Chemotherapy

Chemotherapy is the treatment of cancer through the application of cytotoxins or cancer-destroying drugs. Constant replacement of cells through a process of divide and growth is a part of the body's natural process. But during cancer, cells reproduce in an uncontrolled manner. Drugs used in chemotherapy interfere with a cancer cell's ability to divide and reproduce. A single drug or a combination of several drugs is used. These drugs can be injected into specific cancer sites or can be delivered directly into the bloodstream.

Chemotherapy isn't necessarily painful. But you may feel pain because of vomiting, diarrhea, gut cramps, nausea, altered taste, foggy brain, absent saliva, dental damage, hair loss, mild allergic reactions, mouth ulcers, blood, and electrolyte problems, sweating and racing heart, and incredible exhaustion which are the more direct effects of chemo.

In most countries, the success rate of chemotherapy is less than 2.3 percent.

Depending on the type of cancer, you may take chemotherapy orally, or intravenously, injected into the vein or elsewhere. If your health allows, tablets can sometimes be taken at home. However, you will have to make regular hospital visits to check their health and response to treatment. The dose must be taken exactly when specified by your doctor. If you forgot to take one at a specific time, then you should call the medical team immediately. If your doctor has opted for Intravenous chemotherapy, then the drugs may be injected directly into a vein with a needle or delivered through an IV.

Usually, the decision about whether you should go through chemo or not is taken by your oncologist. But thanks to the recent study which presented at the American Society of Clinical Oncology meeting in Chicago on June 3, 2018, women with the most common type of early-stage breast cancer likely do not need chemotherapy after their surgery.

It usually takes two to four months for the hair to grow back after you finish of your chemotherapy.

You may need 4 to 8 cycles to treat your cancer. A series of cycles is called a course and it can take three to six months to complete and the number of treatment doses scheduled within each cycle depends on the drugs being given.

Most chemo drugs kill cells that are in the process of splitting into two new cells. Our body tissues are made of billions of individual cells, and as most of them are usually fully grown, most of these cells don't divide and multiply much. Our normal cells only divide if they need to repair the damage. In cancer, the malignant cells keep on dividing, and as cancer cells divide much more often than most normal cells (Except for hair and skin), chemotherapy is much more likely to kill them.

In most cases, chemotherapy is worth it. But it is really hard to predict how much chemo is needed to prevent tumor recurrence. But now, a European study of lung cancer shows that cancers or tumors lacking a DNA-repairing protein are very sensitive to chemotherapy, so the patients whose tumors lack the gene for this protein do better after chemo and those whose tumors bear the gene get no additional benefit from the chemo.

It can happen. In addition to killing cancer cells in your body, most forms of chemotherapy also destroy cells in your immune system that raises the chances of you getting infections during your treatment.

In most cases, the chemotherapy stays within the patient's body for 2 to 3 days of the treatment.

• Get as many calories as possible.
• Take the necessary supplements.
• Manage stress.
• Sleep well.
• Move your body, go out and exercise.

Chemotherapy drugs work in the following way:

• The chemotherapy drugs kill the rapidly growing and dividing cancer cells. They prevent the cancer cells from growing and making more cells.
• The normal cells of a healthy body constantly divide, grow, and die. When cancer develops in the body, the body cells tend to reproduce uncontrollably and do not die on their own.
• The chemotherapy drugs tend to interfere with the ability of the cancer cells to divide and reproduce. 
• The doctor may give a single drug or a combination of drugs for killing the cancer cells.

The different types of chemotherapy drugs are:

1. Alkylating agents: These drugs affect the DNA of a person and can kill the cancer cells at different stages of the life cycle of a cancer cell.
2. Antimetabolites: These drugs tend to mimic the proteins that are required by the cells to survive. When the cancer cells consume these medicines, they tend to starve and ultimately die.
3. Plant alkaloids: These types of chemotherapy drugs stop the growth and division of the cancer cells.
4. Anti-tumor antibiotics: These drugs stop the cancer cells from reproducing. They are different from the antibiotics that are used for treating infections.

Chemotherapy is used for the treatment of cancer in the following ways:

1. Adjuvant chemotherapy: The cancer cells that are left behind after surgery or radiation therapy (high-energy radiation beams are used to kill the cancer cells) can be killed using chemotherapy.
2. Neo-adjuvant chemotherapy: The tumor size can be shrunk before surgery or radiation therapy using chemotherapy.
3. Concomitant chemotherapy: Chemotherapy is used in combination with surgery or radiation therapy to treat cancer.
4. Relief of cancer symptoms: Symptoms caused due to the cancer cells, like pain and bleeding, can be relieved using chemotherapy.
5. Recurrent or metastatic cancer: Cancers that come back after treatment are known as recurrent cancers. Cancers that spread to the other parts of the body are known as metastatic cancer. Recurrent and metastatic cancers can be treated using chemotherapy.
6. Chemotherapy can also be used in the following cases:
7. As a preparation for a bone marrow transplant, in which the bone marrow (the soft, spongy part inside a bone) of the patient is replaced by a donor bone marrow.
8. For the treatment of auto-immune disorders, in which the body’s immune system or disease-fighting system attacks the body’s own tissues and organs.

