Chemotherapy, or "treatment with chemicals", has been around since the days of ancient Greece. However, the use of chemotherapy in the treatment of cancer began in the 1940s and since then many new drugs have been developed and tested as part of the research into the effectiveness of chemotherapy.
Called simply 'chemistry', chemotherapy is most often used to describe drugs that destroy, kill or damage cancer cells so that they can no longer reproduce and spread. They are sometimes called "anti-cancer" or "anti-tumor" drugs. More than 100 anti-cancer drugs are currently used in therapy. In addition, many more chemotherapy drugs are being developed and researched.
As cancer is a word that describes many different diseases, there is no universal method of treatment. Chemotherapy is used for different purposes:
Normally, cells live, grow and die in a predictable way. Cancer occurs when a number of cells in the body continue to divide and form additional cells, with no way of stopping this process. Chemotherapy protocol involves destroying the cancer cells, ensuring that they stop reproducing. Unfortunately, chemotherapy can also affect healthy cells.
Modern chemotherapy protocols aim at destroying cancer cells as much as possible, with minimal negative effects on healthy cells.
Chemotherapy drugs can be administered using different methods. The method and dosage of chemotherapy are determined through careful trials, called clinical trials, which are conducted before a particular chemotherapy drug becomes available for widespread clinical use in patients. During these trials, scientists and doctors determine how a particular chemotherapy drug is absorbed by the body and how effectively it works.
There are oral chemotherapy drugs that can be swallowed. They come in different forms - tablets, pills, capsules and liquids. They can all be absorbed through the gastrointestinal tract or placed under the tongue.
Some medicines cannot be taken orally because they are destroyed by stomach acid or cause damage to the mucous membrane. Other medicines are not absorbed by the patient's body through the mucous membrane of the stomach or intestine. If the medicine is not absorbed, it is eliminated with the stool, which is ineffective. Some drugs may be aggressive, causing damage to the gastric mucosa.
Subcutaneous injection involves the use of a short needle used by people with diabetes to inject insulin. The needle is inserted in the space between the skin and the muscle. Subcutaneous injection chemotherapy is usually used with a range of biological response modifiers and adjuvant drugs. If a patient has a low platelet count, a subcutaneous injection is less likely to cause bleeding than an intramuscular injection.
Intramuscular injection is given through the skin into the muscle layer and uses a larger needle than the hypodermic needle. In this case, the drug is injected into the muscle tissue.
Intramuscular injections are a popular method of treating hormone therapy as well as chemotherapy and some of the side effects associated with it. Intramuscular injection of some chemotherapy drugs is unacceptable due to the aggressiveness of the chemical.
Intravenous chemotherapy provides rapid penetration into the bloodstream, during which time the medicine is absorbed into the body through the bloodstream. This is the most common form of chemotherapy as most chemotherapy drugs are easily absorbed through the bloodstream. The intravenous method also offers flexibility in the dosage of drugs. Transfusions can be given over several days or weeks at the same time. A portable pump can be used to administer the medication at a slow, continuous rate using a variety of methods.
Intraventricular or intrathecal chemotherapy is used when the medicine needs to get into the cerebrospinal fluid, which is in the brain and spinal cord. The body's blood-brain barrier prevents many chemotherapy drugs administered systemically from reaching the cerebrospinal fluid. This procedure is most commonly used in cases of acute leukemia, although it can also be used in other situations.
Chemotherapy drugs can also be injected through the abdomen. The catheter is inserted through the abdominal wall and placed into the abdominal cavity that surrounds the organs, rather than into any organ. The patient is advised to change position from side to side and lie on their back to help move the medicine around.
With intra-arterial injection, the medicine is injected into an artery that supplies the tumor with blood. Angiography examines the blood vessels and identifies the arteries that supply blood to the tumor.
The effectiveness of this type of treatment lies in the fact that the tumor is exposed to a high level of drug without the toxicity associated with systematic administration of doses (throughout the body).
Intravesical administration of drugs takes place directly into the bladder using a urinary catheter. This method is often used in patients with superficial tumors of the bladder.
Intrapleural chemotherapy involves injecting chemotherapy drugs into the pleural cavity and is used to control a malignant pleural effusion. A malignant pleural effusion is an accumulation of tumor fluid in the pleural cavity. The fluid can cause respiratory failure and collapse of the lung.
For skin cancer, a chemotherapy cream is applied directly to the skin and absorbed through the skin at the site of the cancer. The use of topical preparations to treat cancer is very limited.
The duration of chemotherapy treatment depends on many factors, such as the type of cancer, the stage of cancer, the type of preparations prescribed, as well as the expected toxicity of these preparations and the time needed for recovery from their toxic effects.
Generally, chemotherapy treatment is carried out in cycles. This allows cancer cells to be attacked at vulnerable times and normal cells in the body to be given time to recover from the damage. There are three issues that relate to cycle time - cycle length, cycle frequency and number of cycles.
Chemotherapy treatment may be given with a single drug or a combination of drugs. It is possible to administer the drugs for one day, several days in a row or continuously in both outpatient and inpatient settings. Treatment can last for minutes, hours or days, depending on the specific protocol.
Chemotherapy can be repeated every week, every fortnight or every month. A cycle is usually defined by an interval of one month. For example, a course of chemotherapy given every fortnight can be classified as one cycle.
