Chemotherapy

Chemotherapy is a systemic therapy which means it affects the whole body. The purpose of chemotherapy and other systemic treatments is to get rid of any cancer cells that may have spread from where the cancer started to another part of the body.

Chemotherapy is effective against cancer cells because the drugs love to interfere with rapidly dividing cells. Unfortunately, cancer cells aren't the only rapidly dividing cells in your body. The cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant, rapid division. This means that the chemotherapy is going to affect them, too.

Still, chemotherapy is much easier to tolerate today than even a few years ago. And for many people, it's an important "insurance policy" against cancer reoccurrence.

How Chemo Works
Chemotherapy is the use of drugs to treat cancer. Before surgery, chemotherapy may be used both to reduce the size of a tumor and to destroy cancer cells wherever they may be. After surgery, chemotherapy works throughout your system to kill cancer cells that may have spread throughout your body. Here's how this systemic treatment works.

Your body's normal cells grow and divide in a controlled manner. Cancer cells, however, grow and divide in total chaos�without any control or logical order. Chemotherapy works by stopping the growth or multiplication of cancer cells, thereby killing them. There is a possibility that you may worry that chemotherapy will kill normal cells, too, and there is that possibility. However, remember that these drugs work best on cells that divide rapidly�namely, cancer cells. This makes chemotherapy particularly effective against cancer.

When used as systemic therapy right after surgery, chemotherapy has another advantage: being in the right place at the right time. Let's say that cancer cells have broken away from the primary tumor, and that these relatively young and small clusters are now located somewhere in your body. These single cells or small clusters have plenty of nutrients and oxygen, and they are dividing quite rapidly (by contrast, with larger tumors the cells are crowded together, there isn't enough food to go around, and the cells don't have the energy to grow). This is perfect timing for chemotherapy because, remember, chemotherapy works best on rapidly dividing cells. And this is why cancer cells are much more sensitive to chemotherapy than normal cells.

A "cycle" of chemotherapy refers to one time treatment, or one "round" in which you go to the doctor and receive the medication. A "course" of chemotherapy refers to all the cycles in your entire treatment. Depending on the drug (or drugs) you receive, you may have anywhere from four to eight cycles of chemotherapy during an entire course.

Who Gets Chemo?
Doctors use many factors to determine who receives chemotherapy. These factors are:

• Key of the particular cancer, including tumor size and grade, hormone receptor status, rate of tumor cell growth, oncogene expression, and lymph node involvement;
• Individual patient profile (age, general health, location of tumor, whether or not there are enlarged lymph nodes under the arm);
• Stage of the disease;
• Risk/benefit factor of the treatment. Your physician will weigh the risks that you face from cancer versus the long-lasting benefits you could realize from the chemotherapy, taking into account the treatment's side effects and your general health picture.

As you and your doctor analyze the information from all of these factors, you'll discuss several widely accepted treatment guidelines. Remember that in determining who receives chemotherapy, every individual's case is different and requires specific consideration.

• Chemotherapy is never recommended for non-invasive, in situ cancers, which have nearly no risk of metastasizing (spreading to other parts of the body). In general, doctors tend to recommend more aggressive treatments in patients with invasive cancer. Chemotherapy is almost always recommended if the lymph nodes are involved, regardless of the size of the tumor.
• Chemotherapy MAY be recommended in cases of breast cancer �especially in pre-menopausal people�if the tumor is invasive, is confined to the breast, is smaller than one centimeter, but has one or more unfavorable "personality features."

Treatment Overview
You've selected your chemotherapy regimen. You're ready to begin treatment. And you still have so many questions! What can I expect? How long will it last? Can I have the treatment at home? What about the side effects? Do they get worse every time? Can I work? Can I take care of my children? What if I live alone? Can I travel? Will this ever end?

Your physician�s staff will be happy to answer your questions about your chemotherapy regimen. They will have lots of information to share with you about your treatment before it begins, and they will be there for you as your treatment progresses. Most physicians/oncologists will meet with you at least twice before your treatment begins. A nurse will be with you during the entire procedure, and will be available twenty-four hours a day afterwards if you have questions.

It's important to remember that while certain factors hold true for anyone receiving chemotherapy, every person has different reactions to the process. Don't worry if your reactions�physically, mentally, or emotionally�don't mirror your neighbor's experience. Every person responds differently.

When? How? Where?

When?
Chemotherapy is given in cycles, with each period of treatment followed by a period of recovery. For instance, you may have your chemotherapy on the first three days of each month, and then rest the remainder of the month. Depending on the regimen you and your doctor choose, the total course of chemotherapy usually lasts from three to six months. Chemotherapy typically begins as soon as possible after surgery.

How?
Chemotherapy can be given by mouth (orally) in pill, capsule, or liquid form. It can be given intravenously, through a thin needle inserted into a vein in your hand or lower arm. For some chemotherapy can be given through a port or "port-a-cath" that is inserted in the chest during a brief, same-day surgery. Even intravenous drugs (those not taken by mouth) can vary, from a single, quick injection to a slow drip or "infusion." How you receive your chemotherapy depends on the regimen you select.

Where?
Chemotherapy can be given in a hospital, a doctor's office, a clinical setting, and sometimes at home. Most people are able to go home between treatments, but some are required to stay in the hospital so that the process can be monitored. In some instances, chemotherapy can be given through a portable pump that is attached to a port inserted in the chest wall. At the end of the treatment period, you'll return to the hospital or infusion center, and the pump will be removed.

Other things you'll want to know
Does chemotherapy hurt? Many people ask this question. Chemotherapy generally feels the same as taking any other medication by mouth or by injection. Having an IV started usually feels like having blood drawn from your vein. If you experience any coolness, burning, or unusual sensation in the area of the injection or IV, you should report these to your doctor or nurse right away.

The chemotherapy treatment can take anywhere from an hour to several hours, depending on your regimen. Quality Infusion Care has four infusion suites, each with television, sofa, recliner and a computer port if you want to do some work or catch up on your email. You might also consider one of the following to help you pass the time:

• Bring a good book or listen to tapes.
• Bring some stationery and complete those thank-you notes you've been meaning to write.
• Practice relaxation or meditation techniques during treatment.
• Make a list of everything you can look forward to when the treatment is over. Practice the art of positive thinking.
• Start a journal or diary of your treatment process. It may be helpful to refer back to it when you start your second cycle.

When your chemotherapy regimen is complete, you will be able to return home. You will be physically able to drive home by yourself, but you might feel more comfortable knowing that someone is there to drive you. You won't be in any pain, but it's probably better to plan a quiet evening, eat non-fatty foods, and definitely stay away from alcohol. As with any medication you are taking, you should consult with your physician for any restrictions on food and drink while you are taking chemotherapy.

During the first week after chemotherapy, you may experience some side effects. While each person responds differently, be prepared to have a decreased appetite, some additional fatigue, and perhaps some nausea. Don't leave your doctor's office without discussing the anti-nausea medication that will be right for you.

Choose a topic on the left for more information.