What Is Chemotherapy?

Chemotherapy is the use of drugs to treat cancer. The drugs often are called "anticancer" drugs.

How Does Chemotherapy Work?

Normal cells grow and die in a controlled way. But cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying at one or more points in their life cycle. Because some drugs work better together than alone, chemotherapy often may consist of more than one drug. This is called combination chemotherapy.

In addition to chemotherapy, other methods sometimes are used to treat cancer. For example, your doctor may recommend that you have surgery to remove a tumor or to relieve certain symptoms that may be caused by your cancer. You also may receive radiation therapy to treat your cancer or its symptoms. Sometimes, as described below, your doctor may suggest a combination of chemotherapy, surgery, and/or radiation therapy.

Other types of drugs may be used to treat your cancer. These may include certain drugs that can block the effect of hormones. Doctors also may use biological therapy to boost the body's natural defenses against cancer.

What Can Chemotherapy Achieve?

Depending on the type of cancer and its stage of development, chemotherapy can be used:

• To cure cancer.
• To keep the cancer from spreading.
• To slow the cancer's growth.
• To kill cancer cells that may have spread to other parts of the body from the original tumor. To relieve symptoms that may be caused by the cancer.

Chemotherapy also can help people live more comfortably; this is known as palliative care.

Will Chemotherapy Be My Only Treatment for Cancer?

Sometimes chemotherapy is the only therapy a patient receives. More often, however, chemotherapy is used in addition to surgery and/or radiation therapy; when it is used for this purpose, it is called adjuvant therapy. There are several reasons why chemotherapy may be given in addition to other treatment methods. For instance, chemotherapy may be used to shrink a tumor before surgery or radiation therapy. It also may be used after surgery and/or radiation therapy to help destroy any cancer cells that may remain.

Which Drugs Will I Get?

Your doctor decides which drug or drugs will work best for you. The decision depends on what kind of cancer you have, where it is, the extent of its growth, how it is affecting your normal body functions, and your general health.

Your doctor also may suggest that you join a clinical trial for chemotherapy, or you may want to bring up this option with your doctor. Clinical trials are carefully designed research studies that test promising new cancer treatments. Patients who take part in research may be the first to benefit from improved treatment methods. These patients also can make an important contribution to medical care because the results of the studies may help many people. Patients participate in clinical trials only if they choose to and are free to withdraw at any time.

To learn more about clinical trials, call the National Cancer Institute's Cancer Information Service and ask for the booklet What Are Clinical Trials All About? You also may want to ask about the videotape "Patient to Patient: Cancer Clinical Trials and You." This videotape can put to rest fears you may have about taking part in clinical trials. The Cancer Information Service can be reached by dialing 1-800-4-CANCER (1-800-422-6237).

Where Will I Get Chemotherapy?

You may get your chemotherapy at home, in your doctor's office, in a clinic, in your hospital's outpatient department, or in a hospital. The choice of where you get chemotherapy depends on which drug or drugs you are getting, your hospital's policies, and your doctor's preferences. When you first start chemotherapy, you may need to stay at the hospital for a short time so that your doctor can watch the medicine's effects closely and make any adjustments that are needed.

How Often Will I Get Chemotherapy, and How Long Will I Get It?

How often and how long you get chemotherapy depends on the kind of cancer you have, the goals of the treatment, the drugs that are used, and how your body responds to them. You may get chemotherapy every day, every week, or every month. Chemotherapy is often given in on-and-off cycles that include rest periods so that your body has a chance to build healthy new cells and regain its strength. Your doctor should be able to estimate how long you will be getting chemotherapy.

It is very important to stick with whatever schedule your doctor prescribes. Otherwise, the anti cancer drugs might not have their desired effect. If you miss a treatment session or skip a dose of medication, contact your doctor for instructions about what to do.

Sometimes, your doctor may delay a treatment based on the results of certain blood tests. (See Fatigue/Anemia.) Your doctor will let you know what to do during this time and when it's okay to start your treatment sessions again.

How Will I Get Chemotherapy?

Depending on the type of cancer you have and the drug or drugs you are getting, your chemotherapy may be given in one or more of the following ways:

• Into a vein (intravenously, or IV). You will get the drug through a thin needle inserted into a vein, usually on your hand or lower arm. Another way to get IV chemotherapy is by means of a catheter, a thin tube that is placed into a large vein in your body and remains there as long as it is needed. This type of catheter is known as a central venous catheter. Sometimes, a central venous catheter is attached to a port, a small plastic or metal container placed surgically under the skin.

