Chemotherapy is a type of treatment that includes a drug or combination of drugs to treat cancer. The goal of chemotherapy 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 term chemotherapy, or chemo, refers to a wide range of drugs used to treat cancer. These drugs usually work by killing dividing cells. Since cancer cells have lost many of the regulatory functions present in normal cells, they will continue to attempt to divide when other cells do not. This trait makes cancer cells susceptible to a wide range of cellular poisons.
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 neoadjuvant chemotherapy. It can destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy. It could also help radiation therapy and biological therapy work well, and destroy cancer cells that have come back (recurrent cancer) or spread to other parts of the body (metastatic cancer).
The chemotherapy agents work to cause cell death in a variety of ways. Some of the drugs are naturally occurring compounds that have been identified in various plants and some are man-made chemicals.
A few different types of chemotherapy drugs are briefly described below.
- Antimetabolites –
Drugs that interfere with the formation of key bio-molecules within the cell including nucleotides, the building blocks of DNA. These drugs ultimately interfere with DNA replication and therefore cell division.
- Genotoxic Drugs –
Drugs that damage DNA. By causing DNA damage, these agents interfere with DNA replication and cell division.
- Spindle Inhibitors –
These agents prevent proper cell division by interfering with the cytoskeletal components that enable one cell to divide into two.
- Other Chemotherapy Agents –
These agents inhibit cell division by mechanisms that are not covered in the three categories listed above.
Depending on your type of cancer and how advanced it is, chemotherapy can:
- Cure cancer –
When chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
- Control cancer –
When chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
- Ease cancer symptoms (also called palliative care) –
When chemotherapy shrinks tumors that are causing pain or pressure.
Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:
- The type of cancer and how advanced it is
- The goals of treatment (whether chemotherapy is used to cure cancer, control its growth, or ease the symptoms)
- The type of chemotherapy
- How your body reacts to chemotherapy
The patient may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives the body a chance to build new healthy cells.
Chemotherapy may be given in many ways.
- Injection –
The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.
- Intra-arterial (IA) –
The chemotherapy goes directly into the artery that is feeding cancer.
- Intraperitoneal (IP) –
The chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries)
- Intravenous (IV) –
The chemotherapy goes directly into a vein. Both chemo port and PICC are central venous access systems which make administering chemotherapy much less cumbersome as it becomes more difficult to find the smaller veins in the arm once chemotherapy begins. Both can be used with any kind of chemotherapy.
- Chemotherapy Port
A chemotherapy port is a small device that is surgically implanted and placed underneath the skin near the clavicle (collarbone) to allow easy access to the bloodstream during cancer treatment. One can feel the port underneath the skin, but there is no extension outside of the body. The health care team often needs access to veins to give treatments such as chemotherapy, transfusions of red blood cells or platelets, antibiotics, or intravenous (IV) fluids. They may also need to take blood samples for testing. The benefits of chemo port are greater comfort & avoidance of delay to find a good vein, especially if the veins have been damaged from repeated blood draws and infusions. It also lowers the risk of extravasation or leakage of medications into the surrounding tissues & muscles. Since many chemotherapy medications are caustic to tissue, a port can reduce the risk of inflammation due to leakage of these medications.
- PICC Line –
A PICC line (peripherally inserted central catheter) is a long, thin, flexible tube known as a catheter which is inserted into one of the large veins of the arm to just above the heart to avoid putting a needle into the veins in the arm every time. PICC line is not surgically implanted & there is an extension of the PICC line outside of the body at all times. Since there is an external portion of the PICC outside the body, it has to be covered with waterproof material as it should not get wet. Getting it wet could be a source of infection. A PICC line may be helpful if doctors and nurses find it difficult to get needles into the veins, or if the walls of the veins have been hardened by previous chemotherapy treatment. A PICC line can be used for antibiotics, pain medicine, chemotherapy, nutrition, or for the drawing of blood. One must contact the hospital & /or doctor if the area of insertion becomes red, swollen, painful or discharge coming out from the site or one develops a high temperature (fever).
- Topically –
The chemotherapy comes in a cream that you rub onto your skin.
The chemotherapy comes in pills, capsules, or liquids that you swallow.
