Sarah Lewis, PharmD
What is chemotherapy?
Chemotherapy is a type of treatment for cancer that uses medications. Cancer is an abnormal growth of cells. Normally, old or damaged cells in the body will stop dividing and die. Healthy young cells replace these cells. Cancer occurs when old or damaged cells divide and multiply uncontrollably. Cancer cells rapidly reproduce even when your body signals them to stop.
Chemotherapy works by slowing or stopping these rapidly growing cells. The goal of chemotherapy can be to cure cancer, control cancer, or relieve the symptoms of cancer.
Chemotherapy, sometimes called chemo, is only one method to treat cancer. You may have other treatment options. Consider getting a second opinion about all of your treatment choices before having chemotherapy.
Types of chemotherapy
The types of chemotherapy include:
Regional chemotherapy affects a specific area of your body instead of your whole body. Regional chemotherapy targets a tumor or tumors contained in one area. It can also help decrease side effects of a large tumor, such as a tumor that presses on another body part causing pain.
Systemic chemotherapy affects your entire body or system. It targets cancer cells that may have spread throughout different areas of your body.
Other procedures that may be performed
Looking for a Doctor?
Doctors sometimes prescribe chemotherapy by itself to treat certain cancers. Your doctor may also prescribe one or more other treatments including:
Biological therapy (immunotherapy) boosts or stimulates your body’s immune system to help fight cancer.
Hormonal therapy blocks the effects of hormones that stimulate growth of certain cancers. In doing this, hormonal therapy deprives cancer cells of what they need to grow. Examples of cancers treated by hormonal therapy include certain breast cancers and prostate cancers.
Laser therapy removes tumors and treats cancer symptoms with a laser.
Photodynamic therapy combines special drugs with specific wavelengths of light. The drug, called a photosensitizer, is injected into your tumor and exposed to the light. The light produces a reaction that kills cancer cells when it hits the drug.
Radiation therapy uses x-ray beams or other forms of radiation to kill cancer cells. It targets tumors and localized cancer cells. Newer technologies allow doctors to precisely target tumors and minimize damage to nearby healthy cells.
Surgery removes cancerous tumors and precancerous tissues.
Why is chemotherapy used?
Chemotherapy treats many types of cancer. Your doctor may use chemotherapy as:
Adjuvant chemotherapy, to destroy cancer cells that may be left after surgery or radiation therapy
Concomitant chemotherapy, to work together with surgery or radiation therapy and help them work better
Neo-adjuvant chemotherapy, to help shrink tumors before surgery or radiation therapy
Relief of symptoms caused by tumors or cancer cells, such as pain or bleeding
Treatment for recurrent or metastatic cancers. Recurrent cancers are cancers that come back after being treated. Metastatic cancers are cancers that have spread to other areas of the body.
Who performs chemotherapy?
Chemotherapy is given by various healthcare professionals, depending on the type of cancer and chemotherapy. Specially trained oncology nurses often administer injections and intravenous chemotherapy. You may be able to give yourself oral or topical chemotherapy at home.
Doctors administer some types of chemotherapy, such as chemotherapy that is injected directly into a tumor. Doctors who administer or lead care teams that give and monitor chemotherapy include:
Gynecological oncologists are obstetrician-gynecologists (Ob/Gyns) who specialize in diagnosing and treating cancer of the female reproductive system, such as ovarian or cervical cancer.
Hematologists are internal medicine doctors who specialize in diagnosing and treating blood disorders.
Medical oncologists are internal medicine doctors who specialize in diagnosing cancer and treating it with chemotherapy and other non-surgical treatments.
Pediatric hematologist-oncologists are pediatricians who specialize in diagnosing and treating blood disorders and cancer in children.
Surgical oncologists are surgeons who specialize in treating patients with cancerous and noncancerous (benign) tumors with surgery and other treatments.
How is chemotherapy given?
Your chemotherapy will be given in an outpatient clinics or hospital setting. You may take some types of chemotherapy at home. You may receive chemotherapy through a variety of methods or devices. These include:
Central venous catheters are thin, soft, hollow tubes, sometimes called long-lines. One end of the catheter sits in a large vein, usually in your chest. The other end remains outside your body, either outside your chest or arm. Your care team can use a catheter to give systemic chemotherapy, medications, fluids, and blood transfusions. Your care team can also take blood through the catheter. Examples include peripherally inserted central catheters (Groshong PICC, Per-Q-Cath), midline catheters (Groshong Midline, Per-Q-Cath Midline), and tunneled central venous catheters (Broviac, Groshong, Hickman, Neostar). Your doctor places a catheter during a short outpatient surgical procedure. It remains in place until all chemotherapy sessions are completed. Your doctor will remove your catheter during another short outpatient procedure.
Implantable venous access ports are small disks made of plastic or metal. A port sits just under the skin of your chest. A catheter attached to the port runs into a large vein, usually in your chest. Your care team can use a port to give systemic chemotherapy, medications, fluids, and blood transfusions. Your care team can also take blood through a port. Examples include BardPort, Infusaport, Medi-Port, PassPort, and Port-A-Cath. Your doctor places a port during an outpatient surgical procedure. It remains in place until all chemotherapy sessions are completed. Your doctor will remove your port during another short outpatient procedure.
Injections are shots that are a form of systemic chemotherapy. Your nurse will give you the shot either in a muscle (intramuscularly) or under your skin (subcutaneously).
Intra-arterial chemotherapy is injected into an artery that directly feeds your tumor. It is limited to certain areas of your body. It is a regional form of chemotherapy.
Intracavitary chemotherapy is put right into your affected body cavity. Examples include your bladder and abdominal cavity (peritoneum). It is a form of regional chemotherapy.
