What is Cancer?

1. What is Cancer? Cancer is UNCONTROLLED and ABNORMAL cell growth that can spread to other parts of the body disrupting normal bodily functions. This means that the cells in your body grow too quickly. When this occurs, some of the cells stop working properly. Sometimes cancer cells grow so quickly that they may cause a lump or tumour to form somewhere in your body. Cancer cells grow uncontrollably, crowding out the normal cells Normal cells

2. Common facts about cancer • It’s nobody’s fault that you have cancer. It is not because you did or said something wrong, and it is not because you were naughty. • Remember, cancer is not contagious! This means that no one passed it to you, and you can’t pass it to anyone else either. But, you should try not to go to crowded places because you may catch infections easily.

3. HOSPITAL Going to the Hospital Who are the people in a hospital? Personal hygiene and infection control… What you might experience in a hospital…

4. Who are the people in a Hospital? Patient Service Associates greet you with a big “Hello!” when you come to the hospital. They help you make appointments to see your doctor, arrange for admission, do billing and cashiering. Nurses take care of you while you are in hospital. They give medicine, monitor blood pressure, draw blood, insert IVs, and work closely with doctors to help you get well. The Doctor that looks after you is called a Pediatric Oncologist. Pediatric Oncologists go through special training to treat children with cancer.

5. Your CCF programme executive makes your time in the hospital a more enjoyable one. They have many fun toys, games and craft activities for you to enjoy. Your CCF Social Worker and Counsellor supports you and your family to cope better with the illness and challenges that comes with it. The health attendant ensures good housekeeping and cleanliness in the wards. They also ensure that you are served warm, healthy food during mealtimes.

6. In the hospital… We need to wash our hands to remove the germs on our hands. This will prevent you from picking up germs that can make you more sick. It is also important to wear your mask. The mask will keep germs away from you.

7. What you might experience • Finger prick – Full Blood Count (FBC) • When you come to the hospital, the nurse will prick your finger using a small needle and collect your blood sample in a plastic tube. • The blood sample will then be sent to the laboratory for examination. • Consultation with your doctor • When your FBC results are out, your doctor would see you and your parents. This special time with your doctor will allow your doctor to check how you are doing in your treatment. He will also check that you are well and record your progress in a file with only your records in it. He might give you medications to take or admit you in hospital for treatment.

8. Fasting • Doctors and nurses may advise you to fast before your treatment starts that particular day. Fasting means not eating or drinking for a few hours. Your parents may encourage you to have something to eat or drink before the fasting starts, so you will have some energy for that day. • Outpatient Day Therapy • Your doctor may plan for you to have a few hours of chemotherapy in the hospital. This means that you will be assigned a hospital bed so that you can lie down to rest while you have chemotherapy. Here, the nurses will give you chemotherapy as planned by the doctors. They will be around to take care of you while that happens.

9. Admission for Inpatient Therapy • Your doctor may also plan for you to stay in hospital for treatment for a day or more. You may also be advised to stay in hospital if you have a fever or when you are not well. The nurses will be there 24 hours a day to take care of you. Your parents can stay with you to keep you company. In hospital, you can watch TV programmes and play games. Remember to ask your CCF programme executive for toys, DVD, books and crafts to occupy your time in hospital.

10. Treatment

11. Chemotherapy • During chemotherapy, very powerful medicine is given to you to stop the cancer cells from growing in your body. The medicine moves through your bloodstream and can be absorbed by your blood to kill the cancer cells more easily! • The doctor or nurse will give you the medicine either by mouth or into your blood through your Port-a-cath or Hickman line. • The types of chemotherapy given to each child is different. The doctors and nurses plan your treatment very carefully so that the cancer cells can be destroyed.

12. emla 5% Port-a-cath • Having a port-a-cath makes it easier for the nurse to put medicine into your body and take blood. It saves you from getting poked over and over again. • Port-a-cath is placed under your skin at your chest area. The doctor will give you some medicine to make you sleep to put the port in you. You cannot see the port because it is under your skin, but you can feel it with your fingers. It feels just like a button! • When it’s time for medicine or blood test, the nurse will “access” your port. She will first put some “emla” cream over the port area to make your skin sleep, so when the needle pokes through, you can’t feel it.

13. Hickman line • Some children do not have a port, they have Hickman line. It is a central line that goes into a vein in your chest for getting medicine and blood tests. The doctor will give you some medicine to make you sleep to put the line in you. • The Hickman line can stay in your body for a long time. It is important to keep your Hickman line dry and very clean. An adult has to change the bandage over your line every week.

14. Some children have Port-a-cath and some have Hickman line. What do you have? Port-a-cath Hickman line

15. Radiotherapy (RT) • During radiotherapy, cancer cells are destroyed by X-rays. It lasts for a few minutes each time. To make sure that all the cancer cells are destroyed, you might need to go for a few radiotherapy sessions. • During RT, you must lie very still so that the X-rays can be directed at the tumour. RT doesn’t hurt but the part of your skin where the X-rays were directed at may become sore and red.

