What is chemotherapy?

Chemotherapy is the use of chemicals (medications) to treat a disorder. "Chemotherapy" is often understood to mean the use of medications to treat cancer. There are over 130 different chemotherapeutic agents currently in use. Most of these are given by injection into a vein but some are taken by mouth. These drugs may be used alone or in combination with other drugs to fight a particular malignancy. There are multiple combinations used to treat different cancers and the origin of cancer generally determines the choice of treatments. Breast cancer metastatic to the lungs is treated as breast cancer, not lung cancer.

How is chemotherapy different from radiation therapy?

Radiation therapy can be administered in different ways. The most common way is external beam radiation. Here an x-ray beam (generated by a linear accelerator) is directed at a specific area of the body. Cobalt was used for many years as a source of x-rays, but is no longer in general use because the x-rays from cobalt are less penetrating of tissue and tended to cause more skin burning. You do not feel the x-ray beam as it penetrates the body. Radiation therapy usually takes a few minutes per day, five days a week for 2 to 6 weeks, depending on the disorder being treated. Side effects depend upon which area of the body is being irradiated.

How long does chemotherapy take?

Some chemotherapy treatments take only a few minutes, but others may take several hours. Treatment schedules vary but weekly, monthly, three or five consecutive days every three or four weeks are commonly used schedules.

Will I have nausea and vomiting?

Although nausea and vomiting were often seen following chemotherapy until a few years ago, the availability now of powerful antinauseants has generally eliminated or at least greatly reduced this unpleasant side effect. If nausea and vomiting occur, it usually begins 4 to 8 hours after treatment and ends by 24-48 hours later.

Will my hair come out and, if so, when?

Many chemotherapy drugs will cause hair loss to some degree. Some agents, such as DOXORUBICIN, can be expected to cause near total hair loss. This may occur 2 to 3 weeks after the first dose and might be preceded by scalp sensitivity or pain. Other agents will cause more gradual hair loss over several weeks to months.

Will my hair come back?

Hair growth begins once chemotherapy stops or even during the course of treatment. Hair almost always returns to pre-chemotherapy levels, but is often curlier for a few years.

What other side effects may I expect?

Acute side effects of chemotherapy often include lowering of white blood cells one to two weeks following treatment. This may be associated with increased susceptibility to infection. Fever is usually an indicator of infection in this setting and it may be advisable to monitor your temperature three or four times per day. Should temperature go over 100 degrees F., infection should be considered and appropriate action taken. We advise calling the office if temperature goes over 100 degrees F. and we will often prescribe an antibiotic. Admission to the hospital for intravenous antibiotics is sometimes indicated. It is extremely important not to ignore fever since untreated infection can become life threatening in an individual with severely reduced white blood cell count. Other side effects might include anemia or low red blood cell count with associated fatigue and shortness of breath. Medication may be given to help build the red blood cell count or sometimes transfusion might become necessary. Low platelet count (platelets are cells in the blood that promote clotting) may predispose to bleeding and occasionally platelet transfusion is needed if the platelet count falls to severely low levels. Soreness of the mouth, diarrhea, constipation, tingling of fingers and toes are sometimes seen. Other side effects might occur and will depend upon the type of chemotherapy used.

Are there any long term side effects from chemotherapy?

Most of the toxicity from chemotherapy is short-lived and reversible. A few side effects may be prolonged or permanent. Immune function most often returns to normal a few weeks after chemotherapy stops. Nerve damage with numbness or tingling in fingers and toes may take months to years to resolve. A few chemotherapy drugs can cause heart muscle weakening that may be permanent. The most common prolonged side effect from chemotherapy is fatigue and this may last months to years following a course of treatment. Some chemotherapy drugs may actually increase the risk of some cancers at a future date but this risk is most often low, especially when compared to the benefits of the treatment involved.

What is "adjuvant" chemotherapy?

Adjuvant chemotherapy is given most often following surgery to increase the cure rate of the surgery. The goal of adjuvant chemotherapy is to eradicate microscopic deposits of cancer that may have settled elsewhere in the body before the primary tumor was removed.

May I use alternative treatments during chemotherapy?

This will depend upon which alternative treatment is being considered. Many of these treatments will not interfere with chemotherapy but some might. This should always be discussed with your doctor.

Will chemotherapy interfere with my sex life?

Some chemotherapy will interfere with sexual intercourse. Neuropathy may cause erectile dysfunction but this is often reversible. Fatigue may preclude sex for some couples. In general there are no restrictions on sex for people on chemotherapy, but any special considerations should always be discussed with your physician.

If I have side effects from chemotherapy, when should I call the doctor?

If you are concerned about a side effect, it is better to call your physician or oncology nurse to discuss this. It is better to overcall, than neglect a potentially serious side effect. We ask that our patients always call immediately for any temperature over 100 degrees.