Chemotherapy
What is 'chemotherapy'?
Chemotherapy means chemicals given in the body as a therapy, Chemotherapy can be given in the veins. Chemotherapy essentially kills rapidly dividing cells that's the whole point and the paradigm for rapidly dividing cells is cancer that's what cancer is, cancer is a cell that refuses to stop dividing, and refuses to die, the Chemotherapy is specially effective which cells that divide quickly, so the purpose of Chemotherapy is to kill cells which divide rapidly, and the despoilments of why Chemotherapy can attack cancer without hooding the people to more than extent in a dies it also explains some of the side effects of Chemotherapy.
What are the basic types of chemotherapy?
The basic classifications of chemo -- there are two ways to think about it. One is you can think about it simply as medicines that you have to take through your veins. They're usually delivered by a central line, which is an IV line which can stay in the body for weeks to months at a time. And then there is oral chemotherapy. And one mistake I see people make is, they think just because this is a pill, it's not very potent. All chemotherapy has to be respected. The pill forms of chemotherapy are just as potent, can cause just as many side effects.
How does chemotherapy work?
The most common chemotherapy type is called an alkylating agent. And an alkylating agent was first discovered in World War I as a poison. Mustard gas was the first alkylating agent. It was discovered active against leukaemia in the 1940's. And what it does, is actually form chemical bonds with DNA and interrupts the double-stranded DNA , so that when a cell goes to replicate, it is interrupted. And when a cell cannot replicate, it cannot grow. That's a common form. In fact, most chemotherapies interfere with the synthesis of cells in some way or another.
What other types of chemotherapy kill cancerous cells?
One of the medicines called Vincristine, actually disturbs microtubules in mitosis where the cell's DNA is arranged in the middle of the cell in metaphase. These chromosomes are pulled back to opposite sides of the cell. Vincristine poisons that. Another form is called a topoisomerase inhibitor--drugs like Etoposide. Again, this is another function of DNA. Topoisomerase is an enzyme that helps DNA unwind from its double helix so that the cell can make a copy of it. This drug, Etoposide, interferes with that.Another form of chemotherapy is called an antimetabolite. These are medicines that mimic either parts of DNA or folic acid metabolism. They act as imposters to be put in normal cell metabolism. There are many more but the alkylating agents, the topoisomerase inhibitors and the antimetabolites are three main classes. In essence, however, you're just trying to interfere with normal cell function.
How does my cancer doctor choose which treatment is best for me?
The way your oncologist will choose for you, should be through the results of large clinical trials. That is where people have volunteered to take either the standard therapy as a base line or the standard therapy with a variation to see which is better. That is how we have advanced knowledge in cancer care is by doing large clinical trials and then applying that information back to the individual patient.
Why does chemotherapy cause hair loss?
The side effects of chemotherapy of best understood, if you remember that chemotherapy is a chemical that kills rapidly dividing cells. So, you think yourself, what are the rapidly dividing cells in my body? Well, the first is cancer, that is the whole point, we won't give the chemotherapy if we won't intending to kill cancer cells. But then, you think of the other cells of your body that after refurnish themselves on the daily bases then you can understand the side effects. The hair of our skull is a rapidly dividing cell. So, many different types of chemotherapy cause people to loss their hair. It's a temporary hair loss and it's not universal for all people. Well, I'll find its better to prepare for and be half away surprised then the girl went through it and just be shocked. So, some of my patients choose to visit their hairdresser or barber to before they even start and take control. Sometimes the hair falls out in combs which can be disconcerting. Sometimes it comes out on your pillow or in hairbrush and usually starts to come out about ten days after starting, most chemotherapies. There are some chemotherapies that do not affect the hair at all.
Can chemotherapy cause oral problems?
Some more cells that divide rapidly are the mucous membranes. Specifically, if you think about the linings of the lips, the gums, and the mouth. When we bits ourselves on the tongue or in the cheek, that heals very quickly because the cells divide rapidly. Well, those cells are vulnerable to Chemotherapy, so people can have soreness in the mouth, they can have sores in the mouth that feel like cold sores, and chemotherapy can affect some people with a sore throat, that, at its worst form, can be a lot like strep throat.
Can chemotherapy cause digestive problems?
When the stomach is affected, that's one of the main causes for nausea. Nausea is just the feeling that your stomach is not at ease, that you can't tolerate food, that someone may even need to vomit. Further down in the gut, the small intestine, those rapidly dividing cells, when they're affected it can cause diarrhoea, which is another common side effect of chemotherapy.
