Chemotherapy

CHEMOTHERAPY BEFORE AND AFTER

Commonly referred to as 'Chemo', it is usually used to treat cancers. Chemotherapy is an aggressive form of chemical drug therapy meant to destroy rapidly growing cells in the body. A specialist doctor who handles cancer treatment is known as an oncologist. They normally will work with the patient to come up with an effective and convenient treatment plan.

Chemotherapy is often used in combination with other therapies, such as surgery, radiation, or hormone therapy. This will depend on the:

• Patient's personal treatment preferences
• Stage and type of cancer
• Location of the cancer cells
• Patient's overall health
• Previous cancer treatments the patient may have had

It is one that is considered a systemic treatment, which means it affects the entire body.

Without a doubt, chemotherapy has been proven to effectively attack cancer cells, however, it can also cause serious side effects that can severely impact the quality of life of the patient. These side effects should be weighed carefully against the risk of not getting treatment when deciding if chemotherapy is the right option.

HOW IT WORKS, HOW AND WHY IT IS USED

Chemotherapy targets cells that grow and divide quickly, just as cancer cells do. Unlike radiation or surgery (which target specific areas), chemo works throughout the body. Unfortunately, it can also affect some fast-growing healthy cells, like those of the skin, hair, intestines, and bone marrow. That is what causes some of the side effects from the treatment.

What does chemotherapy do?

Depending on the kind of cancer and the stage it may be in, it serve as;

Cure - In some cases, chemo can destroy cancer cells to the point that the doctor would no longer detect them in the body. The best outcome after that, would be that they never grow back again, except that it does not always happen that way.

Control - In some other cases, it may only serve to keep the cancer from spreading to other parts of the body or perhaps slow the growth of cancer tumors.

Ease symptoms - Chemotherapy is not able to cure or control the spread of cancer in some cases. In that case, it is simply used to shrink tumors that cause pain or pressure. These tumors often continue to grow back.

How is chemotherapy used?

Sometimes, chemotherapy treats cancer by itself, however often times it is used in combination with:

Surgery In which the doctor removes cancerous tumors or tissue, or organs contaminated with cancerous cells.

Radiation therapy - The doctor uses invisible radioactive particles to kill cancer cells. Depending on the type, it may be delivered by a special machine that bombards parts of the body from the outside, or by putting radioactive material on, near, and even inside the body.

Biological therapy - Within which living material in the form of bacteria, vaccines, or antibodies are carefully introduced to kill the cancer cells.

Chemotherapy may be used to:

• Destroy remaining cancer cells after surgery or radiation therapy (adjuvant chemotherapy)
• Shrink a tumor before radiation therapy or surgery (neo-adjuvant chemotherapy)
• Destroy cancer cells that return or spread to other parts of the body
• To aid other therapies (biological or radiation) and make them more effective

Chemotherapy for conditions other than cancer

Some chemotherapy drugs have proved quite useful in treating other conditions, such as:

Immune system disorders - Low doses of chemotherapy drugs can help control an overactive immune system in diseases such as lupus and rheumatoid arthritis.

Bone marrow diseases - Diseases that affect the bone marrow and blood cells may be treated with a bone marrow transplant, also known as a stem cell transplant. Chemotherapy is often used in preparation for a bone marrow transplant.

How long does chemotherapy last?

That will depend on:

• The type of chemotherapy
• The way the body responds to the therapy
• The type of cancer
• The stage
• The goal of treatment: cure, control growth, or ease pain

One may have chemotherapy in periods (cycles). A period of treatment and then a period of rest. For example, a doctor may opt for a 4-week cycle. This may mean 1 week of treatment and then 3 weeks of rest. The rest will allow the body to make new healthy cells.

How is chemotherapy given?

Oral - A pill or liquid that has the drugs is swallowed.

Injection - The drugs are usually delivered with a shot directly into muscle in the hip, thigh, or arm, or in the fatty part of the arm, leg, or stomach, just beneath the skin.

Intra-arterial (IA) - The drug is injected directly into the artery that is feeding the cancer, through a needle, or soft, thin tube (catheter).

Topical The medicine come in the form of a cream which is rubbed onto the skin.

Intraperitoneal (IP) - The drugs are delivered into the peritoneal cavity, which harbors organs such as the liver, intestines, stomach, and ovaries. It is either done during surgery or through a tube with a special port that is put in by the doctor.

Intrathecal (IT) chemotherapy The medicine is injected into the cerebrospinal fluid (CSF), which is found in the area surrounding the spinal cord and the brain.

Intravenous (IV) - The chemotherapy medicine goes directly into a vein.