During chemo, you may be vulnerable to infection. There are ways to help protect yourself. Here are some things you can do:
- Wash your hands frequently with soap and water. This is especially important after you use the toilet and before cooking and eating.
- Avoid people who have diseases—such as colds or the flu—that you can catch.
- Clean cuts and scrapes right away with warm water and soap. Cover with a bandage. Ask your doctor and care team if using antibiotic creams is right for you
- Avoid crowds where germs can be rampant.
- Be careful not to cut or nick yourself. Use an electric shaver instead of a razor. Wear protective gloves when gardening or cleaning to avoid cuts and scrapes.
Side Effects with Chemotherapy
The side effects of chemotherapy depend on the type of chemotherapy and the amount given. Anticipating and managing side effects can help to minimize them and provide the best possible experience for the person receiving chemotherapy.
As each person’s individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins.
1. Nausea / Vomiting
According to the National Cancer Institute (NCI), based on the time when the side effects occur, the following are four types of nausea and vomiting associated with chemotherapy to treat cancer:
- Anticipatory nausea and vomiting
After receiving a few treatments, some patients feel nausea and begin vomiting in anticipation of the next treatment. The reaction is usually caused by something related to the treatment, like the smell of alcohol or the sight of a medical uniform. Antinausea drugs do not always prevent anticipatory nausea and vomiting. Actions that calm or distract the person work more often. These actions may include guided imagery, hypnosis, relaxation, behavioral modification, or other activities like video games.
- Acute nausea and vomiting
The physical reaction that occurs within 24 hours of administration of the chemotherapy can be mild, moderate, or severe. Additional drugs may be given to control nausea and vomiting. According to the National Cancer Institute, drugs that are commonly given alone or in combination to prevent or treat nausea and vomiting include the following:
- Ondansetron, granisetron, dolasetron
- Dexamethasone, methylprednisolone
- Lorazepam, midazolam, alprazolam
- Delayed nausea and vomiting
In some patients, nausea and vomiting may occur more than 24 hours after taking chemotherapy. This is more common in patients receiving high doses of chemotherapy, patients who experienced acute nausea and vomiting, women, patients who drink little or no alcohol, and young patients. Drugs that are used for acute nausea and vomiting can also be used in delayed nausea and vomiting.
- Nausea and vomiting in advanced cancer
In patients with advanced cancer, nausea and vomiting may become chronic – not related to chemotherapy. Nausea may be related to other drugs taken to relieve pain or depression, or it may be the direct result of a brain or a colon tumor. People with advanced cancer may also experience constipation, abnormal levels of substances in the blood, dehydration, and stomach ulcers – all conditions that can contribute to nausea and vomiting.
The brain controls nausea and vomiting. Nausea is controlled by autonomic nerves, which control involuntary bodily functions such as heartbeat and breathing. Various irritants such as smells, taste, anxiety, pain, motion, or digestive chemicals can trigger a vomiting center in the brain to initiate vomiting as a reflex. Many factors influence whether a person will experience nausea and vomiting. Some chemotherapy drugs are more likely to cause reactions than others. Females and persons under the age of 50 are more likely to experience nausea and vomiting. People who are prone to motion sickness or anxiety are more likely to react to chemotherapy with nausea and vomiting.
Managing Nausea and Vomiting:
Sometimes, a combination of antinausea drugs and alternative therapies will help to minimize nausea and vomiting. It is very important to maintain the proper electrolyte balance and to ensure that vomiting does not deplete the body of important nutrients. Report vomiting that lasts more than a day to your physician.
The NCI provides the following tips for dealing with nausea and vomiting:
Eating and drinking
- Eat and drink slowly.
- Drink liquids frequently and in small amounts.
- Eat many small meals throughout the day instead of three full meals.
- Avoid strong smells by eating food that is cold or at room temperature.
- Drink clear, unsweetened fruit juice or light-colored, non-caffeinated soda.
- If you are nauseated in the morning, keep dry foods such as cereal or crackers at your bedside and eat them before you get up (but not if you have throat or mouth sores or a lack of saliva)
- Do not eat sweet, fatty, or fried foods.
- Savor mints or tart candies.
