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Definition

Chemotherapy is treatment of cancer with anticancer drugs.

Purpose

The main purpose of chemotherapy is to kill cancer cells. It is usually used to treat patients with cancer that has spread from the place in the body where it started (metastasized). Chemotherapy destroys cancer cells anywhere in the body. It even kills cells that have broken off from the main tumor and traveled through the blood or lymph systems to other parts of the body.

Chemotherapy can cure some types of cancer. In some cases, it is used to slow the growth of cancer cells or to keep the cancer from spreading to other parts of the body. When a cancer has been removed by surgery, chemotherapy may be used to keep the cancer from coming back (adjuvant therapy). Chemotherapy also can ease the symptoms of cancer, helping some patients to have a better quality of life.

Precautions

There are many different types of chemotherapy drugs. Oncologists, doctors who specialize in treating cancer, determine which drugs are best suited for each patient. This decision is based on the type of cancer, the patient's age and health, and other drugs the patient is taking. Some patients should not be treated with certain chemotherapy drugs. Age and other conditions may affect the drugs with which a person may be treated. Heart disease, kidney disease, and diabetes are conditions that may limit the choice of treatment drugs.

Description

More than 50 chemotherapy drugs are currently available to treat cancer and many more are being tested for their ability to destroy cancer cells. Most chemotherapy drugs interfere with the ability of cells to grow or multiply. Although these drugs affect all cells in the body, many useful treatments are most effective against rapidly growing cells. Cancer cells grow more quickly than most other body cells. Other cells that grow fast are cells of the bone marrow that produce blood cells, cells in the stomach and intestines, and cells of the hair follicles. Therefore, the most common side effects of chemotherapy are linked to their effects on other fast growing cells.

Types of chemotherapy drugs

Chemotherapy drugs are classified based on how they work. The main types of chemotherapy drugs are described below:

• Alkylating drugs kill cancer cells by directly attacking DNA, the genetic material of the genes. Cyclophosphamide is an alkylating drug.
• Antimetabolites interfere with the production of DNA and keep cells from growing and multiplying. An example of an antimetabolite is 5-fluorouracil (5-FU).
• Antitumor antibiotics are made from natural substances such as fungi in the soil. They interfere with important cell functions, including production of DNA and cell proteins. Doxorubicin and bleomycin belong to this group of chemotherapy drugs.
• Plant alkaloids prevent cells from dividing normally. Vinblastine and vincristine are plant alkaloids obtained from the periwinkle plant.
• Steroid hormones slow the growth of some cancers that depend on hormones. For example, tamoxifen is used to treat breast cancers that depend on the hormone estrogen for growth.

Combination chemotherapy

Chemotherapy is usually given in addition to other cancer treatments, such as surgery and radiation therapy. When given with other treatments, it is called adjuvant chemotherapy. An oncologist decides which chemotherapy drug or combination of drugs will work best for each patient. The use of two or more drugs together often works better than a single drug for treating cancer. This is called combination chemotherapy. Scientific studies of different drug combinations help doctors learn which combinations work best for each type of cancer.

How chemotherapy is given

Chemotherapy is administered in different ways, depending on the drugs to be given and the type of cancer. Doctors decide the dose of chemotherapy drugs considering many factors, among them being the patient's height and weight.

Chemotherapy may be given by one or more of the following methods:

• Orally
• By injection
• Through a catheter or port
• Topically.

Oral chemotherapy is given by mouth in the form a pill, capsule, or liquid. This is the easiest method and can usually be done at home.

Intravenous (IV) chemotherapy is injected into a vein. A small needle is inserted into a vein on the hand or lower arm. The needle is usually attached to a small tube called a catheter, which delivers the drug to the needle from an IV bag or bottle.

Intramuscular (IM) chemotherapy is injected into a muscle. Chemotherapy given by intramuscular injection is absorbed into the blood more slowly than IV chemotherapy. Because of this, the effects of IM chemotherapy may last longer than chemotherapy given intravenously. Chemotherapy may also be injected subcutaneously (SQ or SC), which means under the skin. Injection of chemotherapy directly into the cancer is called intralesional (IL) injection.

