Why have chemotherapy?
Chemotherapy can be used for different reasons:
Cure - Some cancers can be cured by chemotherapy on its own or in combination with other treatments, such as surgery or radiotherapy. The aim of the treatment is to destroy all cancer cells.
To help other treatments - Chemotherapy can be given either before or after other treatments. Used beforehand, its purpose is to make the cancer smaller so your main treatment is more effective (neo-adjuvant therapy). If chemotherapy is given after your main treatment, its aim is to get rid of any remaining cancer cells (adjuvant therapy).
To control the cancer - If the cancer is too large and can't be cured, chemotherapy can be used to control the cancer's growth for an extended period of time.
Symptom relief - When the cancer can't be cured but causes symptoms such as pain, treatment - such as chemotherapy - can provide relief. This is called palliative treatment.
Chemo is given on a schedule. Some people receive it every day. Others receive it every week or every month. Doctors use the word cycles to describe chemo because the treatment periods happen between periods of rest when a person isn't getting any treatment. These breaks allows the person's body to heal from the effects the chemo has on the cancer and on the body's normal cells.
Breaks from treatment are important because, during chemo, a person might experience some temporary health problems called side effects. All medications can have side effects. In their effort to kill cancer cells, chemo drugs can make normal cells sick. Breaks during chemo cycles allow time for normal cells to get better.
Below is a list of the most commonly reported side effects:
Nausea and vomiting
Over half of all patients receiving chemotherapy will experience nausea and vomiting. Doctors will usually prescribe anti-emetics for this. These need to be taken even when symptoms have gone as they will prevent them from coming back. If the anti-emetics do not work the patient should contact his/her doctor who may switch to another anti-emetic.
Alopecia (Hair loss)
Some chemotherapy medications cause hair loss while others don't. If hair does start to fall out this will usually happen a few weeks after treatment starts. On some occasions the hair will just become thinner and more brittle (without falling out). Hair loss can occur in any part of the body.
Most patients receiving chemotherapy will experience some degree of fatigue. This may be a general feeling which exists most of the day, or may only appear after certain activities. Doctors say patients need to make sure they get plenty of rest and not to perform tasks which are overtiring.
While light exercise has been shown to help, it is important to remember to keep the activities 'light'.
If the tiredness becomes severe it is important to tell the doctor, as this could be caused by a significant drop in red blood cells (anemia).
Hearing impairment (deafness, ototoxicity)
Scientists from Oregon Health & Science University reported that deafness as a side effect of chemotherapy has long been underreported by the medical community, because a well-known classification system doctors use for reporting toxicities in patients does not consider high-frequency hearing loss, allowing the magnitude of ototoxicity (hearing damage) in children treated with platinum agents to be miscalculated.
Children with cancer who suffer hearing loss due to the toxic effects of chemotherapy might one day be able to get their hearing back through pharmacological and gene therapy, said researchers from St. Jude Children's Research Hospital after carrying out a study on mice.
Neutropenia (low white blood cells) - Susceptibility to infections
When receiving chemotherapy the immune system will be weakened because the white blood cell count will go down. White blood cells form part of our immune system - they fight infection. Consequently, patients become more susceptible to infections.
Some patients will be prescribed antibiotics which may reduce their risk of developing infections. The following precautions will help reduce the risk of infections:
Personal hygiene - the cleaner you are, the fewer bacteria there will be around which can infect you. Regularly wash your hands with warm water and soap, have a bath/shower at least once a day, change your clothes and bathroom towels and flannels daily. Change your bed linen regularly.
Preparing food - make sure your food is free of food borne pathogens (organisms, such as bacteria that can make you ill). If you handle raw meat make sure you wash your hands before touching plates and cutlery or work surfaces. Thoroughly cook animal sourced proteins before eating them. Wash your dishes thoroughly and always use a clean plate and cutlery - keep the kitchen clean.
Infected people - stay away from people who are ill. This may include those who just have a temperature.
Skin wounds - bacteria find it hard to get in through your skin, unless there is a cut. If you graze or cut your skin, clean the area well with warm water, dry it, and cover it with a sterile dressing.
Patients receiving chemotherapy who develop an infection need immediate treatment. This may mean being hospitalized and receiving antibiotics via an intravenous drip.
Thrombocytopenia (low blood platelet count) - Blood clotting problems
Chemotherapy may lower the patient's blood platelet count. A platelet is a type of blood cell that helps the blood to clot (coagulate). Coagulation is essential, otherwise bleeding does not stop. Lower blood platelet counts linked to chemotherapy is a risk, but less so than lower red or white blood cell counts. If you are affected you will bruise more easily, you will be more likely to have nosebleeds and bleeding gums, and if you cut yourself it may be harder to stop the bleeding.
Patient's whose blood platelet counts fall too low will need a blood transfusion.
Anemia (low red blood-cell count)
As well as lowering you white blood cell count, chemotherapy will also lower your red blood cell count. Tissues and organs inside your body get their oxygen from the red blood cells. If your red blood cell count goes down too many parts of your body will not get enough oxygen and you will develop anemia.
