Chemotherapy is a widely used treatment for cancer. The term chemotherapy refers to the drugs that prevent cancer cells from dividing and growing. Normally our cells grow and die in a controlled way. Cancer cells keep growing without control. Chemotherapy works by killing the cancer cells, stopping them from spreading, or slowing their growth. However, it can also harm healthy cells, which causes side effects.

Quick facts on chemotherapy :
Here are some key points about chemotherapy.
Cost of chemotherapy starts from USD500 per cycle
• Chemotherapy is used in the treatment of cancer.
• It can prevent disease progress or bring about remission by killing the cells as they divide.
• There may be serious adverse effects, and patients should discuss these with their physician.
• Depending on the individual and the stage of the cancer, chemotherapy can bring eliminate cancer cells or bring about long-term remission of symptoms.

What does chemotherapy do?
It depends on the kind of cancer you have and how far along it is.
Cure: In some cases, the treatment can destroy cancer cells to the point that your doctor can no longer detect them in your body. After that, the best outcome is that they never grow back again, but that doesn’t always happen.
Control: In some cases, it may only be able to keep cancer from spreading to other parts of your body or slow the growth of cancer tumors.
Ease symptoms: In some cases, chemotherapy can’t cure or control the spread of cancer and is simply used to shrink tumors that cause pain or pressure. These tumors often continue to grow back.

How is chemotherapy used?
Sometimes, it treats cancer by itself, but more often it’s used in combination with:
• Surgery: A doctor removes cancerous tumors or tissue, or organs contaminated with cancerous cells.
• Radiation therapy: A doctor uses invisible radioactive particles to kill cancer cells. It may be delivered by a special machine that bombards parts of your body from the outside, or by putting radioactive material on, near, and even inside your body.
• Biological therapy: Living material in the form of bacteria, vaccines, or antibodies are carefully introduced to kill cancer cells.
Chemotherapy may be used to:
• Shrink a tumor before radiation therapy or surgery -- called neoadjuvant chemotherapy
• Destroy any remaining cancer cells after surgery or radiation therapy -- called adjuvant chemotherapy
• Make other therapies (biological or radiation) more effective
• Destroy cancer cells that return or spread to other parts of your body

How is chemotherapy given?
• Injection: The drugs are delivered with a shot directly into muscle in your hip, thigh, or arm, or in the fatty part of your arm, leg, or stomach, just beneath the skin.
• Intra-arterial (IA): The drugs go directly into the artery that is feeding the cancer, through a needle, or soft, thin tube (catheter).
• Intraperitoneal (IP): The drugs are delivered to the peritoneal cavity, which contains organs such as your liver, intestines, stomach, and ovaries. It is done during surgery or through a tube with a special port that is put in by your doctor.
• Intravenous (IV): The chemotherapy goes directly into a vein.
• Topical: You rub the drugs in a cream form onto your skin.
• Oral: You swallow a pill or liquid that has the drugs.

Determining which chemotherapy drugs to use
In some cases, the best choice of doses and schedules for each chemo drug is clear, and most doctors would recommend the same treatment. In other cases, less may be known about the single best way to treat people with certain types and stages of cancer. In these cases, different doctors might choose different drug combinations with different schedules.
Factors to consider when choosing which drugs to use include:
• The type of cancer
• The stage of the cancer (how far it has spread)
• The patient’s age
• The patient’s overall health
• Other serious health problems (such as heart, liver, or kidney diseases)
• Types of cancer treatments given in the past
Doctors take these factors into account, along with information published in medical journals and textbooks describing the outcomes of similar patients treated with chemo.

There are different types of chemotherapy drug and different ways of receiving them.
Four major categories are:
• Alkylating agents, which work directly on the DNA and kill the cells at different stages of the cell life cycle. Examples include chlorambucil, cyclophosphamide, thiotepa, and busulfan.
• Antimetabolites, which mimic proteins that the cells need to survive. When the cells consume them, they offer no benefit, and the cells starve. Examples include purine antagonists, pyrimidine antagonists, and folate antagonists.
• Plant alkaloids, which block the ability of the cells to grow and divide. Examples include actinomycin D, doxorubicin, and mitomycin.
• Antitumor antibiotics, which bind with DNA and stop RNA from synthesizing, so that the cells cannot reproduce. These are different from the antibiotics we use for an infection. Examples include doxorubicin, mitoxantrone, and bleomycin.
The physician will recommend a suitable option, depending on what type of cancer a person has, how advanced it is, whether they have had chemotherapy before, and whether they have any other health issues, such as diabetes.

