Understanding Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells. It usually works by keeping the cancer cells from growing, dividing, and making more cells. Because cancer cells usually grow and divide faster than normal cells, chemotherapy has more of an effect on cancer cells. However, the drugs used for chemotherapy are powerful, and they can still cause damage to healthy cells. This damage causes the side effects that are linked with chemotherapy.
Different types of chemotherapy
Treatment with these powerful drugs is called standard chemotherapy, traditional chemotherapy, or cytotoxic chemotherapy.
How does chemotherapy treat cancer?
Doctors use chemotherapy in different ways at different times.
These include:
Before surgery or radiation therapy to shrink tumors. This is called neoadjuvant chemotherapy.
After surgery or radiation therapy to destroy any remaining cancer cells. This is called adjuvant chemotherapy.
As the only treatment. For example, to treat cancers of the blood or lymphatic system, such as leukemia and lymphoma.
For cancer that comes back after treatment, called recurrent cancer.
For cancer that has spread to other parts of the body, called metastatic cancer.
The goals of chemotherapy
The goals of chemotherapy depend on the type of cancer and how far it has spread. Sometimes, the goal of treatment is to get rid of all the cancer and keep it from coming back. If this is not possible, you might receive chemotherapy to delay or slow cancer growth.
Delaying or slowing cancer growth with chemotherapy also helps manage symptoms caused by the cancer. Chemotherapy given with the goal of delaying cancer growth is sometimes called palliative chemotherapy.
Your chemotherapy plan
There are many drugs available to treat cancer. A doctor who specializes in treating cancer with medication, called a medical oncologist, will prescribe your chemotherapy. You may receive a combination of drugs, because this sometimes works better than only 1 drug.
The drugs, dose, and treatment schedule depend on many factors.
These include:
The type of cancer
The tumor size, its location, and if or where it has spread. This is called the stage of cancer.
Your age and general health
How well you can cope with certain side effects
Any other medical conditions you have
Previous cancer treatments
Where is chemotherapy given?
Your health care team may give you chemotherapy at the clinic, doctor's office, or hospital. Some types of chemotherapy are given by mouth, and these can be taken at home.
How long does chemotherapy take?
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 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. Talk with your health care team about the best schedule for you.
How is chemotherapy given?
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. You can take some drugs by mouth. They can be in 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. For example, a drug may be given daily for 4 weeks followed by a 2-week break.
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. You can take some types of chemotherapy in a cream you put on your skin. You get your medication at the pharmacy and take it at home.
And Also:
Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer
How Chemotherapy Works against Cancer
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to:
Treat cancer
Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.
Ease cancer symptoms
Chemotherapy can be used to shrink tumors that are causing pain and other problems.
Who Receives Chemotherapy
Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy and other cancer treatments. The types of treatment that you need depends on the type of cancer you have, if it has spread and where, and if you have other health problems.
How Chemotherapy Is Used with Other Cancer Treatments
When used with other treatments, chemotherapy can:
Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy.
Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy.
Help other treatments work better.
Kill cancer cells that have returned or spread to other parts of your body.
Chemotherapy Can Cause Side Effects
Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.
The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by:
Asking someone to drive you to and from chemotherapy
Planning time to rest on the day of and day after chemotherapy
Asking for help with meals and childcare on the day of and at least one day after chemotherapy
There are many ways you can help manage chemotherapy side effects.
How Much Chemotherapy Costs
The cost of chemotherapy depends on:
The types and doses of chemotherapy used
How long and how often chemotherapy is given
Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
The part of the country where you live
Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.
If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for "financial assistance." Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.
What to Expect When Receiving Chemotherapy
How Chemotherapy Is Given
Chemotherapy may be given in many ways. Some common ways include:
Oral
The chemotherapy comes in pills, capsules, or liquids that you swallow
Intravenous (IV)
The chemotherapy goes directly into a vein
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
Intrathecal
The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord
Intraperitoneal (IP)
The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
Intra-arterial (IA)
The chemotherapy is injected directly into the artery that leads to the cancer
Topical
The chemotherapy comes in a cream that you rub onto your skin
Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.
Catheter
A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter.
Port
A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port.
Pump
Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.
How Your Doctor Decides Which Chemotherapy Drugs to Give You
There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on:
The type of cancer you have and how advanced it is
Whether you have had chemotherapy before
Whether you have other health problems, such as diabetes or heart disease
Where You Go for Chemotherapy
You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them.
How Often You Receive Chemotherapy
Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:
Your type of cancer and how advanced it is
Whether chemotherapy is used to:
Cure your cancer
Control its growth
Ease symptoms
The type of chemotherapy you are getting
How your body responds to the chemotherapy
You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.
Missing a Chemotherapy Treatment
It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.
How Chemotherapy May Affect You
Chemotherapy affects people in different ways. How you feel depends on:
The type of chemotherapy you are getting
The dose of chemotherapy you are getting
Your type of cancer
How advanced your cancer is
How healthy you are before treatment
Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.
How Will I Know If My Chemotherapy Is Working?
You will see your doctor often. During these visits, she will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.
You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.
Special Diet Needs
Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian.
Working during Chemotherapy
Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.