,
02:57 --> 03:00but in leukemias
03:00 --> 03:03they just take up space and so
03:03 --> 03:05that you cannot fight infection.
03:05 --> 03:06The second most common type of
03:06 --> 03:09cancer in children are brain tumors.
03:09 --> 03:11This is where there's an abnormal
03:11 --> 03:14growth or mass in the brain.
03:14 --> 03:17The third most common are lymphomas.
03:17 --> 03:20This is a cancer found in the lymph nodes,
03:20 --> 03:21which are glands located throughout
03:21 --> 03:26our body that help us fight infection.
03:26 --> 03:29And then the remaining cancers involve
03:29 --> 03:30the soft tissues of the body,
03:30 --> 03:33such as the muscles or the
03:33 --> 03:35various organs of the body,
03:35 --> 03:39including the nerves outside the brain or
03:39 --> 03:45the kidney or the bone anywhere in the body.
03:49 --> 03:50So it's very rare
03:50 --> 03:52compared to adult cancer,
03:52 --> 03:55but still obviously very important.
03:56 --> 03:59When we think about adult cancers,
03:59 --> 04:02very often there's an exposure.
04:02 --> 04:04So for example, in lung cancer
04:04 --> 04:07we know that there is a great
04:07 --> 04:09association with cigarette smoking
04:09 --> 04:12or any smoking really. In Melanoma,
04:12 --> 04:14we know that there's an exposure
04:14 --> 04:17to radiation often from the
04:17 --> 04:19sun that occurs.
04:19 --> 04:20For children,
04:20 --> 04:22one would anticipate just
04:22 --> 04:24because they are children that
04:24 --> 04:26they've had less exposures to
04:26 --> 04:28potential carcinogens.
04:28 --> 04:30So can you talk a little bit
04:30 --> 04:33more about the risk factors for
04:33 --> 04:34developing childhood cancers?
04:34 --> 04:37Are many of these genetic or are
04:37 --> 04:39there other things that predispose
04:39 --> 04:41some children to developing
04:41 --> 04:42childhood cancers versus others?
04:44 --> 04:46Overall, most causes of
04:46 --> 04:48childhood cancer are unknown.
04:48 --> 04:51We have learned over the past 50 years
04:51 --> 04:57though, that about 5 to 10% may be inherited.
04:57 --> 05:01There are about 50 cancer predisposition
05:01 --> 05:06syndromes that we call based on genetic
05:06 --> 05:09mutations that a child may inherit.
05:09 --> 05:11Passed on through the
05:11 --> 05:14family or are born with.
05:14 --> 05:17In which there are many other symptoms.
05:17 --> 05:20So when we discover a condition like this,
05:20 --> 05:24we recommend looking at the child
05:24 --> 05:28every couple of months to years,
05:28 --> 05:30looking for cancer itself.
05:30 --> 05:32Some cancers have been
05:32 --> 05:34associated with viral illness.
05:34 --> 05:37Epstein Barr virus has been
05:37 --> 05:40associated with lymphomas.
05:40 --> 05:42HIV has been associated
05:42 --> 05:45with certain cancers and people
05:45 --> 05:48might have heard of human papillomavirus,
05:48 --> 05:51which we are now giving vaccines
05:51 --> 05:54in the teenage years to people to
05:54 --> 06:01prevent several cancers in adulthood.
06:01 --> 06:05A parent who has been exposed to
06:05 --> 06:08radiation while the child is in the womb.
06:08 --> 06:11The child may be affected with cancer.
06:11 --> 06:12There have been some reports,
06:12 --> 06:15possibly of pesticides during
06:15 --> 06:19exposure while in the womb or as a
06:19 --> 06:21very young child causing cancers.
06:21 --> 06:25These are not directly effective,
06:25 --> 06:28but there have been several reports.
06:28 --> 06:31And in our children who have
06:31 --> 06:32had previous cancers,
06:32 --> 06:35they are at an increased risk of
06:35 --> 06:39having cancer because of either their
06:39 --> 06:42genetic predisposition or they've been
06:42 --> 06:45exposed to certain treatments
06:45 --> 06:48that can increase risk of cancer.
06:48 --> 06:49But in general,
06:49 --> 06:52most causes are unknown.
