What is chemotherapy?
Chemotherapy has been used since the days of the ancient Greeks. Chemotherapy for cancer care, however, began with the use of nitrogen mustard in the 1940s. Since then, several new medicines have been created and tested in an effort to discover what is effective in chemotherapy.
Chemotherapy is most commonly used to identify medications that specifically destroy cancer cells. These are sometimes called “anti-cancer” drugs or “antineoplastic.” The current treatment uses more than 100 medicines to treat cancer. There are still more chemotherapeutic drugs under development and research.
Chemotherapy is often abbreviated as ‘chemo’ and sometimes ‘CTX’ or ‘CTx’. It may be used with a curative intent, or it may aim to prolong life or to reduce symptoms (palliative chemotherapy).
If chemotherapy is an effective treatment for you, and what medications you should have, depends on:
- your type of cancer
- the appearance of the cancer cells when looked under a microscope
- whether the cancer has spread
- your overall health
What does chemotherapy do?
The use of chemotherapy depends on the type of cancer you have and how spread it is.
Cure: In some cases, the treatment may kill cancer cells to the point where your doctor can no longer detect them in your body. The best result after that is that they may never grow back again.
Control: In some cases, cancer can either be stopped from spreading to other areas of the body or can delay cancer tumour development.
Symptoms of easiness: In some cases, chemotherapy cannot cure or regulate cancer spread, and is only used to shrink tumours that cause pain or strain. Such tumours also keep on growing again.
What is a chemotherapy regimen and cycle?
A regimen of chemotherapy is usually administered in cycles. A regimen is the specific combination of chemotherapy drugs that you will receive and the number of cycles you will undergo at this stage of treatment. Over time, the prescription can change as doctors and nurses see how the body responds to the different medicines. Many patients may have to change their medication several times before finding the one that works best for them.
One of the common terms used when speaking of chemotherapy is “cycle”. A cycle of chemotherapy is the repetition of the way a drug or group of drugs is delivered for a given number of days. For example, one cycle may mean taking the medication every day one week and then taking rest the next week. The loop repeats several specified times. The doctors select the drugs and the number of chemotherapy cycles. They also determine the dosage of the drugs to be administered and how frequently they should be given. Often you will have to change the dosage or dose of a chemo drug because of the way the body reacts to the medications.
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When do you need chemotherapy?
Whether you need chemotherapy as part of your treatment depends on what type of cancer you have, how big it is and whether it has spread or not. Chemotherapy circulates in the bloodstream in the body. Therefore, cancer can be treated almost anywhere in the body, using chemotherapy.
Surgery only eliminates cancer from that part of the body where it is located. Radiotherapy also treats only the region of the body to which it is intended.
You might need chemotherapy:
- For shrinkage of cancer before surgery or radiotherapy
- For trying to stop cancer recurrence after surgery or radiotherapy
- As a stand-alone therapy if the cancer type is susceptible to it
- Treat cancer that has spread from where it originated
Chemotherapy before surgery or radiotherapy
Before surgery, chemotherapy aims to shrink a tumour so that you will need smaller surgery or to make it easier to get rid of all the cancer. Shrinking the tumour with chemotherapy may also mean you can have radiotherapy to a smaller body area.
This reason for receiving chemotherapy is called neoadjuvant care before other therapies. Doctors may sometimes call it primary treatment.
Chemotherapy after surgery or radiotherapy
Following surgery or radiotherapy, chemotherapy is aimed at lowering the risk of cancer recurrence in the future. This is called adjuvant therapy. Chemotherapy circulates throughout the body and kills any cancer cell that has travelled away from the primary tumour.
Chemotherapy for blood cancer
Sometimes you may not need surgery or radiation for cancer treatment. You may need only chemotherapy as treatment. This is for cancers that are very sensitive to chemotherapy, such as blood cancer.
Chemotherapy for cancer that has spread
When the cancer has already spread, or there is a risk that the cancer might spread, in the future, the doctor may recommend chemotherapy. Cancer cells often split free from a tumour and pass through the bloodstream or lymphatic system into other parts of the body. They can settle on different parts of the body and grow into new tumours. Those are called metastases or secondary cancers. The chemotherapy medications circulate throughout the body inside the bloodstream to kill any spreading cancer cells.
Chemotherapy with radiotherapy
Doctors also recommend both chemotherapy and radiotherapy at the same time. That is known as chemoradiation. It may make radiation more effective but may increase side effects as well.
The chemotherapy drugs you may get depend on where the cancer originated in your body (your type of cancer). That is because there are specific chemotherapy drugs that work on particular types of cancer. Therefore, the medications you need for cancer that originated in the breast and spread to the lung is different from the drugs you would use to treat cancer that originated in the lungs.