Intravenous (IV) delivery in chemotherapy

• Needle - The drugs may be delivered through a thin needle in a vein on the hand or lower arm. The nurse will insert the needle and remove it when treatment is done. Should the patient feel pain or burning during treatment, the doctor must know right away.
• Catheter - A soft, thin tube which the doctor puts one end into a large vein, often times in the chest cavity. The other end stays outside the body and is used to deliver chemotherapy or other drugs, or perhaps to draw blood. It usually stays in place until all the treatment cycles are finished. Patients will need to watch for signs of infection around the catheter.
• Port - A small disc that the surgeon places under the skin. This disc is linked to a tube (catheter) that also connects to a large vein, usually in the chest area. A nurse might insert a needle into the port to deliver chemotherapy drugs or draw blood. The needle can be left in place for treatments that last more than a day. Patients will need to watch for signs of infection around the port.
• Pump - Often attached to catheters or ports, it controls the amount of chemotherapy drugs, and how fast they get into the body.

RISKS FACTORS

The side effects of chemotherapy drugs can be quite significant, with each drug having their own different side effects. Secondly, not every drug causes every side effect, therefore patients should ask their doctors about the side effects of the particular drugs to be received.

SIDE EFFECTS THAT OCCUR DURING CHEMOTHERAPY TREATMENT

Common side effects of chemotherapy drugs include:

• Nausea - term that describes the feeling that one might vomit.
• Vomiting - Or throwing up, is a forceful discharge of stomach contents.
• Diarrhea - A condition in which faeces are discharged from the bowels frequently and in a liquid form.
• Hair loss - Hair loss occurs when new hair does not replace the hair that has fallen out.
• Loss of appetite - When there is a reduced desire to eat.
• Fatigue - A term used to describe an overall feeling of tiredness or lack of energy.
• Fever - A fever is a temporary increase in body temperature, often due to an illness.
• Mouth sores - small lesions that develop in the mouth or at the base of the gums.
• Pain - An unpleasant sensation and emotional experience that links to tissue damage.
• Constipation When bowel movements are tough or happen less often than normal.
• Bleeding When blood escapes from the circulatory system from damaged blood vessels.

Many of these side effects can be treated or even prevented. Conversely, a number of them could also be long-lasting, while other drugs have late-developing side effects.

Late side effects vary depending on the chemotherapy drug but can include:

• Kidney problems
• Risk of a second cancer
• Infertility
• Damage to lung tissue
• Heart problems
• Nerve damage (peripheral neuropathy)

Patients should ask their doctor if there is a risk of any late side effects and what signs and symptoms they should be aware of that may signal a problem.

HOW TO PREPARE

Preparation for chemotherapy depends on which drugs to be received and how they will be administered. The doctor will give specific instructions to prepare for the chemotherapy treatments.

One may need to:

• Undergo tests and procedures to make sure the body is ready to receive chemotherapy. Blood tests to check kidney and liver functions and heart tests to check for heart health can determine whether the body is ready to begin and sustain chemotherapy. The doctor may delay treatment or select a different chemotherapy drug and dosage that is safer for if there's a problem.
• Have a device surgically inserted before intravenous chemotherapy. If patient will be receiving the chemotherapy intravenously the doctor may recommend a device, such as a catheter, port or pump. The catheter or other device is surgically implanted into a large vein, usually in the chest. Chemotherapy drugs can then be given through the device.
• See the dentist. The doctor may recommend that a dentist check a patient's teeth for signs of infection. Since some chemotherapy may reduce the body's ability to fight infections, treating existing infections may reduce the risk of complications during chemotherapy treatment.
• Plan ahead for side effects. For instance, if the chemotherapy treatment will cause infertility, one may wish to consider the options of preserving sperm or eggs for future use. If chemotherapy will cause hair loss, one may need to consider planning for a head covering.
• Make arrangements for help at home and at work. Most chemotherapy treatments are given in an outpatient clinic. This will mean most patients are able to continue working and doing their usual activities during chemotherapy. It will be difficult to predict exactly how the patient will feel but the doctor can tell in general how much the chemotherapy will affect normal life.
• Know from the doctor if they will need time off work or help around the home after treatment. Ask the doctor for the details of the chemotherapy treatment so that arrangements can be made for work, children, pets and/or other commitments.

PREPARING FOR THE FIRST TREATMENT

It may be helpful to arrive for the very first chemotherapy treatment well rested. One might wish to eat a light meal beforehand in case the chemotherapy medications cause nausea.

It may be prudent for patients to have a friend or family member drive them to the first treatment. One might find out that the medications makes him sleepy or cause other side effects that may make driving difficult and dangerous.

WHAT TO EXPECT

The doctor will choose which chemotherapy drugs to use based on several factors that may include:

• Type of cancer
• Stage of cancer
• Overall health
• Previous cancer treatments
• Patient's goals and preferences

Yet another prudence concerning treatment options will be for the patient to consult with their doctor so that together they can decide on the best option.