06:52 --> 06:55Cancer is not something
06:55 --> 06:57that is contagious.
06:57 --> 07:01And it's not something necessarily that you
07:01 --> 07:05can avoid or something that
07:05 --> 07:08you've done to yourself necessarily so
07:08 --> 07:13nobody is really to blame for the cancer.
07:14 --> 07:16When you think about
07:16 --> 07:18most causes being unknown and
07:18 --> 07:20only about 5 to 10% being genetic,
07:20 --> 07:22and then the other etiologic factors
07:22 --> 07:26that we know about,
07:26 --> 07:28viral infections and intrauterine
07:28 --> 07:31exposures to various toxins and so on,
07:31 --> 07:33which one would presumably think
07:33 --> 07:36would be a fairly small proportion
07:36 --> 07:39that leaves the vast majority to
07:39 --> 07:41be something that is not something
07:41 --> 07:43that you can even anticipate.
07:43 --> 07:48Given if you're a
07:48 --> 07:53new parent and you have a healthy child,
07:53 --> 07:55you're not really expecting
07:55 --> 07:58that that child will develop cancer.
07:58 --> 08:00Can you tell us a little bit more
08:00 --> 08:02about some of the side effects,
08:02 --> 08:04some of the symptoms that you
08:04 --> 08:07should be looking for that might tip
08:07 --> 08:09you off that there might be something
08:09 --> 08:11wrong that might be a cancer?
08:11 --> 08:13Is there a way that we can diagnose
08:13 --> 08:14these early?
08:15 --> 08:19It's very difficult to diagnose
08:19 --> 08:21cancers early in children.
08:21 --> 08:23You'd need a sizable amount of these
08:23 --> 08:25abnormal cells to actually show
08:25 --> 08:27themselves and to show a sign or symptom.
08:30 --> 08:32Please note that I will describe a
08:32 --> 08:34whole long list of signs and symptoms,
08:34 --> 08:36but typically children present with
08:36 --> 08:38a combination of these symptoms.
08:38 --> 08:41So not just one symptom means cancer.
08:41 --> 08:42There's a combination,
08:42 --> 08:45and often the symptoms that people
08:45 --> 08:48present with, our children present
08:48 --> 08:50with and grownups too,
08:50 --> 08:54the signs are persistent.
08:54 --> 08:57And they worsen over time
08:57 --> 08:59and they typically can't be
08:59 --> 09:02explained by an infection or an
09:02 --> 09:05injury that the child has had.
09:05 --> 09:07So it's mostly unexplained
09:07 --> 09:09but worsening of symptoms.
09:09 --> 09:12And there's a long list of symptoms,
09:12 --> 09:14unexplained weight loss.
09:14 --> 09:17So not that the child's not eating
09:18 --> 09:22enough or losing weight from too
09:22 --> 09:24much exercise and so not eating
09:24 --> 09:26enough,
09:26 --> 09:28it's weight loss that you can't explain.
09:28 --> 09:29They're eating fine.
09:29 --> 09:31Fevers that you can't explain
09:31 --> 09:33that persist and worsen.
09:33 --> 09:36Not from a simple infection or
09:36 --> 09:37even a complicated infection,
09:37 --> 09:40but fevers that just cannot be explained.
09:40 --> 09:41Night sweats,
09:41 --> 09:43not getting a little damp at night,
09:43 --> 09:46but if your T-shirt and bedding and
09:46 --> 09:48pillow and hair are soaked and you
09:48 --> 09:50have to change it and you're like,
09:50 --> 09:52where did this come from? I'm not even warm.
09:52 --> 09:54I don't even have a fever.
09:54 --> 09:57What is going on? Headaches.
09:57 --> 10:00Headaches are a common sign.
10:00 --> 10:04The headaches are common for a lot of people,
10:04 --> 10:08but the ones that are more worrisome
10:08 --> 10:11usually occur in the early morning,
10:11 --> 10:13are associated with vomiting,
10:13 --> 10:15sometimes awaken you at night,
10:15 --> 10:19and they don't respond to Tylenol or
10:19 --> 10:22ibuprofen or simple remedies that
10:22 --> 10:24we use for headaches or hydration.
