Chemotherapy

What is chemotherapy?

Chemotherapy (sometimes called chemo) means drug treatment and it aims to cure cancer or relieve any symptoms cancer can cause.

It can be used by itself, with surgery, with radiotherapy or both. Your doctor will discuss the best options with you and your family if you wish.

How chemotherapy works

Chemotherapy either kills cancer cells or stops them dividing. In the same way that different bacteria are sensitive to different antibiotics, different cancers are sensitive to different types of chemotherapy.

Chemotherapy reaches the cancer cells through the bloodstream and destroys them as they're in a dividing phase (two cells divide into four, four cells divide into eight, etc). Not all cancer cells are in the dividing stage; some will be in the resting stage and chemotherapy is unable to destroy these.

Over the next few months, as you have more chemotherapy treatments, the cancer cells that were resting will start to divide. This is why a number of chemotherapy treatments, called cycles, make up a course of treatment.

How chemotherapy is given

Chemotherapy can be given in a number of different ways:

• By injection into a vein or a muscle, or the tissue just under the skin
• As an infusion (drip) through a small plastic needle called a cannula. This way is used for large amounts of fluid which need to run over a few hours or days
• As a continuous infusion using a small pump that you can carry around with you. This is usually given via a catheter which is kept in place either in your arm (called a PICC), or in your chest using a soft tube (called a central venous catheter)
• As tablets - your chemotherapy nurse will tell you when to take them and when to stop
• Into a body cavity (for example the bladder or stomach)
• As an ointment applied directly to your skin
• By a lumbar puncture (inserting a needle into your spine) so the chemotherapy reaches the fluid surrounding the brain

Your doctor and chemotherapy team will discuss with you the best way to give you your treatment.

Side effects of chemotherapy

Chemotherapy can produce different reactions in different people and side effects can change from treatment to treatment. Most side effects are temporary and will gradually disappear when your treatment is complete.

There is no connection between the extent of side effects you experience and the effect of the chemotherapy on your cancer. In other words, if you don't have any side effects, it doesn't mean the treatment isn't working.

Some side effects can be tiresome, but you and your doctor must weigh this against the benefits of treatment. It's important that you talk about any side effects and how you are managing with your chemotherapy team, as there are many ways your treatment team can help.

The main areas affected by chemotherapy are those where normal cells divide quickly:

• Bone marrow
• Mouth
• Digestive system (stomach and bowels)
• Hair
• Skin
• Reproductive organs (ovaries and testes)

Effects on bone marrow

Bone marrow is a sponge-like substance that produces blood cells in the hollow spaces of bones. It's sensitive to most types of chemotherapy but the following blood cells are especially sensitive:

• White blood cells help your body to fight infection - if they are low, you'll be more at risk of developing infections. While you are having chemotherapy, you should avoid people with infections such as flu or chickenpox
• Platelets help your blood clot - if they're low, you may notice that you bruise easily, pin-prick type reddish/purple spots on your skin, nose bleeds or bleeding gums, or pass blood when you go to the toilet
• Red blood cells carry oxygen to all the cells in the body - alack of red blood cells can cause anaemia, which may lead to shortness of breath and tiredness

Effects on the mouth

Some chemotherapy drugs can make your mouth dry and sore and sometimes you may develop mouth ulcers.

Effects on the digestive system

• Feeling sick and vomiting may be a problem for some patients, but not all chemotherapy drugs affect people in this way
• Diarrhoea or constipation can be caused by some chemotherapy drugs

Effects on the hair

Not all chemotherapy drugs cause the hair to fall out, your doctor or nurse will tell you if they expect it to happen to you.

Sometimes hair may thin slightly, and some people don't notice, but other chemotherapy drugs can cause partial or complete hair loss. The amount of hair loss will depend on the drug and the dose and usually starts within two or three weeks after treatment. As the hair begins to fall out, there may be some tenderness in the scalp around the hair follicles.

Sometimes other hair on the body will fall out, including eyelashes, eyebrows and facial hair.

Effects on the skin

• Some chemotherapy drugs can make the skin feel dry and itchy, or it may become sensitive to sunlight
• It can develop darker patches, especially over the veins used for chemotherapy
• Nails may discolour and white ridges may appear for a time, or they may split and not grow at their usual rate

Effects on fertility

• Not all chemotherapy drugs cause infertility, which may be temporary or permanent, depending on the drugs used and the length of treatment
• It may still be possible to become pregnant or father a child during chemotherapy treatment
• Some drugs affect the ovaries in women and stop the production of eggs. This may bring on symptoms associated with the menopause such as irregular periods, or no periods at all, hot flushes and dryness of the skin and vaginal dryness
• In men, chemotherapy drugs may reduce the number or quality of sperm produced, affecting the ability to father a child
• There is no medical reason why you cannot continue with a sexual relationship whilst having chemotherapy, but some people find that other side-effects, such as tiredness, hair loss and feeling sick may make you feel less attractive to your partner. Other feelings, such as anger, anxiety or depression may also affect you

Tiredness

• Many people having chemotherapy have extreme tiredness which is not relieved by rest. This is normal. Try to balance rest with gentle exercise and plenty of fresh air
• Relaxation techniques may be helpful
• Warm baths before bed can relax you and help you to sleep
• If you wake early, try not to get agitated and cross. Make a warm drink and maybe listen to some soothing music

Chemotherapy support

All patients treated with chemotherapy will be looked after by a team of healthcare professionals, who are there to support you and access specialist support if required.