How does chemotherapy cancer treatment work?
Chemotherapy drugs kill rapidly dividing cells in a variety of ways depending on how the cancer grows, the types of cells it affects, and the stage it has reached. Some drugs work by damaging the cells' DNA. Others prevent cells from dividing. Still others disrupt cell metabolism or other functions.
What kind of chemotherapy will I have?
Your chemotherapy treatment will be decided upon based on numerous considerations, including:
- Your diagnosis
- The stage of your cancer
- The expected behavior of the cancer
- Where the cancer originated
- Your age
- Other medical problems you may have
- Potential side effects
How is chemotherapy given?
Chemotherapy can be given in several ways, from a pill or an IV line to an injection into a vein or directly into the spinal fluid. Some kinds of chemotherapy are administered at a hospital or outpatient facility, while others can be given at home. For patients undergoing IV treatment, your doctor may recommend implanting a venous access device (VAD) to make it easier for both the patient and doctor to deliver the medicine at each appointment.
How often will I have chemotherapy treatments?
A course of chemotherapy usually comprises several cycles of treatment and rest. Your specific schedule will depend on the type of cancer and the drug combination being used. An individual treatment session may take a few minutes or a few hours. The treatment cycle may last anywhere from one day to one month or more, with treatments given daily or weekly. There are usually four to six treatment cycles.
Why do side effects arise, and how can they affect treatment?
Side effects arise because chemotherapy drugs cannot differentiate between cancer cells and rapidly dividing healthy cells. The drugs often attack normal tissues or organs, causing inconvenience, discomfort and even death. Side effects may be temporary or chronic, mild or life-threatening. If side effects prevent the administration of chemotherapy on schedule at the proper dosage, they can reduce the effectiveness of the treatment.
What side effects can I expect?
The most common side effects of chemotherapy are low blood counts (anemia), nausea, vomiting, hair loss and fatigue. Low white blood cell count (neutropenia) is one of the most serious potential side effects of chemotherapy. It can lead to severe infections or treatment interruptions.
Your doctor will discuss with you the side effects you might expect from your particular course of chemotherapy.
Will I feel sick?
Most patients will experience some degree of nausea and vomiting after a chemotherapy treatment. Anti-nausea/anti-emetic medications during or after a treatment session can help.
Will I lose my hair?
Many chemotherapy drugs cause temporary hair loss. Depending on the type and dosage of the drug, this can be anywhere from a slight thinning to complete baldness that affects not only the scalp but also the eyebrows, eyelashes, armpits, legs and pubic area. Hair loss typically begins about two to three weeks after the start of treatment and reverses about two to three weeks after treatment is completed. The hair that regrows may be a different color or texture than before.
Many patients prepare for hair loss by cutting the hair, purchasing a wig, or trying hats and scarves before treatment starts. Insurance may cover the cost of a hairpiece. During chemotherapy, patients should protect the scalp with sunblock. As hair begins to grow back, it is important to avoid strong chemicals, bleach or coloring agents.
What tests will be performed?
The specific tests you need will be determined by your doctor. In general, blood tests are done on the day of treatment or up to a week beforehand. These include a complete blood count (CBC), chemistry profile and any necessary cancer markers. The CBC is repeated one to two weeks after treatment.
Monitoring the CBC is important because chemotherapy drugs often attack red blood cells, white blood cells and platelets since these cells divide rapidly like cancer cells. Tracking red blood cell (RBC), white blood cell (WBC), or platelet (PLT) counts helps your doctor assess how toxic the chemotherapy is to your body, estimate your risk of complications, and plan your therapy in the future.
Symptoms of reduced blood counts should be reported to your doctor immediately. These include:
- Temperature of over 100.5º F
- Congestion or a cold
- Rash or blisters
- Easily bruised skin
- Signs of bleeding
- Infected cut
- Itching or burning in the genital area
- Weakness, fatigue, or shortness of breath
What is a bone marrow biopsy and aspiration?
Bone marrow is spongy tissue found inside some of your large bones, such as your pelvis. They contain stem cells that turn into white blood cells, red blood cells and platelets. A biopsy is the insertion of a needle to remove a small piece of tissue and blood from the bone marrow.
