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Chemotherapy is a set of drugs for the treatment of cancer.

Chemotherapy is a systemic therapy, which means that medications are administered to the patient and drugs and are distributed through the bloodstream to almost all parts of the body and thereby destroy diseased cells.

Some anticancer drugs work better together than alone, so the proposed chemotherapy scheme for your child most often consists of more than one drug. This approach is called combined chemotherapy.

Chemotherapy can be administered in one or more of the following ways:

• Oral medication - Medications are in liquid or pill form.
If your child has difficulty swallowing pills, in some cases it is possible to break into smaller pieces, or you can crush and mix them with jam, pudding, or other foods.

• Intravenous (IV) medication - medications are infused into a vein or a catheter.

• Intramuscular medication (IM) - medications are injected through a needle into the muscle.

• Subcutaneous medication (SC) - medications are injected through a needle just below the skin.

• Intrathecal medication (IT) - medications are injected into the spinal fluid. Your child will have to go to the hospital or doctor's office to receive the medications. Depending on the medication, your child may need to be admitted to receive chemotherapy.

Oral Chemotherapy
Whenever possible, it is very important to involve the child in treatment.
For example, you can keep a special schedule to help your child control when the medication should be taken.

Older children, especially teenagers, may want to keep track of their medication. Even so, you still need to make sure that the medication is being taken. Do not forget to tell the doctor if the child misses a dose of the medication or if he has vomited.

Intravenous Chemotherapy
Your child will receive the medication through a fine needle placed in a vein, usually in the hand or arm, which can be painful when the needle is placed and the drugs can cause a burning sensation.

If drug overflow occurs it can burn the skin, so care must be taken to ensure that the access is firmly in place.
Another way to infuse chemotherapy is through a catheter. The catheter remains in place during treatment, so that the drug can be administered without the need to repeatedly place a needle in the vein.

The most used are central venous catheters. While the child is under general anesthesia the catheter is placed in a vein.
Two types of central venous catheters are commonly used:

• Broviac Hickman: in this type of catheter, the tube extends outside the body.

• Port-a -Cath: is placed under the skin, and a needle must be placed for use. In addition to chemotherapy, all other medications, transfusions and blood collections can be done through the catheter.

Side Effects of Chemotherapy
Side effects can occur, as chemotherapeutic drugs affect not only sick cells, but healthy cells as well. Side effects can be acute, those that occur soon after the infusion of chemotherapy or delayed, that happen weeks or years after chemotherapy.

The most common side effects of chemotherapy are:

Problems in the digestive tract:

1 - Nausea and vomiting:
can be controlled with drugs, but some recommendations may be valid:
• Feed your child light foods 3-4 hours before treatment.
• Encourage your child to eat small amounts of food, several times and slowly.
• Avoid serving sweet, greasy and spicy foods with a strong odor.
• Serve cold meals, such as sandwiches, instead of hot food.
• Encourage your child to drink fluids first, and then wait 30-60 minutes before eating solids. Most children tolerate liquids better than solids.
• Encourage your child to rest after meals.
• If your child is vomiting, do not give anything to eat or drink until it is under control. Once the vomiting is controlled, give small amounts of fluids. Work gradually until you can get to solid foods.

2 - Diarrhea:
• Talk to the doctor if your child's diarrhea is severe, that is, more than three times a day.
• Avoid fatty foods.
• Try serving foods high in protein and calories but low in fiber, such as plain or vanilla yogurt, rice with broth or pasta.
• Serve foods rich in sodium and potassium. Foods rich in potassium that do not cause diarrhea are bananas, peaches, apple juice and boiled potatoes or mashed potatoes.

3 - Constipation (constipation):
• Talk to your doctor if your child does not have a bowel movement for more than 2 days.
• Encourage your child to drink more fluids, such as apple juice. • Make sure your child does some exercise. • Serve fiber-rich foods, such as whole-grain breads and cereals, brown rice, dried fruits such as raisins and prunes, and fresh vegetables. 4-Heartburn or stomach pain: • Avoid serving fried, fatty or spicy foods.

