❐ What is Chemotherapy?
Chemotherapy is the use of drugs to destroy cancer cells. This type of cancer treatment works by keeping cancer cells from growing, dividing, and making more cells.
Chemotherapy can be used as a treatment for many different cancers. Your doctor may refer to chemotherapy as standard chemotherapy, traditional chemotherapy, or cytotoxic chemotherapy.
❐ How does chemotherapy treat cancer?
Chemotherapy is a systemic medication. This means it travels through the bloodstream and reaches all parts of the body.
There are many different kinds of chemotherapy. In general, drugs used for chemotherapy are powerful chemicals that treat cancer by attacking cells during specific parts of the cell cycle. All cells go through the cell cycle, which is how new cells are made. Cancer cells go through this process faster than normal cells, so chemotherapy has more of an effect on these fast-growing cells.
Because chemotherapy travels through the whole body, it can also damage healthy cells as they go through their normal cell cycle. This is why chemotherapy can cause side effects like hair loss and nausea.
❐ What are the goals of chemotherapy?
The goals of chemotherapy depend on your type of cancer and how far it has spread. Chemotherapy can be given alone or as a part of a treatment plan that includes different treatments. Some of the ways chemotherapy is used include:
◉ As the primary treatment. Sometimes, the goal of chemotherapy treatment is to get rid of all the cancer and keep it from coming back. This might be called “curative chemotherapy.”
◉ Before other treatments. Chemotherapy can be given before surgery or radiation therapy to shrink tumors. This can be called “neoadjuvant chemotherapy.”
◉ After other treatments. Chemotherapy can be given after surgery or radiation therapy to destroy any remaining cancer cells. This is called “adjuvant chemotherapy.”
◉ To slow the progression of cancer and relieve symptoms. Even when the cancer is not curable, chemotherapy can partially shrink tumors and prevent tumor growth and spread for various lengths of time. In such settings, chemotherapy can extend survival, relieve cancer-related symptoms, and improve quality of life. Chemotherapy used for these purposes is sometimes called “palliative chemotherapy.”
Chemotherapy can be used to treat many types of cancers. It can also be used to treat recurrent cancer and metastatic cancer. Reticular Cancer is cancer that comes back after treatment. Metastatic Cancer is cancer that has spread to other parts of the body.
❐ What factors determine a chemotherapy plan?
There are many drugs available to treat cancer. A doctor who specializes in treating cancer with medication is called a medical oncologist. This type of doctor will prescribe your chemotherapy. You may receive a combination of drugs, because this sometimes works better than 1 drug by itself.
The drugs, dose, and treatment schedule depend on many factors. These include:
◉ The type of cancer
◉ The stage of the cancer. Cancer stage is determined by the size and location of the tumor and whether or not the cancer has spread. tumor size, its location, and if or where it has spread.
◉ Your age and general health
◉ Your body weight
◉ The possible side effects of each drug. If a drug causes you to have too many side effects, this can also change your treatment plan.
◉ Any other medical condition you have
◉ Previous cancer treatments
❐ Where do you receive chemotherapy?
Chemotherapy can be given at a medical center or taken at home, depending on the specific drug.
Your health care team may need you to come in regularly to the clinic, doctor’s office, or hospital to receive the chemotherapy. This may be called outpatient treatment.
Some types of chemotherapy can be taken at home.
❐ How is chemotherapy delivered?
Chemotherapy may be given in several different ways, which are discussed below.
◉ Intravenous (IV) chemotherapy. Many drugs require injection directly into a vein. This is called intravenous or IV chemotherapy. Treatment takes a few minutes to a few hours. Some IV drugs work better if you get them over a few days or weeks. You take them through a small pump you wear or carry. This is called continuous infusion chemotherapy.
◉ Oral chemotherapy. Oral chemotherapy is taken by mouth. This can be as a pill, capsule, or liquid. This means that you may be able to pick up your medication at the pharmacy and take it at home. Oral treatments for cancer are now more common. Some of these drugs are given daily, and others are given less often. Be sure to ask your health care team about your drug’s schedule and how to store the drug..