In most cases the number of cycles or the duration of chemotherapy from start to finish is determined by research.
With the exception of adjuvant chemotherapy, when there is no visible cancer, the effectiveness of chemotherapy against cancer cells is measured within the 'response'. Methods of monitoring the response may be similar to those used to diagnose cancer.
Regardless of the type of test used - blood test, cell count or oncomarker test - it should be repeated at regular intervals so that the results can be compared with previous results from the same type of test.
The number of treatments is determined for a newly diagnosed patient prescribed anticancer chemotherapy. For example, the oncologist prescribes a certain number of chemotherapy cycles according to the treatment protocol. The response can be measured at the time of chemotherapy, although the number of cycles usually does not change except when the cancer is growing. If the cancer grows, chemotherapy is likely to be discontinued or replaced with other drugs.
What Is Chemotherapy?
What Is Chemotherapy?
Chemotherapy, or "treatment with chemicals", has been around since the days of ancient Greece. However, the use of chemotherapy in the treatment of cancer began in the 1940s and since then many new drugs have been developed and tested as part of the research into the effectiveness of chemotherapy.
Called simply 'chemistry', chemotherapy is most often used to describe drugs that destroy, kill or damage cancer cells so that they can no longer reproduce and spread. They are sometimes called "anti-cancer" or "anti-tumor" drugs. More than 100 anti-cancer drugs are currently used in therapy. In addition, many more chemotherapy drugs are being developed and researched.
What Is Chemotherapy Used For?
As cancer is a word that describes many different diseases, there is no universal method of treatment. Chemotherapy is used for different purposes:
- To treat a certain type of cancer.
- To control the growth of a tumor.
- To shrink the tumor before surgery or radiotherapy.
- To reduce symptoms, such as pain.
- To kill microscopic cancer cells that may be present after the tumor has been surgically removed (so called adjuvant therapy). Adjuvant therapy is prescribed to prevent a possible recurrence of the tumor.
Chemotherapy Protocol - How Does Chemotherapy Work?
Normally, cells live, grow and die in a predictable way. Cancer occurs when a number of cells in the body continue to divide and form additional cells, with no way of stopping this process. Chemotherapy protocol involves destroying the cancer cells, ensuring that they stop reproducing. Unfortunately, chemotherapy can also affect healthy cells.
Modern chemotherapy protocols aim at destroying cancer cells as much as possible, with minimal negative effects on healthy cells.
How Is Chemotherapy Carried Out?
Chemotherapy drugs can be administered using different methods. The method and dosage of chemotherapy are determined through careful trials, called clinical trials, which are conducted before a particular chemotherapy drug becomes available for widespread clinical use in patients. During these trials, scientists and doctors determine how a particular chemotherapy drug is absorbed by the body and how effectively it works.
- Oral chemotherapy drugs (tablets) - In some cases different chemotherapy drugs can be taken as tablets.
- Intravenous (infusion) - some substances have been found to have an anti-cancer effect when given intravenously.
- Injections - some drugs can be given intramuscularly and/or subcutaneously and some can be absorbed when injected directly into the bladder or abdomen.
Oral Preparations
There are oral chemotherapy drugs that can be swallowed. They come in different forms - tablets, pills, capsules and liquids. They can all be absorbed through the gastrointestinal tract or placed under the tongue.
- Oral chemotherapy drugs are coated with a protective shell, which is dissolved by digestive enzymes. The enzymes release the drug, which is then absorbed through the intestinal mucosa.
- A number of medicines can be coated with another protective layer in which the medicine is released into the body at different times, called modified drug release. This method allows for a longer period between doses.
- Sublingual chemical medicines are absorbed through the oral mucosa and are called sublingual medicines. This type of medicine is placed under the tongue where it dissolves and quickly enters the body's circulatory system. This is a quick method of getting the medicine into the body. It is very effective to take antiemetic tablets in this way, as the medicine will not be lost if the patient vomits.
Why Cannot All Medicines Be Taken Orally?
Some medicines cannot be taken orally because they are destroyed by stomach acid or cause damage to the mucous membrane. Other medicines are not absorbed by the patient's body through the mucous membrane of the stomach or intestine. If the medicine is not absorbed, it is eliminated with the stool, which is ineffective. Some drugs may be aggressive, causing damage to the gastric mucosa.
Subcutaneous Injection
Subcutaneous injection involves the use of a short needle used by people with diabetes to inject insulin. The needle is inserted in the space between the skin and the muscle. Subcutaneous injection chemotherapy is usually used with a range of biological response modifiers and adjuvant drugs. If a patient has a low platelet count, a subcutaneous injection is less likely to cause bleeding than an intramuscular injection.
Intramuscular Injection
Intramuscular injection is given through the skin into the muscle layer and uses a larger needle than the hypodermic needle. In this case, the drug is injected into the muscle tissue.
Intramuscular injections are a popular method of treating hormone therapy as well as chemotherapy and some of the side effects associated with it. Intramuscular injection of some chemotherapy drugs is unacceptable due to the aggressiveness of the chemical.
Intravenous Chemotherapy
Intravenous chemotherapy provides rapid penetration into the bloodstream, during which time the medicine is absorbed into the body through the bloodstream. This is the most common form of chemotherapy as most chemotherapy drugs are easily absorbed through the bloodstream. The intravenous method also offers flexibility in the dosage of drugs. Transfusions can be given over several days or weeks at the same time. A portable pump can be used to administer the medication at a slow, continuous rate using a variety of methods.
