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Chemotherapy

Published by Bupa's health information team, July 2009.

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

Chemotherapy is a treatment to destroy cancer cells using medicine. There are more than 50 chemotherapy medicines available that can be used in a variety of ways according to the type of cancer, how advanced it is and a person's general health.

• About chemotherapy
• About the treatment
• Recovering from chemotherapy
• What are the risks?
• Questions and answers
• Related topics
• Further information
• Sources

About chemotherapy

Chemotherapy 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.

It can be used on its own or alongside other treatments such as radiotherapy, surgery and hormonal, biological and immune therapies.

Chemotherapy can be given at one or more stages. These are described here.

• You may have chemotherapy before surgery (neo-adjuvant therapy) to shrink a tumour so that it's easier to remove. It's usually used for tumours that are too large or too attached to surrounding tissue.
• You may be given chemotherapy after surgery (adjuvant therapy) to make sure that any cancerous cells left in your body are killed. This makes it less likely that the cancer will come back.
• If you have advanced cancer, chemotherapy may be used to shrink the tumour, or, if it has spread to other organs, to slow the progress of the disease and prolong your life. This is known as palliative chemotherapy.

Individual chemotherapy treatment is planned by an oncologist, a doctor who specialises in cancer care.

You may have chemotherapy at the same time as radiotherapy (this is called chemoradiotherapy). For a few tumours this can be more effective than either treatment on its own.

In some types of cancer, particularly leukaemia, high-dose chemotherapy is used. This treatment also destroys many of your body's own immune cells and has to be followed by a bone marrow transplant. This replaces the tissue damaged by the high-dose medicines.

The type of chemotherapy you have will depend on a number of factors, including:

• the type of cancer
• where the cancer started
• what the cancer cells look like under a microscope
• whether the cancer has spread to other parts of your body
• your general health

You will be monitored regularly throughout your treatment by physical examination, X-rays or scans and blood and urine tests.

All chemotherapy medicines work by attacking cells that are dividing rapidly. Normally cells divide in a controlled way and this is how your body grows and repairs itself. Cancer cells don't stop dividing but instead carry on to form a tumour or blood cancer.

Most chemotherapy medicines 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 medicines interfere with the division of cancer cells and may cause the cancer to die completely. Chemotherapy also kills healthy cells, which can lead to side-effects.

Your doctor will discuss your chemotherapy medicines in detail with you.

About the treatment

You're likely to have chemotherapy in sessions of treatment with rests in between to give your healthy cells a chance to recover from side-effects. It also ensures that all cancer cells are killed.

At any one time, some cancer cells will be resting and may not be killed until a later round of chemotherapy. A course of chemotherapy is made up of several of these cycles.

You may be given two or more chemotherapy medicines as they may kill more cancer cells than a single medicine. This is called combination therapy.

Most chemotherapy medicines are fed directly into your bloodstream. This is known as intravenous chemotherapy and can be given through:

• a small tube in a vein in your arm or the back of your hand
• a thin tube inserted through the skin of your chest into a main vein near the heart (a central line) - this can be left in for many months so medicines can be injected through it
• a thin tube placed into a vein in the crook of your arm and threaded through until it's in a vein near your heart (a PICC - peripherally inserted central catheter line) - this can also stay in place for many months. You can't feel the tube inside the vein.
• a thin tube put into a vein ending in an opening (port) just under the skin on your arm or chest (called an implantable port or 'portacath') - medicines are passed via needles through the port
• an infusion pump - this is a portable pump that attaches to a PICC line or a central line and feeds in the correct dose of chemotherapy over a period of time

Other ways of giving chemotherapy medicines include:

• tablets or capsules
• injections into the area around the spinal cord (intrathecal injection)
• injections into a muscle - either in the buttocks or leg (intramuscular injection)
• injection under your skin (subcutaneous injection)
• injections into an affected body cavity such as the bladder (intracavity chemotherapy)
• creams for skin cancers

You can take chemotherapy tablets or apply creams at home, whereas injections or infusions are usually given in hospital. Sessions may take between 30 minutes and a few hours at a time.

Your doctor may change the original ('first line') type of chemotherapy if it's not controlling the cancer or if you have serious side-effects. The new medicine or combination is called the 'second-line' treatment.

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

Duration of chemotherapy treatment

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

For example, intravenous chemotherapy is usually given as several sessions of treatment that can last from a few hours to several days. You will then have a rest period of a few weeks to allow your body to recover from any side-effects and for the number of cells in your blood to go back to normal. Treatment and rest periods make up a cycle. The number of cycles you have depends on how well your cancer is responding to the chemotherapy. For example, treatment will often consist of four or six cycles of treatment given at three-week intervals.

Your doctor will explain your treatment to you. Don't be afraid to ask any questions if you don't understand.

Recovering from chemotherapy

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

The side-effects of chemotherapy (such as sickness and diarrhoea) can make the contraceptive pill less effective. Women should not try to become pregnant during treatment because the chemotherapy medicines can damage a developing baby.

What are the risks?

Side-effects

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

• tiredness
• feeling sick and vomiting
• diarrhoea or constipation
• loss of appetite
• thinning of hair or hair loss
• getting infections more easily
• sore mouth, mouth ulcers and changes in 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 your ears)
• breathlessness
• skin changes - your skin may become dry and discoloured

Most side-effects are temporary and will eventually pass once treatment is over. It's important to weigh up the benefits of chemotherapy against the risks of side-effects. Many side-effects can be controlled using other medicines. For example, sickness can be reduced using anti-sickness medicines. Side-effects can vary greatly between the different types of chemotherapy and between people. One person can be quite ill with chemotherapy, while another may be able to continue working.

Tiredness is the most common side-effect of chemotherapy and can last a long time. Most people find their energy levels return within six months after finishing chemotherapy but it can take longer.

There is a risk of becoming infertile after chemotherapy. For some women it brings on early menopause. It's important that you discuss these risks with your doctor before you start the treatment. You may be offered the opportunity to store eggs, embryos, ovarian tissue or sperm for future fertility treatment.

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

Related topics

• Bone marrow and stem cell transplantation
• Cancer - a general overview
• Leukaemia - a general overview
• Radiotherapy

Further information

• Macmillan Cancer Support
  0808 800 1234
  www.cancerbackup.org.uk
• Cancer Research UK
  0808 800 4040
  www.cancerresearchuk.org

Sources

• What chemotherapy is. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 26 February 2009
• Chemotherapy. Cancer Research UK. www.cancerhelp.org.uk, accessed 26 February 2009
• How chemotherapy is given. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 26 February 2009
• Side effects Cancer Research UK. www.cancerhelp.org.uk, accessed 26 February 2009
• Fertility. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 26 February 2009
• The effects of cancer treatment on reproductive function. Guidance on management. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, accessed 27 March 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009