What is cancer chemotherapy?

Cancer chemotherapy is a type of cancer treatment. It uses medicines to destroy cancer cells.

Normally, the cells in your body grow and die in a controlled way. Cancer cells keep growing without control. Chemotherapy works by killing the cancer cells, stopping them from spreading, or slowing their growth.

Chemotherapy is used to:

• Treat cancer by curing the cancer, lessening the chance it will return, or stopping or slowing its growth.
• Ease cancer symptoms by shrinking tumors that are causing pain and other problems.

What are the side effects of chemotherapy?

Chemotherapy does not just destroy cancer cells. It can also harm some healthy cells, which causes side effects.

You may have a lot of side effects, some side effects, or none at all. It depends on the type and amount of chemotherapy you get and how your body reacts.

Some common side effects are:

• Mouth sores
• Fatigue
• Nausea and vomiting
• Pain
• Hair loss

There are ways to prevent or control some side effects. Talk with your health care provider about how to manage them. Healthy cells usually recover after chemotherapy is over, so most side effects gradually go away.

What can I expect when getting chemotherapy?

You may get chemotherapy in a hospital or at home, a doctor's office, or a medical clinic. You might be given the medicines by mouth, in a shot, as a cream, through a catheter, or intravenously (by IV).

Your treatment plan will depend on the type of cancer you have, which chemotherapy medicines are used, the treatment goals, and how your body responds to the medicines.

Chemotherapy may be given alone or with other treatments. You may get treatment every day, every week, or every month. You may have breaks between treatments so that your body has a chance to build new healthy cells.

There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on:

• The type of cancer you have and how advanced it is
• Whether you have had chemotherapy before
• Whether you have other health problems, such as diabetes or heart disease

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy and other cancer treatments. The types of treatment that you need depends on the type of cancer you have, if it has spread and where, and if you have other health problems.

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer cells.

How Chemotherapy Works against Cancer

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to:

• Treat cancer: Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.
• Ease cancer symptoms: Chemotherapy can be used to shrink tumors that are causing pain and other problems.

When used with other treatments, chemotherapy can:

• Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy.
• Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy.
• Help other treatments work better.
• Kill cancer cells that have returned or spread to other parts of your body.

Chemotherapy may be given in many ways. Some common ways include:

• Oral
  chemotherapy comes in pills, capsules, or liquids that you swallow
• Intravenous (IV)
  chemotherapy goes directly into a vein
• Injection
  chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly
• Intrathecal
  chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord
• Intraperitoneal (IP)
  chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
• Intra-arterial (IA)
  chemotherapy is injected directly into the artery that leads to the cancer
• Topical
  chemotherapy comes in a cream that you rub onto your skin

Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.

• Catheter
  A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter.
• Port
  A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port.
• Pump
  Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

Chemotherapy affects people in different ways. How you feel depends on:

• the type of chemotherapy you are getting
• the dose of chemotherapy you are getting
• your type of cancer
• how advanced your cancer is
• how healthy you are before treatment

Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

• Your type of cancer and how advanced it is
• Whether chemotherapy is used to:
  • Cure your cancer
  • Control its growth
  • Ease symptoms
• The type of chemotherapy you are getting
• How your body responds to the chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor's office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them.

You will see your doctor often. During these visits, she will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by:

• Asking someone to drive you to and from chemotherapy
• Planning time to rest on the day of and day after chemotherapy
• Asking for help with meals and childcare on the day of and at least one day after chemotherapy

There are many ways you can help manage chemotherapy side effects.

The cost of chemotherapy depends on:

• The types and doses of chemotherapy used
• How long and how often chemotherapy is given
• Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
• The part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.
If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for "financial assistance." Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian.

It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

If you get chemotherapy to treat cancer, you’re more likely to get an infection. Learn how to prevent infections during chemotherapy, and about other ways to stay healthy.

Why Does Chemotherapy Raise My Risk of Infections?

How Can I Avoid Getting an Infection During Chemotherapy?

