Chemotherapy - what is it?

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Radiotherapy | Hormone therapy | Biological therapies | Lifestyle & cancer



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Chemotherapy is the use of drugs or chemicals to treat cancer. Conventional chemotherapy works by damaging the structure or metabolism of rapidly dividing cells. Your cancer specialist has a choice of over fifty different chemotherapy drugs that can be used as single agents or in a variety of different combinations. Chemotherapy can be given as the main cancer treatment (radical), to support the main treatment (adjuvant) or to improve symptoms (palliative) - see below. They can be given before or after surgery, before during or after radiotherapy or even in combination with biological agents. Factors such as the extent of your disease, your general condition, and the function of your liver and kidneys are taken into account. For this reason a number of common tests are often required before the start of chemotherapy.

Chemotherapy is normally given in cycles, most commonly two to four weeks apart, to a total of four to six months. Between cycles your body's normal cells recover (blue line) but cancer cells are less able to repair themselves (red line). Over the entire chemotherapy course its hoped that the cancer cells would have been destroyed, leaving the body a little battered but intact.

In most cases, the exact dose of chemotherapy given to you is calculated by measuring your height and weight, then working out your surface area. In this way, treatment is individualised for each patient.

The doses of chemotherapy may be modified during the whole course of treatment, based on your reaction to treatment, lifestyle and further blood and urine tests. A number of drugs are usually given to prevent or alleviate the side effects, symptoms and risks and these may change over the course of the regimen depending on how it is tolerated.

Chemotherapy can be given in the form of oral tablets, or as a liquid injected into a vein in your arm using a device known as an intravenous cannula. Alternatively, it can be injected into a larger vein via a PICC line. This stays in during your chemotherapy course. Also chemotherapy can be given via a line inserted into the front of your chest via an apparatus called a central line. Central lines and PICC lines are permanent catheters introduced into a large vein before the start of chemotherapy, which avoids you having to have a new cannula for each course. Also it allows you to have blood taken without additional injections.

Most chemotherapy drugs are given as an outpatient. Sometimes the drugs have to be preceded by intravenous fluids, and this has to be given as an inpatient staying usually one or two nights. An alternative way of administering chemotherapy is with a continuous infusion pump. In this situation, a drug is carried in a cassette and infused continuously into a central line, while the individual is able to be fully mobile at home or work.

The common regimens for specific cancers explaining the common and rare side effects and risks are linked from the headings below. Information sheets on specific drugs or combinations can also be found from the search box.

Breast cancer - Common chemotherapy regimens:

Bladder Cancer - common regimens

Bowel Cancer - common regimens

Other common regimens by disease of origin

The three main reasons why chemotherapy is recommended
1. Adjuvant chemotherapy. This means that they have had a tumour removed with surgery or radiotherapy but chemotherapy is added as an insurance policy to reduce the chance of it returning in another part of the body in the future.
2. Radical treatment. Chemotherapy aims to cure as the main form of treatment . This treatment tends to be quite intensive, has to be modified regularly, and is usually associated with quite a lot of side effects.
3. Palliative. The third category is where the aim is not to cure, but to control a specific symptom caused by the tumour. This is sometimes known as palliative treatment. The aim of this treatment is to improve the quality of life; therefore the side effects from the chemotherapy should not outweigh the benefits of shrinking the cancer.
In these latter two categories, your oncologist would require a full re-assessment of your disease after two or three cycles, to check whether chemotherapy is working effectively. If not, the chemotherapy regime could be changed.

Coping with side effects
The side effects of chemotherapy depend on a number of factors; Which drugs or combination of drugs, are used; other medical conditions or pre-existing conditions such as nausea or diarrhoea or level of anxiety. An individual's ability to metabolize the drugs such as whether they have certain inherited enzyme deficiencies such as DPD deficiency or abnormalities in their liver or kidney function either due to their cancer or pre-existing conditions; Lifestyle factors such as smoking, diet, exercise levels or alcohol intake (see lifestyle and cancer).
Before you start chemotherapy, your oncologist and specialist nurse would have described which side effects you are most likely to experience. This chemotherapy sheet describing your specific drugs and likely side effects can be found and printed out from this web. Various self initiated strategies can help you cope with the side effects and issues surrounding chemotherapy and afterwards. Specific guidance for various symptoms can be found via the heading below:

Chemotherapy emergencies
A number of anticipated and unforeseen side effect can occur whilst on chemotherapy. Some of these require urgent medical attention. Before you start chemotherapy you should be given emergency contact numbers and have 24 hour access to care. Your GP should also have been sent the contact numbers as well as specific advisory information on the 4 most common emergencies:

Extravasation,

Nausea & vomiting,

Neutropenia and sepsis,

Diarrhoea and dehydration

Links and further resources: