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How Chemotherapy Works To Help You

What is chemotherapy?
Chemotherapy is a cancer treatment developed to attack and kill cancer cells. Chemotherapy is
mainly administered through capsules, tablets, injections, or intravenous infusions, based on
what each patient needs for each type and stage of cancer they have. Depending on the specific
drugs, drug doses, hospital policy, insurance coverage, and doctor recommendations,
chemotherapy may be given at home, in a doctors office, in a clinic, or in a hospital.
Chemotherapy is the most common and most effective cancer treatment today. Chemotherapy is
not without side effects, commonly hair loss, fatigue, pain, and nausea. Side effects occur
because the chemotherapy drugs cannot differentiate between normal cells and cancer cells
because they are designed to attack all dividing cells. Because cancer cells are more likely to be
dividing than normal cells, chemotherapy drugs are more likely to kill cancer cells. A better
understanding of chemotherapy could help you understand why the tradeoff between side effects
and restored health is necessary.

What is cancer?
A proper understanding of how cancer grows is necessary to Cancer cells are normal bodily cells
with the same makeup, but an abnormal gene code that causes the cells to divide more rapidly
than normal cells. The abnormal growth of these clumps of cancer cells, or tumors, damages
important tissues and organs. Different stages indicate the severity of the growth and spread of
these tumors. As shown in image 11, the general numbered stages of cancer are:

Stage 1: Cancer is relatively small and


contained within the organ it started in.
Stage 2: Cancer is either larger than it
was in stage 1 or the cancer has spread
to the lymph nodes nearest the tumor,
depending on the type of cancer.
Stage 3: Cancer is starting to spread into
the surrounding tissues and the cancer
cells are in the lymph nodes. Cancer is
larger than in stage 2.
Stage 4: Also known as secondary or
metastatic cancer, the cancer has spread
to another body organ.2

Image 1: This picture shows the different stages


of cancer.


1
"Staging." National Cancer Institute. N.p., 9 Mar. 2015. Web. 20 July 2016.
<http://www.cancer.gov/about-cancer/diagnosis-staging/staging>.
2

"Stages of Cancer." Cancer Research UK. N.p., 29 Oct. 2014. Web. 20 July 2016.
<http://www.cancerresearchuk.org/about-cancer/what-is-cancer/stages-of-cancer>.

How does cell biology apply to chemotherapy?


The cell cycle is the process of cells dividing to create another cell. This may occur to replace
damaged or older, more worn-out cells. The cell cycle is composed of the G0 phase and four
phases in which the cell is trying to divide. The G0 phase is the phase in which the cell performs
the function for which it was created. Where normal cells spend most of their time in the G0
phase, the phase in which the cells are actually functioning, cancer cells spend most of their time
in the other phases, constantly dividing and growing. Knowing this, chemotherapy drugs often
target cells that are in one of the division stages, as they are more likely to be cancer cells than
cells in the G0 phase.

Image 2: This shows how DNA unwinds during replication.

In the division portion of the cell cycle, the cell needs to replicate its DNA. DNA holds the
genetic set of instructions for each individual cell in a human body. DNA is made up of a sugar
(known as a ribose), a nucleotide base (purine or pyrimidine), and a phosphate group. During the
process of replicating DNA, the DNA must unwind while proteins make a corresponding RNA
copy of the DNA, as shown in image 23. The understanding of DNA replication allowed
scientists to develop chemotherapeutic drugs that interrupt this process. The next section
discusses this.

"The Structure and Replication of DNA." Bitesize. BBC, n.d. Web. 24 July 2016.
<http://www.bbc.co.uk/education/guides/z36mmp3/revision/3?slideshow=2>.

How do chemotherapy drugs work?


