Chemotherapy In Cancer Treatment

Chemotherapy is a general term used to refer to administration of chemotherapeutic drugs to kill the cancer cells.

It’s a common misconception that chemotherapy means “a single drug that kills cancer”. In reality, there are several varieties of chemotherapy drugs. The choice of drug depends on the type of cancer being treated.

Chemotherapeutic drugs are given to kill the cancer cells.

Chemotherapy can be administered through following routes
  • Intravenous route – drugs are infused into the veins .This is the most commonly used route for chemotherapy administration. (Veins carry impure blood from periphery to heart for purification)
  • Intra-arterial route – drugs are infused into the arteries
    (Arteries carry pure blood from heart to peripheral organs. This kind of therapy is done in certain liver tumours and melanomas)
  • Intracavitary chemotherapy –anticancer drugs are instilled into the tumours
  • Oral chemotherapy – the chemotherapy is provided in the form of tablets.

There are several varieties of chemotherapy drugs presently available.

Chemotherapy is a general term used to refer to “cancer treatment using these drugs”.

Usually chemotherapy is repeated at a fixed interval (usually 3 weeks) for a predefined number of times. Each session of chemotherapy is called a cycle.

A single session of chemotherapy may be just one day or a couple of days depending on the drugs being given.

In some instances, the second chemo drug or second dose is given after a gap of several days.

Chemotherapy does mean needle pricks at regular intervals. A minimum of 2-3 needle pricks will be there at each cycle.

So if you are afraid of needles, consider getting a Chemoport for chemotherapy. Since Chemo Port can also be used for drawing blood, injecting antibiotics, blood transfusions besides chemotherapy, you will be free of needle pricks.

The duration of chemotherapy depends on its intended purpose, type of tumor and type of drugs.

If it is given before a planned surgery, to downsize the tumours volume then it typically lasts 3-4 cycles.

If it is given after a definitive surgery- then it may last 6-8 cycles.

At the beginning of the therapy your physician will discuss these details with you.

If your chemotherapy is having good effect on the tumour, you may notice reduction or relief of symptoms caused by tumour (egg: reduced discomfort in swallowing, stoppage of bleeding,reduced abdominal swelling)

The oncologist will get a CT scan or a PET scan after 2-3 cycles of chemotherapy where change in the size of your tumour can be determined.

Your tumour markers are also repeated several times. If you are responding to the treatment well then you will find significant decrease in your tumour marker levels.

You can improve the efficacy of chemotherapy by building your immunity and avoiding infections.

  1. Eat healthy and nutritious food so that you can better tolerate the side effects of chemotherapy and recover faster. Avoid stale food.
  2. Stay hydrated. Drink lots of water. Generally 2.5-3litres of water is recommended.
  3. Avoid infection: do not eat unhygienic food, road side chat, water from unknown sources
  4. Keep exercising
  5. Avoid meeting people, going out, eating out etc. when your immunity is down which is typically in the second week after chemotherapy.
  6. Maintain an active lifestyle to keep you in a positive frame of mind.
Chemotherapy can be administered through following routes a. Intravenous route – drugs are infused into the veins .This is the most commonly used route for chemotherapy administration. (Veins carry impure blood from periphery to heart for purification) b. Intra-arterial route – drugs are infused into the arteries (Arteries carry pure blood from heart to peripheral organs. This kind of therapy is done in certain liver tumours and melanomas) c. Intracavitary chemotherapy –anticancer drugs are instilled into the tumours d. Oral chemotherapy – the chemotherapy is provided in the form of tablets.

Not all chemotherapy drugs cause hair loss.

Drugs like -Cyclophosphamide, Adriamycin, paclitaxel, irinotecan are more likely to cause hair loss.

While drugs like cisplatin, carboplatin are less likely to cause hair loss.

Scalp cooling devices are used to reduce the hair loss of chemotherapy with varying success.

However, what is important is to know that this hair loss is temporary.

In several solid tumours, which are operable but are at a little advanced stage, chemotherapy is given before surgery to reduce the tumour size and kill the circulating tumour cells. This approach has been shown to improve survival.

