Chemotherapy is a drug or combination of drugs that attack cancer cells. This modality is used by a medical oncologist/hematologist. Typically, treatment is administered through a vein, injected into a body cavity, or delivered orally in the form of a pill.
Unlike surgery or radiation therapy in which the area treated is small or localized, chemotherapy circulates in the blood to other parts of the body where the cancer cell may have spread but is not yet seen by the naked eye or it is readily apparent.
More than half of all people diagnosed with cancer receive chemotherapy to improve the likelihood of cure, alleviate symptoms and/or prolong their life enabling patients to enjoy full and productive lives. Importantly, many side effects that were once associated with chemotherapy are now easily prevented or controlled, allowing many people to work, travel, and participate in many of their other normal activities while receiving treatment.
When is chemotherapy used?
Chemotherapy is used in five different ways:
- “Adjuvant therapy” is chemotherapy given after surgery, either alone or with radiation (or another type of therapy), and that is designed to kill microscopic cells that have metastasized but are not seen by the naked eye.
- “Neoadjuvant chemotherapy” is used prior to surgery to shrink a tumor, sometimes in conjunction with radiation therapy.
- “Primary therapy” is used alone when leukemia or lymphoma is present and in the management of other cancers when cure is not possible to control symptoms, improve quality of life and prolong life.
- “Induction chemotherapy” is the initial or first therapy provided before a more definitive therapy. For instance, in the management of some lung cancers, chemotherapy may be given first (induction) followed by either surgery or radiation therapy.
- “Combination chemotherapy” implies the use of two or more chemotherapeutic agents, allowing for each medication to enhance the action of the other and/or attack the cancer in a different way.
How is chemotherapy administered?
Chemotherapy can be given in several different ways: intravenously (into a vein), by mouth, through an injection, or applied to the skin. The type of chemotherapy delivery will depend on the type and stage of a cancer.
Chemotherapy delivered intravenously is provided by a small IV needle in the arm or hand, through a large catheter, port, or pump. A catheter is a soft, thin, flexible tube that is placed in a large vein in the body. It remains in place as long as necessary. Sometimes the catheter is attached to a port, which is a small round plastic or metal disc placed under the skin and a common preferred route for chemotherapy administration. The port stays in place as long as necessary. A pump can be used to control how fast the drugs go into the catheter or port. An external pump remains outside the body. A peripherally inserted central catheter (PICC) is inserted into a vein in your arm and threaded to the deeper, central veins.
An intrathecal catheter delivers chemotherapeutic drugs directly into the spinal fluid. An intracavitary catheter (IC) is placed in the abdomen, pelvis, or chest.
What is a “cycle” and what is a “cycle day”?
Chemotherapy is typically administered on a fixed schedule and at a specified dose; otherwise, it could be less efficacious and/or may produce severe, potentially catastrophic side effects. You will typically be given a calendar to retain for your records. In it, your treatments days should be specified as well as office visits and necessary testing. It considers each day in a 28 consecutive day time period as numbered (1, 2, 3, and so forth). Treatment is typically given in numbered cycles (1, 2, 3 and so forth) every 7, 14, 21 or 28 days. Thus, a treatment may be given and repeated on “cycle day” #1 and #8 in a 21 day (3 week) treatment “cycle”.
Let’s take another example: FOLFOX is a chemotherapy regimen used in gastrointestinal cancer. It is administered over a 2 day period via an external pump. Treatment is repeated every 14 days. Therefore, treatment is given every cycle day #1 and #2 of a 14 day treatment “cycle” which is repeated over and over until the desired number of cycles have been administered.
Does chemotherapy hurt?
Delivering the chemotherapy into the body does not usually hurt. However, some intravenous drugs may give patients a temporary burning or cold sensation. Patients will be told beforehand if this is expected to happen by your infusion center nurse. If pain does develop this may signify a problem such as a drug leaking out of the vein in the tissues (extravasation) and you should notify your physician or nurse immediately.
Why would chemotherapy require hospitalization?
Most chemotherapy drugs can be given in an outpatient office. However, if the chemotherapy drug or regimen requires special medical supervision or the schedule does not permit office administration then the patient may need hospitalization.
What about work and staying active during chemotherapy treatment?
The level of activity during chemotherapy depends on the type of cancer and the patient’s response to the treatment. Many cancer patients work and maintain normal activities during chemotherapy. Your physician will typically discuss your level of activity prior to, during and after therapy.
Can regular foods and drink, such as alcohol, be taken during chemotherapy?
Patients may tolerate chemotherapy better by eating a light meal before and after treatment. Increasing fluid intake before, during, and after chemotherapy by two to four glasses of water daily is usually encouraged. One cocktail or glass of wine in a day will typically not be harmful. However, patients should specifically ask their doctor about the use of alcohol.
Do any medications interfere with chemotherapy?
Patients should talk to their doctor about all medications (including over-the-counter medications, supplements, vitamins, herbal products or complementary cancer therapies) used before starting or during chemotherapy treatment. Some types of medications may interfere with chemotherapy, including blood thinners such as Coumadin, hormones, antibiotics, cough medicine, vitamins, aspirin and medicine for diabetes, etc.
Why do side effects from chemotherapy occur?
Every patient responds to chemotherapy differently and which, if any, side effects they experience also differ from patient to patient. Side effects often depend on the specific drug or drugs used the dosage of the chemotherapy drug and the patient’s overall health. Side effects that occur are typically caused by chemotherapy affecting normal tissues that harbor rapidly dividing cells (which are the most sensitive to chemotherapy) such as the gastrointestinal tract and the bone marrow.
Some side effects are predictable but others are not (such as an allergic reaction to a drug). Common side effects include fatigue, nausea, diarrhea, low blood counts, numbness or tingling of the hands/feet and hair loss. Please also review this websites section on chemotherapy side effects and reasons to immediately call you physician.