Why chemotherapy might not be suitable for you
Several tumours are susceptible to chemotherapy. For them, chemotherapy will work really well. However, certain cancer types do not appear to respond to chemotherapy well. For that scenario, the doctor might not recommend this as a treatment for you. Chemotherapy can be a difficult procedure, and you need to be well enough to receive it. Older people may have other health issues, which may make them more likely to experience severe or long-term side effects. Some treatments may put pressure on organs like the heart. Doctors ensure that you are healthy enough to start chemotherapy, by testing your pulse, lungs, kidneys and liver functions. Before deciding on a care plan, they look at the advantages and disadvantages of the care and will discuss it with you.
When is chemotherapy used?
Chemotherapy can be used in situations where cancer has spread, or there is a possibility that it may.
Chemo can be used to:
- Attempt to absolutely cure cancer (curative chemotherapy)
- Allow more effective other therapies – for example; it can be combined with radiotherapy (chemoradiation) or used before surgery (neoadjuvant chemotherapy)
- Reduce the chance of cancer returning following radiation or surgery (adjuvant chemotherapy)
- Relieve symptoms if cure (palliative chemotherapy) is not possible.
How does chemo work against cancer?
Chemotherapy targets cells that are fast-growing, such as cancer cells. Chemo will work throughout your body as opposed to radiation or surgery which target specific areas. But it may also affect other fast-growing healthy cells, such as skin, hair, intestines, and bone marrow cells. That is why chemotherapy causes some side effects.
For the treatment of cancer, several different forms of chemotherapy medications are used – either individually or in conjunction with other medicines or treatments. These medications vary in their chemical composition, their process of formulation and administration, effectiveness in treating other forms of cancer, and side effects they may have.
Cancer Cells and Chemotherapy
Cancerous tumours are characterized by excessive cell division, which is no longer regulated. Once ‘Normal cells’ come into contact with similar cells, they stop dividing — a process known as contact inhibition. Cancerous cells lose this capacity. When they touch similar cells, cancer cells lose the ability to avoid dividing.
The cell division cycle goes from the resting phase, through active growing phases, and then to mitosis (division). Chemotherapy’s ability to destroy cancer cells relies on its ability to stop the division of cells. Cancer drugs typically operate by disrupting the RNA or DNA that tells the cell how to replicate itself. When the cancer cells cannot divide, they die.
The chemotherapy drugs which destroy cancer cells when they are dividing are called cell-cycle specific. The chemotherapy drugs which kill cancer cells at rest are called cell-cycle non-specific. Chemotherapy scheduling is depended on the type of cells, the rate at which they split, and time that a drug is likely to be successful. That is why chemotherapy is typically administered in cycles.
Chemotherapy is most effective in killing rapidly-dividing cells. Chemo does not know the difference between healthy cells and cancer cells. The healthy cells will grow back, but side effects will occur in the meantime. The healthy cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhoea, and hair loss. Different medicines may affect different parts of the body.
Goals of chemotherapy treatment
When your doctor has prescribed chemotherapy as an option to cure your cancer, while making medical choices, it is important to consider the goals of the procedure. Chemotherapy (chemo) has three main goals in cancer treatment:
Whenever possible, chemo is used to cure cancer, ensuring that the cancer is destroyed – it goes away and does not come back. Most doctors use the word “cure” only as a possible or expected result of treatment. So when offering treatment that may have a chance of curing a person’s cancer, the doctor might describe it as a curative-intentioned treatment.
Though cure can be the goal in these circumstances and is the expectation of those who have cancer, this is not always the way it turns out. Knowing that a person’s cancer is truly cured often takes several years.
When a cure is not achievable, chemotherapy may try to control the disease. Chemo is used in such situations to shrink tumours and/or avoid the development and spread of cancer. This can help cancer patients feel better and live longer.
The cancer does not go away entirely in many cases, but it is monitored and treated as a chronic condition, much like heart disease or diabetes. The cancer can go away for a while in many cases but it is likely to come back.
Chemo may also be used to relieve cancer-caused symptoms. It is called palliation, or palliative chemotherapy, or palliative-intentioned therapy.
If the cancer is at an advanced stage, it is unlikely that it can be controlled. The goal of chemo can be to improve the quality of life or to help the person feel better. Chemo, for example , can help shrink a tumour that causes pain or pressure so that the patient feels better and has less pain.
It is important to note that palliative care treatment is used to alleviate symptoms or improve comfort. Anti-nausea or pain medications, for example, are palliative, and can be used at all levels of treatment. When chemo is used as a palliative treatment it can be confusing, because it is most often used to try to cure or control cancer. But when used with the comfort target, chemo is a part of a programme for palliative care.
How is chemotherapy given?