10:26 --> 10:31If a parent notices swelling or pain in
10:31 --> 10:35arms or legs or at the back of a child,
10:35 --> 10:39if you notice a mass in the neck or in
10:39 --> 10:43the armpits or in the abdomen or pelvis,
10:43 --> 10:47that's just sticking out,
10:47 --> 10:50that can be a sign of cancer if
10:50 --> 10:52they're in combination with all these
10:52 --> 10:54other signs and symptoms. If there's
10:54 --> 10:56a lot of bruising or bleeding.
10:56 --> 11:00Or rash that just doesn't go
11:00 --> 11:02away with simple interventions.
11:02 --> 11:07If somebody seems very pale and
11:07 --> 11:11it worsens overtime or is tired
11:11 --> 11:14not explained by
11:14 --> 11:18only sleeping for five hours a night or
11:18 --> 11:24being tired without really knowing why.
11:24 --> 11:27If anybody has any vision changes
11:27 --> 11:29that's not explained or corrected
11:29 --> 11:32with simple glasses, NOTE Confidence: 0.941908941428571
11:32 --> 11:34these in combination,
11:34 --> 11:38along with a good physical exam
11:38 --> 11:41by the pediatrician is very
11:41 --> 11:45important to see if a person has
11:45 --> 11:47the signs or symptoms that
11:47 --> 11:49seem to be like cancer.
11:50 --> 11:53And many of those really
11:53 --> 11:55seem like they would be commonplace.
11:55 --> 11:57And I think one of the things that
11:57 --> 12:00you made clear is that while these
12:00 --> 12:02symptoms may seem commonplace,
12:02 --> 12:03a little bit of fatigue,
12:03 --> 12:07a little bit of
12:07 --> 12:11fever, maybe a headache, if these
12:11 --> 12:14are persistent and unexplained,
12:14 --> 12:16that's really when you
12:16 --> 12:18want to see your pediatrician and
12:18 --> 12:20kind of get this checked out.
12:20 --> 12:23One question that our listeners might
12:23 --> 12:25have is how persistent is persistent?
12:25 --> 12:27Like, should I wait a week,
12:27 --> 12:30two weeks, two months?
12:30 --> 12:33When would you suggest that if
12:33 --> 12:36if a child is not doing so well?
12:36 --> 12:38How long should you wait before you
12:38 --> 12:41you go and and seek medical advice?
12:42 --> 12:45It's a great question and I think
12:45 --> 12:48it's dependent on each situation.
12:48 --> 12:53Definitely if a child is getting worse each
12:53 --> 12:57day or each hour and your child,
12:57 --> 12:59they'll run around and play
12:59 --> 13:01and when they're not feeling well,
13:01 --> 13:01they don't.
13:01 --> 13:04And if you're noticing more of that,
13:04 --> 13:05they're not playing,
13:05 --> 13:07they're not eating, they're not
13:07 --> 13:10doing the things they need to do,
13:10 --> 13:13then you need to contact your
13:13 --> 13:15pediatrician and tell them of your
13:15 --> 13:18concerns and have the pediatrician take
13:18 --> 13:20a look so I wouldn't wait too long.
13:20 --> 13:23On the other hand, if the symptoms
13:23 --> 13:26are very mild and they come and go,
13:26 --> 13:30they don't impact the child's activities
13:30 --> 13:36or school or appetite and their symptoms
13:36 --> 13:40resolve for months on end,
13:40 --> 13:42then that is not a time to
13:42 --> 13:45necessarily contact your pediatrician.
13:45 --> 13:46Whatever happened,
13:46 --> 13:47it has resolved.
13:49 --> 13:51OK, great. Well, we're going to dive
13:51 --> 13:54more into the diagnosis and treatment
13:54 --> 13:57of childhood cancers right after we
13:57 --> 14:00take a quick break for a medical minute.
14:00 --> 14:02Please stay tuned to learn more
14:02 --> 14:03about the care of childhood cancer
14:03 --> 14:06with my guest, Doctor Mary Hogan.
14:06 --> 14:08Funding for Yale Cancer Answers
14:08 --> 14:10comes from Smilow Cancer Hospital,
14:10 --> 14:12where the gynecologic oncology
14:12 --> 14:14program brings together a team of
14:14 --> 14:16clinicians whose focus is to care
14:16 --> 14:18for women with gynecologic cancers.
