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Chemotherapy – All you wanted to know

Chemotherapy, generally used for the treatment for cancer, denotes medicines that prevent cancer cells from dividing and growing. This is primarily achieved by killing the target cells which have the potential to multiply abnormally. A wide variety of drugs are used to achieve these objectives. The effectiveness of Chemotherapy depends, to some extent, on the stage of cancer that is being treated.

While there are adverse side effects, the benefits of chemotherapy generally outweigh the risk of any adverse effect.

What is Chemotherapy?

Chemotherapy is the use of drugs to destroy cancer cells; these are sometimes called cytotoxic drugs.

Chemotherapy treatments differ, consisting of just one drug (sometimes) or many different drugs that may be administered over a few days or weeks. The treatment will generally comprise of many chemotherapy courses, and the regime a patient is given depends on the type of cancer to be treated.

How is chemotherapy given?

Chemotherapy may be given using different routes, depending on the type of cancer and treatment received.

Most commonly it is given by injection into a vein (intravenously). It can also be given by mouth (orally), by injection into a muscle (intramuscularly) or under the skin (subcutaneously).

In a few cases, chemotherapy will be injected into the fluid around the spinal cord (intrathecally). Whichever way the drugs are given, they are absorbed into the bloodstream and carried around the body so that they can reach the cancer cells.

Intravenous Chemotherapy

Intravenous (IV) chemotherapy can sometimes be given via a ‘drip’ into a vein in your arm. In this case, a fine tube (a cannula) will be inserted into the vein by a doctor or nurse. This will be removed before you go home.

If the veins are difficult to find, it may be necessary for the patient to have a Peripherally Inserted Central Venous Catheter (PICC). This is a very fine tube, which is placed into a vein in the crook of your arm. Once in place, it is secured and can remain in the vein for many weeks.

Alternatively, it may be necessary for some patients to receive chemotherapy via a central line. The line is ‘tunneled’ so that it runs underneath the skin and ends in one of the large veins that lead to your heart. Some popular sites for placement of Central line are ‘ Pectoral region’ taking the sub-clavicular approach or ‘Neck region’ approach for placement in Internal Jugular Vein.

A central line is inserted while the patient is lightly sedated or under local anaesthesia and can remain in place for many weeks throughout the treatment.

Oral Chemotherapy

Chemotherapy tablets may also be given and can be taken at home. The treating doctor or nurse will guide on when and how to take the medication as per the prescription.

The Treatment Plan 

Treatment of the patient and the duration of the same will depend on the type of cancer treated, the drugs being received and the response of cancer to the drugs.

The treating physician and nurse should explain the benefits of the treatment and also the potential side effects that might occur. Before initiating the treatment, the doctor and nurse must ensure that the patient is aware of the pros and cons of taking the Chemotherapy to take an informed decision. The patient will also be asked to give consent for the treatment, and this will involve taking informed consent.

Where is chemotherapy given?

Chemotherapy can be administered on an outpatient basis in the Day Treatment Unit or as an inpatient in the Haematology Ward. The type of chemotherapy a patient is having will determine whether the patient needs to stay in the hospital.

If a patient is receiving chemotherapy in the Daycare treatment Unit, the patient has to undergo certain tests and consult a doctor before the treatment starts. As each patient suffering from cancer needs special attention, patients, as well as attendants, may expect significant delays during the OPD hours.

One major side effect of Chemotherapy is that it affects healthy as well as cancer cells. As a result of that blood counts are frequently deranged. The treatment may have to be delayed if the blood counts of the patient have not recovered completely since the last course of treatment. It may also be delayed if the patient is feeling unwell. The treating doctor will regularly check for the patient’s response to chemotherapy. The results from blood tests, X-rays and scans show how the cancer is responding to the treatment.

Occasionally, it may be necessary to change your treatment plan. This may be because the cancer is not responding as quickly as the doctor had hoped. Altering chemotherapy drugs may produce a better response.

How does chemotherapy work?

Cancer cells are abnormal, rapidly growing and dividing cells. Chemotherapy drugs kill any rapidly dividing cells.

Unfortunately, the drugs cannot tell the difference between cancer cells and other rapidly dividing cells in our body such as hair follicles, skin, bone marrow and the lining of our mouth. This is what causes the side effects associated with chemotherapy.

Side effects of chemotherapy

Not everybody receiving chemotherapy will experience side effects, but you should remember that most side effects are temporary and will gradually disappear once your treatment has stopped.

There are many different chemotherapy regimes, some having specific side effects. The most common side effects are:

  • Hair loss
  • Sore mouth
  • Skin Changes
  • Taste changes
  • Nausea and vomiting
  • Changes in bowel habit
  • Fatigue
  • Infection
  • Bleeding and bruising
  • Infertility and reduced libido.

Outlook

The patient will undergo blood tests as well as other examinations during and after chemotherapy, to measure the progress of the treatment. Side effects of chemotherapy drugs usually go away when the treatment is completed. Sooner the cancer is treated, more likely is the reduction in the duration of chemotherapy, and hence the associated side-effects. While some patients can continue with their routine during the course of chemotherapy, some may have to make adjustments in the daily schedule.

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