To lower your risk of infection—

• Wash your hands often, and ask your family, visitors, and health care providers to wash theirs, too.
• Get a flu shot every year, and encourage your family and friends to get one. Ask your doctor if you need a pneumococcal shot and about the best types and timing of vaccines with your treatment.
• Take a shower or a bath every day with warm water and mild soap.
• Brush your teeth several times a day with a soft toothbrush.
• Protect yourself from cuts: be very careful when using sharp items, and wear gloves when gardening or cleaning.
• If you get a small cut, wash it thoroughly, put antibiotic cream on it, and cover it with a bandage.

Call your doctor right away if you notice any signs of an infection, especially a fever.

What Else Can I Do to Stay Healthy?

You can lower your risk of getting cancer again by making healthy choices like—

• Staying away from tobacco. If you smoke, try to quit, and stay away from other people’s smoke.
• Limiting the amount of alcohol you drink.
• Protecting your skin from exposure to ultraviolet rays from the sun and avoiding tanning beds.
• Eating lots of fruits and vegetables.
• Keeping a healthy weight.
• Being physically active.

Staying Mentally and Emotionally Healthy During Cancer Treatment

Being told you have cancer is scary. It’s normal to feel worried, sad, afraid, or even angry. Some treatments for cancer also can affect your feelings, or make it hard for you to concentrate or remember things.

What Can I Do?

• Talk to your doctor or other health care provider. Your health care team may be able to help, or they can refer you to mental health services.
• Reach out for support to family members, friends, those who share your faith, a support group, or a psychologist.
• Stay as active as you can. Physical activity has been linked to lower rates of depression among cancer survivors.

Call your doctor right away if you get a fever or feel sick during your chemotherapy treatment.

People with cancer who are treated with chemotherapy are more likely to get infections. Your immune system helps your body protect itself from getting an infection. Cancer and chemotherapy can damage this system by reducing the number of infection-fighting white blood cells. This condition is called neutropenia.

An infection can lead to sepsis, the body’s extreme response to an infection. It is a life-threatening medical emergency.

Find out from your doctor when your white blood cell count is likely to be lowest, since this is when you’re most at risk for infection. This usually occurs between 7 and 12 days after you finish each chemotherapy dose, and may last as long as one week.

How to Prevent Infections During Your Cancer Treatment

Watch Out for Fever

If you get a fever during your chemotherapy treatment, it’s a medical emergency. Take your temperature any time you feel warm, flushed, chilled, or not well. Call your doctor right away if you have a temperature of 100.4ºF (38ºC) or higher.

Wash Your Hands Often

Clean hands help prevent infections. You and anyone who comes around you, including family members, doctors, and nurses, also should wash their hands often. Don’t be afraid to ask people to wash their hands.

Know the Symptoms of Infection

Call your doctor right away if you notice any symptoms of an infection, such as a fever, cough, sore throat, stuffy nose, redness or swelling in any area, diarrhea, or vomiting.

Some types of chemotherapy can cause hair on the scalp—as well as on other parts of the body—to fall out. Although hair loss caused by chemotherapy is usually temporary, many patients with cancer consider it one of the most distressing side effects of treatment. “Hair loss can be so distressing that some people avoid getting the recommended treatment,” said Dawn Hershman, M.D., of the Columbia University Herbert Irving Comprehensive Cancer Center, who wrote a recent editorial about two clinical trials testing scalp cooling devices.

Scalp cooling, which has been used in Europe for several decades, is thought to prevent hair loss by reducing blood flow to hair follicles, Dr. Hershman noted. Cooling the scalp causes blood vessels to constrict, which may limit the amount of chemotherapy drug that reaches hair follicles.

The idea of cooling the scalp to prevent hair loss has been around since the 1970s. Early efforts involved putting ice packs on the scalps of patients undergoing chemotherapy. More recent approaches have used cooling caps that are chilled and need replacing periodically during a session to maintain cold.

The most common side effects of the scalp cooling system included headaches induced by the cold, neck and shoulder discomfort, and pain associated with wearing the cooling cap for extended periods.