A bone marrow examination offers detailed information about the condition of your blood cells. Your bone marrow is the central place of where blood cells are formed, so an examination gives detailed information of the types, amount and condition of your blood cells. It specifically can be studied for the presence of:
- diseases involving the formation of blood cells
- cancer cells
- chromosome irregularitie
- iron storage
- monitor the effects of therapy such as chemo
How do I prepare for the procedure?
There is no preparation needed, as there are no restrictions. Take your usual medications. You may eat before the test
If you have an allergy to Lidocaine, let your Physician or Nurse Practitioner know
What can I expect during the procedure?
The bone marrow exam typically takes about 15-20 minutes
You will need to lie on your stomach, as the sample will be taken from your pelvis bone
Your Physician or Nurse Practitioner will talk to you throughout the procedure
When the Lidocaine is injected, you will feel a stinging sensation, then numbness to the area
A biopsy needle will then be inserted into the bone marrow, and a syringe will be used to remove the liquid portion from the bone marrow. This will cause a sharp, brief pain sensation that will quickly pass
A biopsy of the bone marrow will then be taken
After the needle is removed, pressure will be applied for 5-10 minutes or until bleeding stops
What can I expect after the procedure?
- You may resume normal activity
- Keep the pressure bandage on for at least 24 hours
- Do not get the dressing wet for 24 hours, which means no showering or bathing
- A small amount of bleeding is normal
- Avoid heavy lifting or exercise for the next 24 hours
- You may remove the dressing the next day
- You may take Tylenol for the soreness
Call the office for any swelling at the biopsy site, development of fever >100.4 F, increasing redness or drainage at the biopsy site, or worsening pain or discomfort
Are there risk with a bone marrow biopsy?
Risks associated Bone marrow exams do not usually pose any big risks. Complications are rare, however, as with any procedure; risks do exist that you should be aware of
Excessive bleeding, especially in those with a low platelet count or on a blood thinner
- Breaking of needles within the bone, causing infection or bleeding
- Infection, especially in those with compromised immune systems
- Long lasting pain to biopsy site
What other treatments might I receive?
Chemotherapy may be combined with radiation therapy, surgery, targeted therapy, complementary procedures or other treatment modalities. It is commonly recommended to shrink a tumor before operating on it ("neoadjuvant chemotherapy"), or to ensure that all cancer cells have been eradicated after surgery ("adjuvant chemotherapy").
What are colony stimulating factors?
Cancer treatments can compromise your immune system. This is because chemotherapy, which targets and destroys fast-growing cancerous cells, also kills healthy cells. White blood cells (WBCs), which are made in your bone marrow, are responsible for fighting infections by initiating an immune response. Because they are also fast growing, WBCs may also be affected by chemotherapy.
If the number of WBC's falls to low levels, your chance of getting an infection increases. We prescribe a synthetic form of a colony-stimulating factor (CSF) to help your body make more WBC's, which in turn can help your immune system recover. A CSF is a type of protein, known as growth factors that stimulate your bone marrow to increase the number and function of your WBC's. This affects important aspects of your immune system that can enhance your recovery. Your physician or nurse practitioner will determine when you should start and stop treatment. It is generally administered as a subcutaneous injection to the fatty party of your arm.
Some patients may experience side effects, most of which are mild to moderate. Some common side effects include bone pain, slight temperature elevations (usually less than 100.5 F) for a short period of time after the injection; and swelling, redness and/or discomfort at the injection site. These are normal and reduce over time as your body gets used to the medication.
Side effects can be reduced by taking Tylenol/Motrin and Benadryl half an hour to an hour prior to the injection, then applying ice to the site one minute before the injection. Avoid rubbing the skin before or after injection. You may also apply ice after the injection.
Some serious but rare side effects or symptoms may occur. Call you physician immediately if you have the following side effects:
Signs of infection, which can include chills, sore throat, congestion, inflammation (warmth or redness) of an area of the body, or development of a fever, especially if the fever is greater than 100.5 F and continues over 24 hrs.
Have trouble breathing or experience wheezing, fainting, skin rash, hives, or feel you are having an allergic reaction of any kind.
Experience sudden weight gain or other signs of fluid build-up such as swollen legs or feet and shortness of breath.
Develop chest pain, chest discomfort, or a rapid or irregular pulse.