14:18 --> 14:19Learn more at yalecancercenter.org.
14:25 --> 14:28There are over 16.9 million
14:28 --> 14:31cancer survivors in the US and
14:31 --> 14:33over 240,000 here in Connecticut.
14:33 --> 14:34Completing treatment for cancer
14:34 --> 14:37is a very exciting milestone,
14:37 --> 14:38but cancer and its treatment can
14:38 --> 14:41be a life changing experience.
14:41 --> 14:43The return to normal activities
14:43 --> 14:45and relationships may be difficult
14:45 --> 14:46and cancer survivors may face
14:46 --> 14:49other long term side effects of
14:49 --> 14:50cancer including heart problems,
14:50 --> 14:51osteoporosis,
14:51 --> 14:54fertility issues and an increased
14:54 --> 14:56risk of second cancers.
14:56 --> 14:59Resources for cancer survivors are
14:59 --> 15:01available at federally designated
15:01 --> 15:02Comprehensive cancer centers
15:02 --> 15:04such as Yale Cancer Center
15:04 --> 15:06and Smilow Cancer Hospital
15:06 --> 15:08to keep cancer survivors well
15:08 --> 15:10and focused on healthy living.
15:10 --> 15:12The Smilow Cancer Hospital Survivorship
15:12 --> 15:15Clinic focuses on providing guidance
15:15 --> 15:17and direction to empower survivors to
15:17 --> 15:19take steps to maximize their health,
15:19 --> 15:21quality of life,
15:21 --> 15:22and longevity.
15:22 --> 15:25More information is available at
15:25 --> 15:26yalecancercenter.org. You're listening to
15:26 --> 15:28Connecticut Public Radio.
15:28 --> 15:31Welcome back to Yale Cancer Answers.
15:31 --> 15:33This is doctor Anees Chagpar and I'm joined
15:33 --> 15:36tonight by my guest, Doctor Mary Hogan.
15:36 --> 15:38We're talking about the care of patients
15:38 --> 15:41with childhood cancer in honor of
15:41 --> 15:43childhood Cancer Awareness Month.
15:43 --> 15:45And right before the break, Mary,
15:45 --> 15:48you were telling us about all of the symptoms
15:48 --> 15:51that you should really be watching for.
15:51 --> 15:53What can you expect in terms of
15:53 --> 15:56a work up for a potential cancer?
15:56 --> 15:58Tell us more about how the diagnosis
15:58 --> 16:02of childhood cancers are made.
16:02 --> 16:06Your pediatrician and child's pediatrician
16:06 --> 16:10may order some blood tests or some simple
16:10 --> 16:13imaging such as X-rays or an ultrasound,
16:13 --> 16:15and when they find something
16:15 --> 16:17abnormal or alarming or are not sure,
16:17 --> 16:21they'll refer to a pediatric oncologist
16:21 --> 16:25and we will often get blood tests.
16:25 --> 16:28We will often get other more advanced imaging
16:28 --> 16:32such as CT scans or MRIs.
16:32 --> 16:36And based on those, then we get our experts,
16:36 --> 16:39pediatric surgeons to help us get
16:39 --> 16:42a biopsy of a mass that we might
16:42 --> 16:44have found on the imaging.
16:44 --> 16:47Or we ask our specialists in pathology
16:47 --> 16:50to take a look at the blood samples to
16:50 --> 16:53see if there's any abnormal cells there.
16:53 --> 16:55And then once we have an
16:55 --> 16:57idea that it is a cancer,
16:57 --> 16:59we do even more extensive
16:59 --> 17:02testing to find out the exact kind of
17:02 --> 17:06cancer so that we can deliver the most
17:06 --> 17:10appropriate therapy for the best outcomes.
17:10 --> 17:14I can only imagine that when that
17:14 --> 17:17diagnosis comes down and you tell a
17:17 --> 17:19child's parent that their
17:19 --> 17:22child has cancer, that can be
17:22 --> 17:25just devastating for that family.
17:25 --> 17:28Tell me more about how you
17:28 --> 17:30get patients
17:30 --> 17:31and their families,
17:31 --> 17:33through that kind of a diagnosis.
