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What is chemotherapy?

Chemotherapy is a general term for treatments that use chemical agents (drugs) to kill cancer cells. Many different kinds of drugs are used, either alone or in combination, to treat different cancers. The specific drug or combination used is chosen to best combat the type and extent of cancer present.

Chemotherapy drugs are tested against various forms of cancer in an effort to find out which drugs work against that particular type of cancer. Multiple drugs, each individually effective against a certain cancer, are often combined to try and maximize the effect against the cancer. Drugs are combined so that there are few overlapping side effects, to make the treatment more tolerable. These combinations are then tested in clinical trials to see how effective they are. If a combination works better than the current "standard" treatment, it will become the new standard therapy.

Cycles of chemotherapy may be given daily, weekly or monthly for various periods of time. Time between cycles allows the body to recover from the ill effects of chemotherapy. The traditional ways to administer therapy include injections in the vein (IV), muscle or tumor; oral treatment (pills); or topical applications. Doctors determine the best way to administer chemotherapy based on the type and stage of cancer and the medications to be given.

Newer forms of chemotherapy are being developed and tested research centers throughout the world. Many of these drugs are based on an understanding of the biological differences between normal cells and cancer cells. These treatments are often referred to as "targeted therapies." The hope is that these treatments will target the cancer cells only and spare normal cells, or at least greatly reduce the side effects of therapy.

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Chemotherapy drugs are given for several reasons:

  • To treat cancers that respond well to chemotherapy
  • To decrease the size of tumors for easier and safer removal by surgery
  • To enhance the cancer-killing effectiveness of other treatments, such as radiation therapy
  • In higher dosages, to overcome the resistance of cancer cells
  • To control the cancer and enhance the patient's quality of life

Types of Chemotherapy Drugs

Drugs that generally kill cancer cells are referred to as cytotoxic agents. Common types of cytotoxic chemotherapy drugs include:

Alkylating agents modify/damage cancer cell DNA and block the replication of DNA, therefore interfering with the growth of cancer cells.
Antimetabolites block the enzyme pathways needed by cancer cells to live and grow.
Antitumor antibiotics block certain enzyme and cancer cell changes, thus affecting DNA.
Mitotic inhibitors slow cancer cell division or hinder certain enzymes necessary in the cell reproduction process.
Nitrosoureas impede enzymes that repair DNA.

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Other Chemotherapy Drugs

Other drugs used in cancer therapy include:

Hormonal agents target the hormonal processes that may stimulate cancer cell growth and/or survival.
Biological agents affect natural processes that may stimulate cancer cell growth and survival.
Immunotherapy is intended to boost the recognition of cancer cells by the body's immune system, thereby helping the body to kill cancer cells.
Cellular therapy involves the use of immunologic cells that selectively destroy cancer cells.
Signal transduction inhibitors are given to disrupt abnormal processes present within cancer cells and are necessary for the growth or survival of cancer cells.
Radiopharmaceuticals are substances that have been marked with radioactive markers to selectively deliver radiation therapy to cancer cells.
Anticancer antibodies are specially engineered antibodies given with the goal of selectively targeting cancer cells for removal by the immune system.
Anticancer vaccines contain agents intended to help the immune system more readily recognize cancer cells as foreign (and thus attack them).
Anticancer viral therapies involve giving viruses to patients with the hope that the virus will selectively kill cancer cells. (This treatment is currently highly experimental.)
Gene therapies introduce DNA/genetic material into cancer cells in hopes of either restoring them to normal or killing them. (This treatment is currently highly experimental.)

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How are chemotherapy drugs given?

Chemotherapy is given in different ways depending on the cancer type and the drugs used.

Methods of giving chemotherapy drugs include:

  • Intravenously (IV) – injected into a vein
  • Intrathecally (IT) – injected into the spinal canal during a lumbar puncture
  • Intramuscular (IM) – injected into a muscle
  • Intraperitoneal (IP) – injected into the abdominal cavity
  • Intracavitary (IC) – injected into a body cavity
  • Subcutaneous (sub.q.) – injected just under the skin
  • Oral (PO) – as a pill or a liquid to be swallowed

HOW CHEMOTHERAPY WORKS?

Chemotherapy kills rapidly dividing cells. Cancer cells often multiply more rapidly than normal cells. Cancer cell are also less able to recover from the toxic effects of chemotherapy than can normal cells. Normal cells that divide rapidly, such as hair or blood cells, are also killed by chemotherapy. This results in common side effects such as hair falling out and blood counts dropping.

Chemotherapy drugs are tested against various forms of cancer in an effort to find out which drugs work against that particular type of cancer. Multiple drugs, each individually effective against a certain cancer, are often combined to try and maximize the effect against the cancer. Drugs are combined so that there are few overlapping side effects, to make the treatment more tolerable. These combinations are then tested in clinical trials to see how effective they are. If a combination works well than the current "standard" treatment, it will become the new standard therapy.

Cycles of chemotherapy may be given daily, weekly or monthly for various periods of time. Time between cycles allows the body to recover from the ill effects of chemotherapy. The traditional ways to administer therapy include injections in the vein (IV), muscle or tumor; oral treatment (pills); or topical applications. Doctors determine the best way to administer chemotherapy based on the type and stage of cancer and the medications to be given.

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RISK OF CHEMOTHERAPY

The following list is an overview of possible short- and long-term side effects that can occur as a result of chemotherapy. Keep in mind that some side effects are temporary, and others can be minimized through medication and management by your doctor.

  • Hair loss
  • Nausea and vomiting
  • Infection
  • Fatigue
  • Diarrhea
  • Nerve pain
  • Muscle pain
  • Mouth sores
  • Temporary loss of menstrual periods
  • Decrease in red blood cells and/or white blood cells
  • Early menopause/loss of fertility
  • Weight gain
  • Heart disorders
  • Leukemia
  • Sexual dysfunction
  • Urinary incontinence
  • Cognitive complaints (e.g., memory lapses, slower processing of information)
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