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|What Is Chemotherapy?
Chemotherapy (or chemo) is the use of drugs or medicines as a cancer treatment. Where radiation therapy and cancer surgery are considered local therapies which eradicate disease in one area, chemotherapy is a systemic therapy. Systemic therapies work throughout the body seeking to destroy cancer cells which have progressed beyond their point of origin. In recent years courses of chemo have become shorter and more effective drugs, products and techniques are helping to reduce side effects. Deciding whether or not to embark on a course of chemotherapy involves weighing all the expected gains such as improved life span against any possible negative effects. The expected gains will vary according to the type and progression of cancer being treated and the drugs being used. It can be reassuring to talk to other women who have gone through chemotherapy, although it is a different experience for everyone. Some women manage to sail through a chemo course with minimal side effects, while others are hit quite hard. Above all, the support of a healthcare team is essential to managing the many uncertainties associated with chemo.
An oncologist (a doctor who specializes in cancer) may recommend chemotherapy for any of the following reasons:
1. As a means of killing cancer cells which are known to have strayed (metastasized) from the original organ where they started.
Today there are about 100 anti-cancer drugs being used for chemotherapy. Some are used on their own or in combination with each other. In general the drugs tend to work better in combinations, and this is called combination chemotherapy. They may be administered as a pill, injection, liquid or with intravenous lines (IVs). In all cases chemo drugs work by interfering with a cancer cell's ability to grow and reproduce - either by killing the cell outright or by blocking the production of DNA so that the cell cannot divide. Chemotherapy drugs are strong medications and there is a very narrow line between the amounts that will kill the cancer cells and the amounts that will kill the patient. Yet doctors are still required to prescribe doses strong enough to be effective. For this reason, a medical oncologist specially trained in the drugs and their toxicity will decide on the exact level of treatment. The oncologist may also administer the drug or oversee a specially trained chemotherapy nurse do so.
Depending on which type of chemotherapy drugs you receive, your insurance coverage, hospital policy and doctor recommendation, you may receive your treatment at home, in your doctor's office, in a hospital or hospital's outpatient department ('infusion center'). Some hospitals have private treatment rooms while others treat patients together in one large room.
How often a person needs chemo depends on the type of cancer they have, the goal of the treatment, the particular type of drug being used and how the patient's body responds. Treatments may be daily, weekly or monthly but they are usually given in cycles with breaks in between. The cycle allows the woman's body to recover and repair. For example, a common cycle for breast cancer treatment involves 2 drugs injected on the first and 8th day of a 28 day chemo cycle. She will take a set amount of chemo pills at home every day from day 1 through to day 14, and then spends the last 2 weeks of the cycle recovering. A woman with ovarian cancer might also have a 28 day cycle but will spend the first 4 days of the cycle in hospital receiving drugs continuously through an IV and then goes home to recover for 24 days before the next cycle starts. Yet again, a woman with metastatic cancer (cancer which has spread) may get a continuous infusion of chemo drugs dispensed by a small pump she must carry with her at all times. She brings it to the oncologist's office for refills. The idea in this case is to give cancer cells constant smaller zaps without giving them time to recover.
There is little connection between the severity of side effects and how well a chemo therapy is working. In other words, a woman who sails through chemo relatively symptom free can still find her therapy has been highly effective. Attitude seems to an important factor. If a woman thinks of chemo as a life-saving measure she may find it easier to tolerate any side effects. If she thinks of it as toxic to her body, she may not do as well. Fortunately there are also newer medications and various alternative remedies for cancer which can help minimize the side effects. The most common side effects of chemotherapy are:
This can range from mild tiredness to feeling completely wiped out. This sort of fatigue is different from feeling tired after a long day and is not usually cured with a good nights sleep. It tends to be worse at the end of a chemo cycle and usually disappears when chemo finishes. Doctors are not sure of the cause, it may be because the body is working overtime to kill cancer cells and rebuild healthy ones. If you do suffer fatigue, be kind to yourself. Get plenty of rest, eat a balanced diet, include cancer diet foods in your daily menu and take some exercise. A little exercise will help reduce stress, promote sounder sleep and aid digestion.
Most women will be very concerned about possible hair loss (alopecia) as a result of chemo. Not every chemo drug causes hair loss, many do cause some loss and a few cause nearly every woman to lose most of her hair. This temporary hair loss may also affect eyelashes, eyebrows, arms, legs, underarm hair and pubic hair. Usually hair loss does not occur straight away, but begins after a few treatments. It may fall out gradually or in clumps. If you do lose your hair, it nearly always grows back after treatment ends. The oncologist should inform the woman beforehand about the specific side effects of the drugs being used. If a woman knows she is going to receive one of the drugs which most likely cause hair loss, she should consider getting her hair cut short so that the handfuls of hair on the pillow or in the shower are less distressing. It is also easier to shop for a hair piece or wig while the sales assistant can still see the woman's own hair style and color. The American Cancer Society has a free catalog called TLC (Tender Loving Care) which sells flattering hats, scarves, turbans and hairpieces.
While women understandingly worry about potential hair loss, doctors are more concerned with bone marrow damage. Bone marrow produces the white blood cells which protect the body from infection, the platelets that help blood clot and the red blood cells which deliver oxygen around the body. Blood cell levels will be affected by chemo, and the oncologist needs to take this into account. A complete blood count is usually taken at the beginning of each chemo cycle to see what is happening. An extreme drop in white blood cells is called neutrophils and a woman with it is considered neutropenic. This means she is at definite risk of infection and will need to watch for signs of fever, chills, coughing, pain when urinating, sore throat, severe headache or neck ache. An extreme drop in platelets is called thrombocytopenia and puts the woman at risk of bleeding, for example she may notice nose bleeds, bleeding gums, bruises and blood in the stool. Red blood cell counts take longer to lower but the most obvious sign is anemia.
Nausea & Vomiting
Along with hair loss, this must be one of the most dreaded side effects. Nausea may start during treatment and last for a few days. Occasionally it may last for several days. Drugs called anti-emetics can help reduce the problem.
Some women experience temporary complexion changes. The American Cancer Society, along with the National Cosmetology Association jointly sponsors a program called Look Good, Feel Better. Every participant receives a free package of skin care and cosmetic products. See: www.lookgoodfeelbetter.org
Some patients, particularly female patients gain weight during chemo. Why this should be is not clear, it may have something to do with food cravings that lead to excess calorie intake. The average weight gain for women is about 7 pounds.
Other Common Complaints Include:
If you or someone you love is undergoing chemo, check out our list of books on cancer for helpful resources.
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