Chemotherapy 101

Lately, I have found myself, as we wait for this next round to start, in the roll of a teacher. I have talked about PET scans and cancer in general and colorectal cancer specifically. It is now appropriate that I talk about another important topic - chemotherapy. Our wait time is coming to an end as Chuck gets connected tomorrow. This will be the first cycle of 12 over the next 24 weeks. So, sit back and enjoy (if you can) your lesson in (drum roll please and read with a dramatic voice) CHEMOTHERAPY 101.

Now class.....

Chemotherapy, or "chemo", is the use of medicines or drugs to treat disease. Although surgery and radiation therapy remove, destroy, or damage cancer cells in the specific area, chemo works throughout the body. It can destroy cancer cells that have metastasized, or spread to parts of the body away from the primary tumor.

More than 100 chemotherapy drugs are used in various combinations. Although a single chemo drug can be used to treat cancer, generally they are more powerful when used in combination with other drugs. When more than one drug is used, it is call combination chemotherapy. A combination of drugs with different actions can work together to kill more cancer cells and reduce the chance that you may become resistant to a particular chemo drug.

Depending on the type of cancer and its stage of development, chemo can be used to achieve the following goals:

• Cure your cancer
• Keep the cancer from spreading
• Slow the cancer's growth
• Kill cancer cells that may have spread to other parts of the body from the original tumor
• Relieve symptoms caused by cancer

The oncologist will usually discuss the goals of your chemotherapy with you before treatment starts.

Sometimes chemo is the only treatment you will need. More often, it is used in addition to surgery or radiation therapy, or with both. Here's why:

• Chemotherapy may be used to shrink a tumor before surgery or radiation therapy
• It may be used after surgery or radiation to help destroy any remaining cancer cells
• It may be used with other treatments if your cancer returns

When chemo is given after surgery to destroy any cancer cells that may still be present, it is called adjuvant therapy.

When chemo is used to shrink a tumor before surgery or radiation, it is call neoadjuvant therapy.

How often you take chemotherapy drugs and how long your treatment lasts both depend on the kind of cancer you have, the goals of the treatment, the drugs that are used, and how your body responds to them. You may receive treatments daily, weekly, or monthly, but they are usually given in on-and-off cycles. These breaks allow rest periods so that your body can build healthy new cells and regain its strength.

Most chemo drugs are broken down by your kidneys and liver then removed from your body through your urine or stool. The time it takes your body to get rid of the drugs is dependent on many things, including the type of chemotherapy you receive, other medications you take, your age, and your kidney and liver functions. The doctor will tell you if any special precautions will need to be taken because of the drugs you receive.

If your cancer returns, chemo may be used again. This time, different drugs may be given to relieve symptoms or to slow the cancer's growth or spread. Side effects may be different, depending on the drug, the dose, and how it is given.

Most chemo drugs are given to you through a tiny plastic tube, or catheter, which is inserted into a vein in your forearm or hand. This method is called intravenous or IV. IV drugs are given in the following ways:

• The drugs can be given quickly through an IV infusion directly from a syringe over a few minutes: this is called an "IV push".
• An IV infusion can last from 30 minutes to a few hours. A mixed drug solution flows from a plastic bag.
• Continuous infusions are sometimes necessary and usually last one to seven days.

Catheters and needles can scar or weaken veins after several chemo sessions. An alternative is the central venous catheter (CVC). The CCV is a catheter that is surgically implanted in the chest (for example a mediport) or upper arm area, and can remain painlessly in place to provide access to a large vein. Routine blood work can be drawn from these catheters, and drugs can be injected directly into the CVC, or through an IV connected to the CVC, whenever you go for your therapy.

Chemotherapy drugs are made to kill fast-growing cells, but because these drugs travel throughout the entire body, they can affect normal, healthy cells. Damage to healthy tissue is the cause of side effects. Although side effect are not always as bad as you might expect, may people worry about this aspect of their cancer treatment.

The normal cells most likely to be affected are blood forming cells in the bone marrow; hair follicles; and cells in the mouth, digestive tract, and reproductive system. Some chemo drugs can damage cells in the heart, kidneys, bladder, lungs, and nervous system. In some situations, medications called cytoprotective drugs may be given with the chemotherapy to protect the body's normal cells.

