What is Chemotherapy?
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells (including leukaemia and lymphoma). There are over 50 different chemotherapy drugs. Some are given on their own but often several drugs are given together. This is known as combination chemotherapy.
The type of chemotherapy treatment you are given depends on many things, but particularly:
the type of cancer you have
where the cancer started in your body
what the cancer cells look like under the microscope
whether the cancer has spread to other parts of your body.
Chemotherapy may be used alone to treat some types of cancer. It may also be used with other types of treatment such as surgery, hormonal therapy, biological therapies or a combination of these.
How chemotherapy drugs work
Chemotherapy drugs can stop cancer cells dividing and reproducing themselves. As the drugs are carried in the blood, they can reach cancer cells anywhere in the body. They are also taken up by some healthy cells. Healthy cells can repair the damage caused by chemotherapy, but cancer cells cannot and so they eventually die. Different chemotherapy drugs damage cancer cells in different ways. If a combination of drugs is used, each drug is chosen because of its different effects. Unfortunately, as the chemotherapy drugs can also affect some of the healthy cells in your body, they can cause unpleasant side effects. However, damage to the healthy cells is usually temporary and most side effects will disappear once the treatment is over.
Healthy cells in certain parts of the body are especially sensitive to chemotherapy drugs; these parts of the body include:
the bone marrow (which makes blood cells)
the hair follicles
the lining of the mouth
the digestive system.
Chemotherapy is usually given as a series of sessions of treatment. Each session is followed by a rest period. The session of chemotherapy and the rest period is known as a cycle of treatment. A series of cycles makes up a course of treatment. Each session of chemotherapy destroys more of the cancer cells, and the rest period allows the normal cells and tissues to recover.
Why chemotherapy is given
With some types of cancer, chemotherapy is likely to destroy all the cancer cells and cure the disease. Chemotherapy may also be given after surgery or radiotherapy to destroy any cancer cells that remain. Chemotherapy may be given to shrink a cancer before another treatment such as surgery. It can also be given to shrink and control a cancer to help reduce symptoms and prolong life. This is known as palliative chemotherapy.
When chemotherapy is used
Before an operation
Chemotherapy can be used before an operation (this is known as neo-adjuvant or primary chemotherapy) to shrink a cancer that is too large – or too attached to surrounding healthy tissue – to be removed easily during an operation. This can make removing the cancer easier during a later operation.
After an operation
Chemotherapy can be given after an operation (this is known as adjuvant chemotherapy) when all the visible cancer has been removed but there is a risk that some cancer cells, which are too small to be seen, may have been left behind. The aim is to destroy these cancer cells. Chemotherapy may also be given if a cancer cannot be completely removed during an operation. In this situation chemotherapy may not be able to cure the cancer but may shrink it and so reduce symptoms.
During radiotherapy
Sometimes chemotherapy is given at the same time as radiotherapy. This is known as chemoradiotherapy or chemo-radiation.
In advanced cancer
Where cancer has spread into surrounding tissue or other parts of the body (advanced cancer), chemotherapy can sometimes be given with the aim of getting rid of all the cancer and curing it. More commonly however, chemotherapy is given to people in this situation to shrink and control the cancer, to try to extend life and control any symptoms that may occur.
Chemotherapy with bone marrow transplant or stem cell support
For some types of cancer, high-dose chemotherapy is given. This is usually done after initial chemotherapy has got rid of the cancer cells but there is a high risk of the cancer coming back. High doses of chemotherapy would normally destroy the bone marrow – which makes the blood cells – so the bone marrow has to be replaced after the chemotherapy has been given. This is done using stem cells which have been collected from the bone marrow or blood. The stem cells are collected before the high-dose treatment, either from the patient, or from someone else (a donor) whose cells are a good match. They settle in the bone marrow and develop into the different blood cells. This type of treatment is only used in a few types of cancer.
Side effects of chemotherapy
There are advertisements for certain diets claiming they can cure cancer. There is no evidence that this is true and it is far more sensible, and safer, to eat a well balanced diet. The hospital dietitian will be able to provide you with lots of information regarding diet and nutrition. There may be some foods that you need to avoid due to interactions with chemotherapy drugs. Please ask your treatment team if there are any restrictionsthat you need to bear in mind. Listed below are some of the more common side effects along with things that you, your family and your treatment team can do to help you cope with them. The exact side effects that you experience will depend on what kind of drugs you are receiving along with many other individual factors.
