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Chemotherapy

Published by BUPA's health information team, healthinfo@bupa.com, December 2007.

This factsheet is for people who are having chemotherapy as a treatment for cancer, or who would like information about it.

Chemotherapy is a treatment used for cancer. There are many different chemotherapy drugs available, which can be used in different ways according to the type of cancer you have, how advanced it is and your general health.

About chemotherapy
How chemotherapy works
About the procedure
Side-effects of chemotherapy
Effects of chemotherapy on your everyday life
Further information
Sources
Related topics

About chemotherapy

Chemotherapy is a treatment that is used at various stages of cancer. It's used to treat solid tumours (cancerous lumps) affecting organs such as the breast or bowel, as well as blood cancers such as leukaemia.

You can have chemotherapy at one or more of the following stages.

Before surgery (this is known as neo-adjuvant therapy) to shrink a tumour so that it's easier to remove. This is normally used for large tumours or those that are strongly attached to surrounding tissue.
After surgery (this is known as adjuvant therapy) to make sure that any cancerous cells left in the body after removal of a tumour are killed. This makes it less likely that the cancer will come back.
In advanced cancer to shrink the tumour, or to slow the progress of the disease and prolong life.

You will have your own chemotherapy treatment planned by an oncologist, a doctor who specialises in treating cancer.

Some people have chemotherapy at the same time as radiotherapy (this is called chemoradiotherapy). In a few tumours this can be more effective than having either treatment separately.

When cancer has spread to other organs, it may not be possible to cure it completely. In this case, the aim of chemotherapy may be to slow the progress of the disease and to extend the period of good-quality life for as long as possible. This is called palliative chemotherapy.

High-dose chemotherapy is used to treat some types of cancer, particularly leukaemia. This treatment also destroys many of the cells from the body's immune system (which protects the body from infection) and it has to be followed by a bone marrow transplant to replace the tissue damaged by the high-dose drugs.

The type of chemotherapy drugs used depends on a number of things, including:

the type of cancer
where the cancer started
whether the cancer has spread to other parts of your body
your general health

You will be monitored regularly throughout your course of chemotherapy by physical examination, X-rays or scans, as well as blood and urine tests.

How chemotherapy works

All chemotherapy drugs work by attacking cells that are dividing rapidly. Normal cells divide at a rate that is tightly controlled. However, in cancer cells, this process goes wrong, leading to uncontrolled production of new cells and the formation of a tumour or blood cancer.

Most chemotherapy drugs affect the DNA in cancer cells. DNA is the chemical that stores the genetic information in a cell. It controls what a cell does, including how it divides. By affecting the DNA, most chemotherapy drugs interfere with the division of cancer cells and may cause the cancer to die back completely. Your doctor will give you more information about your chemotherapy drugs.

Several newer treatment options are more experimental and may only be available in clinical trials. They include:

angiogenesis inhibitors, which prevent the growth of blood vessels inside a tumour, starving it of blood
immune therapies, which help the body's immune system to attack cancer cells; they include monoclonal antibodies, which target cancer cells and stimulate the body to destroy them

About the procedure

Most chemotherapy drugs are fed directly into the bloodstream. This is called intravenous chemotherapy. There are several ways in which chemotherapy drugs can be introduced into your blood.

A drip in a vein in your arm or the back of your hand.
A central line - a thin tube that leads from the skin of your chest to a main vein near your heart. A central line can be left in place for a few months, so that medicines can be injected through it when you need them.
A peripherally inserted central catheter (PICC) line - a thin tube placed into a vein in the crook of your arm and threaded through the vein until it's in a vein near your heart. A PICC line can stay in place for a few months.
A portable catheter ("portacath") - a thin tube that is put into a vein in your arm or chest.
An infusion pump - a portable pump that attaches to a PICC line or a central line. This feeds the correct dose of chemotherapy drugs into your bloodstream over a few days.

Other ways to have chemotherapy drugs include:

tablets or capsules - this is becoming a more common way of having chemotherapy (this is known as oral chemotherapy)
injections into the area around your spinal cord (intrathecal injections)
injections into a body cavity such as your bladder (intracavity chemotherapy)
creams for skin cancers

You can have chemotherapy in the form of tablets or creams at home, whereas you will usually need to have injections or infusions in hospital. It's sometimes possible to be given chemotherapy at home. These sessions may take between 30 minutes and a few hours at a time.

Combinations of two or more drugs are often used for chemotherapy.

Duration of chemotherapy treatment

The length of chemotherapy treatment depends on your type of cancer, how much it has spread through your body, the types of drugs used, the severity of side-effects and how successful the treatment is.

Chemotherapy is usually given in cycles. Cycles are sessions of treatment with rest periods in between to allow your body to recover from any side-effects. A course of chemotherapy is made up of several cycles. Several cycles of treatment are needed because chemotherapy only attacks cells that are actively dividing. At any one time, some cancer cells will be resting, and they may not be killed until a later round of treatment.

If you have high-dose chemotherapy followed by a bone-marrow transplant, you will need to stay in hospital for several weeks.

Side-effects of chemotherapy

Chemotherapy doesn't only target cancer cells, but any cells that divide rapidly. This includes those in the bone marrow and skin, hair-producing cells, and the cells that line the mouth and digestive system. Damage to these healthy cells during chemotherapy may produce various side-effects, including:

tiredness
feeling sick and vomiting
diarrhoea or constipation
loss of appetite
loss of hair
getting infections more easily
sore mouth, mouth ulcers and changes to your sense of taste
numbness or "pins and needles" in your hands and feet
changes in hearing - some people get tinnitus (a ringing sound in the ears)
skin changes - skin may become dry and discoloured

Most chemotherapy side-effects are temporary and will eventually pass once the treatment is completed. It's important to weigh up the benefits of chemotherapy against the risks of side-effects.

Many of the side-effects can be controlled using other medicines. For example, sickness can be reduced using anti-emetic (anti-sickness) medicines.

Tiredness is the most common side-effect of chemotherapy treatment, and it can last a long time. This may be frustrating because you will feel tired even if you are resting. Most people get back to their normal energy levels within about six months, but it can take longer.

Fertility and chemotherapy

There is a risk of becoming infertile (not being able to become pregnant or father children) after chemotherapy and in some women it can bring on an early menopause. It's important that you discuss these risks with your doctor before you start the treatment.

Different chemotherapy drugs cause different side-effects, so it's important to discuss your specific treatment with your doctor.

Effects of chemotherapy on your everyday life

Some people manage to continue with their lives as normal during chemotherapy. A small number of people even feel better as the symptoms of their cancer improve. But for many people chemotherapy can have a big impact on everyday life. In particular, tiredness often prevents people from carrying on working full time or doing normal levels of physical activity.

The chemotherapy side-effects of sickness and diarrhoea can make the contraceptive pill less effective. Women having chemotherapy shouldn't try to become pregnant during treatment because the chemotherapy drugs can damage a developing baby.

It's important to weigh up the risks of side-effects with the benefits of having the treatment, and to ask your doctor for advice.

Further information

Cancerbackup
0808 800 1234
www.cancerbackup.org.uk
CancerHelp UK
www.cancerhelp.org.uk

Sources

What chemotherapy is. Cancerbackup. www.cancerbackup.org.uk, accessed 13 November 2007
Chemotherapy. Cancer Research UK. www.cancerhelp.org.uk, accessed 13 November 2007
Palliative chemotherapy for advanced or metastatic colorectal cancer. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No: CD001545. www.cochrane.org, accessed 13 November 2007