• By mouth (orally, or PO) in pill, capsule, or liquid form. You will swallow the drug, just as you do many other medications.

• Into a muscle (intramuscularly, or IM), under the skin (subcutaneously, or SQ or SC), or directly into a cancerous area in the skin (intralesionally, or IL). You will get an injection with a needle.

• Topically. The medication will be applied onto the skin.

Chemotherapy also may be delivered to specific areas of the body using a catheter (or a catheter plus a port). Catheters may be placed directly into the spinal fluid, abdominal cavity, bladder, or liver. Your doctor or nurse may use specific terms when talking about certain types of catheters. For example, an intrathecal (IT) catheter is used to deliver drugs into the spinal fluid. Intracavitary (IC) catheters can be placed in the abdomen, pelvis, or chest.

Two kinds of pumps -- external and internal -- may be used to control the rate of delivery of chemotherapy. External pumps remain outside the body. Some are portable and allow a person to move around while the pump is in use. Other external pumps are not portable and may restrict activity. Internal pumps are placed surgically inside the body, usually right under the skin. They contain a small reservoir (storage area) that delivers the drugs into the catheter. Internal pumps allow people to go about most of their daily activities.

Does Chemotherapy Hurt?

Getting chemotherapy by mouth, on the skin, or by injection generally feels the same as taking other medications by these methods. Having an IV started usually feels like drawing blood for a blood test. Some people feel a coolness or other unusual sensation in the area of the injection when the IV is started. Report such feelings to your doctor or nurse. Be sure that you also report any pain, burning, or discomfort that occurs during or after an IV treatment.

Many people have little or no trouble having the IV needle in their hand or lower arm. However, if a person has a hard time for any reason, or if it be comes difficult to insert the needle into a vein for each treatment, it may be possible to use a central venous catheter or port. This avoids repeated insertion of the needle into the vein.

Central venous catheters and ports cause no pain or discomfort if they are properly placed and cared for, although a person usually is aware that they are there. It is important to report any pain or discomfort with a catheter or port to your doctor or nurse.

Can I Take Other Medicines While I Am Getting Chemotherapy?

Some medicines may interfere with the effects of your chemotherapy. That is why you should take a list of all your medications to your doctor before you start chemotherapy. Your list should include the name of each drug, how often you take it, the reason you take it, and the dosage. Remember to include over-the-counter drugs such as laxatives, cold pills, pain relievers, and vitamins. Your doctor will tell you if you should stop taking any of these medications before you start chemotherapy. After your treatments begin, be sure to check with your doctor before taking any new medicines or stopping the ones you already are taking.

Will I Be Able to Work During Chemotherapy?

Most people are able to continue working while they are being treated with anticancer drugs. It may be possible to schedule your treatments late in the day or right before the weekend, so they interfere with work as little as possible.

If your chemotherapy makes you very tired, you might want to think about adjusting your work schedule for a while. Speak with your employer about your needs and wishes at this time. You may be able to agree on a part-time schedule, or perhaps you can do some of your work at home.

Under Federal and state laws, some employers may be required to allow you to work a flexible schedule to meet your treatment needs. To find out about your on-the-job protections, check with your local American Cancer Society, a social worker, or your congressional or state representative. The National Cancer Institute's publication Facing Forward: A Guide for Cancer Survivors , also has information on work-related concerns.

How Will I Know if My Chemotherapy Is Working?

Your doctor and nurse will use several methods to measure how well your treatments are working. You will have frequent physical exams, blood tests, scans, and x-rays. Don't hesitate to ask the doctor about the test results and what they show about your progress.

While tests and exams can tell a lot about how chemotherapy is working, side effects tell very little. (Side effects -- such as nausea or hair loss -- occur because chemotherapy harms some normal cells as well as cancer cells.) Sometimes people think that if they don't have side effects, the drugs aren't working, or that, if they do have side effects, the drugs are working well. But side effects vary so much from person to person, and from drug to drug, that having them or not having them usually isn't a sign of whether the treatment is effective.

If you do have side effects, there is a lot you can do to help relieve them. The next section of this document describes some of the most common side effects of chemotherapy and gives you some hints for coping with them.

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