What is chemotherapy?

Chemotherapy is the treatment of cancer using anti-cancer drugs. The aim is to kill cancer cells while doing the least possible damage to normal cells.

How does it work?

Chemotherapy stops cancer cells from dividing and multiplying. It travels through the bloodstream and kills cancer cells in different parts of the body. It can also affect normal cells. Chemotherapy is more likely to affect the cells in the body that grow quickly, which is why some people lose their hair, have a sore mouth, or have a fall in the number of blood cells. Fortunately, most cells in the body are not growing rapidly and so chemotherapy doesn’t affect them. Even when normal cells are damaged, they grow again. Damaged cancer cells are less likely to grow back.

Targeted treatment

Recently, new drugs have become available that are more specifically directed at cancer cells and the structures essential for their growth and survival than existing chemotherapy drugs. They are now being used in the treatment of a few kinds of cancers, and some promising new compounds are being developed. Through better targeting, these newer drugs should be more effective against cancers resistant to conventional chemotherapy and cause fewer unpleasant and dangerous side effects on health and normal cells.

A test known as microarray analysis can be used to look at the genetic make-up of cancers. It may soon be possible to predict accurately how a cancer will behave and how it will respond to different treatments.

How will I be given chemotherapy?

Sometimes one type of chemotherapy drug is given by itself, either as tablets or capsules, or in a ‘drip’ (IV infusion).

Cannula

A cannula is a small tube. This is put into a vein in your arm or back of your hand. It is put in by the oncology nurse on the day of treatment. The cannula is removed after each treatment cycle.

Source: Macmillan Cancer Support and Cancer Help UK

More often, two or more drugs are given together. You’ll probably be given your drugs by injection or drip into a vein, or via a portable infusion pump.

Photographer: Louise Goossens.

Above: A woman with a cannula in her hand.

Oral chemotherapy

Some chemotherapy drugs are given as tablets. It is very important that you take your tablets when and how your cancer doctor says. If you are not sure about what to do, ask your cancer doctor or nurse to write down instructions for you. Make sure you understand the side effects and who to contact if you have problems. Even though you’re having this treatment at home, remember it is no different from intravenous chemotherapy in the way it works and its possible side effects.


Photographer: Louise Goossens.

Above: A woman talking about her oral chemotherapy with a nurse in the Chemotherapy Suite.

Types of central lines

For repeated or long infusions of chemotherapy or when there is difficulty finding a suitable vein you may require a central venous line. Central lines are put in under a general or local anaesthetic and may be left in for many months. When in place the line is stitched in or a special dressing may be put over it so that it can’t come out. It allows chemotherapy to be delivered directly into your blood stream.

Central venous line

A central venous line is a long, thin, flexible tube that is inserted through the skin of the chest into a vein near the heart.

Hickman and Groschong lines are both commonly used types of central venous line.

Photographer: Louise Goossens.

Above: A man with a central venous line in his chest.

PICC line

A PICC (Peripherally Inserted Central venous Catheter) is inserted into a vein through the skin 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.

Photographer: Louise Goossens.

Above: A man with a PICC line in his arm.

Portacath (an implantable port)

The tip of the line sits just above the heart and the port lies under the skin on your upper chest. Once in place, you can feel and see the port as a small bump underneath the skin. Nothing shows on the outside of your body. To use the portacath, a needle is passed through your skin into a port. The skin over the port can be numbed with an anaesthetic cream first.

Photographer: Louise Goossens.

Above: A man with a portacath line receiving chemotheraphy.

Possible problems with central lines

The two main possible problems with central lines are blockage and infection. If you notice any changes like the ones below it is important to contact the hospital for advice:

  • high temperature (T 38° refer to the section “Infection and fever”)
  • soreness, redness, or darkening around the central line
  • fluid leaking from the skin around the central line
  • swelling of your arm, chest, neck, and shoulder
  • pain in your chest, arm, or neck
  • feeling ‘shivery’ or unwell after your line has been flushed.

Sources: Macmillan Cancer Support and CancerHelp UK

Chemotherapy drugs don’t get into the brain, spinal cord, or the fluid around the brain and spinal cord very easily, so for a few cancers the chemotherapy drugs are injected into the base of the spine through a process called lumbar puncture.

How will my doctors decide on the type of chemotherapy?

The type of treatment your cancer doctor chooses for you depends on what type of cancer you have, how far it has spread, and your general health. Chemotherapy has been used for many years, and new and better treatments are being discovered all the time. Everyone is different; treatments are designed for the individual.

Your cancer doctor and nurses will keep a close eye on you during your treatment. You may have blood tests, X-rays, and scans to see how you are doing. If necessary, your doctors will change your drugs or how they give them to you. Sometimes they will stop the treatment early or continue it for longer than planned. It all depends on how your body and the cancer respond to the treatment.

How long will my treatment last?

Your treatment could last several weeks or several months. You’ll probably get one dose of treatment at a time or over a few days, and then you’ll be given a rest before having the next treatment. Treatment cycles are usually two to four weeks apart. Spacing out your treatment in this way gives your body a chance to recover from any side effects.

Blood tests

Before you have each treatment, a blood sample will be taken. This test (known as a blood count) measures the different cells in your blood. You need to have blood counts because chemotherapy drugs can lower blood count levels. If any part of your blood count is too low, your doctors might give you a longer time between treatments. They may change your drugs, or give you additional treatment that boosts blood counts.

“I got a little scared by tests: it was a shock. I don’t remember what was said but my husband did. He had all the questions.” Debbie

Will it cure me?

Chemotherapy can cure some types of cancer. Sometimes it does this on its own, and sometimes, when used with surgery or radiation treatment. At other times, chemotherapy controls your cancer by stopping it growing or by making it shrink. This treatment can give you a longer life or can help reduce any problems the cancer is giving you. Whether or not chemotherapy cures depends on what sort of cancer you have and its stage. Ask your cancer doctor how chemotherapy will help you.

Use of chemotherapy to help other treatment

Chemotherapy can be used to assist another treatment, such as surgery or radiation treatment; this is called adjuvant chemotherapy.

Adjuvant chemotherapy can be given either before or after the main treatment. When given before other treatment, the drugs can be used to make the cancer smaller so that the main treatment can be more effective.

When given after the main treatment, chemotherapy is often used to kill any potential cancer cells which have not been found but could cause problems later.

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