Chemotherapy is the treatment of cancer using anti-cancer medication. The aim is to kill cancer cells while doing the least
possible damage to normal cells.
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How does it work?
Chemotherapy travels through the bloodstream to stop or slow the growth of rapidly dividing cancer cells. Cancer cells exposed to chemotherapy medication are less likely to grow back than non-treated cancer cells.
Chemotherapy also affects healthy cells. The effects of chemotherapy on healthy cells cause the side-effects. Healthy cells have the potential to grow again.
Why you might have chemotherapy
Depending on the type of cancer you have, chemotherapy may be the only treatment you need. However, it is often used with other treatments such as surgery or radiation treatment.Chemotherapy can be used to help shrink your cancer before other treatments such as surgery or radiation are used (neo-adjuvant therapy).
If chemotherapy is given after other treatments such as surgery or radiation, it is used to treat any cancer cells that may remain (adjuvant therapy), reducing the chance of your cancer returning. For some types of cancer, chemotherapy given at the same time as radiation can make cancer cells more sensitive to radiation treatment (chemoradiation). The combination of treatments may be more effective than having chemotherapy or radiation treatment alone.
Chemotherapy may be used for long periods of time to control the growth of your cancer. Chemotherapy can be used as a palliative treatment to relieve symptoms, such as pain, when your cancer can no longer be cured.
Side-effects that need urgent medical attention
Some side-effects of chemotherapy can be very serious. You must contact your cancer treatment team or go to your nearest hospital emergency department immediately and tell them you are receiving chemotherapy treatment if you develop any of the following symptoms:
• Fever – a temperature over 38˚C
• Chills – shivers or shakes, feeling hot or cold
• Vomiting that continues after taking anti-sickness medication
• Diarrhoea – four or more loose bowel movements than usual
• Gum or nose bleeds, or unusual bleeding (if bleeding does not
stop after 10 minutes of ice and pressure)
• Pain – burning or blood in urine
• Chest pain
• Difficulty breathing
It is important that you do not wait until the next morning or after the weekend to seek assistance.
“I found the hospital admitted you very quickly, which
is great. I did feel like I shouldn’t burden the hospital
and I would end up waiting forever. This was not the
case and I found you’ll be seen promptly. Ben
How will I be given chemotherapy?
Medications to treat your cancer can be given in different ways. These can be taken orally or via intravenous (IV) cannula, central venous access devices (CVADs) and injections.
Some medications are given as tablets that you take at home. It is very important that you take your tablets when and how they are prescribed. Make sure you understand the side-effects and who to contact if you have problems. Even though you’re having this treatment at home, it is no different from medications given at the hospital in the way it works and the possible side-effects.
A cannula is a small tube that is put into a vein in your arm or the back of your hand. It is put in by the nurse when you go for treatment and removed before you go home. A treatment cycle is up to three weeks.
If you have a drip (IV infusion) you’ll feel a brief sting as the cannula goes in and then the pain should stop. If the pain continues, or starts during the infusion, let the cancer nurse know immediately.
Often, two or more medications are given together. You’ll probably be given your medication by slow injection or drip into a vein through the cannula, or via a portable infusion pump.
Image: A portable infusion pump
Types of central lines
Central venous line (CVADs)
When there is difficulty finding a suitable vein or when treatment will be given for a long period of time, you may need a central venous access device (CVAD).
A CVAD will be put in under an anaesthetic (general or local) and may be left in for many months. When in place the line may be stitched in or covered with a special dressing to keep it in place. It allows the medication to be delivered directly into your bloodstream. Types of CVADS commonly used are peripherally inserted central catheters (PICCs), portacaths and Hickman catheters.
Image: a CVAD
A PICC is inserted into a vein through the skin in the bend or upper part of the arm, and threaded through until the end of the tube lies in a vein near your heart.
Portacath (an implantable port)
A portacath (an implantable port) is a thin, soft tube with a rubber disc at the end. It is inserted under the skin, usually on your chest, with the tube going into a vein near your heart. A needle is passed through your skin and into the port. Once in place, you can feel and see the port as a small lump underneath the skin. Nothing shows on the outside of your body. The skin over the port can be numbed with an anaesthetic cream or spray first.
Image: a portacath
Hickman catheters are long, thin tubes inserted under the skin on your chest and into a large vein near your heart. They are stitched in place and usually remain there for the length of your treatment.
Image: Hickman Catheter
Intrathecal (into the spinal column)
Many medications do not reach the brain, the spinal cord or the fluid surrounding them. If you are having intrathecal treatment your doctor will inject the treatment through a needle into your cerebrospinal fluid (the fluid surrounding and protecting the brain and spinal cord). This procedure is called a lumbar puncture and is done under local anaesthetic.
Treatments at home
If you are having chemotherapy or other treatments at home, such as medications through a pump, there are some things to remember:
• Medications may need to be stored in a particular way, such as in the fridge. Always follow the instructions given.
• Other people in your household should avoid direct contact with your cancer medications and avoid picking them up with bare hands. They should be stored out of reach of children.
• If you are having continuous intravenous treatment via a small, portable transfusion device and you notice the drug leaking from the pump or tube, you should close the clamps on the pump, wrap it in a plastic bag and wash your hands.
Most treatment centres provide spill or leakage kits that include instructions on what to do if your pump leaks. You should contact your cancer treatment team immediately afterwards.
Possible problems with central lines
The two main possible problems with CVADs are blockage and infection. If you notice any changes it is
important to contact your treatment team immediately.
How long will my treatment last?
Your treatment could last anywhere from a few weeks to many months. Treatment cycles are usually two to four weeks apart. Spacing out your treatment in this way gives your body a chance to recover from any side-effects. Some treatments, such as blood cancer treatments, require a tablet being taken for a much longer time.
Before you have treatment, a blood sample may be taken. This test is to ensure that it is safe for you to continue receiving your treatment.Tests may include a full blood count, kidney and liver function tests, and sometimes tumour markers.