Chemotherapy may also be given by a catheter or port permanently inserted into a central vein or body cavity. A port is a small reservoir or container that is placed in a vein or under the skin in the area where the drug will be given. These methods eliminate the need for repeated injections and may allow patients to spend less time in the hospital while receiving chemotherapy. A common location for a permanent catheter is the external jugular vein in the neck. Intraperitoneal (IP) chemotherapy is administered into the abdominal cavity through a catheter or port. Chemotherapy given by catheter or port into the spinal fluid is called intrathecal (IT) administration. Catheters and ports may also be placed in the chest cavity, bladder, or pelvis, depending on the location of the cancer to be treated.

Topical chemotherapy is given as a cream or ointment applied directly to the cancer. This method is more common in treatment of certain types of skin cancer.

Treatment location and schedule

Patients may take chemotherapy at home, in the doctor's office, or as an inpatient or outpatient at the hospital. Most patients stay in the hospital when first beginning chemotherapy, so their doctor can check for any side effects and change the dose if needed.

How often and how long chemotherapy is given depends on the type of cancer, how patients respond to the drugs, patients' health and ability to tolerate the drugs, and on the types of drugs given. Chemotherapy administration may take only a few minutes or may last as long as several hours. Chemotherapy may be given daily, weekly, or monthly. A rest period may follow a course of treatment before the next course begins. In combination chemotherapy, more than one drug may be given at a time, or they may be given alternately, one following the other.

Preparation

A number of medical tests are done before chemotherapy is started. The oncologist will determine how much the cancer has spread from the results of x rays and other imaging tests and from samples of the tumor taken during surgery.

Blood tests give the doctor important information about the function of the blood cells and levels of chemicals in the blood. A complete blood count (CBC) is commonly done before and regularly during treatment. The CBC shows the numbers of white blood cells, red blood cells, and platelets in the blood. Because chemotherapy affects the bone marrow, where blood cells are made, levels of these cells often drop during chemotherapy. The white blood cells and platelets are most likely to be affected by chemotherapy. A drop in the white blood cell count means that the immune system cannot function properly. Low levels of platelets can cause a patient to bleed easily from a cut or other wound. A low red blood cell count can lead to anemia (deficiency of red blood cells) and fatigue.

When a chemotherapy treatment takes a long time, the patient may prepare for it by wearing comfortable clothes. Bringing a book to read or a tape to listen to may help pass the time and ease the stress of receiving chemotherapy. Some patients bring a friend or family member to provide company and support during treatment.

Sometimes, patients taking chemotherapy drugs known to cause nausea are given medications called anti-emetics before chemotherapy is administered. Anti-emetic drugs help to lessen feelings of nausea. Two anti-nausea medications that may be used are Kytril and Zofran.

Other ways to prepare for chemotherapy and help lessen nausea are:

• Regularly eat nutritious foods and drink lots of fluids
• Eat and drink normally until about two hours before chemotherapy
• Eat high carbohydrate, low-fat foods and avoid spicy foods.

Aftercare

Tips for helping to control side effects after chemotherapy include:

• Follow any instructions given by the doctor or nurse
• Take all prescribed medications
• Eat small amounts of bland foods
• Drink lots of fluids
• Get plenty of rest.

Some patients find it helps to breathe fresh air or get mild exercise, such as taking a walk.

Risks

Chemotherapy drugs are toxic to normal cells as well as cancer cells. A dose that will destroy cancer cells will probably cause damage to some normal cells. Doctors adjust doses to do the least amount of harm possible to normal cells. Some patients feel few or no side effects, and others may have more serious side effects. In some cases, a dose adjustment is all that is needed to reduce or stop a side effect.

Some chemotherapy drugs have more side effects than others. Some of the most common side effects are:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Anemia and fatigue
• Infection
• Easy bleeding or bruising
• Sores in the mouth and throat
• Neuropathy and other damage to the nervous system
• Kidney damage.

Nausea and vomiting are common, but can usually be controlled by taking antinausea drugs, drinking enough fluids, and avoiding spicy foods. Loss of appetite may be due to nausea or the stress of undergoing cancer treatment.

