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What is chemotherapy?

What is chemotherapy?
Chemotherapy is widely used to treat certain cancers. But it is not suitable for all forms of cancer or for all cancer patients
Most of us have heard of chemotherapy, and 28 per cent of all cancer patients experience it as part of their treatment. However, what do you really know about it?

Medical Terminology 

  • Oncologist: A doctor who specialises in cancer. He or she may have training in one or more types of the disease.
  • Induction therapy: This is an initial chemotherapy treatment used to reduce cancer cell count.
  • Consolidation therapy: Treatment that follows immediately after induction therapy to stop a cancer from returning.
  • Maintenance therapy: Longer-term treatment to prevent relapse.
  • Remission: The point when cancer cells can no longer be detected.
  • Relapse: This is the re-occurrence of cancer cells after remission.

How chemotherapy is used

Chemotherapy, though widely used to treat some cancers, is not suitable for all forms of cancer or for all cancer patients. An oncologist will take into account the type and location of the cancer and your age and general health in deciding whether to recommend chemotherapy or other treatments such as surgery or radiotherapy. 
Fast-progressing cancers such as Hodgkin's disease and leukaemia tend to respond well to chemotherapy: because the cells are fast-growing, they are quickly affected by the chemotherapy drugs. Chemotherapy is also used for some slower-growing cancers such as those of the ovary, breast or bladder.
What is chemotherapy?
The point in your cancer treatment at which chemotherapy is used will also depend on the type, stage and location of a tumour as well as its grade. The grade indicates how closely the cancer cell resembles the normal cell; grade I has the closest resemblance to the normal cell, grade III shows little resemblance. This can help to estimate how aggressive the cancer will be.
Chemotherapy may be used early in treatment to shrink a tumour before surgery or radiotherapy (this is known as neo-adjuvant therapy); straight after surgery to destroy any cancer cells left behind (adjuvant therapy); when cancer has recurred; or to control the symptoms of an advanced cancer (palliative therapy).
"Your feelings about whether this treatment is right for you should form part of the decision-making process"
Strong drugs are used in chemotherapy, which can have debilitating effects on the rest of the body. Your feelings about whether this treatment is right for you should form part of the decision-making process. In deciding whether or not to have chemotherapy, patients must weigh the side effects against the effectiveness of the treatment in attacking their particular cancer.

What drugs are used

Many drugs are used in chemotherapy. Most are poisons that attack cancer cells (cytotoxics), but recent scientific advances are producing new drugs that interfere with the cancer process in other ways. For example, some of these experimental drugs hone in on cancer cells by targeting genetic markers and interfering with cell division. 
Others, called anti-angiogenic drugs, stop the growth of new blood vessels to a cancer. The most effective drugs for each case are selected according to the type, stage and location of the cancer, among other factors.
Most chemotherapy drugs are taken either by mouth or via a tube directly into a large vein in the arm; some can also be taken by injection. As far as possible, chemotherapy is given on an outpatient basis or at home, but sometimes a short spell in hospital is necessary. Most currently used cytotoxics affect normal body cells as well as cancerous cells, so they can have unpleasant side effects.
Normal cells tend to recover more quickly than cancerous cells. Chemotherapy is often given in short courses interspersed with several weeks of nontreatment to allow time for normal cells to recover.
Sometimes, a long tube is implanted into one of the major veins in the chest, not just for one chemotherapy session but for the duration of the course of treatment. This is known as a central venous line; two main types are used, called Hickman lines and Groshong lines. 
Central venous lines are used when large amounts of chemotherapy need to be given, and when additional products (such as blood and platelets) may be needed frequently. They also make it easy to take blood samples. However, there is a risk of infection with this procedure, and it is essential that strict hygiene is observed.