16. Bone Marrow Transplant (BMT) • Sometimes, a bone marrow transplant is needed for you to get well. Our bone marrow is where new blood cells are formed in our body. • Before BMT, your bone marrow which produces cancer cells are destroyed by very high doses of medicine and radiation. • During BMT, the doctor will replace your bone marrow with a healthy bone marrow, either from a donor or from yourself. Now, your new marrow will no longer produce cancer cells!

17. Regular tests • Tests are done regularly to measure how well the treatments are working for you! • Finger prick (FBC) • When you come to the hospital, the nurse will prick your finger using a small needle and collect your blood sample in a plastic tube. • The blood sample will then be sent to the laboratory for examination. • Bone marrow aspiration (BMA) • Your bone marrow produces your body’s blood cells and sometimes, doctors need to test your bone marrow to check if there are still cancer cells in your body. • Before the BMA, the doctor will put you to sleep for awhile. The doctor will do the BMA on your hip bone and remove a small amount of marrow for tests to be done.

18. Magnetic Resonance Imaging (MRI) scan • You may have to do a MRI scan to examine the structures, like tissues and muscles in your body. To do the MRI, you have to lie on a bed and be pushed into a tunnel. You will hear some humming and thumping during the MRI scan, but it doesn’t hurt! • Computerised Axial Tomography (CAT) or CT scan • A CT scan is used to examine the bone structure in your body. Before the scan, you have to fast meaning you cannot eat or drink. You will be placed on a scanning couch for the scan to be done. You will also be given a contrast medium, which is like a colourful dye. This dye goes into your blood and makes it clearer for the doctor to see the structures in your body.

19. Common side effects • During treatment, your body will react to the different drugs given and you will experience side effects. This means that you will go through some not so nice things. It’s going to be tough but there are certainly things you can do to help make you feel better. • But remember, these side effects are not forever!

20. Hair loss… maybe yes, maybe no • Some chemotherapy (chemo) drugs can cause hair loss, not a very cool thing to happen. It will change the way you look and how you feel about yourself. Don’t worry, you’re not going to stay bald forever because your hair will grow again when you finish treatment. Phew! • What you can do to feel better: • Imagine yourself without hair; it will be less of a shock when it happens • Cut your hair short, it might help you to get used to the hair loss gradually • Try different accessories, like a cap, beanies, bandannas or even a wig • Try loving your new look • Remember… it is temporary!

21. Vomit bag Nausea and vomiting… yucks! • After chemo, you may feel like throwing up (nausea) which of course is a yucky feeling. It may also be difficult for your food to stay in your stomach. Your doctor will give you some anti-nausea medicine to help you feel better. Take the medicine before you begin your chemo. It helps! • What you can do to feel better: • Have a vomit bag with you at all times • Cut food into bite-sized pieces to make it easier to swallow • Choose food which doesn’t have a strong smell • Try eating while watching your favourite TV programme or reading a comic book. It’ll help to take your mind off the food.

22. Mouth or throat ulcers… ouch :( • Chemo can cause ulcers in your mouth and throat, also known as “mu-co-si-tis”. You may also feel dryness in your mouth and find it hard for food to go down your throat. It might hurt when you drink too. • What you can do to feel better: • Drink through a straw • Eat soft, smooth, blended food that are gentle to your mouth • Avoid rough and crunchy food like chips • Make sure your mouth stays clean so that you do not get an infection. Use a mouthwash after every meal. A soft foam brush helps too.

23. Diarrhoea… “I got to go!!!” • Diarrhoea is a common and uncomfortable side effect of cancer treatment. It is when your faeces or poo is soft and more watery. Your stomach will also feel crampy and you’ll be saying, “I got to go!!!” rather often. One more thing, you are most likely going to get a sore butt. Ask your nurse for special cream or wipes to help you feel better. • What you can do to feel better: • Drink! Drink! Drink! (but avoid milk) • Eat small amounts of food • Stay away from fried, greasy food

24. Loss of appetite… “Can I not eat?” • Chemo can make you lose your appetite, which means that you may not feel like eating. This will probably make your loved ones worry. You’ve got to remind yourself that if you want to fight the bad cells, your body has to stay strong. It’s important to eat something. • What you can do to feel better: • Eat small amounts of food • This is a good time for snacks and smaller frequent meals • Eat slowly and take breaks during meals • Get some fresh air if you can, it helps

25. Useful links for children/teens with childhood cancer Children • http://www.royalmarsden.org/captchemo/ Teens • http://www.2bme.org/2bMe.html • http://www.teenslivingwithcancer.org/