- Chew your food well to help with digestion.
- Drink an hour before or after, instead of with, each meal.
- Rest but do not lie down for at least several hours after eating.
Eating before treatment
- A light meal before treatment is helpful unless you become nauseated during chemotherapy. If nausea is a problem, do not eat for at least several hours before treatment.
- Your physician may prescribe antinausea medications. Keep your physician informed as to their effectiveness.
- Avoid strong smells that may be unpleasant for you such as cooking smells, perfume, and smoke.
- If you are feeling nauseated, distract yourself.
- Breathe deeply and slowly when you are feeling nauseated.
- Wear loose-fitting clothes.
2. Hair Loss
Many chemotherapy agents are designed to kill fast-growing cells, which means that they attack healthy growing cells as well as cancer cells. Because cells in hair follicles are fast growing, many chemotherapy drugs cause hair loss or alopecia. People can lose hair from anywhere on the body – the head, eyebrows, eyelashes, and facial and pubic hair. Loss usually occurs one to three weeks into treatment, depending on the specific drugs being given. Once it starts to fall out, hair may simply become thinner or it may fall out altogether.
How to manage the hair loss:
People often choose to wear wigs, scarves, or hats while after losing their hair. If this is what you would like to do, pick them out ahead of time and start wearing them before your hair is completely gone. Other ways to manage your hair during treatment include the following:
- Wash it less frequently.
- Use a gentle moisturizing shampoo.
- Avoid coloring products, permanents, or other products with strong chemicals.
- Do not use brush rollers, curling irons, or blow dryers on hot settings.
- Consider cutting your hair short before you begin treatment.
Will my hair return
Yes. The color or texture may be different but it usually begins to grow about six weeks after you have completed chemotherapy.
3. Mucositis / Mouth Sores
Mucositis (also known as stomatitis) is the swelling, irritation, and ulceration of the cells that line the digestive tract. These cells reproduce rapidly and have a shorter life span than other cells in the body. Because chemotherapy agents do not differentiate between healthy cells and cancer cells, they can quickly destroy digestive tract cells, breaking down the protective lining and leaving them inflamed, irritated, and swollen. Mucositis can occur anywhere along the digestive tract from the mouth to the anus and can be aggravated by nausea and vomiting.
What are the symptoms of mucositis?
The following are the most common symptoms of mucositis. However, each individual may experience symptoms differently. Symptoms may include:
- Redness, dryness, or swelling of the mouth
- Burning or discomfort when eating or drinking
- Open sores in the mouth and throat, abdominal cramps, or tenderness
- Rectal redness or ulcers
The symptoms of mucositis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
What can be done to manage the symptoms?
Symptoms may occur a week or longer after treatment is completed and may not be preventable. However, there are things you can do to reduce the severity of symptoms and provide some level of comfort. To relieve symptoms of oral mucositis, consider the following:
- Drink plenty of fluids to keep your mouth moist.
- Have someone check your mouth with a flashlight every day to see if any new sores have developed or if existing sores have become worse.
- Cleanse the mouth after each meal and before bedtime.
- Use a soft toothbrush and be gentle when brushing your teeth.
- Do not use mouthwashes with alcohol. Your physician can prescribe a special mouthwash if necessary.
- Do not eat food that is very hot or very cold.
- Do not use tobacco products or drink alcohol.
- If your sores become very painful, your physician may be able to prescribe a solution that will help to numb your mouth, providing comfort to the affected areas.
4. Bone Marrow Suppression
Nearly all chemotherapy agents suppress the bone marrow that, in turn, causes a reduction in the number of blood cells. The timing of this reduction varies according to which agents are used for your treatment. Red blood cells carry oxygen, white blood cells fight infection, and platelets help to control bleeding and bruising. Thus, the risks for anemia, fatigue, infection, bleeding, and bruising are increased with bone marrow suppression.
What are symptoms of bone marrow suppression?
The following are the most common symptoms of bone marrow suppression. However, each individual may experience symptoms differently.
