CHEMOTHERAPY INFORMATION

The use of chemicals to treat cancer is intruiging, especially since the biogical processes of
cancer can be understood in chemical terms. Chemotherapy is using various "agents" to poison
cancer cells, which usually divide at a quicker rate than normal cells. It was first discovered that
the Mustard Gas used in World War I destroyed quickly dividing cells in the bone marrow, and
experiments with Mustard Gas derivatives, called "alkylating agents" at Stanford University in
the 1940's layed the basis for chemotherapy to treat lymphoma (white blood cell cancer).

How is chemotherapy given?

Chemotherapy can be given in quite a few ways:

* Orally (by mouth, in pill form)

* Intravenously (IV, through a vein, either as a short infusion or continuously for one or more
days)
* As an injection or needle
* Directly into a body cavity (i.e.: the bladder, abdominal cavity)
* Intra-arterially (in special cases, such as limb perfusion treatment for melanoma)

Doctors often combine specific and non-specific chemotherapies so that they complement each
other and work together. This combination of different medications is called a "regimen". These
regimens are often given names based on first letter of the medications used in them. For
instance, CHOP, a common regimen for lymphoma, is made up of cytoxan (cyclophosphamide),
adriamycin (hydroxydoxorubicin), oncovin (vincristine), and prednisone. This combination is
given in "cycles" (blocks of time). For example, a cycle may be 21 days, and in the case of
CHOP, cytoxan, adriamycin and oncovin are given on day 1, prednisone on days 1-5, followed
by 16 days off (no treatment), for a total of 21 days, and then it starts over again with the next
cycle.

Chemotherapy is considered a "systemic" therapy, meaning that it travels throughout the body,
unlike surgery or radiation, which are "local" therapies. Doctors also use terms to describe when
chemotherapy is given in the sequence of treatments:

* Adjuvant therapy: therapy given after surgery to reduce the likelihood of the cancer
returning.
* Neo-adjuvant therapy: therapy given before surgery to shrink the tumor, allowing the
surgery to be more successful.
* Concurrent therapy: when 2 or more therapies are given together, such as chemotherapy and
radiation.

What are the side effects of chemotherapy?

The side effects of chemotherapy are caused by the medication's inability to differentiate
between tumor cells and healthy cells. Chemotherapy kills rapidly dividing cells, and these are
the cells where we see the side effects. Despite this fact, every drug is different and, while one
drug may cause hair loss, another may not, but may cause sores in the mouth. It is also important
to keep in mind that every patient is different and they will experience different side effects to
different degrees. Some commonly seen side effects are: hair loss, mouth sores, diarrhea, nausea
and/or vomiting, loss of appetite and fatigue (feeling tired).
Other Blood Cells Affected by Chemotherapy

Red blood cells serve a vital function in the body by carrying oxygen. Chemotherapy destroys
red blood cells, causing anemia (low red blood cell count).

Symptoms of anemia include:

* Fatigue, dizziness, lightheadedness

* Shortness of breath
* Difficulty staying warm
* Chest pains

Your complete blood count ( CBC ) will show a drop in the hemoglobin and hematocrit. Anemia
usually resolves after blood transfusions are given or when the blood count begins to rise again
on its own.

If any of the symptoms occur, call your doctor or visit the emergency room. You may require a
blood transfusion. This can sometimes be done on an outpatient basis. When your red blood
counts are low, try to get more rest. Pace your activities, limiting the amount of work done in a
day.

Red blood cell stimulating factors are also available which may help to prevent anemia. These
are medications given to enhance red cell production in the bone marrow. Your physician may
recommend these to reduce the risk of anemia.

Platelets are the blood cells which facilitate the clotting of blood to stop bleeding from an injury.
These clotting cells are also destroyed by chemotherapy.

Some of the first signs of a low platelet count (thrombocytopenia) are constant bleeding from a
cut and bruising easily. Some people notice bleeding from the gums after eating a meal or
brushing their teeth. A very common sign are small, pinpoint hemorrhages, known as petechiae,
inside the mouth or elsewhere on the body, such as on the arms and legs.

If nose bleeds occur, apply pressure to the nostrils while remaining in an upright position. Apply
ice to the nose, if necessary. If bleeding continues, contact your physician immediately. Bleeding
can also occur from the bladder or rectum and show up as blood in the urine or stool. If this
happens, contact your physician at once.

Avoid injury to the skin during the period when platelets are low. This means avoiding the use of
a razors (use an electric razor) or nail clippers. If injury does occur, apply pressure to any spots
which are bleeding for at least 10 minutes. Call your physician immediately if the bleeding does
not stop.

To prevent bleeding from the mouth, use a soft bristle toothbrush. Avoid the use of dental floss
until blood counts are within the normal range. Be sure dentures fit properly to cut down on
irritation to the gums. When dentures are removed, rinse with a mouthwash low in alcohol to
prevent drying out the insides of the mouth and increasing the risk of bleeding.

Bleeding can also be found in the stool when platelets are low. It is important to keep the stool
soft and to refrain from straining. Straining can rupture tiny blood vessels in the rectal area and
cause hemorrhoids. Straining also increases the pressure around the brain, increasing the risk of
another hemorrhage. You may take a stool softener and/or laxative to keep your bowels soft and
regular.

Medical Oncology is the subspecialty of treating cancer with chemotherapy, and it requires at
total training of 6 years after medical school (3 years of Internal Medicine or Pediatrics and 3
years of subspecialty training). Our In-Depth Transcript is Oncologist written, and describes the
theory behind how chemotherapy works, what a patient can expect in and goes into detail about
the side-effects of chemotherapy and how to best manage them for safety and comfort.

Readers will truly have an In-Depth understanding of how this common therapy is used today,
which will exceed what many Primary Care doctors remember about it. The field of Medical
Oncology has undergone rapid advancement in the past 2 decades, with today's new practitioners
experienced in Bone Marrow Transplant and a host of agents that have been recently developed.
Learn in detail how chemotherapy is used and what to expect of treatment by ordering this Plain
English review today.