Develop any other unexpected symptoms, or unusual side effects.
What is a prognosis?
People facing cancer are naturally concerned about what the future holds. A prognosis gives an idea of the likely course and outcome of a disease—that is, the chance that a patient will recover or have a recurrence (return of the cancer).
What factors affect a patient’s prognosis?
Many factors affect a person’s prognosis. Some of the most important are the type and location of the cancer, the stage of the disease (the extent to which the cancer has metastasized or spread), and its grade (how abnormal the cancer cells look and how quickly the cancer is likely to grow and spread). In addition, for hematologic cancers (cancers of the blodd or bone marrow) such as leukemias and lymphomas, the presence of chromosomal abnormalities and abnormalities in the patient’s complete blood count (CBC) can affect a person’s prognosis. Other factors that may also affect the prognosis include the person’s age, general health, and response to treatment.
How do statistics contribute to predicting a patient’s prognosis?
When doctors discuss a person’s prognosis, they carefully consider all factors that could affect that person’s disease and treatment and then try to predict what might happen. The doctor bases the prognosis on information researchers have collected over many years about hundreds or even thousands of people with cancer.
When possible, the doctor uses statistics based on groups of people whose situations are most similar to that of an individual patient. Several types of statistics might be used to discuss prognosis. Some commonly used statistics are described below:
- Survival rate indicates the percentage of people with a certain type and stage of cancer who survive for a specific period of time after their diagnosis. For example, 55 out of 100 people with a certain type of cancer will live for at least 5 years, and the other 45 people will not. Survival statistics may further categorize the people who die by cause of death because some will die from unrelated causes. For example, of the 45 people mentioned above, 35 may die from their cancer and 10 may die from other causes.
- The 5-year survival rate indicates the percentage of people who are alive 5 years after their cancer diagnosis, whether they have few or no signs or symptoms of cancer, are free of disease, or are having treatment. Five-year survival rates are used as a standard way of discussing prognosis as well as a way to compare the value of one treatment with another. It does not mean that a patient can expect to live for only 5 years after treatment or that there are no cures for cancer.
- Disease-free or recurrence-free survival rates represent how long one survives free of the disease, rather than until death.
Because survival rates are based on large groups of people, they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and treatment and responses to treatment vary greatly.
The doctor may speak of a favorable prognosis if the cancer is likely to respond well to treatment. The prognosis may be unfavorable if the cancer is likely to be difficult to control. It is important to keep in mind, however, that a prognosis is only a prediction. Again, doctors cannot be absolutely certain about the outcome for a particular patient.
Is it helpful to know the prognosis?
Cancer patients and their loved ones face many unknowns. Understanding cancer and what to expect can help patients and their loved ones plan treatment, think about lifestyle changes, and make decisions about their quality of life and finances. Many people with cancer want to know their prognosis. They find it easier to cope when they know the statistics. They may ask their doctor or search for statistics such as survival rates on their own. Other people find statistical information confusing and frightening, and they think it is too impersonal to be of use to them.
The doctor who is most familiar with a patient’s situation is in the best position to discuss the prognosis and to explain what the statistics may mean for that person. At the same time, it is important to understand that even the doctor cannot tell exactly what to expect. In fact, a person’s prognosis may change if the cancer progresses or if treatment is successful.
Seeking information about the prognosis is a personal decision. It is up to each patient to decide how much information he or she wants and how to deal with it.
What is the prognosis if a patient decides not to have treatment?
Because everyone’s situation is different, this question can be difficult to answer. Prognostic statistics often come from studies comparing new treatments with best available treatments, not with “no treatment.” Therefore, it is not always easy for doctors to accurately estimate prognosis for patients who decide not to have treatment. However, as mentioned above, the doctor who is most familiar with a patient’s situation is in the best position to discuss prognosis, taking into account individual characteristics of the patient that can affect the overall situation.
There are many reasons patients decide not to have treatment. One reason may be concern about side effects related to treatment. Patients should discuss this concern with their doctor. Many medications are available to prevent or control the side effects caused by cancer therapies. Another reason patients might decide not to have treatment is that their type of cancer does not have a good prognosis even when treated. In these cases, patients may want to explore clinical trials (research studies). A clinical trial may offer access to new drugs that may be more promising than the standard treatments available.