◉ Injected chemotherapy. This is when you receive chemotherapy as a shot. The shot may be given in a muscle or injected under the skin. You may receive these shots in the arm, leg, or abdomen. Abdomen is the medical word for your belly.
◉ Chemotherapy into an artery. An artery is a blood vessel that carries blood from your heart to another part of your body. Sometimes chemotherapy is injected into an artery that goes directly to the cancer. This is called intra-arterial or IA chemotherapy.
◉ Chemotherapy into the peritoneum or abdomen. For some cancers, medication might be placed directly in your abdomen. This type of treatment works for cancers involving the peritoneum. The peritoneum covers the surface of the inside of the abdomen and surrounds the intestines, liver, and stomach. Ovarian Cancer is one type of cancer that frequently spreads to the peritoneum.
◉ Topical chemotherapy. Some types of chemotherapy come as a cream that you put on your skin. You get your medication at the pharmacy and apply it at home.
❐ What types of chemotherapy are there?
Chemotherapy for cancer includes more than a 100 different drugs. Although all chemotherapy drugs damage cells, they attack different cell targets at different times during the cell cycle. Combining drugs that damage the cancer cell in different ways can increase how well the treatment works.
Below are the main types of chemotherapy:
◉ Alkylating agents
◉ Antimetabolites
◉ Anti-tumor antibiotics
◉ Topoisomerase inhibitors
◉ Mitotic inhibitors
◉ Plant alkaloids
❐ Chemotherapy in combination with other cancer treatments
There are other types of drugs besides chemotherapy that also treat cancer, such as hormone therapy, immunotherapy, and targeted therapy. Sometimes oncologists use chemotherapy alongside another type of drug in a person’s treatment plan. These categories of drugs work in different ways to treat cancer, and their side effects are usually different than chemotherapy. Talk with your health care team about what to expect with your specific prescriptions.
◉ Hormone therapy. Hormone therapy is a type of cancer treatment that removes, blocks, or adds specific hormones to the body. It is also called hormonal therapy or endocrine therapy. Hormone therapy can be used to treat several types of cancer.
◉ Immunotherapy. This type of treatment helps your body’s natural defenses fight the cancer Immune therapy has developed rapidly during the last few years, and is now an important part of treatment for several types of cancer.
◉ Targeted therapy. These treatments target and disable genes or proteins found in cancer cells that the cancer cells need to grow Targeted Therapy can treat many types of cancer.
❐ How long will I need chemotherapy?
Chemotherapy is often given for a specific time, such as 6 months or a year. Or you might receive chemotherapy for as long as it works.
Side effects from many anti-cancer drugs are too severe to give treatment every day. Doctors usually give these drugs with breaks, so you have time to rest and recover before the next treatment. This lets your healthy cells heal.
For example, you might get a dose of chemotherapy on the first day and then have 3 weeks of recovery time before repeating the treatment. Each 3-week period is called a treatment cycle. Several cycles make up a course of chemotherapy. A course usually lasts 3 months or more.
Some cancers are treated with less recovery time between cycles. This is called a dose-dense schedule. It can make chemotherapy more effective against some cancers. But it also increases the risk of side effects.
Your health care team will explain how often and for how long you’ll receive chemotherapy. Be sure to talk with your doctor, nurse, or other team member regularly about side effects of chemotherapy, including what you can expect and what you are experiencing.
❐ What to Expect When Having Chemotherapy?
It is normal to feel worried or overwhelmed when you find out that you need chemotherapy. However, learning more about this type of cancer treatment may help you feel more prepared and less anxious. The information in this article can help you get ready for your first treatment.
❐ Side Effects of Chemotherapy
Chemotherapy treats many types of cancer effectively. But like other cancer treatments, it often causes side effects. It is important to be aware of possible side effects from chemotherapy so you know what to watch for and can talk with your health care team about preventing and relieving them.
The side effects of chemotherapy are different for each person. They depend on the type of cancer, location, drugs and dose, and your general health.
❐ Why does chemotherapy cause side effects?