The most common side effects of chemotherapy include:

• Nausea and vomiting
• Hair loss
• Fatigue
• Increased chance of bruising and bleeding
• Anemia
• Infection

How chemotherapy may affect parts of the body:

• Intestinal problems
• Appetite and weight changes
• Sore mouth, gums, and throat
• Nerve and muscle problems
• Dry and/or discolored skin
• Kidney and bladder irritation
• Sexuality and fertility issues due to effects on reproductive organs

Please note that not every person gets every side effect and some get few, if any. And, the severity of side effects varies greatly from person to person. Many people have no long-term problems from chemo. Although side effects can be unpleasant, they must be measured against the treatment's ability to destroy cancer cells.

Most side effects gradually disappear after treatment ends because the healthy cells recover quickly. The time it takes to get over some side effects and regain energy varies from person to person and depends on many factors, including your overall health and the specific drugs you are receiving.

Although many side effects go away fairly rapidly, some may take months or years to disappear completely. Sometimes the side effects can last a lifetime, such as when chemotherapy causes permanent damage to the heart, lungs, kidneys, or reproductive organs. Certain types of chemotherapy occasionally cause delayed effects, such as a second cancer that may show up many years later.

Chemotherapy may affect the blood cell count because it produces three important blood components:

• Red blood cells, which carry oxygen to cells throughout the body
• White blood cells, which fight infection
• Platelets, which help blood clot and stoop bleeding

Chemo treatments destroy some of the bone marrow cells so fewer blood cells are produced. A drop in the levels of any of these cells results in specific side effects. The doctor will check your blood cell count often during your treatments and may give you growth factors to help your bone marrow make new blood cells.

When you have too few red blood cells, your body tissues don't get enough oxygen to do their work. This condition is called anemia. You may have these symptoms:

• Fatigue
• Dizziness
• Paleness
• A tendency to feel cold
• Shortness of breath
• Weakness
• A racing heart rate

Your doctor will check your blood cell count often during your treatment. If your red blood cell count falls too low, you may need a blood transfusion or treatment with a growth factor to boost your bone marrow's red blood cell production.

Having a low white blood cell count, a condition called leukopenia, decreases your body's ability to fight infections. One type of white blood cell, the neutrophil, is especially important in fighting infections. Infections can begin in almost any part of your body and most often start in your mouth, skin, lungs, urinary tract, and rectum.

If your white blood cell count drops too much, your doctor may postpone treatment, give you a lower dose of chemo, or prescribe treatment with a growth factor that boosts white blood cell production in the bone marrow.

Report any signs of infection immediately. IF you have a fever, don't use aspirin, acetaminophen, or any other medicine to bring your temperature down without first checking with your doctor.

Platelets are the blood cells that help top bleeding by plugging up damaged blood vessels and by helping your blood to clot. If your blood does not have enought platelets, you may bleed or bruise more easily than usual, even from a minor injury. Your doctor will check your platelet count often during your treatment. If it falls to low, you may need a platelet transfusion.

Signs that you may have problems with your platelet count:

• Unexpected bruising
• Small red spots under the skin
• Reddish or pinkish urine
• Black or bloody bowel movements
• Any bleeding from your gums or nose
• Bad headaches
• Dizziness
• An increase in weakness
• Pain in joints and muscles

One last topic I would like to discuss regarding chemotherapy is that of coping with chemo in your daily life. Some tips to help during chemo:

• Try to keep your treatment goals in mind. This will help you keep a positive attitude on days when the going gets rough.
• Eating well is very important. Your body needs food to rebuild tissues and regain strength.
• Learn as much as you want to know about your cancer and its treatment. This can lessen your fear of the unknown and increase your feeling of control.
• Keep a journal or diary while you're being treated.....OR a blog!
• Take it easy. You may not have as much energy as usual, so try to get as much rest as you can. Let the small stuff slide and only do the things that are most important to you.
• Try new hobbies and learn new skills.
• Exercise of you can and if your doctor approves. Using your body can make you feel better about yourself, help you get rid of tension or anger, and build your appetite.

In reading through all of this about chemo, I'm sure that it jogs your memory with previous posts made by Chuck and myself since we started this journey in 2009. Nothing like understanding things AFTER the fact!! But, hey, at least I finally connected the dots for us!!


Class dismissed.....

The American Cancer Society has more information regarding understanding chemotherapy. Should you need more in depth information, please contact them or go on their website at www.cancer.org. Material for Chemotherapy 101 was taken from their pamphlet, Understanding Chemotherapy, A guide for Patients and Families.