Chemotherapy, or 'chemo', is the most common form of cancer treatment. Chemo uses drugs called cytotoxics to kill or slow the growth of cancer cells.
- The thing is, while chemotherapy drugs can stop cancer cells growing and multiplying, they also affect normal, healthy cells in the process.
- That’s why fast growing cells such as the ones in your hair and inside your mouth are damaged by chemotherapy.
- The most effective way of killing cancer through chemotherapy is by using a number of different drugs rather than relying on one.
Each period of chemotherapy treatment is called a cycle. After each cycle there is usually a rest period, so that normal cells repair themselves and the body begins to regain its strength.
How is it given?
Chemo drugs can be given in a variety of ways, depending on the type of cancer you have and the chemotherapy drugs used.
Most often chemotherapy is given by injection into a vein. This is known as intravenous chemotherapy.
- Some drugs are given as tablets or capsules (oral chemotherapy).
- Some are injected into a muscle (intramuscular injection).
- Others may be injected just under the skin (subcutaneous injection).
Chemotherapy treatments can be given daily, weekly or monthly for several months to a year. It depends on the type of chemotherapy you get, and how long it takes for new healthy cells to grow between treatments.
This section is an overview of chemotherapy and how it is given, but as there are over 200 different types of cancer and over 50 chemotherapy drugs which can be given in various ways, you may have further questions. It’s best to discuss the details of your own treatment with your doctor, who will be familiar with your particular situation and type of cancer.
There are four ways of giving chemotherapy drugs directly into the vein. These are through a:
- Canula – a small tube inserted into a vein in your arm or the back of your hand.
- Central line – a thin, flexible tube inserted through the skin of the chest into a vein near the heart.
- PICC line (a peripherally inserted central catheter) – a thin, flexible tube passed into a vein in the bend or upper part of the arm and threaded through until the end of the tube lies in a vein near the heart.
- Implantable port (also called a portacath) – a thin, soft plastic tube that is put into a vein. It has an opening (port) just under the skin on your chest or arm.
- You may be given chemotherapy tablets or capsules to take at home. You’ll be told when to take them and will be given other instructions such as whether or not to take them with food. If you can’t take your medicines for any reason you should contact your doctor immediately for advice.
- It is important to take the drugs given to you by the hospital exactly as they have been prescribed. Always read the labels on the boxes before you leave the hospital – if the instructions are unclear, ask your nurse, doctor or pharmacist.
You may be given quite a few different medications, which can get confusing. Writing down instructions or even making a chart, if you’re especially organised, can really help.
Intraventricular/Intrathecal chemo treatments
Intraventricular or intrathecal chemotherapy is used when drugs need to reach the cerebrospinal fluid in the brain and spinal cord (CSF). There are two ways chemotherapy can be given to the CSF:
- Lumbar puncture (Intrathecal) - Chemotherapy can be given through a lumbar puncture (also called a spinal tap). In this case a small amount of chemotherapy is injected during the lumbar puncture, directly into the CSF.
- Ommaya reservoir (Intraventricular) - The ommaya reservoir is a small, dome-shaped device with an attached catheter. It is placed into the subcutaneous tissue (the layer of tissue between the skin and the muscle) on the scalp. The catheter is threaded into the lateral (outer) ventricle of the brain.
A nurse or doctor, who is specially trained in this method of giving chemotherapy, will insert a small needle through the skin on the scalp into the ommaya reservoir to inject the chemotherapy.
This procedure is used most commonly in acute leukemias but can be used in other situations as well.
The word 'Chemotherapy' encompasses a wide range of therapy treatments, and terms such as 'adjuvant,' 'neoadjuvant,' 'consolidation,' and 'palliative' can add to the confusion surrounding chemotherapy if not properly explained… So here goes:
- First line chemotherapy - Chemotherapy that has been determined to have the best probability of treating a given cancer. This may also be called 'standard therapy.'
- Second line chemotherapy - Chemo that is given if the cancer has not responded or has reoccurred after first line chemotherapy. In some cases, this may also be referred to as 'salvage therapy.'
- Adjuvant chemotherapy - Chemotherapy given to destroy left-over (microscopic) cells that may be present after the known tumour is removed by surgery. Adjuvant chemo is given to prevent a possible cancer re-occurrence.
- Neoadjuvant chemotherapy - Chemo given prior to the surgical procedure. Neoadjuvant chemo may be given to attempt to shrink the cancer so that the surgical procedure may not need to be as extensive.
- Induction chemotherapy - Chemotherapy given to induce a remission. This term is commonly used in the treatment of acute leukaemias.
- Consolidation chemotherapy - Chemo given once a remission is achieved. The goal of this therapy is to sustain a remission. Consolidation chemo may also be called 'intensification therapy.' This term is commonly used in the treatment of acute leukaemias.
- Maintenance chemotherapy - Chemo given in lower doses to assist in prolonging a remission. Maintenance chemo is used only for certain types of cancer, most commonly acute lymphocytic leukaemias and acute promyelocytic leukaemias.
- Palliative chemotherapy – Palliative chemo is given specifically to address symptoms, without expecting to significantly reduce the cancer.