Extravasation
If you receive your chemotherapy intravenously you must let the nursing team know if you experience any pain, discomfort or notice any swelling while the drugs are being infused. It is possible that the chemotherapy may have leaked out from the cannula into the surrounding skin, this is called extravasation. This can occur if the cannula has moved out of the vein, so the drug is not flowing into the blood stream, but is collecting in the tissue around the cannula. The infusion should be stopped immediately as some chemotherapy drugs can cause serious damage to the skin, which if left untreated can result in scarring or the need for a skin graft. All centres that give chemotherapy will have guidelines for the treatment of extravasation. The nurses will be appropriately trained in how to deal with such an occurrence to prevent serious damage to the skin.
Problems associated with eating and appetite
Maintaining a healthy diet is a good way that cancer patients and their families can do something positive. Even if you cannot eat you should try and maintain an adequate intake of fluids. This is important to keep organs such as your kidneys functioning as normal. Your treatment team will be able to advise you about diet and fluid intake. If any aspect of your diet, such as weight loss, particularly worries you speaking to the hospital dietitian may be helpful.
Nausea and vomiting
Feeling sick is probably the most common side effect experienced but there are many things that can be done to minimise this. There are very effective anti-sickness (anti-emetic) injections and tablets that can be given during your course of treatment. You may also be given some tablets to take at home. It is important to tell your doctors/nurses if you start feeling sick or that the anti-sickness medication you are taking is not working or has stopped being effective. The earlier you let them know, the better; they can review your chemotherapy and possibly alter the timings of your anti-sickness medication.
How you can help:
Take your anti-sickness medication as prescribed. Ask someone else to prepare your meals for you if you are feeling sick. Eat small amounts regularly; snacking can often prevent nausea developing Try dry food such as toast or crackers. Eating ginger (i.e. ginger biscuits) sometimes helps to reduce nausea. Avoid cooking smells whenever possible. Avoid fatty/fried foods. Some people find acupressure bands helpful. Try and maintain a positive approach. You could use distraction therapy; take a relative or friend to your chemotherapy appointments, listen to. music or relaxation tapes/CDs. If you are worried about your diet or weight ask to speak to the hospital dietitian for further advice.
Anorexia – loss of appetite
This is the reduction of appetite for food and can happen for a number of reasons. How you can help:
Try and have your meals early in the day as they are usually easier to tolerate, Have small frequent meals every two hours if possible, Try and tempt your taste buds by making your food look as attractive as possible. Keep a supply of foods to snack on when you are out and about such as crisps, nuts, fruit or chocolate. Try using nutritional drinks, soups and yoghurts (yoghurt may not be suitable if you are neutropenic – please ask your treatment team) to supplement the occasional meal. You could make your own supplements such as fruit smoothies or milk shakes. Take your time over your meals, keep relaxed and eat in a room without distractions. Take time to digest your food. Your appetite will fluctuate from day to day, so on your good days make the most of them and remember that after your treatment has finished you will begin to have more and more good days and eventually your appetite should return. Alcohol can often help stimulate the appetite before a meal. Your treatment team will advise you about drinking alcohol whilst receiving chemotherapy. Chemotherapy can also affect your sense of taste. This will return to. Normal after treatment. Experiment and find foods that taste good to you now.
Some dietitians recommend avoiding your favourite foods during. treatment as the taste changes can put you off them permanently.. Altered bowel habit. Chemotherapy can affect the bowels at various times during or after. your treatment. You may find that you become constipated or experience diarrhoea.These side effects can be distressing but there are things you can do to help pase them. It is very important that you let your treatment team know if your bowel habits change. Constipation is difficulty in emptying the bowels. Your team should be able
to inform you if the chemotherapy you are receiving is known to cause constipation. You should always discuss symptoms with your doctor, who will advise you if a laxative is necessary.
How you can help:
Drink plenty of fluids, Ensure your diet is high in fibre. This can be found in some breakfast cereals, brown bread/rice, fresh fruit and vegetables. Gentle exercise can often help if you feel able. If you begin to experience diarrhoea (loose bowel motions) you must let your treatment team know because although diarrhoea is usually a side effect of the chemotherapy they need to rule out infection as the cause.
Once this has been established they may be able to prescribe some medication to ease the frequency of the diarrhoea. Drinking plenty of water is particularly important if you are having diarrhoea. If your diarrhoea is severe you may need to have some fluid replaced intravenously whilst you are attending the hospital. Your doctor may also recommend that you take a medicine to replace the electrolytes (salts) that you lose when you have diarrhoea.
How you can help:
Avoid foods with lots of fibre, for example salad, bran, brown breads/rice and eating too many vegetables. Contact the hospital for advice if the diarrhoea lasts more than two days Mucositis. Some chemotherapy drugs can damage the cells that line the digestive tract all the way from the mouth to the anus. This leads to inflammation and soreness that can be very painful. This is called mucositis. When this occurs in the mouth it is called stomatitis.