17:34 --> 17:38Cancer is a devastating diagnosis.
17:38 --> 17:40Everybody has been touched by
17:40 --> 17:42cancer in some way or form,
17:42 --> 17:45whether it be relative or a neighbor,
17:45 --> 17:47and they bring their own
17:47 --> 17:49experiences with them to this.
17:49 --> 17:52So once you hear your child has cancer,
17:52 --> 17:55as you said, it is devastating
17:55 --> 17:57and everybody is in shock.
17:57 --> 18:03And it is difficult to deliver that news,
18:03 --> 18:04however, at the same time,
18:04 --> 18:07we want to get the child better and we
18:07 --> 18:10want a cure, and we want to get moving
18:10 --> 18:12on treatment so we can get there.
18:12 --> 18:18So we don't want to wait too
18:18 --> 18:21long in belaboring it.
18:21 --> 18:23So we want to be supportive of the family.
18:23 --> 18:25We have social workers and psychologists
18:25 --> 18:28help us so that we can deliver the news
18:28 --> 18:33to where the family is and
18:33 --> 18:35understanding from their experiences,
18:35 --> 18:38but also the child at different
18:38 --> 18:40ages you have different
18:40 --> 18:42cognitive abilities,
18:42 --> 18:46and so it's important to answer
18:46 --> 18:48their questions appropriately
18:48 --> 18:50and make them aware of this.
18:50 --> 18:54They are directly involved in
18:54 --> 18:57the treatment, they will need
18:57 --> 19:00blood tests and imaging as I
19:00 --> 19:02mentioned and the therapies that we
19:02 --> 19:04give have to be sometimes taken by
19:04 --> 19:07mouth or given intravenously or
19:07 --> 19:11you have to sit still for radiation therapy.
19:11 --> 19:15So the child needs to be aware of
19:15 --> 19:18why they're getting the therapy and
19:18 --> 19:21what it means to complete
19:21 --> 19:24your treatment of therapy.
19:24 --> 19:27It's a very difficult conversation and
19:27 --> 19:31we all are upset by it.
19:31 --> 19:34And at the same time, we want to help.
19:37 --> 19:40And I do find that a lot of
19:40 --> 19:43kids are really pretty resilient
19:43 --> 19:46and they will power through
19:46 --> 19:51that with with some form of enthusiasm
19:51 --> 19:56even when their parents may be more
19:56 --> 19:58devastated than the child sometimes.
20:00 --> 20:02For sure. Kids are amazing.
20:02 --> 20:04They're like, how long is this going to take?
20:04 --> 20:06I need to get to baseball practice.
20:07 --> 20:08Is this going to interfere with the prom?
20:08 --> 20:10Because we need to rearrange this
20:10 --> 20:12treatment schedule
20:12 --> 20:14and so we ask the kids,
20:14 --> 20:16where are you at?
20:16 --> 20:17What do we need to do?
20:17 --> 20:19How do we get you to the clinic?
20:19 --> 20:21And how do we get you to the more
20:21 --> 20:23important things of your life as well?
20:23 --> 20:26So kids are amazing.
20:26 --> 20:27And so are the parents.
20:28 --> 20:29Talk to us a little bit
20:29 --> 20:32more about the the various treatment
20:32 --> 20:34modalities that are used to treat
20:34 --> 20:36children with cancer and
20:36 --> 20:39I realize that it's a little
20:39 --> 20:41difficult given the fact that there
20:41 --> 20:44are so many different kinds of cancer
20:44 --> 20:46that are kind of all clumped under
20:46 --> 20:48the umbrella of childhood cancer.
20:48 --> 20:50But talk to us a bit about the types
20:50 --> 20:52of therapies and their duration so that
20:52 --> 20:55we can get a sense of what exactly does
20:55 --> 20:57treatment look like for these kids.
20:58 --> 20:59Sure, treatment
20:59 --> 21:02is directed toward the specific type of cancer.
21:02 --> 21:05And every year we become more specific
21:05 --> 21:08about the type of cancer you have.
21:08 --> 21:10We just don't lump it under leukemia.
21:10 --> 21:12Now we we literally go
21:12 --> 21:15down the path of directed
21:15 --> 21:17targeted therapies and the reason
21:17 --> 21:20why we do that is to reduce toxic
21:20 --> 21:22effects from these medications.