Symptoms of a low red blood cell count may include:
- Paleness of skin, lips, and nail beds
- Increased heart rate
- Easy tiring with exertion
- Shortness of breath
Symptoms of a low white blood cell count may include:
- Fever and chills
- Signs of infection (anywhere in the body), including:
- An area that is warm to touch
Symptoms of a low platelet count may include:
- Easy bruising
- Bleeding: Nose Bleeds, Gums, or Mouth
- Tiny red spots on the skin
- Blood in the urine
- Dark or black bowel movements
The symptoms of bone marrow suppression may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
Red blood cells (RBCs) carry oxygen to other cells throughout your body. Chemotherapy can damage your body’s ability to make RBCs, so body tissues do not get enough oxygen, a condition called anemia. People who have anemia may feel short of breath, very weak or tired, dizzy, faint, or short of breath, or may feel that their hearts are beating very fast. Consult your physician immediately if you experience any of these symptoms.
You will be given frequent tests to measure your hemoglobin and hematocrit during your therapy. If these measurements are low, you may be given a medication that can boost the growth of your red blood cells.
If your blood is too low in red blood cells, you may need a blood transfusion or a medication called erythropoietin (also called EPO) to raise the number of red blood cells in your body.
What can I do if I am anemic?
Consider the following strategies to help manage anemia and fatigue:
- Plan time to rest during the day.
- Take short naps or breaks.
- Limit your activities to those that are most important.
- Try easier or shorter versions of activities you enjoy.
- Take short walks or do light exercise, if possible.
- Consider activities such as meditation, prayer, yoga, guided imagery, or visualization.
- Eat as well as you can in small amounts at a time. Drink plenty of fluids.
- Join a support group. Your physician can help you find a support group in your area.
- Limit caffeine and alcohol.
- Ask for help with daily responsibilities.
- Talk to your physician regarding ways to conserve your energy and reduce fatigue.
- Report any changes in energy level to your physician.
Many chemotherapy drugs can damage the bone marrow, where blood cells are made. White blood cells are the cells that fight many types of infections, which means that chemotherapy can leave you at risk for infection. The bacteria that cause most infections are normally found on your skin and in your mouth, intestines, and genital tract. Sometimes, the source of an infection is unknown. Infections can happen to people even when they are very careful.
How can I help prevent infections?
The National Cancer Institute (NCI) offers the following suggestions for reducing your risk of infection:
- Wash your hands frequently throughout the day, especially before eating, after using the bathroom, and after touching animals.
- Clean your rectal area gently but thoroughly after each bowel movement. Consult your physician if the area becomes irritated or if you develop hemorrhoids.
- Avoid people who are sick with communicable (contagious) illnesses, including a cold, the flu, measles, or chickenpox.
- Avoid crowds.
- Stay away from children who have recently been given “live virus” vaccines such as chickenpox and oral polio, as they may be contagious to people with a low blood cell count.
- Avoid accidents and injuries. Be careful not to cut yourself in any way, including the cuticles of your nails. Use an electric shaver instead of a razor to avoid cutting yourself while shaving.
- Clean cuts and scrapes immediately with warm soapy water and an antiseptic.
- To protect your mouth and gums, brush your teeth after meals and before bedtime.
- Do not squeeze or scratch pimples.
- Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry; do not rub it.
- Use lotion or oil if your skin becomes dry.
- Avoid contact with animal litter boxes and waste. Avoid bird cages and fish tanks as well.
- Avoid standing water such as in bird baths, flower vases, or humidifiers.
- Wear gloves when gardening or cleaning up after others, especially small children.
- Consult your physician before receiving any type of immunizations or shot, such as flu or pneumonia shots.
- Do not eat raw fish, seafood, meat, or eggs.
What are the symptoms of an infection?
If you experience any of the following symptoms, consider it a medical emergency and consult your physician right away, before taking any medications:
- Fever over 100° F
- Chills, especially chill that cause your body to shake
- Earaches, headaches, or stiff neck
- Blisters on the lips or skin
- Mouth sores
- A severe cough or a sore throat
- Sinus pain or pressure
- Loose bowel movements
- Frequent rush to urinate or burning with urination
- Unusual vaginal discharge or itching
- Redness, swelling, or tenderness, especially around a wound, sore, ostomy (an artificial opening in the abdomen), pimple, rectal area, or catheter site