- An intravenous catheter can be placed in a vein in the arm or wrist and removed after the chemotherapy drugs have been given. This is a temporary device that is placed by the nurse before treatment begins and removed after treatment has ended. The duration of use of intravenous catheters varies from a few minutes to a few days.
- A peripherally implantable central catheter (PICC line) is considered temporary, although it can be inserted and used from six weeks to several months. With PICC a long plastic tube is inserted into one of the large veins in the arm. This option is ideal for repeated short transfusions carried out in hospital or at home using a portable pump.
- A non-tunnel catheter is inserted into the jugular or subclavian vein through the skin and guided through the blood vessel to the superior vena cava or the right atrium of the heart. In order to position the catheter correctly, an X-ray is carried out. Most often, non-tunnel catheters are used for short-term or emergency situations, as prolonged use creates the risk of catheter infection. Therefore, the catheter needs to be dressed and cared for properly.
- Tunnel catheters are inserted through the skin in the middle of the chest. They are guided from the subcutaneous tissue and placed in the superior vena cava at the entrance to the right atrium of the heart. This catheter is placed during outpatient and surgical procedures, and X-ray is needed to make sure the catheter is in the right place. The catheter can be left in place for months or years with a low risk of infection. In this case it is also necessary to change the dressing and take proper care of it. This type of catheter can have several openings (inlets) for administering transfused medicine or drawing blood. Tunnel catheters are most often used for large-scale chemotherapy, such as in bone marrow transplant procedures.
- A port catheter is placed under the skin of the chest and then into the superior vena cava at the entrance to the right atrium of the heart. This catheter can be placed by an interventional radiologist or surgeon in the operating theatre and takes approximately one hour to insert. The duration of use of the port catheter can range from three to five years. The port catheter can be used to administer medication and draw blood, reducing the need to draw blood from the arm. A portable pump and port catheter can be used to administer medication at home.
Intraventricular Or Intrathecal Chemotherapy
Intraventricular or intrathecal chemotherapy is used when the medicine needs to get into the cerebrospinal fluid, which is in the brain and spinal cord. The body's blood-brain barrier prevents many chemotherapy drugs administered systemically from reaching the cerebrospinal fluid. This procedure is most commonly used in cases of acute leukemia, although it can also be used in other situations.
There are two ways of injecting chemotherapy into the cerebrospinal fluid:
- Lumbar puncture. Intrathecal chemotherapy can be administered via a lumbar puncture (spinal puncture). In this case a small amount of chemotherapy is injected directly into the cerebrospinal fluid through the lumbar puncture.
- Ommaya reservoir (intraventricular). The Ommaya Reservoir is a soft plastic dome-shaped device that is placed under the scalp. A catheter is connected to this dome and is inserted into the lateral ventricle of the brain. For an injection of chemotherapy, the head of a small needle is inserted through the skin into the Ommaya reservoir.
Intraperitoneal Chemotherapy
Chemotherapy drugs can also be injected through the abdomen. The catheter is inserted through the abdominal wall and placed into the abdominal cavity that surrounds the organs, rather than into any organ. The patient is advised to change position from side to side and lie on their back to help move the medicine around.
Intra-Arterial Chemotherapy
With intra-arterial injection, the medicine is injected into an artery that supplies the tumor with blood. Angiography examines the blood vessels and identifies the arteries that supply blood to the tumor.
The effectiveness of this type of treatment lies in the fact that the tumor is exposed to a high level of drug without the toxicity associated with systematic administration of doses (throughout the body).
Intravesical Chemotherapy
Intravesical administration of drugs takes place directly into the bladder using a urinary catheter. This method is often used in patients with superficial tumors of the bladder.
- Once the urinary catheter has been inserted, the medicine is injected into the catheter, which is then closed. The closure of the catheter results in the medicine remaining in the bladder.
- The patient is advised to turn from side to side and lie on his or her back so that the medicine reaches all points of the bladder.
- After the specified time has elapsed, the catheter is opened and the liquid is drained. The catheter is removed.
Intrapleural Chemotherapy
Intrapleural chemotherapy involves injecting chemotherapy drugs into the pleural cavity and is used to control a malignant pleural effusion. A malignant pleural effusion is an accumulation of tumor fluid in the pleural cavity. The fluid can cause respiratory failure and collapse of the lung.
- A thoracic tube is placed in the pleural cavity. Existing fluid is drained (this may take several days). Chemotherapy is given through a drainage tube.
- Chemotherapy causes the pleural leaflets to stick together, allowing the lungs to expand again and stay dilated.
- Intrapleural chemotherapy is used mainly for symptomatic relief.
Local Chemotherapy
For skin cancer, a chemotherapy cream is applied directly to the skin and absorbed through the skin at the site of the cancer. The use of topical preparations to treat cancer is very limited.
How long does chemotherapy last?
Duration Of Chemotherapy Treatment
The duration of chemotherapy treatment depends on many factors, such as the type of cancer, the stage of cancer, the type of preparations prescribed, as well as the expected toxicity of these preparations and the time needed for recovery from their toxic effects.
Generally, chemotherapy treatment is carried out in cycles. This allows cancer cells to be attacked at vulnerable times and normal cells in the body to be given time to recover from the damage. There are three issues that relate to cycle time - cycle length, cycle frequency and number of cycles.
