ABOUT CHEMOTHERAPY

What Is Chemotherapy?
Chemotherapy is the treatment of cancer with drugs that can destroy cancer cells. These drugs often are called "anticancer" drugs.

How Does Chemotherapy Work?
 Normal cells grow and die in a controlled way. When cancer occurs, cells in the body that are not normal keep dividing and forming more cells without control. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying. Healthy cells can also be harmed, especially those that divide quickly. Harm to healthy cells is what causes side effects. These cells usually repair themselves after chemotherapy.

Because some drugs work better together than alone, two or more drugs are often given at the same time. This is called combination chemotherapy.

Other types of drugs may be used to treat your cancer. These may include certain drugs that can block the effect of your body's hormones. Or doctors may use biological therapy, which is treatment with substances that boost the body's own immune system against cancer. Your body usually makes these substances in small amounts to fight cancer and other diseases. These substances can be made in the laboratory and given to patients to destroy cancer cells or change the way the body reacts to a tumour. They may also help the body repair or make new cells destroyed by chemotherapy.

What Can Chemotherapy Do?
Depending on the type of cancer and how advanced it is, chemotherapy can be used for different goals:

  • To cure the cancer. Cancer is considered cured when the patient remains free of evidence of cancer cells.
     
  • To control the cancer. This is done by keeping the cancer from spreading; slowing the cancer's growth; and killing cancer cells that may have spread to other parts of the body from the original tumour.
  • To relieve symptoms that the cancer may cause. Relieving symptoms such as pain can help patients live more comfortably.

Which Drugs Are Given?
Some chemotherapy drugs are used for many different types of cancer, while others might be used for just one or two types of cancer. Your doctor recommends a treatment plan based on:

  • What kind of cancer you have.
     
  • What part of the body the cancer is found.
     
  • The effect of cancer on your normal body functions.
     
  • Your general health.

Some people with cancer want to know every detail about their condition and their treatment. Others prefer only general information. The choice of how much information to seek is yours, but there are questions that every person getting chemotherapy should ask.

Where Will I Get Chemotherapy?
Chemotherapy can be given in many different places: at home, a doctor's office, a clinic, a hospital's outpatient department, or as an "inpatient" in a hospital. The choice of where you get chemotherapy depends on which drug or drugs you are getting and sometimes your own and your doctor's wishes. Most patients receive their treatment as an "outpatient" and are not hospitalized. Sometimes, a patient starting chemotherapy may need to stay at the hospital for a short time so that the medicine's effects can be watched closely and any needed changes can be made.

How Often and for How Long Will I Get Chemotherapy?
How often and how long you get chemotherapy depends on:
The kind of cancer you have.
The goals of the treatment.
The drugs that are used.
How your body responds to them.
You may get treatment every day, every week, or every month. Chemotherapy is often given in cycles that include treatment periods alternated with rest periods. Rest periods give your body a chance to build healthy new cells and regain its strength. Ask your health care provider to tell you how long and how often you may expect to get treatment.

Sticking with your treatment schedule is very important for the drugs to work right. Schedules may need to be changed for holidays and other reasons. If you miss a treatment session or skip a dose of the drug, contact your doctor.

Sometimes, your doctor may need to delay a treatment based on the results of certain blood tests. Your doctor will let you know what to do during this time and when to start your treatment again.

How are chemotherapy drugs given?

Chemotherapy may be given in different ways, depending on the type of cancer you have and the chemotherapy drugs used.

Most often it is given by injection into a vein (intravenously). Some drugs are given as tablets or capsules (orally) and some are injected into a muscle (intramuscular injection) or just under the skin (subcutaneous injection). Drugs given in this way are absorbed into the blood and carried around the body so that they can reach all the cancer cells.

For some types of cancer chemotherapy may be injected into the fluid around the spine (intrathecal injection). Sometimes the chemotherapy may be injected into particular body cavities (such as the pelvic cavity or bladder): this is intra-cavity chemotherapy. Drugs given in this way tend to stay in the area in which they are given and do not affect cells in other parts of the body.