Chemotherapy drugs can be given in different ways. The method of administering the chemotherapy drug depends on the type of cancer diagnosed and the effectiveness of the drug. Common methods include:
- Intravenous (IV) – Into a vein
- Oral (PO)- By mouth
- Intramuscular (IM) injection – Into a muscle
- Subcutaneous (SC) injection – Under the skin
- Intrathecal Therapy(I.Th) – Within the spinal canal
- Intraventricular (I.Ven) – Into the brain
It is also called PO – “per os” meaning “orally” or “by mouth”. The drug may be taken as a tablet, capsule, with water or juice and is absorbed into the blood through the mucosa of the mouth, stomach, and intestine. The medication travels through the bloodstream and is transported to organs that further process. Not every drug can get through the digestive tract to the blood; therefore, other routes of administration may be required.
IV – “intravenous” means “into the vein”. A syringe or central venous catheter is used to deliver the drug directly into a vein. It is the only possible route of administering certain chemo drugs because of its chemical composition. Drugs administered intravenously can also be expected to have a more rapid effect. Intravenous administration may be done either as a rapid injection called “bolus” or as an infusion for a short or long duration.
Subcutaneous means “under the skin”. A thin cannula or needle is used to inject the chemotherapy drug, just below the skin.
Intramuscular means “into the muscle”. In this process of administering chemo, the drug is inserted into the muscles, using is a fine needle.
Intrathecal means “into the cerebrospinal fluid (CSF)”. With the help of a lumbar puncture, the chemotherapy drug is injected into the CSF to reach the central nervous system (CNS).
Intraventricular means “into the ventricle” of the brain. The chemotherapy medication is delivered into one of the ventricles in the brain from where it distributes into the central nervous system (CNS).
Where you can have chemotherapy
Patients may get chemotherapy in various ways, depending on the type of chemotherapy: in a chemotherapy care centre, in an outpatient clinic, during a hospital stay, or at home.
1. Chemotherapy day-care centres
Chemotherapy can be taken at day-care centres. Healthcare professionals in chemotherapy day-care centres take samples of your blood, give you chemotherapy and monitor you for side effects. They will also provide you and your family with information and assistance. The nurses work to ensure that the unit has a relaxed atmosphere and that the patient is comfortable. If you need to relax, there are usually recliner seats and some beds. Often, a relative or friend can stay with you while you are being treated. Some units also have additional therapists who include services including massage and reflexology.
A chemotherapy session may take from half an hour to a few hours. However, you may have to wait for blood tests results, chemotherapy drugs to be prepared and checked and to see the oncologist.
2. Chemotherapy in hospital
Some chemotherapy treatments may take longer time. You may need to stay in the hospital for a night or a couple of days, to have your treatment. This is necessary if:
- You need to receive the drug very slowly and in a controlled way
- You may need to have fluids through a drip a few hours before or after the medication you have
- If you have a reaction to the drug, your doctor wants you to be monitored during the treatment
- You need to have the drug several times a day for a couple of days in a row
3. Chemotherapy at home
Chemotherapy at home may be chosen by individuals to avoid the fear of travelling to a treatment facility. ZenOnco.io works diligently on bringing to your doorstep, one of the most common cancer treatment procedures. Taking advantage of the advances in medical technology, ZenOnco.io uses all available tools to tailor the care and deliver it to the patient in need.
We allocate an experienced healthcare professional, after consulting with the oncologist. They administer dosages of medication and stay with you for the duration of the procedure. The treatment can last between half an hour and a few hours. Generally, the treatment is given with portable infusion pumps or tablets.
The portable infusion pump is a pouch with the injection tube, containing the medicines to be injected into the body, by inserting the other end of the tube to a vein. It usually takes a few hours to complete the procedure without any complications. The tube is flushed to see if it is all working well. Then, the tube injects a vitamin solution into the body. The chemotherapy drug eventually goes into the body.
There is nothing to worry about taking chemotherapy at home, as the specially trained health care professionals can deal with any complications or anxieties that might occur during the process. When something ever goes wrong, doctors on call are available round the clock for consultation.
Safety measures for taking chemotherapy at home:
Chemotherapy must be performed in a clean environment, if not in a sterile environment. Since there is a high risk of infection with the low immunity levels of the patient, extra care helps to prevent unintended complications of health.
Cancer drugs can come into contact with caregivers accidentally during administration. Hence adequate use of protective gloves and clothing should be done. Clothes and linen for the patient have to have separate washing arrangements.
The chemotherapy drugs will be present in the body for 48-72 hours after chemotherapy is administered. The patient must also take care to use the washroom safely at home and have the area regularly cleaned.
In case the drug spills over the skin, there is a high risk of discomfort or rashes occurring. Wash the area with soap and water, quickly.
Before, during, and after Chemotherapy
Preparing for Chemotherapy
Because chemotherapy is a serious treatment for a serious condition, it is crucial to plan ahead before the therapy begins. Your doctor and staff at the hospital will help you anticipate possible treatment-related issues. You will undergo a series of tests before you start chemotherapy, to help determine if you are healthy enough for the therapy. You will require heart and blood test tests to assess the kidney and liver health. These tests will guide your doctor when deciding what kinds of chemotherapy can be used for you.