Cycle Length
Chemotherapy treatment may be given with a single drug or a combination of drugs. It is possible to administer the drugs for one day, several days in a row or continuously in both outpatient and inpatient settings. Treatment can last for minutes, hours or days, depending on the specific protocol.
Frequency Of Cycles
Chemotherapy can be repeated every week, every fortnight or every month. A cycle is usually defined by an interval of one month. For example, a course of chemotherapy given every fortnight can be classified as one cycle.
Number Of Cycles
In most cases the number of cycles or the duration of chemotherapy from start to finish is determined by research.
- Adjuvant chemotherapy is therapy after surgical removal of a visible cancer and may last for 4-6 months. Adjuvant chemotherapy is common, e.g. in breast and colorectal cancer. In testicular cancer, Hodgkin's and non-Hodgkin's lymphoma and leukemia, treatment with chemotherapy can last up to one year.
- For some diseases, the duration of chemotherapy treatment depends on the response of the disease to therapy. If the tumor has completely disappeared, chemotherapy may be continued for 1-2 cycles to kill individual microscopic tumor cells.
- If the tumor shrinks in size but does not disappear, chemotherapy will continue until it stops growing.
- If the disease progresses, chemotherapy may be stopped or replaced with another chemotherapy regimen. Depending on the patient's health status and wishes, different drugs may be prescribed to beat the cancer. Chemotherapy may be stopped and the aim changed to focus on the patient's comfort and quality of life.
How Do I Know If Chemotherapy Is Working?
With the exception of adjuvant chemotherapy, when there is no visible cancer, the effectiveness of chemotherapy against cancer cells is measured within the 'response'. Methods of monitoring the response may be similar to those used to diagnose cancer.
- Swellings or tumors, which also include lymph nodes, can be palpated and measured on external physical examination.
- Some internal tumors are visible on X-rays or CT scans and can be measured with a ruler.
- Blood tests may be performed to determine organ function.
- An oncomarker test may be carried out in connection with some types of cancer.
Regardless of the type of test used - blood test, cell count or oncomarker test - it should be repeated at regular intervals so that the results can be compared with previous results from the same type of test.
How Is Efficacy Determined?
The evaluation of the disease for treatment is determined by several methods:
- Complete response - the tumor disappears completely. There is no sign of the disease.
- Partial response - the tumor is reduced in percentage, although the disease is still present.
- Stabilization - the tumor is not growing or shrinking, and the tumor volume is not changing.
- Progressive disease - the tumor is growing and the disease has progressed compared to the beginning of the treatment period.
When Is The Disease Assessed?
The number of treatments is determined for a newly diagnosed patient prescribed of anticancer chemotherapy. For example, the oncologist prescribes a certain number of chemotherapy cycles according to the treatment protocol. The response can be measured at the time of chemotherapy, although the number of cycles usually does not change except when the cancer is growing. If the cancer grows, chemotherapy is likely to be discontinued or replaced with other drugs.
For patients with relapsed or relatively advanced disease, it is not possible to prescribe a specific number of cycles. Instead, 2-3 cycles are prescribed and the response is assessed. If the disease is stable or declining, additional chemotherapy is given until the response is maintained, if the toxicity of the chemotherapy is tolerated. Usually 2-3 cycles of chemotherapy are needed to evaluate the response; one course may not be enough to evaluate the effectiveness of chemotherapy.
What Is Chemotherapy?
Chemotherapy, or "treatment with chemicals", has been around since the days of ancient Greece. However, the use of chemotherapy in the treatment of cancer began in the 1940s and since then many new drugs have been developed and tested as part of the research into the effectiveness of chemotherapy.
Called simply 'chemistry', chemotherapy is most often used to describe drugs that destroy, kill or damage cancer cells so that they can no longer reproduce and spread. They are sometimes called "anti-cancer" or "anti-tumor" drugs. More than 100 anti-cancer drugs are currently used in therapy. In addition, many more chemotherapy drugs are being developed and researched.
What Is Chemotherapy Used For?
As cancer is a word that describes many different diseases, there is no universal method of treatment. Chemotherapy is used for different purposes:
- To treat a certain type of cancer.
- To control the growth of a tumor.
- To shrink the tumor before surgery or radiotherapy.
- To reduce symptoms, such as pain.
- To kill microscopic cancer cells that may be present after the tumor has been surgically removed (so called adjuvant therapy). Adjuvant therapy is prescribed to prevent a possible recurrence of the tumor.
Chemotherapy Protocol - How Does Chemotherapy Work?
Normally, cells live, grow and die in a predictable way. Cancer occurs when a number of cells in the body continue to divide and form additional cells, with no way of stopping this process. Chemotherapy protocol involves destroying the cancer cells, ensuring that they stop reproducing. Unfortunately, chemotherapy can also affect healthy cells.
Modern chemotherapy protocols aim at destroying cancer cells as much as possible, with minimal negative effects on healthy cells.
How Is Chemotherapy Carried Out?
Chemotherapy drugs can be administered using different methods. The method and dosage of chemotherapy are determined through careful trials, called clinical trials, which are conducted before a particular chemotherapy drug becomes available for widespread clinical use in patients. During these trials, scientists and doctors determine how a particular chemotherapy drug is absorbed by the body and how effectively it works.