Chemotherapy drugs are placed in groups based on the ways they work, their different chemical
structures, and how they interact with other drugs. The most common groups are alkylating
agents, antimetabolites, and anti-tumor antibiotics.
Alkylating agents
These chemotherapy drugs are injected directly into the tumor. Once inside the tumor, this class
of drugs replaces the hydrogen atoms of DNA with alkyl groups, altering the structure of the
DNA chain, as seen in image 34. This process does not allow the DNA to be transcribed into
RNA, which stops these cells from producing protein. Once protein synthesis is stopped, this
triggers cell death in these tumor cells. This process occurs most often in rapidly dividing cells,
like cancer cells, but can also occur in normal cells, which makes it most prudent to inject
alkylating agents into the tumors.5

Image 3: This shows how alkylated DNA can change the


structure of DNA in several ways.

4
"Cytotoxic Chemotherapy." RnCeus. N.p., n.d. Web. 20 July 2016.
<http://www.rnceus.com/chem/Mechanism.html>.
5

"Alkylating Agents." Livertox. National Library of Medicine, 28 June 2016. Web. 20 July 2016.
<https://livertox.nlm.nih.gov/AlkylatingAgents.htm>.

Antimetabolites

Image 4: This shows how 5-FU resembles two pyrimidine bases.

Antimetabolites attack cells when they are replicating DNA. The most common types of
antimetabolites are purine antagonists and pyrimidine antagonists. Both of these antimetabolites
work in essentially the same way. As discussed in the cell cycle section previously, cells need to
create copies of their DNA for the new cells. During this process, basic building blocks of DNA,
purines and pyrimidines, need to be readily available.
After entering the bloodstream of the patient, taken orally or through injection, antimetabolites
seek out cells in the S phase of the cell cycle. These antimetabolites intermix with purines and
pyrimidines during this process. As seen in image 46, their chemical structure closely resembles
these building blocks. After one of these is mistaken for a building block of DNA, it bonds with
the other building blocks of DNA, where the purines or pyrimidines should be. Once this bond is
completed, the synthesis of DNA is stopped, and the cell attempting to divide dies.7


6
Heron, Prof. J. F. "5-Fluorouracil." OncoProf. N.p., 17 June 2009. Web. 20 July 2016.
<http://www.oncoprof.net/Generale2000/g09_Chimiotherapie/Complements/g09gb_comp11.html>.
7

"Pyrimidine Antagonists." CancerQuest. Emory University, 2016. Web. 20 July 2016.


<http://www.cancerquest.org/pyrimidine-antimetabolites.html>.

Anti-tumor antibiotics
Anthracyclines are the most common form of anti-tumor antibiotics. As DNA strands replicate,
they must unwind to create corresponding strands of RNA. Specific proteins bind to these
unwound strands to generate corresponding pieces of RNA. Anthracyclines enter the
bloodstream and find DNA in this process. These anthracyclines bind to the protein binding
spots. These antibiotics block proteins that would help with the DNA replication process.
Without being able to make these corresponding RNA strands, these DNA strands cannot
replicate, and the cells die.8

Why understand the processes behind chemotherapy?


Chemotherapy attacks and kills cancer cells by targeting rapidly dividing cells, as cancer often
grows very rapidly. The most common forms of chemotherapy are alkylating agents, which
replace the hydrogen atoms of DNA strands, antimetabolites, which replace purines and
pyrimidine of DNA strands, and anti-tumor antibiotics, which block RNA-forming proteins.
Each of these methods of chemotherapy affects patients with different types of cancer
differently. Even with the possible side effects of hair loss, pain, fatigue, and nausea, the chance
of surviving cancer while undergoing chemotherapy is greatly increased in the long run.
Understanding these processes will give you a better idea of why side effects may occur and why
the side effects may be a necessary tradeoff to preserve your health.


8
Lah, Katarina. "Anthracyclines - Mechanism of Action." Toxipedia. N.p., 9 May 2011. Web. 20 July
2016. <http://www.toxipedia.org/display/toxipedia/Anthracyclines+-+Mechanism+of+Action>.