21:22 --> 21:24If you don't need as much
21:24 --> 21:26therapy to achieve a cure,
21:26 --> 21:28we would like to eliminate those therapies.
21:28 --> 21:30Whereas if you have a more
21:30 --> 21:31difficult cancer to treat,
21:31 --> 21:33we want to give you all the
21:33 --> 21:35available therapies, and
21:35 --> 21:37therapies, as I mentioned before,
21:37 --> 21:40can be taken by mouth or intravenously
21:40 --> 21:43or given in a variety of different ways.
21:43 --> 21:45So our basic
21:45 --> 21:48treatments are called chemotherapy.
21:48 --> 21:50They're given in combinations because
21:50 --> 21:53they act on the cancer cells differently.
21:53 --> 21:56And over the past 50 years,
21:56 --> 21:58based on children who have
21:58 --> 22:00enrolled in our clinical trials,
22:00 --> 22:02we've come up with standard
22:02 --> 22:04of care throughout the nation.
22:04 --> 22:05How best to treat this.
22:05 --> 22:09And we're always trying to improve upon this.
22:09 --> 22:13More recently to our chemotherapies, well
22:13 --> 22:14not more recently,
22:14 --> 22:16but standardly to chemotherapy
22:16 --> 22:19certain cancers may need radiation therapy,
22:19 --> 22:22where special ionized particles
22:22 --> 22:25are delivered to the cancer
22:25 --> 22:28site to kill cancer cells.
22:28 --> 22:31Surgery is also very important in our
22:31 --> 22:34treatment of cancers for certain types
22:34 --> 22:38of cancers where the tumor is removed.
22:38 --> 22:42And we now have more recently immune
22:42 --> 22:47therapy where we can give medication to
22:47 --> 22:52target a protein on the tumor which will
22:52 --> 22:54allow our immune system to attack the
22:54 --> 22:57tumor or cancer as if it was foreign.
22:57 --> 22:59And that's really cool.
22:59 --> 23:02And our targeted therapies work
23:02 --> 23:04by attacking the gene that's in
23:04 --> 23:07the gene mutations that are in the
23:07 --> 23:10cancer cells so that we're leaving
23:10 --> 23:13our normal healthy cells alone.
23:13 --> 23:16So we have very strong therapies
23:16 --> 23:18called hematopoietic stem cell
23:18 --> 23:21transplant or bone marrow transplant
23:21 --> 23:23where strong medicines are given
23:23 --> 23:26to eliminate the cancers.
23:26 --> 23:30Not many cancers require this
23:30 --> 23:34for therapy and we also have even
23:34 --> 23:36stronger therapy called chimeric
23:36 --> 23:38antigen receptor T cell therapy
23:38 --> 23:41also used in very rare instances.
23:41 --> 23:44Cancer therapy may last as long as
23:44 --> 23:48two to three years in certain cases.
23:48 --> 23:50And as short as you know,
23:50 --> 23:53three to six months,
23:53 --> 23:57so it really is on us to find
23:57 --> 23:59the exact cancer you have and
23:59 --> 24:01to treat it appropriately.
24:02 --> 24:05And so one would imagine that with
24:05 --> 24:08whatever type of therapy kids get
24:08 --> 24:12treated with for their childhood cancer,
24:12 --> 24:14that's going to cause some side
24:14 --> 24:16effects and so whether this is a
24:16 --> 24:18three month course of therapy or
24:18 --> 24:20a three-year course of therapy,
24:20 --> 24:22how do you deal with some
24:22 --> 24:23of those side effects?
24:23 --> 24:25Can you talk to us about those
24:25 --> 24:27side effects that kids may
24:27 --> 24:29face going through cancer therapy
24:29 --> 24:31and how that kind of affects their
24:31 --> 24:34lives both in terms of the time in
24:34 --> 24:35which they're getting the therapy?
24:35 --> 24:38How does that affect
24:38 --> 24:41them going to school and
24:41 --> 24:43in interacting with their friends?
24:43 --> 24:46And so on and so forth as well as long term,
24:46 --> 24:48I mean are there effects that people
24:48 --> 24:51should be cognizant of in terms of
24:51 --> 24:53the long term side effects of some of
24:53 --> 24:56these therapies for childhood cancer?
