Chemotherapy and side effects

Are you looking for information on Chemotherapy treatment for cancer? Read this article about cancer treatment using chemotherapy. This article also explains the side effects of chemotherapy, adjuvant chemotherapy, and palliative chemotherapy.

What is cancer?

Cancer is a broad term Cancer happens when damaged or old cells divide and multiply in an uncontrolled manner. Some types of cancer cause rapid cell growth. Some other types cause cells to grow and divide at a slower rate.

Healthy cells have a fixed lifespan. Cells die so that body can replace them with newer cells. But cancerous cells do not have the components that instruct them to stop dividing and to die.

Therefore cancerous cells build up in the body and form tumors. They also damage the immune system. Cancer cells spread in the body through lymph nodes. Lymph nodes are clusters of immune cells and are located throughout your body.

Some cancers may cause the growth of visible tumors. Some other types of cancer like leukemia are not visible.

When cells start behaving abnormally the old or damaged cells survive and don’t die. On the other side, new cells are formed when they are not needed. These cancerous cells can divide without stopping. Such cells form growths which are called tumors.

Cancer cells reproduce and multiply uncontrollably even when your body tells them to stop. These cells spread into surrounding tissues and cause cancer. Cancer can start in any part of the body.

Your doctor is the best person to advise you regarding various types of cancer treatment. This article gives an overview of radiation therapy and chemotherapy as general information.

Table of Content

What is chemotherapy? Chemotherapy is a procedure where drugs are used for cancer treatment. Cancer can be of different types and at different stages. Therefore a variety of cytotoxic drugs are used. Cytotoxic means that these drugs are toxic to cells. A combination of drugs can also be used. These drugs kill the fast reproducing cancer cells. Chemotherapy with cytotoxic drugs disrupts the way cancer cells grow and divide.

Most chemotherapy drugs are injected into the blood. Due to this, the drug can reach cancer cells anywhere in the body. The negative side of chemotherapy drugs is that it kills healthy cells also. However, in most cases, healthy cells can recover from the damage done by the drug.

Different drugs cause different side effects. Some side effects are mild. Such side effects can be treated easily with medicines. However, some side effects are more difficult to manage. Your doctor will suitably advise you about them.

When healthy cells are damaged by chemotherapy drugs, it causes side effects. But you need not worry about it. Most of the side effects disappear and go away slowly after the treatment ends.

Your doctor will explain the side effects of your chemotherapy. The main areas that may get affected are those where new cells are being made and replaced. These areas are:-

• The lining of your mouth (inside of your mouth)
• Digestive system
• Hair follicles
• Bone marrow, where blood cells are made

Overview of Chemotherapy

• In chemotherapy drugs are used to kill cancerous cells.
• The drug targets cancerous cells that divide and grow in an uncontrolled manner.
• In some cases, the drug destroys cancer cells completely. In the best-case scenario cancer cells never grow back. However, this is not always the case.
• In some cases, chemotherapy prevents cancer from spreading to other parts of your body.
• Chemotherapy is also used to shrink cancerous tumors before it is removed by surgery.
• Chemotherapy is also used after surgery and radiation therapy to destroy remaining cancer cells.
• Chemotherapy is given in “Cycles”. There will be a period of treatment, after which there will be a period of rest so that healthy cells can recover. For example, there may be a gap of one week between two sessions of chemotherapy.
• Chemotherapy drugs may be given by injection. It can be Intra-Arterial, Intra-Peritoneal, Intravenous, or Intrathecal.
• In Intra-Arterial injection the drug directly into the artery which supplies blood to the cancerous part.
• In Intra-Peritoneal injection, the drug is delivered to the peritoneal cavity. The peritoneal cavity contains organs and body parts like the liver, ovaries, stomach, and intestines.
• In Intravenous chemotherapy, the drug goes directly into the vein of the patient.
• In Intrathecal chemotherapy, the drug is injected into the area surrounding the spinal cord or the brain

Your doctor will the best therapy for you based on your disease condition. It may involve a combination of different treatments also.

Chemotherapy types

There are different types of chemotherapy. It depends on how the chemotherapy drug is being given. It also depends on the objectives of chemotherapy, type of cancer, and at what stage the cancer is. Generally, chemotherapy is given as an outpatient. In some cases, hospitalization may be required. Chemotherapy is done in the following ways:-

• The chemo drug may be given directly into a vein, using a drip or by injection. It is called intravenous chemotherapy.
• In oral chemotherapy, the patient takes a tablet or capsule. It is called oral chemotherapy.
• The drug may be given by injecting it into muscle. It is called intramuscular chemotherapy.
• The drug may be injected under the skin (subcutaneous)
• The drug is given by injection into the fluid which surrounds the spine or brain. It is called intrathecal chemotherapy.
• It can be delivered directly into the body cavity like a bladder. It is called intracavitary chemotherapy.
• For skin cancer, it can also be applied as a cream over the skin.
• Sometimes the drug is given in more than one way. For example, the drug may be given into a vein and also as a tablet.

