Understanding Chemotherapy

Chemotherapy is usually everyone’s least favorite part of cancer treatment. When someone is newly diagnosed, there is often real fear about this part of the care plan. We have all seen movies or read books in which someone is treated with chemo and rendered totally miserable. I have worked in Cancer World long enough to remember the days when that was a fairly common experience. We used to hand out small plastic emesis basins to patients as they left the Infusion Room and headed to the garage. We knew that some of them would not even make it to their cars before needing it. Blessedly, times have changed.

Chemotherapy...is the broad term used to describe the many drugs that are used to destroy cancer cells.

The drugs now used to manage chemo symptoms, especially nausea and vomiting, work very well. For the first treatment, all we can do is give someone the drugs that generally work best. However, everyone is different, and some people do better with a different drug cocktail. If you are feeling rotten after chemo, call your doctor! There is someone who can prescribe something that may work better for you. Sometimes people just suffer because they think: I guess this is how chemo makes you feel. It shouldn’t.

It is helpful to understand what chemo is and how it works. Chemotherapy — sometimes called standard chemotherapy, traditional chemotherapy, or cytotoxic chemotherapy — is the broad term used to describe the many drugs that are used to destroy cancer cells. Surgery and radiation therapy target specific parts of the body, but chemo goes everywhere. Even with the most sophisticated scans or MRIs, there is never a way to be 100% certain that some cancer cells are not present somewhere in the body. It takes a large cluster of cancer cells to show on a scan, and even a few rogue cells are potentially dangerous. Hence, the frequent recommendation for chemo even if all the scans look clear.

Because cancer cells generally grow and divide or multiply more quickly than normal cells, chemo is designed to kill all fast-growing cells. This explains why some chemo drugs make you lose your hair or give you mouth sores. It is also why chemo is held while someone is healing from surgery or another injury. Since the drugs used for chemotherapy are so powerful, they cause damage to many growing cells, including healthy ones. It is this damage that causes the side effects linked with chemo treatment. If chemotherapy is prescribed for you, your doctor or nurse will give you comprehensive information about the particular drugs being used in your care.

Chemo is prescribed in several situations. For people with early cancers, the goal of chemotherapy is cure. Although oncologists can’t ever promise someone that the cancer is truly gone, chemo frequently succeeds. The best we can hope to hear at follow up visits is: Everything looks great. You are doing fine. NED (no evidence of disease). There are a few cancers, most commonly leukemia or other blood cancers, that are generally considered cured if there is no sign of a recurrence after five years. Many solid tumors don’t necessarily fit this pattern, and the five-year mark is important, but not a guarantee of continued good health.

For people whose cancer has returned or was never completely removed by surgery, chemo can be used to control the disease. In these situations, the individual will receive treatment indefinitely, probably for the rest of their life. After an indeterminate period of time, any one chemo regimen will stop being effective. Cancer cells are very smart and eventually mutate and develop resistance to any drug. At that point, it is time to change therapies.

Finally, chemotherapy can be used to ease side effects and generally help someone feel better. If someone is very ill, there is a balance between the benefits of chemo and the possible side effects. This inevitably means there are complicated and careful conversations with your doctors in order to make the best choice.

Chemotherapy is usually planned in cycles. This means, for example, that you might receive a treatment on Monday, called Day 1, and a second treatment the next Monday, called Day 8. This counts as one cycle and you then have two or three or four weeks before the next. The time off gives your body, especially your blood counts, time to recover. If you are being treated this way, you will quickly learn what the pattern is for you and be able to plan your life around the days you feel best.

Most of us think of chemo as being given as an infusion, an IV. There are, however, other possibilities. Some chemo drugs are given as an injection directly into a muscle in your arm or hip/butt, or even your stomach. Sometimes, especially if the veins in your arm are hard to access, a port is surgically placed in your upper chest, and the drugs then go directly into an artery there. Less often the drugs can be delivered IP/Intraperitoneal; this is done through a special port that delivers the drugs directly to certain organs like your liver, stomach, or ovaries. IT/intrathecal chemotherapy is medicine that is injected directly into the cerebrospinal fluid (CSF) which delivers the drug to the brain or spinal cord. Finally, some chemo is topical, a cream that you rub into your skin, or is oral: pills or a liquid.

Several other kinds of drugs are also used to treat cancer. Many of the newer ones are called targeted therapies. Targeted therapies damage and kill cancer cells by blocking specific genes or proteins that are present. Increasingly, gene analysis is done on tumor cells to ascertain if a particular cancer has any of these targets. Most targeted therapies are either small-molecule drugs small enough to enter a cell and attach to a target within, or monoclonal antibodies. Monoclonal antibodies attach to specific targets on cancer cells. Sometimes they mark a cancer cell to make it more obvious to chemo drugs or the immune system; they can also directly attack the cells or carry toxins into them. Many targeted therapies have the advantage of fewer side effects than chemo drugs as they do not attack normal cells.

All chemotherapy drugs have been very carefully tested before they are ever given to people. They must then be evaluated through rigorous clinical trials before being approved by the FDA for clinical use in cancer care.