What is Chemotherapy?
Chemotherapy is the use of drugs in the form of tablets, injections and drips to treat Cancer. These drugs are given as single agents or combinations of them.
How does Chemotherapy work?
Different Chemotherapy drugs have different ways of killing Cancer cells. For example, some drugs damage the cell wall, others stop the growth of cells and some others cause death of the cell by damaging the DNA.
How often is Chemotherapy given?
Chemotherapy is given in cycles. A typical cycle lasts three weeks but can be every week or every two or four weeks. Usually 4-6 such cycles are used. For example, if a cycle is every 3 weeks and 6 cycles are needed, then the Chemotherapy lasts for 18 weeks or 4.5 months. This is called as a course.
How long does it take for chemotherapy to be given?
The duration of Chemotherapy depends on the type of drugs used. Some drugs take less than a minute while others are given over an hour to a few hours. Some chemotherapy schedules involve continuous infusion of the drug over a number of weeks.
When is Chemotherapy used?
Chemotherapy can be used at different stages of the cancer treatment process. First, a diagnosis of cancer is confirmed with a biopsy. After that the stage of cancer is determined based on the results of all the tests including scans. Then treatment options are made based on the type of cancer, fitness of the patient and stage of the cancer. It is usually decided by then whether the cancer is potentially curable or not.
Potentially curable Cancer
Here, the treatment offered for the cancer has the chance of curing it completely. In this setting, Chemotherapy is used in the following ways.
Neo-adjuvant- This is a setting where Chemotherapy is used prior to a definitive treatment for cancer such as Surgery or Radiotherapy. The benefit of Chemotherapy here is to enhance the effect of the definitive treatment.
Adjuvant- Here the Chemotherapy is used after the definitive treatment has been done such as surgery or radiotherapy. Again, the benefit of chemotherapy here is to maximize the effect of the definitive treatment.
Concurrent- Here the chemotherapy is given at the same time as definitive treatment, usually radiotherapy. This type of treatment is called as concurrent chemo radiotherapy.
Chemotherapy alone- Some Cancers such as those arising from the blood or lymphatic system are treated with chemotherapy being the most important or the only form of treatment.
In cancers that are stage 4 or non-curable, Chemotherapy forms a very important option to help control the Cancer, improve symptoms and prolong survival. This form of Chemotherapy is called as Palliative Chemotherapy, where the aim is not cure as it is not possible.
Do I need to have a central line inserted to have Chemotherapy?
Normally, Chemotherapy is given into a vein on the back of the hand or on the forearm. In situations, where the access to the veins is difficult or when the course of chemotherapy is prolonged or when continuous infusion of chemotherapy is needed, a central line is inserted to make it easy to give the treatment. There are different types of lines that can be placed as these are briefly described below. For more detail, see faq’s on chemotherapy lines.
What are the side effects of Chemotherapy?
Chemotherapy consists of a number of drugs and each drug can cause different side effects. The side effects a patient will experience will depend on the type of Chemotherapy that is given. Below are some of the general side effects that can happen with many drugs. For side effects of specific drugs, please look at the product leaflet of the drugs used.
Nausea and Vomiting- Vomiting is a side effect of Chemotherapy and therefore good medicines are given prior to chemotherapy to prevent this side effect. Tablets have to be taken for a few days after Chemotherapy also to prevent vomiting.
Hair Loss- This is a known side effect of some but not all Chemotherapy drugs. Your doctor will explain to you if it is likely to happen. If hair loss occurs, it happens in the 2nd and 3rd week after 1st chemotherapy cycle. Hair usually grows back once chemotherapy is finished.
Risk of Infection- Chemotherapy reduces the number of cells in the blood (white blood cells) that protect against infection. Therefore, there is an increased risk of infection during the period of treatment. If the patient develops a fever above 100F or feels unwell, the patient should seek medical advice urgently as infections can increase quickly.
Risk of Bleeding- Just like white blood cells, other cells in the blood called platelets can also decrease after Chemotherapy. This increases the risk of bleeding and therefore any bleeding symptoms should be reported to the doctor urgently.
Anaemia- Reduced Haemoglobin (Hb) in the blood also called anaemia can be a side effect of chemotherapy.
Loss of taste- Chemotherapy reduces the number of taste buds on the tongue and therefore food does not taste as before. This along with reduced appetite makes it difficult to eat well.
Tiredness and weakness- This is a common side effect of Chemotherapy and is variable depending on the drugs used and the fitness of the patient.
Effect on Periods- Periods can stop temporarily or permanently in women who have Chemotherapy. They tend to stop permanently in older women who are close to menopause. In younger women, there may be a temporary stoppage of periods, but these can return in a few months after completing chemotherapy.
Reduced Fertility- Chemotherapy can cause reduced fertility, that is it can reduce the chances of having a baby later if it is given. Therefore, in patients who have not completed a family but need to have chemotherapy should see a fertility specialist to discuss available options. Options of fertility preservation include sperm banking in a male where the semen is collected and stored prior to start of treatment. In women, the options include storage of oocytes (egg) or storage of embryos.
Drug dependent side effects- Some side effects that happen depend on the type of drugs that are used as Chemotherapy and the common ones are given below.
Platinum drugs- Platinum drugs such as Cisplatin and Carboplatin can affect the kidneys and close monitoring of the kidney function is needed. Cisplatin can cause reduced hearing. Oxaliplatin causes neuropathy leading to tingling in the hands and feet.
Taxanes- Common taxane drugs such as Docetaxel and Paclitaxel cause neuropathy which leads to development of tingling and numbness in the hands and feet. They can also also mucositis leading to a sore mouth, tummy pain and loose motions. Hair loss and changes in the nails also happen.
Capecitabine and Fluorouracil- These drugs are commonly used and can cause soreness in the mouth, loose motions, redness and soreness of the hands and feet, dry skin and cracking of the skin.
Anthracyclines- These drugs can affect the heart in the long term and anyone due to have these drugs has an Echocardiogram and ECG to make sure their cardiac function is adequate.
What is the cost of chemotherapy?
Chemotherapy includes a number of drugs given in various forms including tablets, injections and drips. Each of these drugs used has a price. Some of these drugs are very cheap costing less than Rs100, where as others may cost up to Rs100,000 or more. Therefore, the cost of chemotherapy treatment depends on the type of drugs used to treat the cancer. Along with the cost of the drugs, other charges such as bed charges, nursing and doctor charges are added on. It is important to ask the doctor about the approximate cost of each cycle of Chemotherapy before the treatment starts.
It is also important to consider other costs that can occur during Chemotherapy. These include costs related to hospital admissions to manage any side effects of the treatment.
How do I know if the chemotherapy is working?
A scan is typically done after two or three cycles of treatment and compared with the scan prior to the start of treatment. This will enable us to tell whether the treatment is working or not. Some cancers such as Breast, Prostate, Ovarian, Colon or Pancreatic Cancers have tumour marker blood tests which can also tell whether the Cancer is responding to treatment or not.