Chemotherapy creams may be used for some cancers of the skin: they only affect the cells in the area to which the cream is applied.

Sometimes, two or more types of chemotherapy may be used together.

How are chemotherapy drugs given?

  • (Most commonly) by injection into a vein
  • As tablets or capsules
  • By injection into a muscle
  • By injection under the skin
  • By injection into the fluid around the spine
  • By injection into body cavities
  • As a cream for cancer of the skin 

Intravenous injection

There are 3 main ways of giving chemotherapy drugs directly into the vein. These are through a:

  • cannula - a small tube inserted into a vein in your arm or the back of your hand.
  • central line - a thin, flexible tube inserted through the skin of the chest into a vein near · the heart.
  • PICC line (a peripherally inserted central line) -- a thin flexible tube is passed into a vein in the crook of your arm and then threaded through until the end of the tube lies in a vein near the heart.
  • portocath - a portocath is also called an implantable port and is a thin, soft plastic tube that is put into a vein. It has an opening (port) just under the skin on your chest or arm. 

Cannula

The nurse or doctor will put a short, fine tube (cannula) into a vein in the back of your hand or the crook of your arm. You may find this uncomfortable or a little painful but it should not take long. Once the cannula is in place it will be taped securely to keep it in place.

If you find it painful to have the cannula put in, an anaesthetic cream can be used on the skin to numb the area beforehand. The cream takes 10-20 minutes to work.

 

The chemotherapy can then be given through the cannula. Usually a drip is attached to the cannula and some drugs are given by injection into a rubber bung in the drip tubing. This can take from a few minutes to about 20 minutes. Some chemotherapy drugs are diluted in a drip bag and the drip is attached to the cannula.

If you feel any discomfort or a change in sensation around the area of the cannula while the drug is being given, let your nurse or doctor know immediately.

Central lines

Another way of giving intravenous chemotherapy is through a long, fine plastic tube (called a central line) put into a vein in your chest. Hickman or Groshong lines are common types. The doctor or chemotherapy nurse will explain the procedure to you. You will be given a general or local anaesthetic before the central line is put in.

  1. Central line is inserted into your chest here
  2. The line is tunnelled under your skin
  3. It comes out here

Once it is in place, the central line is either stitched or taped firmly to your chest to prevent it being pulled out of the vein. It can remain in the vein for many months and means that you do not have to have cannulas put in when you have your intravenous chemotherapy. Blood can also be taken through this line for testing.

You will be able to bathe or shower; although you should prevent water from getting to the area where the tube enters the skin - a plastic dressing can be used for this.

There are very few restrictions to everyday life. Before you go home, make sure you are confident about looking after your central line. If you do have any problems, contact the staff on the ward for advice.

Possible problems with central lines

Two potential problems with central lines are blockage and infection. Once or twice a week the line has to be flushed with heparin, a drug which prevents clotting, and the nurses on the ward can teach you how to do this.

If you notice any reddening, darkening or soreness of the skin around the central line, or if you have a high temperature, let your doctor know as it could be a sign that you have an infection in the line. If this happens you will need to have antibiotics through the line to clear the infection.

Most hospitals consider a temperature above 38°C (100.5°F) to be high, but some hospitals use a lower or higher temperature. The doctors and nurses at your hospital will tell you which temperature they use.

PICC lines

Your doctor may decide to put a long, fine line into a vein in the crook of your arm. This is called a peripherally inserted central venous catheter (PICC). The doctor or chemotherapy nurse will explain the procedure to you. You will be given a local anaesthetic before the line is put in.

 

The tube is threaded through the vein until the end is near to your heart
 

The end of the tube comes out just below the crook of your elbow.

Once it is in place, the PICC line is taped firmly to your arm to prevent it being pulled out of the vein. It can remain in the vein for many months. As with the central line it means that you do not have to have cannulas put in when you have your intravenous chemotherapy. Blood can also be taken through the line for testing.