- Oral chemotherapy drugs (tablets) - In some cases different chemotherapy drugs can be taken as tablets.
- Intravenous (infusion) - some substances have been found to have an anti-cancer effect when given intravenously.
- Injections - some drugs can be given intramuscularly and/or subcutaneously and some can be absorbed when injected directly into the bladder or abdomen.
Oral Preparations
There are oral chemotherapy drugs that can be swallowed. They come in different forms - tablets, pills, capsules and liquids. They can all be absorbed through the gastrointestinal tract or placed under the tongue.
- Oral chemotherapy drugs are coated with a protective shell, which is dissolved by digestive enzymes. The enzymes release the drug, which is then absorbed through the intestinal mucosa.
- A number of medicines can be coated with another protective layer in which the medicine is released into the body at different times, called modified drug release. This method allows for a longer period between doses.
- Sublingual chemical medicines are absorbed through the oral mucosa and are called sublingual medicines. This type of medicine is placed under the tongue where it dissolves and quickly enters the body's circulatory system. This is a quick method of getting the medicine into the body. It is very effective to take antiemetic tablets in this way, as the medicine will not be lost if the patient vomits.
Why Cannot All Medicines Be Taken Orally?
Some medicines cannot be taken orally because they are destroyed by stomach acid or cause damage to the mucous membrane. Other medicines are not absorbed by the patient's body through the mucous membrane of the stomach or intestine. If the medicine is not absorbed, it is eliminated with the stool, which is ineffective. Some drugs may be aggressive, causing damage to the gastric mucosa.
Subcutaneous Injection
Subcutaneous injection involves the use of a short needle used by people with diabetes to inject insulin. The needle is inserted in the space between the skin and the muscle. Subcutaneous injection chemotherapy is usually used with a range of biological response modifiers and adjuvant drugs. If a patient has a low platelet count, a subcutaneous injection is less likely to cause bleeding than an intramuscular injection.
Intramuscular Injection
Intramuscular injection is given through the skin into the muscle layer and uses a larger needle than the hypodermic needle. In this case, the drug is injected into the muscle tissue.
Intramuscular injections are a popular method of treating hormone therapy as well as chemotherapy and some of the side effects associated with it. Intramuscular injection of some chemotherapy drugs is unacceptable due to the aggressiveness of the chemical.
Intravenous Chemotherapy
Intravenous chemotherapy provides rapid penetration into the bloodstream, during which time the medicine is absorbed into the body through the bloodstream. This is the most common form of chemotherapy as most chemotherapy drugs are easily absorbed through the bloodstream. The intravenous method also offers flexibility in the dosage of drugs. Transfusions can be given over several days or weeks at the same time. A portable pump can be used to administer the medication at a slow, continuous rate using a variety of methods.
- An intravenous catheter can be placed in a vein in the arm or wrist and removed after the chemotherapy drugs have been given. This is a temporary device that is placed by the nurse before treatment begins and removed after treatment has ended. The duration of use of intravenous catheters varies from a few minutes to a few days.
- A peripherally implantable central catheter (PICC line) is considered temporary, although it can be inserted and used from six weeks to several months. With PICC a long plastic tube is inserted into one of the large veins in the arm. This option is ideal for repeated short transfusions carried out in hospital or at home using a portable pump.
- A non-tunnel catheter is inserted into the jugular or subclavian vein through the skin and guided through the blood vessel to the superior vena cava or the right atrium of the heart. In order to position the catheter correctly, an X-ray is carried out. Most often, non-tunnel catheters are used for short-term or emergency situations, as prolonged use creates the risk of catheter infection. Therefore, the catheter needs to be dressed and cared for properly.
- Tunnel catheters are inserted through the skin in the middle of the chest. They are guided from the subcutaneous tissue and placed in the superior vena cava at the entrance to the right atrium of the heart. This catheter is placed during outpatient and surgical procedures, and X-ray is needed to make sure the catheter is in the right place. The catheter can be left in place for months or years with a low risk of infection. In this case it is also necessary to change the dressing and take proper care of it. This type of catheter can have several openings (inlets) for administering transfused medicine or drawing blood. Tunnel catheters are most often used for large-scale chemotherapy, such as in bone marrow transplant procedures.
- A port catheter is placed under the skin of the chest and then into the superior vena cava at the entrance to the right atrium of the heart. This catheter can be placed by an interventional radiologist or surgeon in the operating theatre and takes approximately one hour to insert. The duration of use of the port catheter can range from three to five years. The port catheter can be used to administer medication and draw blood, reducing the need to draw blood from the arm. A portable pump and port catheter can be used to administer medication at home.
Intraventricular Or Intrathecal Chemotherapy
Intraventricular or intrathecal chemotherapy is used when the medicine needs to get into the cerebrospinal fluid, which is in the brain and spinal cord. The body's blood-brain barrier prevents many chemotherapy drugs administered systemically from reaching the cerebrospinal fluid. This procedure is most commonly used in cases of acute leukemia, although it can also be used in other situations.
There are two ways of injecting chemotherapy into the cerebrospinal fluid:
- Lumbar puncture. Intrathecal chemotherapy can be administered via a lumbar puncture (spinal puncture). In this case a small amount of chemotherapy is injected directly into the cerebrospinal fluid through the lumbar puncture.