HOW CHEMOTHERAPY DRUGS ARE GIVEN

Chemotherapy drugs can be given in various ways, including:

• Creams Such chemo drugs come in the form of Creams or gels that can be applied to the skin to treat certain types of skin cancer.
• Injections - Chemotherapy drugs can be injected with a needle just like a normal injection.
• Infusions - Chemotherapy is most often given as an infusion into a vein (intravenously). The drugs are given by inserting a tube with a needle into a vein in the arm or into a device in a vein in the patient's chest.
• Pills - Some drugs that are used for chemotherapy can be taken in pill or capsule form.
• Chemotherapy given directly to the cancer - Chemotherapy can be given directly to the cancer, or where the cancer used to be after surgery. An instance is when thin disk-shaped wafers containing chemotherapy drugs are be placed near a tumor during surgery. These wafers break down with time, and release the chemotherapy drugs. Chemo drugs may also be injected into a vein or artery that directly feeds a tumor.
• Drugs used to treat particular areas of the body Some chemotherapy drugs can be given directly to one area of the body. E.g. chemotherapy drugs can be given directly in the abdomen, chest cavity or central nervous system. Some of the drugs can also be given through the urethra into the bladder.

CHEMOTHERAPY TREATMENTS - HOW OFTEN?

Doctors will determine how often one will receive chemotherapy treatments based on the drugs being used, the characteristics of the cancer and how well the host body recovers after each treatment. Chemotherapy treatment schedules vary. It can be continuous, or it may be alternated between periods of treatment and periods of rest to allow for recovery.

WHERE TO RECEIVE CHEMOTHERAPY TREATMENTS

Where to receive the chemotherapy treatments will depends on the situation. Treatments for Chemo can be given:

• At home, especially when taking chemotherapy pills
• In the hospital
• In an outpatient chemotherapy unit
• In a doctor's office

RESULTS

Patients will need to meet with their oncologist (cancer doctor) regularly during chemotherapy treatment. The oncologist will ask about side effects if any, since many of these side effects can be controlled.

Depending on the situation, one may also undergo scans and other tests to monitor the cancer during chemotherapy treatment. These tests can give the doctor an idea of how the cancer is responding to the treatment regime. The treatment may be adjusted accordingly, if need be.

THE BODY AFTER TREATMENT

Whereas some side effects of chemotherapy only happen during the treatment and disappear quickly after that, others can linger for months or years, or may never completely go away.

Patient should let their doctor know how they feel, and must watch out for signs of chemo's long-term changes in the body. The doctor can suggest ways to manage the symptoms.

Brain - Some patients feel a little foggy after the treatment. That may suggest a touch of chemo brain. It is possible for the patient to notice a difficulty to concentrate or remember names and dates. Some may also forget things easily or have trouble with multi-tasking.

The exact cause of chemo brain is yet to be identified. However, it seems more likely to happen after higher doses of chemotherapy.

Heart - Certain chemo drugs can damage cells in the heart. Chemotherapy may also increase the risk of having heart problems, in ways such as:

• Heart attacks
• The weakening of the heart muscle (cardiomyopathy)
• Problems with heart rhythm (arrhythmia)

If the doctor plans to use a medication that could affect the heart, he may ask for tests that monitor how well the patient's ticker works.

Hair - In the event of hair loss after chemo, it will typically start to grow back in a month or two. However it is possible at first to notice changes in its texture, shape, and color.

Over time, as the effects of the chemo on the hair follicles wear off, the hair will most likely return to the way it was before treatment. In rare cases, especially after years of strong chemotherapy, the hair follicles could shut down and subsequently, prevent new hair from growing. The patient may become permanently bald.

Weight - Some types of chemo can make the patient put on extra pounds in weight. Such weight may stay on even when the treatment ends.

For example, some drugs that treat breast cancer can cause the loss of muscle and instead, gain fat. This makes it much more difficult to get the weight off. Working with a dietitian or nutritionist and adding strength exercises to workout routine would help shed some of the weight.

Energy - Most patients are hit by fatigue during chemo treatment. Some people still feel extremely tired even after treatment ends.

One may find that even after enough rest, he would still feel sluggish. It is advised that patients talk to their doctors for suggestions on ways to raise their energy levels.

Fertility - Whether man or woman, chemotherapy can affect the ability to have children.

For men, it has to do with the way chemo drugs target fast-growing cancer cells. Healthy sperm cells divide quickly, and so chemo can also damage them. If chemo kills the immature stem cells in the testicles that become new sperm, one may become infertile.

In the case of women, chemotherapy can damage the eggs and harm the ovaries. Regular monthly menstrual cycles may cease after treatment. Many women who have had chemo experience menopause at ages that are earlier than usual.

For both sexes, chemotherapy's effect on fertility depends on a number of factors, including the type of drugs and the dose. The higher the dose of chemo, the more likely it is to have an impact.