Chemotherapy works by targeting active cells. Active cells are cells that are growing and dividing as a part of the normal cell cycle. Both cancer cells and healthy cells are active cells going through the cell cycle. Cancer cells typically grow faster than normal, healthy cells, which means it is easier for chemotherapy to attack the cancer cells. But some normal cells will be damaged by the chemotherapy as well. These include cells in your blood, mouth, digestive system, and hair follicles.
Side effects happen when chemotherapy damages these healthy cells. For example, you might lose your hair or experience nausea and vomiting.
For most types of chemotherapy, side effects do not show how well treatment is working.
❐ What are common side effects of chemotherapy?
The side affects you experience while on chemotherapy depend on which drug or combination of drugs are prescribed. Different drugs cause different side effects. And each person’s experience is different. People may not experience the same side effects even when taking the same drug. And you can have different side effects than you did in the past if you take the same drug again.
That is why it is important to talk with your cancer care team regularly about the side affects you are worried about or are experiencing. Tell them about all the side affects you notice. It may be helpful to track side effects over time and share that information with your care providers.
Common side effects of chemotherapy include:
⯐ Fatigue. Fatigue is feeling tired or exhausted even if you get enough sleep. It is the most common side effect of chemotherapy..
⯐ Hair loss. Some types of chemotherapy, but not all, cause hair loss. Hair on your body may come out a little at a time or in large clumps. Hair loss usually starts after the first several weeks of chemotherapy. It tends to increase 1 to 2 months into chemotherapy. Your doctor can predict the risk of hair loss based on the drugs and doses you are receiving.
⯐ Pain. Chemotherapy sometimes causes pain. This can include:
◉ Headache
◉ Muscle Pain
◉ Stomach pain
◉ Pain from Nerve Damage, such as burning, numbness, or shooting pains, usually in the fingers and toes
Most types of pain related to chemotherapy get better or go away between individual treatments. However, nerve damage often gets worse with each dose. Sometimes the drug causing the nerve damage has to be stopped. It can take months or years for nerve damage from chemotherapy to improve or go away. In some people, it may cause permanent damage.
Treatment of any cancer-related pain will start by considering the cause. It is important to talk with your health care team about your pain levels during chemotherapy. There can be other reasons for pain besides the chemotherapy itself. If the pain is related to chemotherapy, doctors can treat it by:
◉ Giving pain-relieving medications
◉ Blocking pain signals from the nerves to the brain with spinal treatments or nerve blocks
◉ Adjusting your dose of specific drugs
⯐ Mouth and throat sores. Chemotherapy can damage the cells inside the mouth and throat. This causes painful sores in these areas, a condition called mucositis. Mouth sores usually happen 5 to 14 days after a treatment. It is also important to watch for infection in these sores.
Eating a healthy diet and Keeping Mount Clean can lower your risk of mouth sores. Mouth sores usually go away completely when treatment ends., including ways to relieve discomfort.
⯐ Diarrhea. Some chemotherapy causes loose or watery bowel movements. Preventing diarrhea or treating it early helps keep you from getting dehydrated (losing too much body fluid). It also helps prevent other health problems..
⯐ Constipation. Chemotherapy can cause constipation. This means not having a bowel movement often enough or having difficult bowel movements. Other medicines, such as pain medication, can also cause constipation. You can lower your risk of constipation by drinking enough fluids, eating balanced meals, and getting regular exercise.
⯐ Nausea and vomiting. Chemotherapy can cause nausea (feeling sick to your stomach) and vomiting (throwing up). Whether you have these side effects, and how often, depends on the specific drugs and dose. There are medications that are given before and after each dose of chemotherapy that can usually prevent nausea and vomiting.
⯐ Blood disorders. Your bone marrow is the spongy tissue inside your bones. It makes new blood cells. Chemotherapy affects this process, so you might have side effects from having too few blood cells.
Usually the number of blood cells return to normal after chemotherapy is complete. But during treatment, low numbers of blood cells can cause problems and must be watched closely. During chemotherapy, your doctor will routinely check your blood counts using 2 tests: complete blood count (CBC) and platelet count.
A CBC test shows the levels of red blood cells and white blood cells in your blood. Not enough red blood cells causes a condition called anemia Symptoms include fatigue, dizziness, and shortness of breath. Not enough white blood cells causes a condition called leukopenia. This raises your risk of getting infections. When your white blood cells are low, getting an infection can be serious. If this happens, you need antibiotics as soon as possible.
