Understanding chemotherapy

According to the American Cancer Society, “Chemotherapy usually refers to the use of medicines or drugs to treat cancer. The thought of having chemotherapy frightens many people. But knowing what chemotherapy is, how it works, and what to expect can often help calm your fears. It can also give you a better sense of control over your cancer treatment.”

Chemotherapy is only one of many modalities of cancer treatment. Depending on your type of cancer, your medical team may include any number of these forms of treatment, in varying sequence:

• Surgery
• Radiation
• Hormonal (endocrine) therapy
• Immunotherapy or Biologic therapy - a type of treatment that uses the body's immune system to kill cancer cells by boosting the body's natural defences, to fight cancer.

Listen to top health experts explore the ins and outs of cancer treatment here.

Different cancers respond to different chemotherapy drugs and you may be given just one type of chemo drug or a combination of drugs, depending on the type of cancer, where it is in your body, as well as your overall health.

Your treating doctor will advise on your treatment regimen – this includes details of the drugs to be given, how often you will need to be treated and for how long your treatment may last.

Doctors use chemotherapy in different ways and at different times. These include:

• Before surgery or radiation therapy, to shrink tumours (known as neo-adjuvant chemotherapy)
• After surgery or radiation therapy, to kill any remaining cancer cells (adjuvant chemotherapy)
• For cancer that has recurred after treatment
• For cancer that has spread to other parts of the body (metastatic cancer).

How is chemotherapy given?

There are a number of different ways chemo can be administered and your doctor will decide which will work best for you:

• Intravenous (IV) chemotherapy.

Many drugs require delivery directly through an needle into a vein or through a central line. Infusional treatment takes anywhere from a few minutes to a few hours. Some IV drugs may be administered over a few days or weeks through a small pump you wear or carry. This is called ‘continuous infusion chemotherapy’.

• Oral chemotherapy

Any drug taken orally (swallowed) to treat cancer. A number of targeted cancer therapies are administered orally.

• Injected chemotherapy

Certain chemo drugs may be injected directly into the bloodstream or into the tumour (intralesional) or into the muscle (intramuscular) or under the skin (subcutaneously).

• Other forms of chemotherapy delivery

Less common ways of getting chemotherapy include infusion into an artery, into the peritoneum or abdomen, topical chemotherapy on the skin and chemotherapy into the fluid surrounding the brain and spinal cord.

How does chemotherapy work?

Chemotherapy damages dividing cells. Cancer cells divide much faster than most normal cells so chemotherapy is able to damage cancer cells and can destroy them. A number of normal cells also divide very often, such as your skin, hair and nails. Chemotherapy may also damage these cells and although they’re able to repair themselves and recover, this does cause side effects in the process.

Listen to our podcast and learn from experts on dealing with cancer treatment’s side effects here.

Possible side-effects include:

• An altered sensation in your hands and feet – peripheral neuropathy
• Feeling tired and weak
• Having a higher risk of getting an infection (neutropenia)
• Battling with your hearing
• Feeling breathless
• Losing your sensation of taste and/or your appetite
• Issues around sex and fertility
• Nausea and vomiting
• Changes in appetite
• Constipation or diarrhoea
• Oral changes including sores and ulcers on your lips, in your mouth including your tongue
• Pain when swallowing
• Hair loss
• Changes to your skin and nails.

Most chemotherapy side effects are temporary and disappear once your treatment is over. But for some people, chemotherapy can cause long-term changes to the body which may happen only months or many years after the treatment has finished.

Long-term effects can include:

• Early menopause
• Infertility
• Peripheral neuropathy
• Heart and lung problems.

Chemo is usually given for a specific time, such as six months or a year, or for as long as it works. Because of the side effects, doctors usually give these drugs with breaks - for example, one dose on the first day and then three weeks of recovery time before repeating. Several of these treatment cycles make up a course of chemo with the time in between doses enabling you to rest and recover while your healthy cells heal before the next treatment.

Useful tips:

• Ask questions – and remember to write down any questions you may have ahead of time, so that you don’t forget them when you are consulting with your doctor. Also take a note book along to record the answers.
• Find out if there are any clinical trials that you may be eligible to be enrolled in to.
• Chat to your healthcare team about medications that are not approved in South Africa but are approved in other parts of the world and that may benefit you.