Intralesional chemotherapy is injected directly into a tumor or cancerous growth. Your doctor may use this method if he or she can safely reach a tumor with a needle. It is a form of regional chemotherapy.
Oral medications are pills, tablets, capsules or liquids that you take by mouth. They are a form of systemic chemotherapy.
Peripheral infusions slowly drip chemotherapy medication through an intravenous (IV) line. This is a form of systemic chemotherapy. Your nurse will usually put your IV line in your hand or arm. Your nurse will put an IV line in before each session and remove it afterward. Tell a member of your care team right away if you feel any pain or burning during an IV chemotherapy infusion.
Topical medications are creams and lotions that doctors generally prescribe to treat skin cancer. They are a form of regional chemotherapy.
Your doctor will advise you on which method of chemotherapy is best for you based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of chemotherapy and ask why your doctor will use a particular type for you.
Will I feel pain with a chemotherapy procedure?
Your comfort and relaxation is important to you and your care team. You may feel a brief pinch or prick during IV or needle insertion for certain types of chemotherapy. These include having chemotherapy by infusion, injection, or through an IV access port under the skin.
Take a few long, deep breaths to help yourself relax. Tell your care team if any discomfort does not pass quickly or if you have pain or burning during chemotherapy.
Types of anesthesia that may be used
You will have regional anesthesia (a nerve block) to numb the pain during placement of a central venous catheter or port. A nerve block numbs the area where your doctor inserts the device. You may have sedation to keep you relaxed and comfortable.
What are the risks and potential complications of chemotherapy?
Most chemotherapy is monitored with periodic blood tests. This ensures that you receive the right amount of chemotherapy. It also helps check for problems from the chemotherapy.
Side effects are likely with chemotherapy because of the way it works. Chemotherapy works by slowing or stopping cells that are rapidly multiplying. Your body has some cells that normally multiply quickly. Examples are cells of your hair follicles and the lining of your digestive tract. Chemotherapy may also damage these normal cells, resulting in side effects.
Some chemotherapy medications carry more risks than others. Ask your doctor about the specific risks and complications of your chemotherapy.
General risks and potential complications of chemotherapy include:
Anemia from low red blood cells. Symptoms include fatigue, weakness, and shortness of breath.
Bleeding from low blood platelets
Cold sensitivity, numbness or tingling
Infection from low white blood cells
Nausea and vomiting
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Drinking plenty of fluids to stay hydrated
Following activity, dietary and lifestyle restrictions and recommendations
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Keeping all scheduled appointments including laboratory testing to monitor your blood cell counts
Not skipping your chemotherapy sessions without consulting with your healthcare provider
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for chemotherapy?
You are an important member of your own healthcare team. The steps you take before chemotherapy can improve your comfort and outcome.
You can prepare for chemotherapy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications and allergies at all times.
Arranging for a ride home from your procedure or treatment appointment
Following instructions about eating or drinking just prior to your procedure or treatment
Getting testing as directed. Testing will vary depending on your age, health, and specific chemotherapy. Testing may include X-rays or other imaging tests, blood tests, biopsies, and other tests as needed.
Taking or stopping medications exactly as directed. For catheter or port placement, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. For chemotherapy treatments, this may include taking a variety of pretreatment medicines.
Questions to ask your doctor
Preparing for chemotherapy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before chemotherapy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Common questions include:
Why do I need chemotherapy? Are there any other options for treating my condition?
Do I also need other treatments, such as surgery or radiation?
What is the goal of chemotherapy in my case? Will chemotherapy cure my cancer?
How will we know my chemotherapy is working? If it doesn’t work, are there other options for treating my cancer?
How long will I need chemotherapy? How often will I need it? When can I go home after each treatment?
What restrictions will I have? Will I be able to work, go to school, and perform other activities?
How will you treat my pain?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
Does my insurance cover chemotherapy? Is any assistance available? What records do I need to keep?
When will I receive the results of any tests?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my chemotherapy procedure?
Knowing what to expect after a chemotherapy treatment can help you get back to your everyday life as soon as possible.
How will I feel after the treatment?
You may feel tired or fatigued after chemotherapy. This is the most common side effect of chemotherapy. Follow your care team’s instructions for rest after chemotherapy. Other effects vary from person to person. Your care team will give you pain medication to control pain as needed. You might feel a little drowsy if you had a sedative or pain medications.
When can I go home?
You can go home right after an outpatient chemotherapy treatment. If you had a procedure to place a central venous catheter or port, you will go home when the major effects of sedation have worn off and you are fully alert, breathing effectively, and your other vital signs are stable. You will need a ride home from your procedure or your chemotherapy treatment. You may need help at home and with meals for the first 24 hours.
When should I call my doctor?
It is important to keep your follow-up appointments after chemotherapy. Call your physician if you have any concerns between appointments including:
Bleeding, bruising, red spots on your skin, black or bloody stool, bleeding from your nose or mouth, or unusual or abnormal vaginal or menstrual bleeding
Cough, chills, rash, headache, earache, or stiff neck
Difficulty urinating, painful or frequent urination, or bloody or cloudy urine
Dizziness, confusion, memory problems, shaking, weakness, numbness, vision changes, or loss of balance and coordination
Fever. Follow your doctor’s instructions for checking your temperature and when to call.
Mouth sores or pain in your mouth
Pain that is not controlled by your pain medication
Signs of infection around your catheter or port. This includes redness, swelling, soreness, tenderness, and drainage.
Vomiting for more than 24 hours, vomiting right after drinking even small amounts of liquid, or if your medicine for nausea is not working
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