How can chemotherapy affect blood production?
A rapidly dividing cell is your bone marrow and the bone marrow is the soft middle part of the bone that is responsible for making the blood and those blood cells are being replenished every day. Chemotherapy will suppress normal blood production. That's why people undergoing chemotherapy may have anaemia which is a low red blood cell count or low platelets which can predispose to bleeding or more dangerously a low white blood cell count where you may be more vulnerable to infection and your doctor will consider chemotherapy and a fever to be an emergency that needs to be dealt with immediately.
How do I deal with nausea caused by chemotheraphy?
Dealing with nausea is one of the bains of chemotherapy. The primary way that we try to deal with nausea is to prevent it, different chemotherapies actually have a signature which lets you predict how much nausea they will cause. There's a chemotherapy called vinchristin which causes almost no nausea it's commonly used in leukaemia or lymphoma. There's another chemotherapy called sisplatin which is used in lung and, head and neck cancer which is notorious at higher doses. So the first thing to deal with nausea is that your oncologist will try to prevent it with potent medicines based on the type of chemotherapy that you're receiving. There's some other tricks you can use as well, some people find that pungent odours really make nausea worse so they'll choose to take the cover off their food and let it sit awhile before eating or avoid they'll certain restaurants. There are also certain medicines that can rescue nausea, so you try to prevent it, you avoid certain situations which may trigger it and then there are medicines that can shut down nausea before it gets worse, before it leads to vomiting.
What is 'chemobrain'?
The best scientific explanation is just that we use high doses of toxic chemicals which were never intended to encounter the brain. And going through chemotherapy, whether a drug passes the blood brain barrier or not, some of it does, and it affects people. And so chemo brian has been described in many different ways. The most common manifestation is people have a slowing down of their thinking. Perhaps they were once very sharp with dates, and now they require a calendar to recall things. Perhaps you go to a party and there is someone you know but it takes awhile to get the name and perhaps you don't get the name until afterward. People who were quick with numbers often find that it takes awhile to regain their skill. It's a very real phenomenon. It has been studied mostly in ladies undergoing chemotherapy for breast cancer. And it seems like it is temporary, which I think is incouraging. So realize it's a common experience. It's a slowing down of mental acuity probably due to chemo therapy or some of it's side affects. It will not last forever. And I've actually had some people tell me it goes the other way around. Rather than feeling intellectually sluggish they actually feel hyper and have a harder time attending to things, almost like a new adult ADHD.
Is chemotherapy painful?
There are some uncomfortable components to taking chemotherapy. Such as, people experience abdominal cramping, they experience vomiting, sometimes just receiving the chemotherapy itself can burn, they're using pretty toxic medications that go through your veins and sometimes that alone causes pain. And everyone has a very different reaction to chemotherapy, so, I wouldn't want to say no and I certainly wouldn't want to just make a blatant statement and say it's going to hurt, but I would definitely say there are some uncomfortable and unfortunate side effects to taking chemotherapy.
How soon will I start to feel better after a chemotherapy treatment?
The truth is, it really is different for every person; but, a general experience of my patients has been the week before the next intended cycle of chemotherapy tends to be the very best, and so I believe our first week of giving chemotherapy for most people is successful because our medicines to prevent nausea are effective in the majority of people, and few chemotherapies cause severe nausea like you've seen on television. So, the first week, while logistically inconvenient, tends to be well-tolerated. I find most of my patients have their hardest week during the second week. Between seven and fourteen days into the cycle, that's when blood counts can fall; it's when the mucous membranes of the mouth or the digestive tract can be irritated, causing mouth sores or diarhhea, and that's a tough week. Usually--and we give chemotherapy on three-week cycles--for most people, the third week is the best. That's when the blood counts start to recover, the irritation of the mucous membranes heals, and you start to think, "Wow, I'm doing good." And then, it's time for the next cycle; but, don't be discouraged--it won't go on forever.
Will there be long-term side-effects from my chemotherapy treatment?
Some of the long-term side effects chemotherapy tend to be directed against the bone marrow, which makes the blood. It's not unusual for somebody to have an abnormal complete blood count after finishing chemotherapy, perhaps even for years. The worst thing that could happen would even be to develop a leukemia, secondary from chemotherapy, although that's pretty rare. In large studies of breast cancer patients, that happens less than one half of one percent of the time.