A platelet count measures the number of platelets in your blood. Platelets are cells that stop bleeding. They do this by plugging damaged blood vessels and helping blood form clots. Not having enough platelets causes a condition called thrombocytopenia. You can bleed and bruise more easily than normal.
The doses of chemotherapy can often be adjusted to prevent low blood counts. Drugs are also available to treat these blood disorders. The drugs help your bone marrow make more blood cells. They can help prevent leukopenia in people with a high risk.
⯐ Nervous system effects. Some drugs cause nerve damage. This can cause the following nerve or muscle symptoms:
◉ Tingling
◉ Burning
◉ Weakness or numbness in the hands, feet, or both
◉ Weak, sore, tired, or achy muscles
◉ Loss of balance
◉ Shaking or trembling
◉ Stiff neck or headache
◉ Problems seeing, hearing, or walking normally
◉ Feeling clumsy
These symptoms usually get better with a lower chemotherapy dose or after treatment. It can take 6 to 12 months for symptoms to get better after chemotherapy ends. Some side effects can be permanent..
⯐ Changes in thinking and memory. Some people have trouble thinking clearly and concentrating after chemotherapy. Cancer survivors often call this chemo brain. Your doctor might call it cognitive changes or cognitive dysfunction. This condition usually improves or resolves after chemotherapy ends.
⯐ Sexual and reproductive issues. Chemotherapy can affect your fertility. Fertility is the ability to get pregnant and carry a pregnancy or to make someone else pregnant. If you want to have a child after cancer treatment, be sure to talk with your cancer care team about your options for fertility preservation before chemotherapy begins.
Being tired or feeling sick from cancer or treatment can affect your ability to enjoy sex. Talk with your doctor about these possible side effects before treatment starts.
Some people might need a Pap Test before starting chemotherapy. This is because chemotherapy can cause misleading results on the test. A Pap test gathers a sample of cells from the cervix.
Chemotherapy can also harm an unborn baby. This is especially true during the first 3 months of pregnancy, when the organs are still developing. If you could get pregnant during treatment, use effective birth control. If you do get pregnant, tell your doctor right away..
⯐ Appetite loss. You might eat less than usual, not feel hungry at all, or feel full after eating a small amount. If this lasts through treatment, you may lose weight and not get the nutrition you need. You may also lose muscle mass and strength. All these things make it harder to recover from chemotherapy..
⯐ Heart problems. Some types of chemotherapy can affect your heart. Ask your doctor if your heart will need testing before treatment. This way, doctors can tell if treatment causes problems later. One common test is an ECO. This test uses ultrasound waves to create a moving picture of the heart.
❐ Questions to ask the health care team
◉ What type of chemotherapy do you recommend for me? Why?
◉ What are the goals of this chemotherapy?
◉ Will chemotherapy be my only cancer treatment? If not, will it be given before, during, or after another cancer treatment?
◉ How will I receive chemotherapy, such as by pill or by IV? How often? For how long?
◉ Where will I receive this chemotherapy?
◉ If I need to come into the medical center for chemotherapy, how long will it take to give the treatment? How often will I need to travel to the center?
◉ If I should take this medication at home, are there special instructions on how to store or handle the chemotherapy? What should I do if I miss a dose?
◉ What are the possible side effects of this treatment in the short term?
◉ Will this treatment affect my daily life? Will I be able to work, exercise and do my usual activities?
◉ Will chemotherapy affect what or how I eat? If so, how can I eat well during my treatment period?
◉ What are the possible long-term effects of this treatment?
◉ Who should I talk with about any side effects I experience? How soon?
◉ Who should I call with questions or problems?
◉ How can I reach them during regular office hours? After hours?
◉ If I’m very worried or anxious about having this treatment, what can I talk with?
◉ If I’m worried about managing the cost of this treatment, who can help me?
◉ How will we know if the chemotherapy is working?
◉ Will I need any tests or scans before, during, or after chemotherapy?
◉ Could the dose or duration of my chemotherapy change over time?
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