Some chemotherapy drugs cause hair loss, but it is almost always temporary.

Low blood cell counts caused by the effect of chemotherapy on the bone marrow can lead to anemia, infections, and easy bleeding and bruising. Patients with anemia have too few red blood cells to deliver oxygen and nutrients to the body's tissues. Anemic patients feel tired and weak. If red blood cell levels fall too low, a blood transfusion may be given.

Patients receiving chemotherapy are more likely to get infections. This happens because their infection-fighting white blood cells are reduced. It is important to take measures to avoid getting infections. When the white blood cell count drops too low, the doctor may prescribe medications called colony stimulating factors that help white blood cells grow. Neupogen and Leukine are two colony stimulants used as treatments to help fight infection.

Platelets are blood cells that make the blood clot. When patients do not have enough platelets, they may bleed or bruise easily, even from small injuries. Patients with low blood platelets should take precautions to avoid injuries. Medicines such as aspirin and other pain relievers can affect platelets and slow down the clotting process.

Chemotherapy can cause irritation and dryness in the mouth and throat. Painful sores may form that can bleed and become infected. Precautions to avoid this side effect include getting dental care before chemotherapy begins, brushing the teeth and gums regularly with a soft brush, and avoiding mouth washes that contain salt or alcohol.

Normal results

The main goal of chemotherapy is to cure cancer. Many cancers are cured by chemotherapy. It may be used in combination with surgery to keep a cancer from spreading to other parts of the body. Some widespread, fast-growing cancers are more difficult to treat. In these cases, chemotherapy may slow the growth of the cancer cells.

Doctors can tell if the chemotherapy is working by the results of medical tests. Physical examination, blood tests, and x rays are all used to check the effects of treatment on the cancer.

The possible outcomes of chemotherapy are:

• Complete remission or response. The cancer completely disappears. The course of chemotherapy is completed and the patient is tested regularly for a recurrence.
• Partial remission or response. The cancer shrinks in size but does not disappear. The same chemotherapy may be continued or a different combination of drugs may be tried.
• Stabilization. The cancer does not grow or shrink. Other therapy options may be explored. A tumor may stay stabilized for many years.
• Progression. The cancer continues to grow. Other therapy options may be explored.
• A secondary malignancy may develop from the one being treated, and that second cancer may need additional chemotherapy or other treatment.

Key Terms

Adjuvant therapy

Treatment given after surgery or radiation therapy to prevent the cancer from coming back.

Alkaloid

A type of chemical commonly found in plants and often having medicinal properties.

Alykylating drug

A drug that kills cells by directly damaging DNA.

Antiemetic

A medicine that helps control nausea; also called an anti-nausea drug.

Antimetabolite

A drug that interferes with a cell's growth or ability to multiply.

Platelets

Blood cells that function in blood clotting.

Further Reading

For Your Information

Books

• Dollinger, Malin, Ernest H. Rosenbaum, and Greg Cable. Everyone's Guide to Cancer Therapy, Rev. 3rd ed. Kansas City, MO: Andrews McMeel Publishing, 1997.
• Drum, David. Making the Chemotherapy Decision. Los Angeles, CA: Lowell House, 1996.
• McKay, Judith, and Nancee Hirano. The Chemotherapy Survival Guide. Oakland, CA: New Harbinger Publications, 1993.

  Organizations

• American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329. 1-800-ACS-2345.
• Cancer Information Service of the National Cancer Institute. 1-800-4-CANCER.

  Other

• National Cancer Institute. National Institutes of Health. "Chemotherapy and You: A Guide to Self-Help During Treatment." http://www.cancernet.nci.nih.gov/chemotherapy/chemoint.html.
• OncoLink. "What is Chemotherapy?" University of Pennsylvania Cancer Center, September, 1997. http://www.oncolink.upenn.edu/specialty/chemo/general/whatis_chemo.html.
• OncoLink. "Introduction to Chemotherapy." University of Pennsylvania Cancer Center, 1998. http://www.oncolink.upenn.edu/specialty/chemo/general/chemo_intro.htm.l.

Gale Encyclopedia of Medicine. Gale Research, 1999.