People with anemia feel very tired. A patient on chemotherapy who has anemia will feel extra tired - much more tired than straightforward fatigue caused by the treatment. Dyspnea (shortness of breath) is also another symptom of anemia, as are palpitations (when the heart beat is irregular).
Anemia linked to chemotherapy requires immediate treatment. A blood transfusion will bring the red blood cell count back up immediately. Erythropoietin (EPO) is a drug that makes the body produce more red blood cells.
Mucositis (inflammation of the mucous membrane)
Chemotherapy attacks rapidly dividing cells, such as blood cells, bone marrow cells, and cells of the mucous membranes that line the digestive system - this includes the mouth, esophagus, stomach, intestines, and the rectum to the anus. Chemotherapy may damage and even destroy some of those mucous membrane cells.
Oral Mucositis (in the mouth) - patients more commonly experience symptoms in their mouth.
Loss of appetite
Loss of appetite is a common side effect of chemotherapy. It is possible that the chemotherapy, or the cancer itself, affects the body's metabolism. If the loss of appetite is just due to the chemotherapy it will come back when the treatment is finished - although this may sometimes take a few weeks.
The severity of appetite and consequent weight loss depends on the type of cancer and chemotherapy treatment.
Although this is sometimes easier said than done, it is important to keep trying to eat well and take in plenty of fluids. Many patients find that smaller and more frequent meals are easier to get down than the typical three meal-a-day regime. Also, drinking liquids through a straw may result in a better fluid intake.
Patients who become seriously affected by lack of food and liquid intake may need to be hospitalized and fed through a nasogastric tube. The tube goes into the patient's nose and down to his/her stomach.
Nails and skin
Chemotherapy can sometimes cause dry and sore skin. Nails may also become flaky and brittle. The skin may become more sensitive to sunlight. It is important to protect yourself from too much sunlight exposure. This includes staying out of the sun during peak times of the day, using sun blocks, and wearing clothes that provide maximum protection. Surprisingly, scientists at Michigan University, USA, reported that the chemotherapy drug fluorouracil appeared to reduce the appearance of sun-damaged and aging skin as well as the number of potentially pre-cancerous skin patches.
About one fifth of patients undergoing chemotherapy report some kind of cognitive problem, including attention, thinking and memory. This can sometimes have an impact on daily tasks. Patients who do experience these symptoms should talk to their doctor, and social worker.
Symptoms may include:
Shorter attention span; concentration, focus and attention problems
Memory problems; especially the short-term memory
Comprehension and understand problems
Judgment and reasoning problems
Organizational skills may be affected
Multitasking problems (performing/thinking about several things at the same time)
Experts are unsure how much is due to the chemotherapy, and how much is due to fatigue, stress and anxiety that comes with having cancer.
Libido (sex drive) and fertility
For a significant proportion of patients, chemotherapy may result in a lower sex drive (less interest in sex). This is temporary and usually returns after treatment is completed.
Depending on the type of medication administered, chemotherapy may also damage men's sperm. Some women may become infertile. In most cases - though not all - fertility returns after treatment is over.
Men who wish to father children and women who plan to become pregnant one day should discuss possible options with their doctors before starting treatment. It is possible to freeze sperm and embryos.
Bowel movement problems (diarrhea or constipation)
Sometimes when damaged cells in the intestinal tract are rapidly expelled from the body there is a risk of diarrhea. Constipation is also a possible risk for chemotherapy patients. You should talk to your doctor if you experience any unpleasant change in your bowel movements. Symptoms, if they do occur, will do so a few days after chemotherapy begins.
The risk of developing depression is already higher for patients with cancer. It is normal to feel distressed, anxious, sad and stressed - especially if you are concerned about what the future holds and whether treatment is going to be effective.
What can I do to take care of myself during chemo?
During your chemo, take special care of yourself. Your doctor or nurse will give you tips on how to do that. But there are some basic things you should do, such as:
Get plenty of rest. You may feel more tired than normal during treatment. Give yourself time for rest breaks when you need them.
Eat healthy foods. It’s important for your body to get enough protein and calories to rebuild the healthy cells that it loses during treatment. Your doctor, nurse, or dietitian (die-uh-tish-un) may work with you to make sure you are eating the right foods to get what you need. If you have trouble eating or don’t feel like eating, talk to your doctor or nurse.
Get exercise and fresh air if your doctor says you can. Exercise can help reduce stress and tiredness, and can help you feel like eating. Check with your doctor about your exercise plan to make sure it’s OK.
Ask your doctor or nurse about alcohol. Small amounts of beer or wine may help you relax and help you feel hungry. But alcohol can cause problems with some chemo drugs. Your health care team can tell you if it’s OK to drink.