Chemotherapy process

Chemotherapy is given in different ways. Following are the main chemotherapy processes:-

Oral chemotherapy

• The drug is given in the form of a tablet, capsule, or liquid. The drug is swallowed. It is broken down by the digestive system in the stomach. The medicine is then absorbed through the lining of the stomach.
• Some drugs are kept under the tongue. This is referred to as sublingual. The medicine under the tongue dissolves and is absorbed by the body. The medicine gets introduced into the body quickly.
• All medicines can’t be given in the oral form. Stomach acid may destroy some of the medicines. Some other medicines don’t get absorbed through the stomach lining. So they become ineffective.

Subcutaneous Injection

• In subcutaneous injection of chemo drug, a short needle is used to inject the drug. The needle goes into the space between the skin and the muscle.
• Most of the chemotherapy drugs have harsh chemicals. So many of such drugs can’t be given intra-muscularly because they will irritate the muscles.
• Subcutaneous chemo injections are used for some types of biologic response modifiers and chemotherapy support drugs.

Intra-muscular injection

• The injection is given into the muscular layer. So a large needle is used which goes deeper than subcutaneous injection.
• The chemotherapy drug is absorbed more rapidly than when the medicine is taken orally. But the absorption is slower than sublingual, subcutaneous injection, and intravenous injection.
• Most of the chemotherapy drugs can’t be given by intramuscular injection due to the harsh chemicals in chemo drugs.
• This method is avoided if the patient has low platelets, to avoid complications due to internal bleeding.

Intravenous chemotherapy

• It is also called IV Chemo. It is the most common method of chemotherapy administration.
• The drug is rapidly absorbed through the bloodstream.
• Intravenous chemotherapy’s advantage is that the drug is rapidly carried out in the entire body through blood circulation.
• An angiocatheter is placed in the vein of the arm. The chemo drug is administered through this catheter. It is removed after the drug has been administered. The procedure may last from a few minutes to a few days.
• Some other methods are PICC Line, Non-Tunnelled Catheters, Tunnelled Catheters, and Port-a-Cath

Intraventricular or intrathecal chemotherapy

• This method is used when the drug is required to reach the fluid which is in the spinal cord and brain.
• The chemotherapy drug is administered through a spinal tap. It is also called a lumbar puncture. It is one way of intrathecal chemotherapy
• In intraventricular chemotherapy, ommaya reservoir is used. It is a dome-shaped reservoir with an attached catheter. It is placed into the subcutaneous tissues of the scalp. This procedure is used most commonly in acute leukemia.

Intraperitoneal Chemotherapy

• The chemotherapy medicine is given directly into the abdominal cavity.
• A catheter is placed through the abdominal wall. It drains into the cavity surrounding the organs. Chemotherapy medicine is infused directly into this cavity.
• The patient is required to change position from side to side. The patient is also required to lie on the back and on the stomach. This way the medicine gets applied all over and the organ gets bathed in the medicine.
• In some types of treatment, the medicine is drained out after few hours.
• However, in some cases, the medicine is left inside and gets absorbed slowly.
• The tumor and the cancerous part get exposed to the medicine without exposing the rest of the body to the toxic chemicals of a chemotherapy drug.

Intravesicular Chemotherapy

• This method is used for bladder cancer.
• Medication is administered directly into the bladder using a urinary catheter.
• The catheter is placed into the bladder. The chemotherapy drug is injected into the bladder through the catheter.
• The patient rolls from side to side so that the medication is applied all over.
• After some time the medication is drained out by urination.