24:56 --> 24:59One of our secondary goals
24:59 --> 25:01during our cancer therapy is to
25:01 --> 25:04make sure kids get back to school
25:04 --> 25:07and keep up with their school work
25:07 --> 25:08and all their fun activities.
25:16 --> 25:18Sometimes the children will be back in the classroom,
25:18 --> 25:20sometimes we will need to provide tutors
25:20 --> 25:23because they're in the hospital setting.
25:23 --> 25:25So some of the short term side
25:25 --> 25:28effects of her medication range from
25:28 --> 25:30mild where you don't really notice
25:30 --> 25:34it to more severe where we need to
25:34 --> 25:36give supportive medications so that
25:36 --> 25:39it eliminates these side effects.
25:39 --> 25:43A common side effect is nausea and vomiting,
25:43 --> 25:44and this is dealt with
25:44 --> 25:49with mild to very strong anti nausea
25:49 --> 25:51medications. We have multiple combinations
25:51 --> 25:57of them and compared to 30 years ago,
25:57 --> 26:01many of our children need to be
26:01 --> 26:03hospitalized for intravenous fluid because
26:03 --> 26:07they're having excessive nausea and vomiting.
26:07 --> 26:11Another common side effect is with
26:11 --> 26:13certain therapies is hair loss.
26:13 --> 26:19It is temporary but also very upsetting.
26:19 --> 26:23We haven't found a supportive
26:23 --> 26:24cure for that just yet,
26:24 --> 26:29but some children will wear hats or
26:29 --> 26:32wigs to make them feel more comfortable.
26:32 --> 26:35Another side effect is to our blood cells.
26:35 --> 26:37Our blood cells help us fight infection.
26:37 --> 26:38Those are the white blood cells,
26:38 --> 26:39or red blood cells,
26:39 --> 26:40carry oxygen to a body.
26:40 --> 26:41Those are red cells.
26:41 --> 26:44And the platelets help us clot
26:44 --> 26:46our blood when we're injured.
26:46 --> 26:49And so sometimes a person may need
26:49 --> 26:52transfusions or injections of
26:52 --> 26:55medications to stimulate the production
26:55 --> 26:58of these cells so that you don't feel
26:58 --> 27:00tired and that you don't have nosebleeds
27:00 --> 27:04and that you don't have infections.
27:04 --> 27:07We are giving many
27:07 --> 27:09preventative medications for
27:09 --> 27:14infections so that there are less
27:14 --> 27:15hospitalizations for bacterial
27:15 --> 27:18infections or fungal infections.
27:18 --> 27:21Those are some of the short
27:21 --> 27:23term side effects.
27:23 --> 27:27I think the main one that I didn't talk
27:27 --> 27:30about was feeling tired and we try to
27:30 --> 27:33Improve energy levels with
27:33 --> 27:36nutrition and supporting the red
27:36 --> 27:38blood cell count as much as we can,
27:38 --> 27:42but we often will recommend not going
27:42 --> 27:46full tilt on all your activities
27:46 --> 27:48until the therapy is over.
27:48 --> 27:49But do what you can,
27:49 --> 27:52because we really support you going
27:52 --> 27:55to school and seeing your friends and
27:55 --> 27:58continuing with your activities over
27:58 --> 28:03the long term. Some children may
28:03 --> 28:05suffer a severe side effect from
28:05 --> 28:08their medication at the time of the
28:08 --> 28:10chemotherapy treatments and so may
28:10 --> 28:12have residual side effects later on.
28:12 --> 28:14Most children who have completed
28:14 --> 28:15their therapy do well,
28:15 --> 28:18but approximately 40% of our
28:18 --> 28:20childhood cancer survivors may have
28:20 --> 28:22one or more late effects.
28:22 --> 28:26Those are signs or symptoms in other parts
28:26 --> 28:30of the body that it can cause issues.
28:30 --> 28:33Doctor Mary Hogan is an associate professor of
28:33 --> 28:34Clinical Pediatrics and hematology
28:34 --> 28:38oncology at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu,
28:42 --> 28:45and past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:52learn more about the fight against
28:52 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

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