How you can help:
Drink lots of fluid. Try diluting fruit juices; however the more acidic ones (citrus fruits) may sting the mouth. Use a very soft toothbrush, such as one designed for children, this will make cleaning your teeth much easier. Ensure you use your mouthwashes as prescribed from the hospital and avoid alcohol-containing mouthwashes. You will probably be given antibacterial and antifungal mouthwashes. If your mouth is painful you may be prescribed one with a local anaesthetic in it; ask your specialist team for advice. Avoid very hot drinks; often the cooler the drink the more soothing you will find it. Avoid heavily spiced foods. Alcohol and smoking will irritate your mouth so try and limit these . Activities wherever possible. If your mouth has become very sore you may need to consider a soft diet such as ice cream, rice puddings, mashed potatoes etc. If you wear dentures leave them out as much as possible (unless your team advises you otherwise) as this will prevent them chafing your gums, Hair loss (alopecia)
Some chemotherapy drugs cause complete hair loss. Other drugs may only cause your hair to thin while some rarely or never cause hair loss.. Your treatment team can advise you about the chance of your particular. Chemotherapy causing hair loss. This can be a distressing side effect for many patients, male and female alike, so it is important for everyone to find their own way to cope. Some people find it easier if they have their hair cut short prior to starting treatment so that it is not so much of a shock when it starts to fall out.
You will not wake up one morning and find yourself completely bald, your hair will take time to come out and often thins first, or you may find that small clumps come away whilst washing or brushing your hair. Most hospitals can assist you in obtaining a wig if you need one. Please remember hair almost always grows back once treatment has finished.
Infection
The chemotherapy you receive will affect healthy cells as well as cancer cells, including those involved in the production of normal white blood cells. Neutrophils are a type of white blood cell that helps to protect the body against bacterial and fungal infection. When you have a low neutrophil count (called neutropenia) your ability to fight infection is reduced. This can lead to a serious infection developing rapidly. If you develop symptoms whilst your blood counts are low during or after chemotherapy you must report this to the hospital immediately.
These symptoms may include:
A temperature of 38°C or above. Chills or sweating. Cold or flu-like symptoms (runny nose, stuffy nose or watery eyes). Feeling generally unwell. A rash. Pain, redness or swelling around your central line site or other skin sores. Diarrhoea or vomiting. Burning sensation during urination. Toothache, sores or ulcers in the mouth, a dry/cracked tongue. Unusual vaginal discharge or itching. Shortness of breath or rapid breathing. Cough or sore throat. Do not think that these symptoms will just pass – infection when your. Neutrophil count is very low can be life-threatening so you must seek advice.
If an infection does develop you may require treatment in hospital for several days; you will be closely monitored and given strong antibiotics to combat the infection.
How you can help to prevent an infection:
Hygiene. Wash your hands often and with extra care before eating or preparing food and after using the toilet. Clean your bottom gently but thoroughly after each bowel movement; women should always wipe from front to back. Take a bath/shower every day. Dry your skin gently and carefully. Use a simple moisturiser or lotion to prevent dryness and cracking of the skin. Attend to your mouth care as advised by the hospital. Use a soft. Toothbrush that will not hurt your gums. Do not allow anyone to share your toothbrush and replace it every two months Wash any cuts immediately with soap and water. Clean with antiseptic and cover with a dressing. Remove the dressing and look at the cut daily. Contact your hospital if it appears to be getting worse. Always wear shoes or slippers to prevent cuts and bruises to the feet
Use paper tissues only once and place directly in a bin – do not leave them lying around. Handkerchiefs are not recommended. Use an electric shaver, not a razor, to minimise damage to the skin and avoid shaving underarm and leg hair. This can damage the skin and cause in-growing hairs.
Diet
Make sure that all foods are handled properly, washed and thoroughly cooked. Follow your hospital guidelines concerning any high-risk foods . Drink plenty of fluids every day to prevent urinary tract infections.
Lifestyle
Ask your treatment team if there are any sexual practices you should avoid while you have a low white cell count and always use a barrier method of contraception. Do not have vaccinations without first consulting your doctor. Seek advice about contact with children who have received live. Vaccinations such as the MMR vaccine. Seek advice if you have been in contact with anyone who has chicken pox/shingles or measles or have been in contact with someone else who has been exposed.
Household tasks
Arrange for someone else to groom your pets, empty cat litter trays and clean pet cages. If this is not possible always wear protective gloves to perform these tasks and ensure you wash your hands when finished. Do not change a baby’s nappy; if absolutely necessary wear protective gloves and wash your hands well afterwards. Always contact the hospital if you are at all concerned, don’t be afraid. that you are bothering them unnecessarily – it is better to be safe and the sooner treatment is started for an infection the better the outcome
Information courtesy of Cancer Research UK (CRUK)