Chemotherapy after a successful surgery is based on the stage of the cancer and the amount of spread. These details are obtained by detailed histopathological analysis by a trained pathologist who studies the minute details of tumour characteristics under a microscope and prepares a detailed report. This report gives us the final stage of the tumour along with adverse features of the tumor. Based on these features it is decided whether a patient needs chemotherapy after surgery. If the tumor has spread to the surrounding lymph nodes or to the outer layers of organs (T3, T4) chemotherapy is generally recommended.

Chemotherapy is offered only when such a treatment is proven to improve survival, disease free interval and thus quality of life of patients undergoing treatment. The adverse effects of chemotherapy are always taken into account and chemo is advised only when the benefits outweigh the risks.

Dietary therapy, oxygen therapy and several other methods are claimed to be alternatives to chemotherapy, but none have sufficient scientific proof to be viable alternatives.
Immunotherapy:

Although you don’t have to make drastic changes in your routine diet there are certain things you should consider doing with your diet.

  • Avoid raw meat, raw vegetables and unpasteurized beverages
    Including fruit juices, vegetables juices, unwashed or moldy fruits and vegetables
  • Avoid smoking and alcohol
  • Avoid fatty, spicy and overly sugary foods
  • Avoid foods with strong smell as it may induce nausea
  • Avoids eating your favorite food as you may end up associating it with nausea.
It depends on how well you are tolerating the chemotherapy and the nature of your work. If the side effects are low and your workplace environment, type of your work, support from your colleagues are supportive you can definitely consider working while on chemo. However, all the precautions and care as advised by your treating doctor have to be strictly adhered to. Special care needs to be taken especially when your blood counts are on a decreasing trend (which usually happens between 9-14 days after chemo) and you have a higher chance of catching an infection.

You can receive your chemotherapy either in a hospital or in a daycare center. While deciding the place of chemo, you have to keep the following things in mind

  • The distance and time taken to reach place
  • Parking facility
  • Time taken to complete the official formality before the chemo actually begins
  • Costs incurred
  • Whether your insurance covers it.

Each variety of chemotherapy contains one or more specific chemotherapeutic drugs. Each one of these drugs has specific side effects.

When planning your chemotherapy sessions your medical oncologist will discuss specific side effects in detail.

The patient's overall health condition, height and weight , pre existing problems- liver /kidney diseases, heart ailments, bowel conditions are taken into account while deciding the type and dose of chemotherapeutic drugs.

To reduce the side effects each session of chemotherapy also involves several other drugs that counter the immediate side effects.

The side effects you develop are carefully monitored and necessary changes are made in the chemotherapy drug dosages if needed.

The side effects of chemotherapy depend upon the type of chemotherapeutic drugs that are used.

Some of the common side effects of chemotherapy are,

  • Fatigue
  • Weakness
  • Pain in the muscles, joints, headache
  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea
  • Sore mouth and ulcers
  • Tingling and numbness in hands and feet.
  • Low blood counts

Treating medical oncologists always adds medications to prevent these common side effects.

If the adverse reactions are severe, a change in the dosage of the drug or shifting to another drug may be considered by the doctor.

Administering chemotherapy is a special science and needs expertise.
The chemo drugs are not administered in predefined doses, as other common medicines (pain killers, antibiotics etc).
The medical oncologist will carry out a comprehensive evaluation of your health, taking into consideration your nutrition, pre existing conditions like diabetes, blood pressure, kidney –liver ailments, adverse reactions to previous chemo before choosing the best possible drugs with most effective doses with least amount of side effects.
The dose of each chemo drug is calculated based on your body surface area (calculated using your height and weight) and suitable adjustments are made to the dose based on your evaluation.
Before each cycle, the side effects are evaluated and discussed with you.
If necessary the doses are modified or the drugs are changed.

A medical oncologist, who is a physician certified and trained for chemotherapy will administer your chemotherapy.

If your chemotherapy does not work, it may mean that disease is progressing despite chemotherapy. In such a situation a change in the drugs may be required.

You can usually continue taking your other medications while on chemotherapy or when you are in between chemotherapy sessions. However, we advise you to discuss all the medications with your medical oncologist.

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