Chemotherapy
Chemotherapy is the use of drugs to treat cancer by destroying malignant cells remaining in the body. It may be used prior to surgery to shrink tumors or after surgery to kill off any remaining cancer cells that surgery couldn't remove. "Chemo" is sometimes described as "systemic" therapy, since the drugs course through the bloodstream, affecting the entire body. Decisions about the need for chemotherapy depend on the stage of cancer at diagnosis. The lower the stage, the less advanced the cancer, and the less the need for chemotherapy. Chemotherapy may not be recommended for certain cancers, since not all cancers respond to drugs. If chemo is recommended, the type of cancer and its stage dictate the choice of drug or drug combinations.
The powerful anti-cancer drugs used for chemotherapy can be administered alone or in combination; but since most are more effective when used together, combination therapy is the rule rather than the exception. The drugs work either by stopping cancer cells from growing or by preventing them from multiplying. The choice of drugs depends on the type of cancer, where it is in the body and whether it is at an early or advanced stage. Some of the drugs come in pill, capsule or liquid form, which can be taken by the patient at home with frequent visits to the doctor to monitor progress. Other drugs are injected under the skin, administered intravenously, or given via a catheter (a tube inserted into a vein that remains in place until the entire course of chemotherapy is complete), and need to be administered in a doctor's office or hospital.
Chemotherapy treatment may take months or even years. The schedule depends on the type of cancer, the drug that is used and the body's response. Often, the drugs are given once every few weeks so that patients have a chance to recover between treatments.
During chemotherapy, patients get frequent blood tests to evaluate whether the drugs are compromising the production of red and white blood cells. Since white blood cells are needed to fight infections, if levels fall due to the effects of chemotherapy, patients have to be very careful not to risk infectionsuch as avoiding people with colds or other illnesses and taking care not to cut themselves when using knives, scissors or other sharp tools. If the bone marrow is not producing enough red blood cells to prevent anemia, patients may experience severe fatigue. When red blood cell production falls too low, blood transfusions may be recommended. Drugs can now be given
Another potential problem is related to whether chemo is affecting the ability of the bone marrow to make platelets, the blood cells responsible for clotting. When platelets are low, bleeding and bruising can occur more easily than normal. It's important to report to your doctor any signs of bleeding, including a bloody nose, bleeding from the gums, pink or reddish urine or black or blood stools. Bruises or small red spots under the skin may also indicate a platelet problem. Drugs are available to enhance platelet production (neumega).
Despite these serious problems, many patients worry most about the hair loss and nausea that can accompany chemotherapy. Both of these side effects are due to the fact that anticancer drugs are designed to kill off fast-growing cancer cells, but dont spare other fast-growing cells, such as those in bone marrow, hair follicles and the digestive tract. Not all anti-cancer drugs cause hair loss (and lost hair does grow back after treatment). Nausea and vomiting can now be well controlled with three relatively new drugs, Zofran (ondanseton), Kytril (granisteron) and Anzemet (dolasetron) administered at the time of chemotherapy.
Another common side effect, the pain from sores that can develop in the mouth and throat, can be managed with medication. If sores develop, it is best to avoid spicy, acidic or salty food, and very dry foods such as raw vegetables and toast.
Although the side-effects of chemotherapy usually disappear once treatment ends, the drugs can have long-term effects; and some of them are permanent, for example, the ability of men to produce sperm. Chemo can lead to temporary or permanent infertility. Even if the drugs do not render a man infertile, they can damage the chromosomes in sperm and cause birth defects.
Chemo can also damage the female reproductive system, leading to menstrual irregularities and, sometimes, a temporary or permanent cessation of ovarian hormone production. When the ovaries can no longer function, a woman enters menopause, will not menstruate and cannot become pregnant.
Other possible long term effects of chemo include permanent damage to the heart, lungs or kidneys and an increased risk that a second cancer will develop years after treatment. It's important to keep these dangers in perspective and focus on the life-saving potential of chemotherapy rather than the chance that it will lead to other problems.
Last updated September 30, 2000