You will be able to bathe or shower, although you should prevent water from getting to the area around the tube - a plastic dressing can be used for this.

There are very few restrictions to everyday life. Before you go home, make sure that you are confident about looking after your line. If you do have any problems contact the staff on the ward for advice.

The possible problems are the same as for central lines: blockage and infection

Portocaths (implantable ports)

An implantable port is a thin, soft plastic tube that is put into a vein and has an opening (port) just under the skin on your chest or arm. This allows medicines to be given into the vein or blood to be taken from the vein.

The tube is a long, thin hollow tube known as a catheter and the port is a disc about 2.5 to 4 cm in diameter. The catheter is usually inserted (tunnelled) under the skin of your chest. The tip of the catheter lies in a large vein just above your heart and the other end connects with the port which sits under the skin on your upper chest. The port will show as a small bump underneath your skin which can be felt, but nothing is visible on the outside of your body.

Infusion pumps

Infusion pumps may be used to give some types of chemotherapy. There are various types of portable pump. These can be used to give a controlled amount of drugs into the bloodstream over a period of time (from a few days to a few weeks).

The pump is connected to a central line or a PICC line. This means that you can go home with the pump and so you need fewer visits to hospital. The pumps are small enough to be carried in a bag or belt holster.

The chemotherapy drugs are prepared at the hospital. You, and perhaps a family member or friend, will be taught how to look after the pump. Some pumps are battery-operated and care has to be taken not to get them wet when you are washing (the nurses will give you full instructions).

Some pumps are disposable after use and are operated by a balloon mechanism or spring control.

Chemotherapy tablets or capsules

You may be given tablets or capsules to take at home as all or part of your treatment. Tablets or capsules are known as oral chemotherapy. You will be told when to take them and will be given other instructions such as whether or not to take them with food.

If you cannot take your medicines for any reason you should contact your doctor immediately for advice. The drugs that you have been given by the hospital make up a complete course of treatment, and it is important to take them exactly as they have been prescribed.

If you need to have further supplies of the drug it is important to get these from your hospital specialist and not from your GP or local pharmacist.

Intramuscular injection

Some chemotherapy drugs are given by injection into a muscle. The doctor or nurse will explain the procedure to you. The drug is injected into the muscle of the leg or buttock. This may be painful or uncomfortable, but only lasts for a short time.

Subcutaneous injection

Some drugs can be given by injection just under the skin. A very fine needle is used and this may be uncomfortable for a short time.

Intrathecal injection (into the fluid around the spinal cord)

In some conditions such as leukaemia or lymphoma (cancer which starts in the lymph system) cancer cells can pass into the fluid which surrounds the brain and spinal cord. The fluid is known as cerebrospinal fluid or CSF.

To prevent this from happening, or to treat it if it occurs, chemotherapy may be given into the CSF. To do this you need to lie on your side with your legs drawn up. The doctor will then use local anaesthetic to numb an area of skin over your spine. A needle is then inserted into the space between two of the spinal bones and into the CSF. The chemotherapy is injected into the CSF through the needle.

This procedure takes from 15 to 30 minutes and you may need to lie flat afterwards for a few hours. You may have a headache, which will last for a few hours. Painkillers can be given for this. Chemotherapy given in this way does not usually cause any other side effects.

Intra-cavity chemotherapy

To give chemotherapy drugs in this way a tube is inserted into the affected body cavity, for example the bladder, and the chemotherapy is flushed in through the tube. It may then be drained out again after a set period of time.

Drugs given in this way may cause some irritation or inflammation in the area to which they are given but they do not tend to cause side effects in other parts of the body.

Chemotherapy creams

Chemotherapy creams are used for some types of skin cancer. They are put on to the affected area of skin in a thin layer and may need to be used regularly for a few weeks. They may cause some soreness or irritation of the skin in the affected area but do not cause side effects in other parts of the body.

While you are using chemotherapy creams you may need to wear a dressing over the affected area of skin.

 

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