Topical chemotherapy

• In some types of skin cancer chemotherapy creams are applied directly on the skin.
• This type of chemotherapy has very limited scope

Video on Chemotherapy

Chemotherapy side effects

Not all types of cancer are treated with the same chemotherapy drugs. The drug will depend on the type of cancer. This will be decided by your doctor. Different drugs have different side effects. Most of the side effects go away soon. But some may take months to go away completely. Following are some of the side effects of chemotherapy:-

• Sore mouth or dry mouth. The patient has to maintain good oral hygiene and take prescription medicine prescribed by the doctor.
• Change in taste. This improves gradually after the chemotherapy.
• Feeling tired. This can be managed by walking and light exercise.
• Possibility of infection. Chemotherapy may cause a low count of white blood cells. This makes the patient prone to infection. Take the advice of your doctor.
• Loss of appetite
• Hair loss. Some drugs affect hair follicles. So hair can fall off. Hair grows back after sometime
• Bone health can be affected due to chemotherapy. So it is important to eat a healthy diet. Increase your physical activity and reduce alcohol consumption.
• Easy bruising and bleeding
• Anemia due to low red blood cell count
• Fever
• Rashes
• Allergic reaction
• Intense chills
• Intense headache
• Shortness of breath
• Blood in stool or urine
• Constipation
• Diarrhea
• Vomiting
• Urine frequency and bladder changes
• Dry skin or change in color of the skin
• Lack of concentration and focus
• Change in sexual function
• Fertility issues

Please note that it is not essential that all or some of the side effects will happen to a patient. However, if you have such symptoms, do not take them lightly. Make sure to contact your doctor.

Adjuvant chemotherapy

It is a treatment to keep cancer from returning. For example, the patient’s tumor may be removed by an oncology surgeon. But after the surgery, the patient may be referred to another oncology doctor for further treatment. This is called adjuvant treatment. Your doctor will decide whether you require adjuvant chemotherapy.

Even if a tumor is removed by surgery there may remain some cancerous cells. This may result in cancer coming back after some time. So chemotherapy may be required to kill these microscopic cancer cells. Such a type of treatment is called adjuvant chemotherapy. Adjuvant therapy does not guarantee that cancer will not return back. But it certainly reduces the risk.

Sometimes chemotherapy treatment may be given before the main treatment. For example, chemotherapy is done to shrink a tumor before it is removed by surgery. Such treatment is called neoadjuvant chemotherapy.

Types of Adjuvant Chemotherapy

• Chemotherapy
• Hormone therapy
• Immunotherapy
• Radiation therapy
• Targeted therapy

Adjuvant chemotherapy effectiveness

All chemotherapy treatments have side effects. So your doctor will tell you about the benefits of adjuvant chemotherapy versus the risks. Following factors will decide the benefit versus risk:-

• Type of cancer – Adjuvant therapy has been found to be beneficial in certain types of cancer like bladder cancer, breast cancer, and colon cancer.
• Stage of cancer – If cancer is of late-stage and has spread to other parts, adjuvant therapy has been found to be beneficial. If cancer is at a very early stage then there are fewer chances of it returning back.
• The number of lymph nodes affected by cancer – If cancer has spread to many lymph nodes its chances of returning back is higher, even after surgery. In such a case doctor may advise adjuvant chemotherapy.
• Cancer-specific changes – Some cancers have changed inside their cells. Due to this cancer may return back. In such cases adjuvant treatment is beneficial.

Chemotherapy Video in Hindi

What is palliative chemotherapy?

Palliative chemotherapy is designed to prolong the survival of terminally ill cancer patients. It reduces the symptoms and pain but does not cure cancer. Palliative chemotherapy is given to cancer patients during the last few months of their lives.

Does chemotherapy cause second cancer?

It is still not known how the cancer survivors treated for cancer develop cancer again. Some studies have analyzed the cause of second cancer as mentioned below:

• Chemotherapy and radiation therapy make your immune system weak. So, second cancer develops quickly as your body cannot fight. Chemotherapy used to treat first cancer causes changes in bone marrow cells. This also contributes to the development of second cancer.
• Radiation therapy kills cancer cells and also few healthy cells. This damage causes second cancer. It is called radiation-induced second malignancy.
• After radiation exposure, there is the possibility of the development of leukemia. It can be like acute myelogenous leukemia, chronic myelogenous leukemia, and acute lymphoblastic leukemia.

Not every cancer survivor will develop second cancer. It is challenging to predict the risk of second cancer.

What to expect while having radiation therapy?

You may get tensed or feel worried when you learn that your doctor advises you radiation therapy. It is a normal feeling. But, if you know more about different cancer treatments, your tension will be relieved, and you will be better prepared to undergo radiation therapy. This article will help you understand and feel comfortable with your radiation treatment.

There will be a team of experts for your radiation therapy. The team will have a Radiation oncologist, Radiation oncology nurse, medical radiation specialist, dosimetrist, radiation therapist, and other staff members.

References

Ovarian Cyst

Ovarian Cancer

Palliative Chemotherapy