Your doctor may also suggest that you visit your dentist before treatment begins. As chemotherapy affects the ability of your body to heal, any infection in your gums or teeth may potentially spread all over your body. If you are receiving chemotherapy via an intravenous ( IV ) line, your doctor may install a port. It is a device that is implanted in your body, typically near your shoulder in your chest. This makes it easier to enter the veins and less painful. The IV line will be inserted into your port over each treatment.
Consider these preparation tips for chemotherapy treatment:
- Make work arrangements. During chemotherapy, most people can work, but you may want to put yourself on a lighter workload until you know what kinds of side effects you may have.
- Get your house ready. Stock up on groceries, do your laundries and perform other tasks before starting chemotherapy, as you may be too weak to do these after chemotherapy.
- Arrange whatever help you may need. It can be incredibly helpful to have a friend or family member to assist with household tasks or to look after pets or babies.
- Anticipate side effects. Talk with your doctor about potential side effects and how to prepare appropriately. If infertility can be a side effect and you want to conceive a child, you might want to store sperm, eggs or fertilized embryos and freeze them. If hair loss is likely, you may want to buy head-covers or wigs.
- Become part of a support group. Talking to someone outside your family and about what you are going through can help you stay optimistic. This will also help to ease any concerns that you may have about medication.
You and your doctor can work together to consider all variables and determine the best course of your treatment. Chemotherapy is usually given in the form of a pill or by injection or an IV directly into the veins. It may also be administered in several other ways, in addition to these two forms.
Chemotherapy administering options include:
- Chemotherapy can be administered directly into the tumour, depending on the location of the tumour. If you have to undergo surgery to remove the tumour, your doctor can, over time, implant slow-dissolving disks that release medicines.
- Chemotherapy creams can be used to treat some skin cancers. They can be applied directly on the skin.
- Chemotherapy may be delivered through localized treatment to a specific part of the body, such as directly into the abdomen, chest, central nervous system or through the urethra into the bladder.
- Some forms of chemotherapy can be taken as pills by mouth.
- Drugs for liquid chemotherapy may be delivered in single shots, or you may have a port. On the first visit, the infusion method with a port may involve discomfort at the injection site, but the port needle will loosen gradually.
Where you get treatment depends on the delivery system you have chosen. If you are using creams or tablets, for example, you can give yourself home treatments. Other procedures usually take place in a hospital or cancer treatment centre. Nowadays chemotherapy can be taken at home itself. Your chemotherapy schedule will be personalized to suit you, as will how frequently you undergo medication. It can be changed if your body does not respond to the treatment well, or it can be increased or decreased depending on how well the cancer cells respond to treatments.
Your health care provider will track the efficacy of your medications regularly. These will include imaging, blood testing and possibly more. Your health care team can adjust your treatment at any time.
The more you will share how chemotherapy impacts you with your doctor, the better the care experience will be. You must tell them about any side effects or treatment-related issues you are having so they can adjust to your treatment if necessary.
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Risks and side effects of chemotherapy
Chemotherapy risks typically relate to side effects caused by the breakdown of normal, healthy cells or by the response of the body to the particular drugs being used. Oncologists know how to avoid many side effects associated with the administered chemotherapy. They can also use medicines to treat those side effects, reducing their discomfort and damage.
Side effects can be short-term and vanish after treatments for chemotherapy have finished, or they may be long term that may not occur for months after chemotherapy has stopped. Several factors can cause or modify a patient’s side effects, and these can keep changing during chemotherapy.
Most chemotherapy side effects are attributable to the destruction of healthy cells. Since chemotherapy affects all rapidly developing cells, it may affect any rapidly growing cells such as bone marrow, digestive tract lining, hair follicle, and lining cells of the reproductive tract.
List of side effects
You may have a lot of side effects, some, or none at all. Some of the common side effects of chemotherapy are:
- Appetite Changes
- Eye Changes
- Flu-like symptoms
- Fluid retention
- Hair Loss
- Mouth and Throat Changes
- Nausea and Vomiting
- Nervous System Changes
- Sexual Changes
- Skin and Nail Changes
- Urinary, Kidney, or Bladder Changes
Chemotherapy is a powerful medicine, and avoiding close contact with the medications is best for people without cancer. That is why doctors and oncology nurses wear gloves, goggles, gowns and sometimes masks. These products are disposed of in separate bags or bins when the treatment session is over.
The drugs can remain inside your body for up to a week after each chemotherapy session. This depends on the type of medications that are used. Then, the medications are released into urine, faeces and vomit. They could also be carried to other bodily secretions such as saliva, sweat, vaginal discharge, semen, and breast milk.