Chemotherapy drugs kill rapidly dividing cells in a variety of ways depending on how the cancer grows, the types of cells it affects, and the stage it has reached. Some drugs work by damaging the cells' DNA. Others prevent cells from dividing. Still others disrupt cell metabolism or other functions.
Your chemotherapy treatment will be decided upon based on numerous considerations, including:
Chemotherapy can be given in several ways, from a pill or an IV line to an injection into a vein or directly into the spinal fluid. Some kinds of chemotherapy are administered at a hospital or outpatient facility, while others can be given at home. For patients undergoing IV treatment, your doctor may recommend implanting a venous access device (VAD) to make it easier for both the patient and doctor to deliver the medicine at each appointment.
A course of chemotherapy usually comprises several cycles of treatment and rest. Your specific schedule will depend on the type of cancer and the drug combination being used. An individual treatment session may take a few minutes or a few hours. The treatment cycle may last anywhere from one day to one month or more, with treatments given daily or weekly. There are usually four to six treatment cycles.
Side effects arise because chemotherapy drugs cannot differentiate between cancer cells and rapidly dividing healthy cells. The drugs often attack normal tissues or organs, causing inconvenience, discomfort and even death. Side effects may be temporary or chronic, mild or life-threatening. If side effects prevent the administration of chemotherapy on schedule at the proper dosage, they can reduce the effectiveness of the treatment.
The most common side effects of chemotherapy are low blood counts (anemia), nausea, vomiting, hair loss and fatigue. Low white blood cell count (neutropenia) is one of the most serious potential side effects of chemotherapy. It can lead to severe infections or treatment interruptions.
Your doctor will discuss with you the side effects you might expect from your particular course of chemotherapy.
Most patients will experience some degree of nausea and vomiting after a chemotherapy treatment. Anti-nausea/anti-emetic medications during or after a treatment session can help.
Many chemotherapy drugs cause temporary hair loss. Depending on the type and dosage of the drug, this can be anywhere from a slight thinning to complete baldness that affects not only the scalp but also the eyebrows, eyelashes, armpits, legs and pubic area. Hair loss typically begins about two to three weeks after the start of treatment and reverses about two to three weeks after treatment is completed. The hair that regrows may be a different color or texture than before.
Many patients prepare for hair loss by cutting the hair, purchasing a wig, or trying hats and scarves before treatment starts. Insurance may cover the cost of a hairpiece. During chemotherapy, patients should protect the scalp with sunblock. As hair begins to grow back, it is important to avoid strong chemicals, bleach or coloring agents.
The specific tests you need will be determined by your doctor. In general, blood tests are done on the day of treatment or up to a week beforehand. These include a complete blood count (CBC), chemistry profile and any necessary cancer markers. The CBC is repeated one to two weeks after treatment.
Monitoring the CBC is important because chemotherapy drugs often attack red blood cells, white blood cells and platelets since these cells divide rapidly like cancer cells. Tracking red blood cell (RBC), white blood cell (WBC), or platelet (PLT) counts helps your doctor assess how toxic the chemotherapy is to your body, estimate your risk of complications, and plan your therapy in the future.
Symptoms of reduced blood counts should be reported to your doctor immediately. These include:
Chemotherapy may be combined with radiation therapy, surgery, targeted therapy, complementary procedures or other treatment modalities. It is commonly recommended to shrink a tumor before operating on it ("neoadjuvant chemotherapy"), or to ensure that all cancer cells have been eradicated after surgery ("adjuvant chemotherapy").
Cancer treatments can compromise your immune system. This is because chemotherapy, which targets and destroys fast-growing cancerous cells, also kills healthy cells. White blood cells (WBCs), which are made in your bone marrow, are responsible for fighting infections by initiating an immune response. Because they are also fast growing, WBCs may also be affected by chemotherapy.
If the number of WBC’s falls to low levels, your chance of getting an infection increases. We prescribe a synthetic form of a colony-stimulating factor (CSF) to help your body make more WBC’s, which in turn can help your immune system recover. A CSF is a type of protein, known as growth factors that stimulate your bone marrow to increase the number and function of your WBC’s. This affects important aspects of your immune system that can enhance your recovery. Your physician or nurse practitioner will determine when you should start and stop treatment. It is generally administered as a subcutaneous injection to the fatty party of your arm.
Some patients may experience side effects, most of which are mild to moderate. Some common side effects include bone pain, slight temperature elevations (usually less than 100.5 F) for a short period of time after the injection; and swelling, redness and/or discomfort at the injection site. These are normal and reduce over time as your body gets used to the medication.
Side effects can be reduced by taking Tylenol/Motrin and Benadryl half an hour to an hour prior to the injection, then applying ice to the site one minute before the injection. Avoid rubbing the skin before or after injection. You may also apply ice after the injection.
Some serious but rare side effects or symptoms may occur. Call you physician immediately if you have the following side effects:
Signs of infection, which can include chills, sore throat, congestion, inflammation (warmth or redness) of an area of the body, or development of a fever, especially if the fever is greater than 100.5 F and continues over 24 hrs.
Have trouble breathing or experience wheezing, fainting, skin rash, hives, or feel you are having an allergic reaction of any kind.
Experience sudden weight gain or other signs of fluid build-up such as swollen legs or feet and shortness of breath.
Develop chest pain, chest discomfort, or a rapid or irregular pulse.
Develop any other unexpected symptoms, or unusual side effects.