Chemotherapy

Chemotherapy means the use of medicines that contain chemicals to kill cancer cells. Chemotherapy is also called anti-cancer treatment or anti-neoplastic treatment. In treating cancers, chemotherapeutic agents can be used alone or in combination. Chemotherapeutic drugs can be administered into a large vein of the body, or the chemotherapy pill can be taken by mouth. However, thanks to advancements in chemotherapy, various administration methods are now introduced into the clinical practice.

For colon and rectum cancers and ovarian cancers, the chemotherapeutic agent is diluted and warmed before it is instilled into the abdominal cavity; this method is also called "Hot Chemotherapy" and "Hypothermic Intraperitoneal Chemotherapy (HIPEC)." Moreover, administration of intrapleural (into the thoracic cage) and intrathecal (into the central nervous system) are available.

Since very potent active substances are used in chemotherapy preparations and spread to the whole body, healthy cells are influenced along with cancer cells. This is the primary underlying mechanism behind the side effects of the chemotherapy. On the other hand, infection, multi-organ dysfunctions, heart failure, and nutritional disorders are also common in cancer patients. Both those side effects and the presence of comorbidities require a multidisciplinary approach to the treatment of cancer.

Chemotherapy can be used to treat cancer, slow down the growth of the tumor, reduce the size of the tumor before surgery or radiotherapy to cancer cells that may remain after surgery, and treat or relieve tumor-related complications if no definitive treatment is available.

No single chemotherapeutic agent can be used to treat all types of cancers. There are now almost one hundred chemotherapy medicines with proven efficacy for different types of cancers. On the other hand, more than one chemotherapeutic preparation can be used in combination (sequentially or concomitantly) depending on the type and stage of the cancer.

Chemotherapy protocol implies chemotherapy that is planned according to the type and stage of cancer and that is administered and paused for particular intervals. In a chemotherapy protocol, one or more than one chemotherapeutic agent is administered at a specific dose for a definite period (e.g., 28 days), and each chemotherapy drug is issued on a particular day (e.g., first day, fifth day). Each one of these treatments is referred to as a cycle. Your doctor will inform you in detail about the medicine(s) to be used, the doses, the day they will be administered, and the total duration of the treatment. While patients take some chemotherapy drugs in a routine daily life, others need to be administered at the hospital under supervision. Since many factors should be taken into consideration while chemotherapy is planned, you should undoubtedly ask all your questions and concerns about the chemotherapy designed for you by your doctor.

Risks

Chemotherapy drugs cause a broad spectrum of side effects. Although each chemotherapy drug has a unique profile of side effects, the severity of these side effects is also affected by your health status and the drug dose.

Common side effects caused by chemotherapy drugs include:

• Fever
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Lack of appetite
• Changes in hematological parameters (counts of white blood cells, red blood cells, and platelets)
• Mouth sore
• Susceptibility to bleeding
• Fatigue
• Hair loss

Your doctor will consider the side effects listed above and other possible side effects you may experience to initiate appropriate treatments in a timely manner. Moreover, other medical specialists may also be involved in managing side effects, considering the side effects experienced and their severity.

Treatment Process

Since chemotherapy drugs affect healthy cells of your body along with cancer cells, it is necessary to check your health status to determine whether your body is ready to cope with both the therapeutic and side effects of chemotherapy before chemotherapy is started. Therefore, your heart, kidneys, lungs, and liver are examined, and other tests, such as blood and urine tests, imaging studies, and ECG, are ordered. If a problem is identified, it is necessary to stabilize comorbidity before chemotherapy begins. Since chemotherapy drugs compromise blood cells that fight against infection, you will be more prone to infections after chemotherapy is initiated.

Accordingly, you will need to have various tests to investigate whether there is an infection in your body, and you will also be referred to a dentist to determine a possible infection. For couples of childbearing age who plan pregnancy after completion of the chemotherapy, counseling to an In Vitro Fertilization specialist will also be needed. If the disease-related conditions allow, sperm or eggs are retrieved, frozen, and stored for future use. The fact that chemotherapy drugs cause some side effects is unavoidable, irrespective of whether the chemotherapy pill is taken by mouth in routine daily life or the chemotherapeutic agent is administered into a vein at a hospital under supervision. Due to these side effects, you will need to modify your home and work life.

The vulnerability to infection caused by chemotherapy will pose a risk both for you and your family members. You may feel sleepy and tired. You may institute methods to use your energy more efficiently in this case. It would help to ask your treating healthcare team what to do during and after chemotherapy. You will need to visit your medical oncologist at regular intervals throughout your chemotherapy.

Your body's response to chemotherapy and your general health status will be evaluated in these visits. The dose or even the chemotherapy drug can be changed after your response to treatment, and the available health status and side effects are considered. In addition, you should call your doctor immediately if you experience a symptom other than the ones specified by your doctor.