- Ommaya reservoir (intraventricular). The Ommaya Reservoir is a soft plastic dome-shaped device that is placed under the scalp. A catheter is connected to this dome and is inserted into the lateral ventricle of the brain. For an injection of chemotherapy, the head of a small needle is inserted through the skin into the Ommaya reservoir.
Intraperitoneal Chemotherapy
Chemotherapy drugs can also be injected through the abdomen. The catheter is inserted through the abdominal wall and placed into the abdominal cavity that surrounds the organs, rather than into any organ. The patient is advised to change position from side to side and lie on their back to help move the medicine around.
Intra-Arterial Chemotherapy
With intra-arterial injection, the medicine is injected into an artery that supplies the tumor with blood. Angiography examines the blood vessels and identifies the arteries that supply blood to the tumor.
The effectiveness of this type of treatment lies in the fact that the tumor is exposed to a high level of drug without the toxicity associated with systematic administration of doses (throughout the body).
Intravesical Chemotherapy
Intravesical administration of drugs takes place directly into the bladder using a urinary catheter. This method is often used in patients with superficial tumors of the bladder.
- Once the urinary catheter has been inserted, the medicine is injected into the catheter, which is then closed. The closure of the catheter results in the medicine remaining in the bladder.
- The patient is advised to turn from side to side and lie on his or her back so that the medicine reaches all points of the bladder.
- After the specified time has elapsed, the catheter is opened and the liquid is drained. The catheter is removed.
Intrapleural Chemotherapy
Intrapleural chemotherapy involves injecting chemotherapy drugs into the pleural cavity and is used to control a malignant pleural effusion. A malignant pleural effusion is an accumulation of tumor fluid in the pleural cavity. The fluid can cause respiratory failure and collapse of the lung.
- A thoracic tube is placed in the pleural cavity. Existing fluid is drained (this may take several days). Chemotherapy is given through a drainage tube.
- Chemotherapy causes the pleural leaflets to stick together, allowing the lungs to expand again and stay dilated.
- Intrapleural chemotherapy is used mainly for symptomatic relief.
Local Chemotherapy
For skin cancer, a chemotherapy cream is applied directly to the skin and absorbed through the skin at the site of the cancer. The use of topical preparations to treat cancer is very limited.
How long does chemotherapy last?
Duration Of Chemotherapy Treatment
The duration of chemotherapy treatment depends on many factors, such as the type of cancer, the stage of cancer, the type of preparations prescribed, as well as the expected toxicity of these preparations and the time needed for recovery from their toxic effects.
Generally, chemotherapy treatment is carried out in cycles. This allows cancer cells to be attacked at vulnerable times and normal cells in the body to be given time to recover from the damage. There are three issues that relate to cycle time - cycle length, cycle frequency and number of cycles.
Cycle Length
Chemotherapy treatment may be given with a single drug or a combination of drugs. It is possible to administer the drugs for one day, several days in a row or continuously in both outpatient and inpatient settings. Treatment can last for minutes, hours or days, depending on the specific protocol.
Frequency Of Cycles
Chemotherapy can be repeated every week, every fortnight or every month. A cycle is usually defined by an interval of one month. For example, a course of chemotherapy given every fortnight can be classified as one cycle.
Number Of Cycles
In most cases the number of cycles or the duration of chemotherapy from start to finish is determined by research.
- Adjuvant chemotherapy is therapy after surgical removal of a visible cancer and may last for 4-6 months. Adjuvant chemotherapy is common, e.g. in breast and colorectal cancer. In testicular cancer, Hodgkin's and non-Hodgkin's lymphoma and leukemia, treatment with chemotherapy can last up to one year.
- For some diseases, the duration of chemotherapy treatment depends on the response of the disease to therapy. If the tumor has completely disappeared, chemotherapy may be continued for 1-2 cycles to kill individual microscopic tumor cells.
- If the tumor shrinks in size but does not disappear, chemotherapy will continue until it stops growing.
- If the disease progresses, chemotherapy may be stopped or replaced with another chemotherapy regimen. Depending on the patient's health status and wishes, different drugs may be prescribed to beat the cancer. Chemotherapy may be stopped and the aim changed to focus on the patient's comfort and quality of life.
How Do I Know If Chemotherapy Is Working?
With the exception of adjuvant chemotherapy, when there is no visible cancer, the effectiveness of chemotherapy against cancer cells is measured within the 'response'. Methods of monitoring the response may be similar to those used to diagnose cancer.
- Swellings or tumors, which also include lymph nodes, can be palpated and measured on external physical examination.
- Some internal tumors are visible on X-rays or CT scans and can be measured with a ruler.
- Blood tests may be performed to determine organ function.
- An oncomarker test may be carried out in connection with some types of cancer.
Regardless of the type of test used - blood test, cell count or oncomarker test - it should be repeated at regular intervals so that the results can be compared with previous results from the same type of test.
How Is Efficacy Determined?
The evaluation of the disease for treatment is determined by several methods:
- Complete response - the tumor disappears completely. There is no sign of the disease.
- Partial response - the tumor is reduced in percentage, although the disease is still present.
- Stabilization - the tumor is not growing or shrinking, and the tumor volume is not changing.
- Progressive disease - the tumor is growing and the disease has progressed compared to the beginning of the treatment period.
When Is The Disease Assessed?
