Chemotherapy and Medical Oncology

How does chemotherapy work?

Chemotherapy targets specific parts of the cancer cell growth cycle, which prevents the cells from growing or multiplying. We use chemotherapy in many ways:

• To cure cancer
• To slow cancer’s growth
• To relieve cancer symptoms

Sometimes, chemotherapy is enough on its own. Often, we use it in combination with another therapy, such as radiation or surgery, to help shrink or destroy cancer cells. The chemotherapy drug your doctor recommends will be based on the type of cancer you have.

How is chemotherapy given?

Chemotherapy can be given to the patient in several ways: through an IV or injection, by mouth, or as a topical medication applied to the skin. The stage and type of cancer dictate which method we use to give chemotherapy. Getting chemotherapy usually doesn’t hurt. Some IV drugs may cause a temporary burning or cold sensation. The doctor or nurse will warn you before treatment if this is expected.

Patients can take chemotherapy at home, at the doctor's office, or in the hospital. The location depends on the drugs we recommend and your health insurance requirements.

What are the possible side effects of chemotherapy?

Everyone responds to chemotherapy differently. Side effects depend on the drug itself, the dosage, and personal tolerance of the medication. Possible side effects include:

• Chemo brain (mental fogginess or fuzziness)
• Diarrhea
• Fatigue
• Hair loss
• Nausea
• Weakened immune system (low white blood cell count)

Because nausea is a common side effect, the doctor may prescribe anti-nausea medications during chemotherapy. We also test each patient’s white blood cell count before we begin chemotherapy. If your count is low, we’ll give you medications to boost your immune system and ward off additional illness.

How long does chemotherapy last?

Chemotherapy treatment can range from several months to years, depending on the type of cancer, the type of drug, and how the tumor responds. Most chemotherapy drugs are given weekly or monthly, but some are given daily.

During treatment, many people can work, go to school, and participate in their regular activities. However, we encourage rest if you feel tired after treatments.

What foods, drinks, and medications are allowed during chemotherapy?

We provide nutrition services to our cancer patients. A cancer-trained dietitian will work with our patients to ensure good nutrition, which will help combat the side effects of cancer drugs. Some people tolerate chemotherapy better when they eat a light meal before and after treatment. We recommend increasing fluid intake before, during, and after chemotherapy by two to four glasses of water daily.

For many patients, one cocktail or glass of wine in a day will not be harmful. Ask your doctor if it’s safe to drink alcohol with the type of chemotherapy you’re taking.

Some types of medications may interfere with chemotherapy, including:

• Antibiotics
• Anticoagulants (blood thinners)
• Aspirin
• Barbiturates
• Cough medicine
• Diabetes medication
• Hormones

The doctor will review your list of medications before starting chemotherapy to make any necessary adjustments.

The different types of chemotherapy treatments include:

• Immunotherapy: Some drugs are used to stimulate a patient's immune system to attack cancer cells.
• Alkylating Agents: Alkylating agents work directly on a person's DNA to prevent cancer cells from reproducing. Examples of alkylating agents include busulfan, cisplatin, carboplatin, chlorambucil, cyclophosphamide, ifosfamide, dacarbazine (DTIC), mechlorethamine (nitrogen mustard), and melphalan. These drugs are used to treat chronic leukemia, non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, and certain cancers of the lung, breast, and ovary.
• Antimetabolites: Antimetabolites are a class of drugs that interfere with DNA and RNA growth. Examples of antimetabolites include 5-fluorouracil, capecitabine, methotrexate, gemcitabine, cytarabine (ara-C), and fludarabine. Antimetabolites are used to treat chronic leukemia as well as tumors of the breast, ovary, and the gastrointestinal tract.
• Antitumor Antibiotics: Antitumor antibiotics interfere with the body's DNA by stopping enzymes and cell division or by altering the membranes that surround cells. Examples of antitumor antibiotics include dactinomycin, daunorubicin, doxorubicin (Adriamycin), idarubicin, and mitoxantrone. These are not the same as antibiotics used to treat infections. Since these agents work in all phases of the cell cycle, they are widely used for a variety of cancers.
• Corticosteroid Hormones: Called steroids, these are natural hormones and hormone-like drugs that are useful in treating cancers such as lymphoma, leukemia, and multiple myeloma. Often they are combined with other types of chemotherapy drugs to increase their effectiveness. Examples include prednisone and dexamethasone.
• Mitotic Inhibitors: Mitotic inhibitors are plant alkaloids and other compounds derived from natural products. They can inhibit or stop enzymes from making proteins needed for reproduction of the cancer cells. Examples of mitotic inhibitors include paclitaxel, docetaxel, etoposide (VP-16), vinblastine, vincristine, and vinorelbine.
• Nitrosoureas: This is a group of anticancer drugs that can cross the blood-brain barrier and interfere with enzymes that help repair DNA. Since these agents are able to travel to the brain, they are used to treat brain tumors as well as non-Hodgkin's lymphoma, multiple myeloma, and malignant melanoma. Examples of nitrosoureas include carmustine (BCNU) and lomustine (CCNU).
• Sex Hormones: Sex hormones alter the action or production of female or male hormones. They are used to slow the growth of breast, prostate, and endometrial cancers, which normally grow in response to hormone levels in the body. Examples include anti-estrogens (tamoxifen, fulvestrant), aromatase inhibitors (anastrozole, letrozole), progestins (megestrol acetate), anti-androgens (bicalutamide, flutamide), and LHRH agonists (leuprolide, goserelin).