Determining chemotherapy doses
Most chemotherapy (chemo) drugs are strong medicines that have a fairly narrow range for dose safety and effectiveness. Taking too little of a drug will not treat the cancer well and taking too much may cause life-threatening side effects. For this reason, doctors must calculate chemo doses very precisely.
Depending on the drug(s) to be given, there are different ways to determine chemo doses. Most chemo drugs are measured in milligrams (mg).
The overall dose may be based on a person’s body weight in kilograms (1 kilogram is 2.2 pounds). For instance, if the standard dose of a drug is 10 milligrams per kilogram (10 mg/kg), a person weighing 110 pounds (50 kilograms) would get 500 mg (10 mg/kg x 50 kg).
Some chemo doses are determined based on body surface area (BSA), which are calculated using height and weight. BSA is expressed in meters squared (m2).
Because children’s bodies process drugs differently, dosages for children and adults differ, even after BSA is taken into account. Children may have different levels of sensitivity to the drugs, too. For the same reasons, dosages of some drugs may also be adjusted for people who:
• Are elderly
• Have poor nutritional status
• Are obese
• Have already taken or are currently taking other medicines
• Have already had or are currently getting radiation therapy
• Have low blood cell counts
• Have liver or kidney diseases

Determining a chemotherapy schedule (cycle)
Chemotherapy is commonly given at regular intervals called cycles. A cycle may be a dose of one or more drugs followed by several days or weeks without treatment. This gives normal cells time to recover from drug side effects. Sometimes, doses may be given a certain number of days in a row, or every other day for several days, followed by a period of rest. Some drugs work best when given continuously over a set number of days.
Each drug is given on a schedule that makes the most of its anti-cancer actions and minimizes side effects. If more than one drug is used, the treatment plan will say how often and exactly when each drug should be given. The number of cycles given may be decided before treatment starts, based on the type and stage of cancer. In some cases, the number is flexible, and will take into account how the treatment affects the cancer and the person’s overall health.

What to expect
Chemotherapy is an invasive treatment that can have severe adverse effects. This is because the drugs often target not only cancerous cells but also healthy cells.
The adverse effects can be worrying, but given early, chemotherapy can in some cases achieve a complete cure, making the side effects bearable for many patients.
It is important that patients know what to expect before starting treatment.

Side effects
Chemotherapy often involves severe adverse effects, but recent scientific advances mean that many of these are far more manageable than in the past.
Depending on the type and extent of the treatment and other individual factors, adverse effects can range from mild to severe. Some people will have no adverse effects.
The impact of treatment on a person's daily life will depend on the extent of the symptoms.
Here are some of the adverse effects that may occur.

1: Nausea and vomiting
Nausea and vomiting affect over 70 percent of patients. Anti-emetic drugs may help. These should be taken even when symptoms have gone, to prevent them from returning.
Ginger or ginger supplements may help increase the effectiveness of anti-emetics.

2: Alopecia, or hair loss
Hair may start to fall out or become thin or brittle a few weeks after treatment begins with some types of chemotherapy. It can affect any part of the body.
Hair loss has no physical health consequences, but it may cause distress. A doctor may put the patient in touch with a counselor or offer advice about obtaining a wig or other suitable covering.
Using a cold cap can keep the scalp cool while a dose is being administered, and this may prevent or reduce hair loss. Patients who need the medication to reach their scalp, however, cannot use a cold cap. This includes patients with leukemia.
Hair normally grows back soon after treatment is finished. Nails, too, can become flaky and brittle. The skin may become dry and sore and oversensitive to sunlight. Patients should stay out of the sun during peak times, use sun blocks, and wear clothes that provide maximum protection.

3: Fatigue
Fatigue is a common side effect. It may be present most of the time or only after certain activities. Patients should get plenty of rest and avoid tasks that are overtiring.
Severe tiredness should be reported to the doctor, as a significant drop in red blood cells could be leading to anemia.

4: Hearing impairment
The toxic effects of chemotherapy can lead to temporary or permanent hearing loss in some patients.