The number of treatments is determined for a newly diagnosed patient prescribed of anticancer chemotherapy. For example, the oncologist prescribes a certain number of chemotherapy cycles according to the treatment protocol. The response can be measured at the time of chemotherapy, although the number of cycles usually does not change except when the cancer is growing. If the cancer grows, chemotherapy is likely to be discontinued or replaced with other drugs.
For patients with relapsed or relatively advanced disease, it is not possible to prescribe a specific number of cycles. Instead, 2-3 cycles are prescribed and the response is assessed. If the disease is stable or declining, additional chemotherapy is given until the response is maintained, if the toxicity of the chemotherapy is tolerated. Usually 2-3 cycles of chemotherapy are needed to evaluate the response; one course may not be enough to evaluate the effectiveness of chemotherapy.
What Is Chemotherapy?
Chemotherapy, or "treatment with chemicals", has been around since the days of ancient Greece. However, the use of chemotherapy in the treatment of cancer began in the 1940s and since then many new drugs have been developed and tested as part of the research into the effectiveness of chemotherapy.
Called simply 'chemistry', chemotherapy is most often used to describe drugs that destroy, kill or damage cancer cells so that they can no longer reproduce and spread. They are sometimes called "anti-cancer" or "anti-tumor" drugs. More than 100 anti-cancer drugs are currently used in therapy. In addition, many more chemotherapy drugs are being developed and researched.
What Is Chemotherapy Used For?
As cancer is a word that describes many different diseases, there is no universal method of treatment. Chemotherapy is used for different purposes:
- To treat a certain type of cancer.
- To control the growth of a tumor.
- To shrink the tumor before surgery or radiotherapy.
- To reduce symptoms, such as pain.
- To kill microscopic cancer cells that may be present after the tumor has been surgically removed (so called adjuvant therapy). Adjuvant therapy is prescribed to prevent a possible recurrence of the tumor.
Chemotherapy Protocol - How Does Chemotherapy Work?
Normally, cells live, grow and die in a predictable way. Cancer occurs when a number of cells in the body continue to divide and form additional cells, with no way of stopping this process. Chemotherapy protocol involves destroying the cancer cells, ensuring that they stop reproducing. Unfortunately, chemotherapy can also affect healthy cells.
Modern chemotherapy protocols aim at destroying cancer cells as much as possible, with minimal negative effects on healthy cells.
How Is Chemotherapy Carried Out?
Chemotherapy drugs can be administered using different methods. The method and dosage of chemotherapy are determined through careful trials, called clinical trials, which are conducted before a particular chemotherapy drug becomes available for widespread clinical use in patients. During these trials, scientists and doctors determine how a particular chemotherapy drug is absorbed by the body and how effectively it works.
- Oral chemotherapy drugs (tablets) - In some cases different chemotherapy drugs can be taken as tablets.
- Intravenous (infusion) - some substances have been found to have an anti-cancer effect when given intravenously.
- Injections - some drugs can be given intramuscularly and/or subcutaneously and some can be absorbed when injected directly into the bladder or abdomen.
Oral Preparations
There are oral chemotherapy drugs that can be swallowed. They come in different forms - tablets, pills, capsules and liquids. They can all be absorbed through the gastrointestinal tract or placed under the tongue.
- Oral chemotherapy drugs are coated with a protective shell, which is dissolved by digestive enzymes. The enzymes release the drug, which is then absorbed through the intestinal mucosa.
- A number of medicines can be coated with another protective layer in which the medicine is released into the body at different times, called modified drug release. This method allows for a longer period between doses.
- Sublingual chemical medicines are absorbed through the oral mucosa and are called sublingual medicines. This type of medicine is placed under the tongue where it dissolves and quickly enters the body's circulatory system. This is a quick method of getting the medicine into the body. It is very effective to take antiemetic tablets in this way, as the medicine will not be lost if the patient vomits.
Why Cannot All Medicines Be Taken Orally?
Some medicines cannot be taken orally because they are destroyed by stomach acid or cause damage to the mucous membrane. Other medicines are not absorbed by the patient's body through the mucous membrane of the stomach or intestine. If the medicine is not absorbed, it is eliminated with the stool, which is ineffective. Some drugs may be aggressive, causing damage to the gastric mucosa.
Subcutaneous Injection
Subcutaneous injection involves the use of a short needle used by people with diabetes to inject insulin. The needle is inserted in the space between the skin and the muscle. Subcutaneous injection chemotherapy is usually used with a range of biological response modifiers and adjuvant drugs. If a patient has a low platelet count, a subcutaneous injection is less likely to cause bleeding than an intramuscular injection.
Intramuscular Injection
Intramuscular injection is given through the skin into the muscle layer and uses a larger needle than the hypodermic needle. In this case, the drug is injected into the muscle tissue.
Intramuscular injections are a popular method of treating hormone therapy as well as chemotherapy and some of the side effects associated with it. Intramuscular injection of some chemotherapy drugs is unacceptable due to the aggressiveness of the chemical.
Intravenous Chemotherapy
Intravenous chemotherapy provides rapid penetration into the bloodstream, during which time the medicine is absorbed into the body through the bloodstream. This is the most common form of chemotherapy as most chemotherapy drugs are easily absorbed through the bloodstream. The intravenous method also offers flexibility in the dosage of drugs. Transfusions can be given over several days or weeks at the same time. A portable pump can be used to administer the medication at a slow, continuous rate using a variety of methods.