Check with your doctor or nurse before taking vitamins or supplements. There is no “magic” diet, herb, or substance that can cure cancer, no matter what anyone claims. If you already take vitamins or supplements, tell your doctor what you take and ask if it’s OK to keep taking them.
Keep thinking about the treatment goals. Dealing with chemo can be hard. A good way to handle the effects of chemo is to remind yourself why you’re getting it.
Learn more about your cancer and treatment. The more you know, the better you will be able to cope.
Take time to enjoy your hobbies. Doing the things you like to do can help you cope with chemo, too.
Chemotherapy medicines come in many forms and can be given in many ways:
Intravenously (IV) as a slow drip (also called an infusion) through a thin needle in a vein in your hand or lower arm. The nurse will put the needle in when each infusion begins and take it out when the infusion is done. Tell your doctor or nurse right away if you feel any pain or burning while you're getting chemotherapy through an IV infusion.
Injection as a single shot into a muscle in your arm, leg, or hip, or under skin in the fatty part of your arm, leg, or tummy.
By mouth (orally) as a pill or capsule.
Through a port (sometimes called by brand names such as Port-a-cath or Mediport) inserted in your chest during a short outpatient surgery. A port is a small disc made of plastic or metal about the size of a quarter that sits just under the skin. A soft thin tube called a catheter connects the port to a large vein. Your chemotherapy medicines are given through a special needle that fits right into the port. You also can have blood drawn through the port. When all your cycles of chemotherapy are done, the port is removed during another short outpatient procedure.
Through a catheter (sometimes called a "long line") in your chest or arm. A catheter is a soft thin tube that is inserted into a large vein during a short, outpatient surgery. The other end of the catheter stays outside your body. This is basically the same as having a port, only you don't have the port itself. Your chemotherapy medicines are given through a special needle that fits into the catheter. You also can have blood drawn through the catheter. When all your cycles of chemotherapy are done, the catheter is removed during another short outpatient procedure.
Chemo is a type of treatment that includes a drug or combination of drugs to treat cancer. The goal of chemo is to stop or slow the growth of cancer cells. Chemotherapy is considered a systemic therapy. This means it may affect your entire body. Chemo drugs target rapidly growing cancer cells, but they can also affect healthy cells that grow rapidly. The effect of these drugs on both cancer and normal cells often causes chemo side effects. For example:
A number of blood cells that divide rapidly can be damaged along with cancer cells during chemo:
White blood cells help protect the body from infection. A low white blood cell count is known as neutropenia. If your white blood cell count gets too low you could get a serious infection.
Red blood cells carry oxygen throughout your body. A low red blood cell count is known as anemia. Anemia can lead to fatigue, chest pain, and more serious complications.
Platelets are structures in the blood that help stop bleeding. A low platelet cell count is known as thrombocytopenia. A low platelet count can cause bruising and bleeding.
Hair follicles have cells that can be affected by chemo, leading to hair loss, also called alopecia.
Cells lining your stomach can also be affected by chemo. This can cause vomiting and diarrhea and may be associated with nausea.
History of chemotherapy The first drug used for cancer chemotherapy did not start out as a medicine. Mustard gas was used as a chemical warfare agent during World W ar I and was studied further during World War II. During a military operation in World War II, a group of people were accidentally exposed to mustard gas and were later found to have very low white blood cell counts. Doctors reasoned that something that damaged the ra pidly growing white blood cells might have a similar effect on cancer. So, in the 1 940s, several patients with advanced lymphomas (cancers of certain white blood cells) we re given the drug by vein, rather than by breathing the irritating gas. Their improvement, although temporary, was remarkable. That experience led researchers to look for other s ubstances that might have similar effects against cancer. As a result, many other dru gs have been developed.
How is chemotherapy used? Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy , or biological therapy . Chemotherapy can: ■ ■ Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy . ■ ■ Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy . ■ ■ Help radiation therapy and biological therapy work better. ■ ■ Destroy cancer cells that have come back ( recurrent cancer) or spread to other parts of your body ( metastatic cancer)
The severity of chemotherapy's side effects depends on which of the more than 20 commonly used drugs is administered, the individual characteristics of the patient, and the drug dosage.
Most side effects resolve once treatment is completed, and some cease even during continued therapy. Whereas decreasing the dose may be required in some cases, even small changes in treatment are usually avoided to insure the treatment's effectiveness.
Minor discomforts and inconveniences (skin problems, edema, weight gain and loss, alterations in sexual performance, digestive disturbances, fatigue) are common and collectively may present a serious problem for the patient. Patients who experience these side effects should bring them to the attention of a member of the treatment team--a simple coping strategy may be sufficient to alleviate the problem...
The purpose of chemotherapy is to kill cancer cells. Not only is it often used to treat patients with cancer that has metastasized (spread) from the site in the body where it originated, today chemotherapy can be used to prevent metastasis as well. Chemotherapy destroys cancer cells throughout the body, killing cells that have broken off from the main tumor and traveled through the blood or lymph systems to other parts of the body.
Chemotherapy can cure some types of cancer...