Chemotherapy: An Introduction
Chemotherapy is a type of drug treatment that kills cancer cells, controls their growth or relieves disease-related symptoms. It may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
Patients also can get chemotherapy to shrink tumors before surgery (called neoadjuvant therapy). It may also be used after surgery to eliminate any remaining cancer cells (adjuvant therapy).
Types of chemotherapy
Chemotherapy is administered in several ways:
- Intravenous (IV) is the most common method. A needle is inserted into a vein and attached with tubing to a plastic bag holding the drug.
Some IV chemotherapy requires a catheter, a tube that connects directly to a large vein and is left in place throughout treatment. Patients may choose to have a catheter inserted to avoid frequent needle sticks. Patients with a catheter may have an IV connection device called a port implanted under the skin.
- Oral chemotherapy drugs are taken by mouth, either in pill or liquid form.
- Injections are administered into the muscle, under the skin, or directly into a tumor, depending on the type or location of the cancer.
- Intrathecal chemotherapy is delivered directly into the cerebrospinal fluid, a liquid that surrounds and protects the brain and spinal cord. It is typically delivered with an injection between two vertebrae. Intrathecal chemotherapy is used to treat patients with evidence of cancer in the cerebrospinal fluid. It is also used as a preventive treatment for patients with cancers that have a high risk of spreading to the central nervous system, such as leukemia and lymphoma.
- Isolated limb perfusion is a way to deliver chemotherapy directly to tumors in the arm or leg. The blood supply of the affected limb is isolated from the rest of the body. Heated chemotherapy drugs are then pumped into the treatment area through tubes inserted into tiny incisions. Isolated limb perfusion is used to treat advanced or metastatic melanoma and some sarcomas.
- Hepatic arterial infusion is a method of delivering chemotherapy directly to tumors in the liver. It is typically used to treat cancers that have metastasized, or spread, to this organ. A tiny pump is surgically inserted under the skin and connected to the hepatic artery, which supplies blood to the liver.
- Topical chemotherapy delivers the drug as a cream applied to the skin. It is used to treat skin cancer.
Side Effects of Chemotherapy
The side effects of chemotherapy depend on the specific drug or drugs that a patient receives. The duration and severity of chemotherapy side effects differ from patient to patient. Most are temporary and will disappear once treatment has ended.
The most common side effects of chemotherapy include:
- Hair loss
- Nausea and vomiting
- Mouth sores
- Low levels of certain blood cells. This can lead to an increased risk of bleeding and infection.
- Cognitive issues, such as memory problems and trouble concentrating. This side effect is often called chemobrain.
Patients experiencing side effects should talk to their care team. They may be able to offer treatments to help alleviate some of the more severe symptoms. These treatments may include medications or complementary therapies.
Chemotherapy is one of the most common treatments for cancer. It’s typically used to kill cancerous cells in the body, but it can also be used to control the growth of cancer cells and relieve disease-related symptoms.
Due to its powerful nature, chemotherapy can cause side effects in patients. We spoke with medical oncologist Adaeze Iheme, M.D., to learn more about chemotherapy side effects, how long they can last and how to manage them.
Common chemotherapy side effects
“Chemotherapy kills bad cells and good cells in the body,” says Iheme. “When chemotherapy kills the good cells, that’s when side effects occur.”
Some common side effects from chemotherapy include:
- Nausea: upset stomach
- Fatigue: intense exhaustion
- Hair loss: loss of hair on the scalp and other parts of the body
- Neuropathy: nerve damage that causes tingling, burning, weakness or numbness in the hands and/or feet
- Diarrhea and/or constipation: disruptions or changes to bowel functions
- Low blood count: A low red blood cell count can put you at risk for conditions like anemia and infections.
- Chemobrain: difficulty remembering or processing information
The side effects from chemotherapy tend to be the worst the day after it’s administered.
“If you’re on a strong chemo regimen, usually the day after is when you’ll experience the worst symptoms,” says Iheme. “By worst, I mean you’ll experience the most fatigue, weakness and nausea. Normally, three or four days after chemo, your symptoms will get better.”
Most side effects last just for the duration of your chemotherapy treatment. However, some side effects, such as fatigue, neuropathy, hair loss and heart damage, can last a lifetime.
“But that’s rare,” says Iheme. “The good news for symptoms like fatigue is that a few weeks or months after you complete chemo, your body gets used to not receiving treatment and your fatigue will start to go away.”
How can chemotherapy side effects be managed?
Most times, the side effects from chemotherapy can be managed with medication or adjustments to your chemo dosage.
Nausea, vomiting and fatigue can be managed with medication. To manage neuropathy, physicians will often lessen a patient’s dosage and prescribe medications to help restimulate the growth of your nerves.
“That’s why it’s important to see your physician before every chemo cycle, especially if you’re on a very strong chemo regimen,” says Iheme. “We have to know if your symptoms get worse, so we can cut your dosage, if necessary.”
Patients should disclose their full medical history before beginning chemotherapy.
“We tailor your chemo treatments based on your current health status,” says Iheme. “We have to make sure we administer the right dosage – not giving you too much or too little – to prevent long-term side effects.”
For example, diabetic patients can receive chemotherapy, but it’s done with caution to prevent more nerve damage and other side effects that are more common in diabetics.
To help manage symptoms at home, Iheme advises patients to do the following:
- Stay hydrated by drinking 1 to 2 liters of water every day.
- Keep items you use frequently, like your phone, close by to cut down on having to move back and forth in your house. Less back-and-forth movement can help curb fatigue.
- Make a daily task list and use your smartphone or alarms to alert you of important things if you’re experiencing chemobrain.
- Go to sleep and wake up at the same time every day, so your body gets used to a routine.
What resources does MD Anderson offer patients undergoing chemotherapy?
MD Anderson offers several resources to chemotherapy patients.
One of these is MD Anderson’s Chemotherapy Guide, which is available to every patient who is about to begin chemotherapy. “It has information about everything, including side effects, hygiene and what to expect during chemotherapy,” Iheme says.
The Integrative Medicine Center also offers therapies and clinical services, such as nutrition counseling and health psychology, to help patients deal with the stress and anxiety of cancer treatment. Many patients say integrative medicine also helps curb their chemotherapy side effects.
Why is follow-up care after chemotherapy so important?
Aside from making sure the cancer doesn’t return, follow-up care after chemotherapy is important to check for any changes in your health.
“For example, if your blood counts are low, that could cause serious infections because your body no longer has a defense system,” says Iheme. “Follow-ups would include getting bloodwork and doing exams so that we can catch it early and intervene before serious or long-term side effects occur.”
What else should we know about chemotherapy side effects?
Iheme stresses the importance of taking every side effect seriously, especially diarrhea, which could indicate a serious infection. Your physician should be aware of any changes to your body or health.
If you are undergoing chemotherapy, you should contact your care team if you:
- have a fever of 100.5 degrees Fahrenheit or higher
- have diarrhea lasting more than two days
- are bleeding or have bruises anywhere on your body
Remember, side effects are common during and right after chemotherapy. If you begin to experience any side effects, speak with your care team, so they can determine the best way to manage your symptoms.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.