- An intravenous catheter can be placed in a vein in the arm or wrist and removed after the chemotherapy drugs have been given. This is a temporary device that is placed by the nurse before treatment begins and removed after treatment has ended. The duration of use of intravenous catheters varies from a few minutes to a few days.
- A peripherally implantable central catheter (PICC line) is considered temporary, although it can be inserted and used from six weeks to several months. With PICC a long plastic tube is inserted into one of the large veins in the arm. This option is ideal for repeated short transfusions carried out in hospital or at home using a portable pump.
- A non-tunnel catheter is inserted into the jugular or subclavian vein through the skin and guided through the blood vessel to the superior vena cava or the right atrium of the heart. In order to position the catheter correctly, an X-ray is carried out. Most often, non-tunnel catheters are used for short-term or emergency situations, as prolonged use creates the risk of catheter infection. Therefore, the catheter needs to be dressed and cared for properly.
- Tunnel catheters are inserted through the skin in the middle of the chest. They are guided from the subcutaneous tissue and placed in the superior vena cava at the entrance to the right atrium of the heart. This catheter is placed during outpatient and surgical procedures, and X-ray is needed to make sure the catheter is in the right place. The catheter can be left in place for months or years with a low risk of infection. In this case it is also necessary to change the dressing and take proper care of it. This type of catheter can have several openings (inlets) for administering transfused medicine or drawing blood. Tunnel catheters are most often used for large-scale chemotherapy, such as in bone marrow transplant procedures.
- A port catheter is placed under the skin of the chest and then into the superior vena cava at the entrance to the right atrium of the heart. This catheter can be placed by an interventional radiologist or surgeon in the operating theatre and takes approximately one hour to insert. The duration of use of the port catheter can range from three to five years. The port catheter can be used to administer medication and draw blood, reducing the need to draw blood from the arm. A portable pump and port catheter can be used to administer medication at home.
Intraventricular Or Intrathecal Chemotherapy
Intraventricular or intrathecal chemotherapy is used when the medicine needs to get into the cerebrospinal fluid, which is in the brain and spinal cord. The body's blood-brain barrier prevents many chemotherapy drugs administered systemically from reaching the cerebrospinal fluid. This procedure is most commonly used in cases of acute leukemia, although it can also be used in other situations.
There are two ways of injecting chemotherapy into the cerebrospinal fluid:
- Lumbar puncture. Intrathecal chemotherapy can be administered via a lumbar puncture (spinal puncture). In this case a small amount of chemotherapy is injected directly into the cerebrospinal fluid through the lumbar puncture.
- Ommaya reservoir (intraventricular). The Ommaya Reservoir is a soft plastic dome-shaped device that is placed under the scalp. A catheter is connected to this dome and is inserted into the lateral ventricle of the brain. For an injection of chemotherapy, the head of a small needle is inserted through the skin into the Ommaya reservoir.
Intraperitoneal Chemotherapy
Chemotherapy drugs can also be injected through the abdomen. The catheter is inserted through the abdominal wall and placed into the abdominal cavity that surrounds the organs, rather than into any organ. The patient is advised to change position from side to side and lie on their back to help move the medicine around.
Intra-Arterial Chemotherapy
With intra-arterial injection, the medicine is injected into an artery that supplies the tumor with blood. Angiography examines the blood vessels and identifies the arteries that supply blood to the tumor.
The effectiveness of this type of treatment lies in the fact that the tumor is exposed to a high level of drug without the toxicity associated with systematic administration of doses (throughout the body).
Intravesical Chemotherapy
Intravesical administration of drugs takes place directly into the bladder using a urinary catheter. This method is often used in patients with superficial tumors of the bladder.
- Once the urinary catheter has been inserted, the medicine is injected into the catheter, which is then closed. The closure of the catheter results in the medicine remaining in the bladder.
- The patient is advised to turn from side to side and lie on his or her back so that the medicine reaches all points of the bladder.
- After the specified time has elapsed, the catheter is opened and the liquid is drained. The catheter is removed.
Intrapleural Chemotherapy
Intrapleural chemotherapy involves injecting chemotherapy drugs into the pleural cavity and is used to control a malignant pleural effusion. A malignant pleural effusion is an accumulation of tumor fluid in the pleural cavity. The fluid can cause respiratory failure and collapse of the lung.
- A thoracic tube is placed in the pleural cavity. Existing fluid is drained (this may take several days). Chemotherapy is given through a drainage tube.
- Chemotherapy causes the pleural leaflets to stick together, allowing the lungs to expand again and stay dilated.
- Intrapleural chemotherapy is used mainly for symptomatic relief.
Local Chemotherapy
For skin cancer, a chemotherapy cream is applied directly to the skin and absorbed through the skin at the site of the cancer. The use of topical preparations to treat cancer is very limited.
How long does chemotherapy last?
Duration Of Chemotherapy Treatment
The duration of chemotherapy treatment depends on many factors, such as the type of cancer, the stage of cancer, the type of preparations prescribed, as well as the expected toxicity of these preparations and the time needed for recovery from their toxic effects.
Generally, chemotherapy treatment is carried out in cycles. This allows cancer cells to be attacked at vulnerable times and normal cells in the body to be given time to recover from the damage. There are three issues that relate to cycl