Effects on the rest of the body

The side effects of chemotherapy can be very unpleasant and may include intense nausea and sometimes vomiting, a dry mouth, diarrhoea, fatigue, headaches, loss of hair, bone marrow failure with an increased risk of infection, infertility and weight gain.
Everyone reacts differently to chemotherapy. Some people undergo the treatment with few troubles, while others find that the course of chemotherapy causes them even more problems than their tumour did. It is vital to talk to your health care team about any problems that you may be experiencing since many side effects can be effectively treated.
Chemotherapy side effects
You may want to take time off work or arrange for help in the home during this period. Be sure to take advice from your health care team, however, before you make any drastic alterations to your normal routine.
Some side effects, such as infertility, make prior planning necessary. Before beginning chemotherapy, women can have sections of their ovaries and eggs stored and men can have sperm set aside for future use.
"Take advice from your health care team before you make any drastic alterations to your routine"
Many unwanted effects of chemotherapy can be treated. The options available include anti-emetic drugs such as 5HT3 antagonists or steroids such as dexamethasone to treat feelings of nausea or episodes of vomiting, antidiarrhoeal medicines such as loper amide; constipation treatments such as lactulose; low-dose steroid tablets to maintain a healthy appetite; and growth factors such as G-CSF to boost production of blood cells and fight infection.

Complementary therapies 

Complementary therapies can play an important part in helping people to get through chemotherapy. Acupressure, for example, may help to control nausea; nutritional approaches may promote appetite; and relaxation therapy may encourage rest.
However, there is no convincing evidence that any complementary therapy can actually kill cancer cells. It is therefore very important not to abandon conventional treatment in favour of a complementary approach; use the two together.

Jayne's story

Jayne, 34, had chemotherapy for cancer of the ovary. When Jayne's tumour was discovered it had spread to other parts of the body. After surgery to remove the tumour her oncologist recommended chemotherapy. 
Jayne said, "I knew that chemo could make you feel very sick. But to me it represented the hope of a cure. I hoped that I would be one of the ones who sail through it—some of the women I met in the clinic had a really rough time but others had very few side effects."
Jayne was started on two drugs, carboplatin and paclitaxel. In order to have the drugs, she had a large tube (a central venous line) implanted in one of the veins going to her heart. 
"I was quite scared about this operation but it was all over very quickly. The only problem is that I had to keep the central line very clean because bacteria from my skin could have gone straight to my heart," Jayne said. 
"The worst thing was losing my hair. But I tried to see it as a sign that the chemo was doing its job."
If this happened, the bacteria could have caused an infection in the heart or be pumped around her body. Chemotherapy partly suppresses the immune system so she would not have been able to fight infection as effectively as normal.
Jayne felt tired and depressed on some days, and had to try different medicines to control diarrhoea and nausea. 
"The worst thing was losing my hair," she says. "But I tried to see it as a sign that the chemo was doing its job."
As Jayne hoped, her hair grew back after the end of her treatment and her cancer went into remission.

Coping with hair loss

Hair loss is a common although by no means inevitable side effect of some chemotherapy drugs. With the right strategies it can be minimized or disguised. Patients often begin to lose their hair soon after starting chemotherapy. 
Loss may be minimal, partial or complete, affecting all body hair. Hats, scarves or wigs can be used to cover up. Ask your health care team about wigs available through the NHS or talk to your hairdresser.
How to cope with hair loss from chemotherapy
Hair loss can be minimized by using a cooling cap to reduce the blood supply to the hair follicles while chemotherapy is being given. If you wear a cooling cap, your follicles receive only a low dose of chemotherapy because less blood (containing chemotherapy drugs) is pumped to them. 
As a result, they are less likely to be damaged. Cooling caps work only with certain chemotherapy drugs, however, and their use is not suitable in some types of cancer.
Although hair loss may seem terrible at first, you will probably need to cope with the problem only for a brief period. In most cases, the hair grows back very quickly once chemotherapy is finished: within three to six months it should be back to normal. But the hair might be different from before—for example, it may be curlier or a different colour.
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