5: Low white blood cell count and susceptibility to infections
When receiving chemotherapy, the immune system will be weakened because the white blood cell count will go down.
This is known as neutropenia. White blood cells form part of our immune system, and they fight infection. This can make patients more susceptible to infections. Antibiotics may help reduce the risk of developing infections. Patients and their carers should also be careful to follow regular precautions.
These include:
• Personal hygiene: Regular hand washing with warm water and soap, bathing or showering at least once a day, changing clothing, bedclothes, and bathroom towels regularly.
• Preparing food: Follow food hygiene practices, including keeping meat and vegetable separate, thoroughly cooking animal produce, washing all vegetables and keeping surfaces, cutlery, and crockery clean.
• Infected people: Stay away from anyone with signs of illness or infection.
• Skin wounds: carefully dress any cuts or grazes and cover them with a sterile dressing, to prevent bacteria from entering the skin.
Chemotherapy patients who develop an infection need immediate treatment. This may mean being hospitalized and receiving intravenous antibiotics.

6: Low blood platelet count and bleeding problems
Also known as thrombocytopenia, this can lead to blood clotting problems. Platelets are a type of blood cell that helps the blood to coagulate, or clot. A low platelet count can lead to bruises or bleeds, for example, nosebleeds and bleeding gums. The blood flow from a minor cut may be hard to stop.
If the platelet count falls too low, the person will need a blood transfusion.
To reduce the risk of bleeding, patients should:
• Use an electric razor, or avoid shaving
• Use a soft toothbrush
• Take care when using sharp objects, such as kitchen utensils or gardening tools. Gloves can help prevent injuries when gardening.

7: Low red blood-cell count and anemia
Red blood cells carry oxygen to all the tissues in the body. A low level of red blood cells will lead to anemia. Symptoms include tiredness, shortness of breath, and heart palpitations.
A person with severe anemia may need an urgent blood transfusion. Erythropoietin (EPO) is a drug that makes the body produce more red blood cells. Good food sources of iron include dark green leafy vegetables, beans, meat, nuts, prunes, raisins, and apricots.

8: Mucositis
Mucositis, or inflammation of the mucous membrane, can affect any part of the digestive system, including the mouth, esophagus, stomach, intestines, the rectum, and the anus.
Oral mucositis can lead to symptoms in their mouth, often starting 7 to 10 days after treatment begins. There may be pain as if the mouth has been burned.
Ulcers can appear on the lining of the mouth, the tongue, and around the lips. Eat, drink, and talking can be painful. If bleeding occurs, there is a risk of infection. The severity of symptoms is linked to the strength of the chemotherapy dose. Caphosol is often prescribed for mucositis. Newer drugs can now reduce the risk of mucositis.
Symptoms disappear a few weeks after finishing treatment.

9: Loss of appetite
Either chemotherapy or the cancer itself can affect the body's metabolism, leading to a loss of appetite and weight loss until the cancer goes into remission or until treatment is finished.
Severity depends on the type of cancer and chemotherapy treatment. Taking smaller, more frequent meals may help to keep up a supply of nourishment. Drinking liquids through a straw can help maintain fluid intake.
Patients who are unable to consume food or liquid may need to be hospitalized and fed through a nasogastric tube, which goes directly to the stomach through the nose.

10: Pregnancy and fertility
Many patients temporarily lose interest in sex during chemotherapy. Libido usually returns after treatment is completed.
Depending on the type of medication administered, chemotherapy may also reduce fertility in men and women. Fertility often, but not always, returns after treatment is over.
Patients who may wish to have children in the future may consider freezing sperm or embryos for later use. Many chemotherapy drugs may cause congenital disabilities, so it is important to avoid becoming pregnant during treatment.
A barrier method of birth control should be used during treatment and for at least a year after. Oral birth control methods may interfere with chemotherapy. If a woman is pregnant or becomes pregnant at the time of treatment, it is essential to tell the doctor at once.

11: Bowel problems
Diarrhea can result when damaged cells are suddenly expelled from the body. Constipation may also occur. These symptoms often begin a few days after treatment starts.

12: Cognitive and mental health problems
Up to 75 percent of patients report problems with attention, thinking, and short-term memory during chemotherapy. For up to 35 percent, this may persist for months or years after treatment. It can also affect the ability to reason, to organize, and to multitask.
Mood swings and depression can also develop, whether related to the treatment itself or fears for the future.

Getting support during treatment
Talking to a doctor or counselor or joining a local or online support group may help. It is important to keep in close contact with a doctor during any cancer treatment, as they can help deal with adverse effects. Patients should not make sudden changes to their lifestyle without first consulting their physician.
Chemotherapy can be expensive. It is important to talk to the doctor to find out what your options are, and to discuss with your health insurance provider which services are covered.
Some people will be able to work during chemotherapy, but others will need sick leave. Some employers are legally obliged to adapt the work schedule for patients undergoing this type of treatment.

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