Despite advances in surgery, radiation and targeted therapies, chemotherapy remains an important part of many cancer treatments. But what is it? There’s a lot of misinformation surrounding chemotherapy. Here we’ll look at the facts surrounding what chemotherapy is, how it works, and what to expect if your treatment includes this option.
History of Traditional Chemo
The history of chemo starts in the early 1900’s. Chemotherapy got its name from German chemist Paul Ehrlich who defined it as the use of chemicals to treat disease (not necessarily only for cancer). He also was the first person to note the effectiveness of using animal models to test new chemicals to treat disease. Although his discoveries would eventually have huge implications for cancer research, he was never optimistic that the treatments he tested would make a difference for human patients.
The idea of using chemicals to treat cancer really took off in the period during and after World War II. Although mustard gas was not used in WWII, around that time scientists found that people who had been exposed to the substance in WWI had reduced white blood cell counts compared to those who did not. This finding led researchers to want to learn more about whether the chemical compounds in the gas could be used against cancers growing in white blood cells. Two Yale pharmacologists, Alfred Gilman and Louis Goodman, led the study, first using drugs derived from mustard gas to treat animal models with established lymphomas. Once it was proven that the tumors could be treated with mustard gas agents, they moved forward by injecting mustine (a less volatile form of the gas) into a human patient in 1943 (the study was not released to the public until 1946). The patient experienced reduced tumor sizes after the treatment. This event started the search for chemicals to treat cancer.
How Traditional Chemo Works
To understand how chemo works it is important to know how cancer starts and develops. The National Cancer Institute defines cancer as “the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues”.
So what does this mean?
Imagine a grassy lawn. Now picture a dandelion growing in this lawn. Because dandelions grow faster than the grass, they can start to take over. As the population of dandelions grows, it gets harder and harder for the grass to do its job. This is how cancer develops – one cell develops a mutation that makes it different than the others and it starts to divide and grow faster than the other cells.
However, the fact that cancer cells grow faster than healthy cells is also the Achilles heel that lets doctors target these cells with chemotherapy. In the very basic sense chemo works by killing cells that are dividing rapidly, like cancer cells do. Unfortunately, this can also mean killing some normal rapidly-diving cells, such as the cells that make your hair. However, most of your body’s cells don’t divide this quickly and so can usually fix the damage caused by chemotherapy. However, while chemotherapy kills more cancer cells than healthy cells, various forms and dosages of chemotherapy may come with collateral damage. When healthy cells are killed along with cancer cells, there can be side effects.
How Chemotherapy is Given
Chemo can be administered to patients in various ways including orally (via pill, liquid or capsule), through a vein, injection, and more (for a full list please visit Cancer.gov). Sometimes if a patient is receiving chemotherapy through a vein they will have a “port” inserted to make it easier to deliver the drug. The port is a small disc placed under the skin, which is connected to a vein by a thin tube called a catheter (not to be confused with catheters commonly used to help patients empty their bladders!). When you receive chemotherapy, a doctor or nurse may connect your port to a pump that controls how much and how fast the chemo enters your body.
While chemo is a life-saving treatment for many cancer patients, it may come with unwelcome side effects. When chemotherapy is chosen and administered correctly, it should do more good than harm. When this is not the case, you and your treatment team may choose to adjust your program or explore other treatment options.
Side effects can include:
- Mouth sores
- Chemo brain
- Muscle pain
- Reproduction and sexual issues
- Appetite loss
- Hair loss
- Rash and other skin problems
In addition to the physical side effects of chemotherapy, patients often talk about anxiety and other worries that come with this kind of treatment. Talk to your doctors and nurses. They will help you manage side effects as you go through treatment. Some may recommend you keep track of how you feel after receiving chemo and how it affects your quality of life. In addition to the advice from your care team, there are many things you can do at home to ease discomforts you may experience. For example, CancerCare.org lists ideas to help relieve many of the side effects listed above.
The Future of Chemotherapy
For many early stage cancer patients, traditional chemo may be the best treatment option. However, in cases where the cancer has reached a later stage, chemotherapy may not be as effective. For these patients, researchers are working to discover new treatments that kill cancer cells without the side effects often associated with chemotherapy. Many of these new strategies are described as “targeted treatments”. However, these targeted treatments may only work against very specific kinds of cancer, and not every type of cancer has been matched with a targeted treatment. Treating every cancer with targeted therapy remains very far away. Until research provides new options for every cancer type, chemotherapy will remain an important tool against the disease.
How often will I get treatment?
Chemotherapy is given in “cycles” that usually range from 2 to 6 weeks. The number of cycles you will need depends on many factors such as the cancer’s location, stage and your physical characteristics.
Where will I get my treatment?
Typically patients will receive their medication in an infusion center either at a hospital or community clinic. Some patients will be admitted to the hospital for chemo. Your doctor will explain specifics of your treatment plan.
Will I receive other treatments in addition to my chemo?
Some patients may also have radiation, surgery, targeted treatments or even multiple kinds of chemotherapy during their treatment. In addition to developing new therapies, learning to use existing drugs in precise combinations is helping patients live longer and better lives. Be sure to ask your doctor about the specifics of your plan.
Can I work during chemo?
This is an individual decision for each patient. Sometimes patients feel well enough to return to work after their treatment while others may have side effects that keep them for working. Be sure to check out the Americans with Disabilities Act and the Family and Medical Leave Act to know your rights while you are going through cancer treatment.