5- Oral problems Sores in the mouth or throat
• Ask your doctor about medications for your child's mouth. Take it regularly to the dentist and ask for directions.
• The toothbrush must be soft. If you can't brush, wash your mouth every 2-3 hours and after meals, using a solution recommended by your doctor or dentist.
• Avoid serving foods that are too cold, hot, spicy or acidic.
• Try serving soft foods.
• Talk to the doctor if your child has mouth sores, painful areas, red or white spots on the mouth.

6 - Alteration of taste:
Foods may have less taste or a bitter metallic taste.
If there is a change in taste, try to offer the child's favorite foods.

7 - Hair:
• Hair loss: use a mild shampoo.
• Avoid using hair dryers and electric stylers. • Use a wide-toothed comb.
• If you are planning a wig, select it before your child's total hair loss, this way the made wig will be closer to the hair
• If you want to cover your child's head, try a variety of hats and scarves.
• Protect your child's scalp with sunscreen.

8- Skin:
Redness of the skin: call your doctor in case of redness, pain or swelling of the skin. Itchy skin and dryness: use mild soap and moisturizers. If your child is receiving radiation therapy, consult your child's doctor before using moisturizer.

Moist skin: wash your child's skin 2-3 times a day. Dry with a clean towel and lightly add talcum powder with cornstarch.

Rashes: Call your child's doctor, who can prescribe the proper medication. Sensitivity to the sun: avoid exposure to the sun and use an SPF 30 protector.

9 - Kidneys and bladder:
Bladder irritation
• Offer your child plenty of fluids, especially on the day of treatment, on the days before and after treatment. The amount of fluids depends on the size of your child, and you can get information from your doctor.
• Avoid giving drinks with caffeine (coca-cola, mate tea and coffee, for example).
• Inform the doctor if your child experiences pain or burning when urinating, frequent urination, red or bloody urine, or if he reduces the amount of diuresis. Change in urine color and strong odor. Some drugs cause urine to turn orange, red or bright yellow and have a strong odor. Ask your doctor if chemotherapy can change the color of your urine.

10 - Fever:
Many anticancer drugs decrease the number of white blood cells (leukocytes) in your blood. These cells are very important in fighting infection. See your doctor if your child's temperature is above 38 ° C. Give your child the fever medication prescribed by their doctor.

Symptoms can occur a few hours or even a few days after chemotherapy.
They include muscle pain, headache, tiredness, fever, chills and poor appetite.

Here are some recommendations you can make:
• Whenever possible, avoid taking your child out of the crowd.
Avoid being around people with colds, flu, or other contagious diseases. Avoid contacting your child with anyone who has had a recent vaccination with a vaccine containing live viruses: measles, rubella, mumps, polio and chickenpox.
• Call your doctor if your child comes into contact with known infectious diseases, for example, measles or chickenpox (chickenpox).
• If your white blood cell count is low, your doctor may postpone your next treatment or give you a lower dose of drugs for a while. This decision must be made by the medical team responsible for your child's treatment.

11 - Anemia:
Chemotherapy can decrease the bone marrow's ability to produce red blood cells, causing anemia. The most common symptoms are: Weakness, tiredness, dizziness, chills or shortness of breath. Call your doctor if your child has any of these symptoms.

12 - Blood clotting problems (hemorrhage):
Chemotherapy can affect the body's ability to produce platelets, the blood cells that help blood to clot.
Symptoms are: Bruising: red or purple spots on the skin

13 - Bleeding gums or nose Red or pink urine Intestinal bleeding
Call the doctor if your child has any of these symptoms.

14 - Swelling / fluid retention
Call your doctor if you notice swelling on your child's face, hands, feet or abdomen.
Your child's doctor may recommend limiting salt and salty foods or recommending medication to reduce edema.

15 - Allergic reaction
Rash, difficulty breathing.
Call the doctor immediately. This side effect can be serious, but it is not common.

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