Chemotherapy is performed by Oncologists (cancer specialists).

The following diagnostic tests may be performed before chemotherapy:

1. Physical examination: The doctor checks the physical health of the patient, and the symptoms, medical history, and family history of the patient are noted.
2. Blood tests: These tests help in checking for any underlying medical conditions.
3. Tissue biopsy: The doctor removes a small portion of the suspected tumor, and this sample is sent to the laboratory for further evaluation.
4. FNAC / Fine needle aspiration cytology: A thin needle is inserted by the doctor into the growth lump and the cells harvested are then examined under a microscope.

The type of drugs given and how they are administered determines the preparation for chemotherapy, and may include the following:
Intravenous chemotherapy (drugs injected directly in the veins of the patient) is preceded by the surgical insertion of a device like a catheter (a flexible, long tube), port (small disks that are made up of plastic or metal), or pump (a device attached to a catheter or port which allow the controlled release of drugs) in the chest. 
The patient should inform the doctor about any medical conditions that he/she may be having. 
The doctor should know about any medications, supplements, or herbs that the patient is taking currently.
The doctor should know about any allergies that the patient may be having.
Inform the doctor if you are pregnant, or are planning to get pregnant.
The doctor will recommend which medicines can or cannot be taken before the procedure.
Arrange for help at work and home following chemotherapy.

The type of chemotherapy drug given depends on the stage and type of cancer if there were any previous cancer treatments, the preferences, and overall health of the patient.
Based on what drugs are given, the doctor will determine how often chemotherapy treatments can be given. The schedule of chemotherapy treatment varies. The treatment may be continuous, or it may alternate between periods of treatment, known as chemotherapy cycles, and rest.
Chemotherapy can be provided in the following different ways:

Chemotherapy infusions:
Chemotherapy drugs are most commonly given as an infusion into a vein (intravenously).
The drugs are given by the insertion of a tube with a needle into a vein in the arm, or into a device in a vein in the chest.

Chemotherapy pills:
Some chemotherapy drugs can be taken in a capsule or pill form.

Chemotherapy shots:
Some chemotherapy drugs can be injected using a needle, just like receiving a shot.

Chemotherapy creams:
Gels or creams consisting of chemotherapy drugs can be applied to the skin (topically) for the treatment of certain types of skin cancer.

Chemotherapy drugs for the treatment of one area of the body:
Some chemotherapy drugs can be directly administered to one area of the body.
For example, chemotherapy drugs can be given directly in the chest cavity (intrapleural chemotherapy), abdomen (intraperitoneal chemotherapy), central nervous system (intrathecal chemotherapy), or into the bladder (where urine is stored) through the urethra (from where urine is removed) (intravesical chemotherapy).

Chemotherapy drugs given directly to the cancer site:
Chemotherapy drugs can be given directly to the site of the tumor, or post-surgery where cancer once was.
Chemotherapy drugs can also be injected into an artery or vein that feeds the tumor directly.

The post-procedural steps following chemotherapy include:

• It is normal to feel fatigued after chemotherapy.
• The doctor may prescribe some painkillers to relieve your pain and discomfort.
• Include protein-rich foods, and have a well-balanced diet after chemotherapy to maintain your weight.
• Increase the intake of multivitamin supplements, as per the doctor’s advice.
• Limit the consumption of red meat and salty foods after chemotherapy.
• Avoid UV rays or extended exposure to sunlight after chemotherapy.
• Use sunscreen of a good SPF level when stepping out in the sun.
• Increase your physical activity gradually after chemotherapy.
• Limit alcohol consumption.
• Quit smoking.

The complications associated with chemotherapy are:

• Fatigue
• Weakness
• Shortness of breath
• Anemia (low red blood cells)
• Bleeding
• Numbness
• Tingling
• Cold sensitivity
• Diarrhea
• Hair loss
• Infection
• Mouth ulcers or sores
• Nausea
• Vomiting
• Constipation
• Complications that may occur much later, and may last for a long time include:
• Lung tissue damage
• Heart problems
• Kidney problems
• Infertility
• Nerve damage (peripheral neuropathy)
• Recurrent cancer

Depending on the type and stage of cancer, chemotherapy can be given as a single dose for one day, or for a couple of weeks or months
 

Chemotherapy is generally considered to be safe for the mother and the child during the last 6 months of pregnancy. However, it is important to postpone hormone therapy and radiation therapy till after birth.

The cost of chemotherapy varies depending on the type and severity of cancer, and the overall health status of the patient.
The cost also varies amongst different doctors in different hospitals. The approximate cost of chemotherapy in India is between INR 75,000 to INR 1,00,000.

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