chemotherapy

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Chemotherapy is the drug treatment of cancer with so-called cytostatics. It is used either as a sole therapy or in combination with other treatment methods. Read everything about the process of chemotherapy, what it is used for and what risks it brings with it.

What is chemotherapy?

Chemotherapy is the treatment of malignant tumors with drugs called cytostatics. The term cytostasis means something like "cell arrest". This means that the cytostatics intervene in the cancer cells' cycle of reproduction and thus inhibit tumor growth. The faster cells multiply, the better the chemotherapy works. Since cancer cells have a particularly high division rate, they are particularly susceptible to the cytostatic drugs. However, there are other cell types in our body that multiply quickly, for example those in the blood-forming bone marrow or the mucous membrane. Since the cytostatics usually do not differentiate between healthy and diseased cells, there are often numerous side effects.

Chemotherapy can be carried out as part of an inpatient hospital stay as well as on an outpatient basis. The patient receives outpatient chemotherapy either in an oncological practice or in the outpatient clinic.

There are basically three phases that the patient goes through in chemotherapy:

• Induction phase: intensive chemotherapy until the tumor regresses
• Consolidation phase: chemotherapy with a reduced dose to stabilize tumor regression
• Maintenance phase: less aggressive therapy that is administered over a longer period of time in order to prevent the tumor cells from reappearing

Neoadjuvant chemotherapy and adjuvant chemotherapy

Cancer is often not treated with chemotherapy alone, but also with, for example, radiation therapy or surgical removal of the tumor.

Neoadjuvant chemotherapy is chemotherapy that takes place before surgical removal of the tumor. The aim is usually to reduce the size of the tumor and to counteract the early spread of tumor cells (metastasis). This is to ensure that the intervention itself no longer has to be so radical. In international parlance, this is often referred to as “primary chemotherapy”.

Adjuvant chemotherapy, on the other hand, means that the cytostatics are used after another cancer treatment.It is intended to prevent a tumor (recurrence) from developing again after a healing tumor therapy, for example an operation. For example, adjuvant chemotherapy is currently administered for certain stages of breast, colon or testicular cancer.

Curative or Palliative Chemotherapy?

If the goal of chemotherapy is to cure the patient of their cancer, it is called a curative intention. Unfortunately, there are also situations in which a cure is no longer possible, for example if the tumor has already spread to other organs: Then the doctor can use what is known as palliative chemotherapy. Their goal is to alleviate discomfort and extend the patient's survival. It is important to provide the patient with precise information about palliative chemotherapy. Life expectancy and prognosis must be clearly and comprehensibly explained to the patient; the doctor must clearly communicate that no cure is possible. It often makes sense to include psychological support in palliative chemotherapy.

How long does chemotherapy last?

How long a patient has to receive cytostatics cannot be said in general terms. The duration of chemotherapy depends on the cancer, the general health of the patient and the drug combination chosen. Basically, chemotherapy is referred to as treatment cycles. This means that the patient is given medication for one or more days, after which he is given a few weeks so that the medication can work and the body can recover from the side effects. Then a new cycle begins.

When is chemotherapy performed?

Chemotherapy is used to treat malignant tumor diseases. The cytostatics are supposed to destroy the cancer cells. Areas of application are, for example, leukemia, lymphoma, lung cancer, colon or stomach cancer, breast cancer and soft tissue tumors.

Chemotherapy for lung cancer

Chemotherapy is currently the most important treatment method, especially for so-called small cell lung cancer. Lung cancer of the non-small cell type is more likely to be removed surgically; treatment with platinum-containing cytostatics is used here, if at all, as a supplement.

Chemotherapy for breast cancer

Chemotherapy is also used in patients with breast cancer. In particular, the following people with these tumors can benefit from adjuvant chemotherapy:

• Hormone sensitive tumors
• HER2-positive tumors
• Tumors that have spread to the lymph nodes
• Tumors with a high risk of recurrence

Even patients who develop breast cancer before the age of 35 usually receive chemotherapy. Breast cancer preparations are usually the so-called taxanes and anthracyclines. Standard chemotherapy takes 18 to 24 weeks.

Depending on the size and location of the tumor, neoadjuvant chemotherapy prior to surgical removal of the tumor can open up the possibility of breast-conserving surgery. Six to eight cycles are administered preoperatively.

Chemotherapy for stomach cancer

Chemotherapy is also used for advanced tumors of the stomach and the transition from the esophagus to the stomach. Often perioperatively, that means both before and after surgical removal of the tumor. Cisplatin chemotherapy is often administered in combination with epirubicin and 5FU (ECF protocol).

The so-called PLF protocol, in which epirubicin is replaced by leukovorin, is easier to use. In patients with very advanced gastric cancer, taxane-containing combinations are increasingly being used, but these have more side effects. So-called FLOT chemotherapy (Fluoruracil, Leukovorin, Ocaliplatin and Docetaxel) is gentler.

Chemotherapy: colon cancer

Adjuvant chemotherapy for colon cancer only makes sense if the entire tumor has been surgically removed beforehand. The preparations oxaliplatin and 5FU / folinic acid, which are used in combination, are used. The oncologist calls this scheme FOLFOX. Alternatively, the patient can receive a so-called fluoropyrimidine as a single therapy.

Chemotherapy: leukemia

In acute leukemia, it is important to initiate intensive chemotherapy (high-dose chemotherapy) quickly. Acute leukemia is combated in the induction phase over five weeks with chemotherapy, followed by a four-week consolidation phase. Maintenance therapy should be continued for up to two years after the diagnosis has been made; for example, methotrexate is used for this. Since high-dose chemotherapy has more side effects than conventional chemotherapy due to its intensity, careful clinical monitoring is necessary.

What do you do with chemotherapy?

In chemotherapy, the doctor gives the patient cytostatics that attack the tumor cells and thus shrink the tumor or inhibit its growth.

The typical course of chemotherapy takes place in cycles. This means that the patient is given cytostatics at regular intervals. The periods of time that lie between the cycles are precisely defined. How many such cycles should be carried out is decided by the doctor together with the patient. If the patient does not tolerate chemotherapy well, the breaks between the cycles can be extended or the chemotherapy can be stopped.

Between cycles, the doctor will check whether the cancer is responding to chemotherapy. He recognizes this by whether the tumor has become smaller or whether cancer cells have regressed. If the treatment has no effect, there is no point in continuing the chemotherapy according to the previous scheme.

Chemotherapy: tablets or infusion?

Only a few chemotherapy drugs can be taken as tablets. They often consist of a precursor to the actual active ingredient. This is then metabolized in the liver, which releases the actual active ingredient and transfers it into the blood. One difficulty with oral cytostatic drugs is the ability to dose them: since each patient has an individual metabolism and their own food intake habits, the drugs are absorbed at different rates through the stomach or intestines. This makes precise dosing difficult.

The doctor usually gives the patient the cytostatics as an infusion into a vein, through which they enter the heart. This then pumps the medication into the whole body (systemic effect). If, on the other hand, chemotherapy is not to work systemically but only on the organ affected by the tumor, this is known as regional chemotherapy. The cytotoxic drugs are injected into an artery instead of a vein.

In the case of brain or spinal cord tumors, on the other hand, the cytostatics are given directly into the nerve fluid, which is known as intrathecal administration.

Chemotherapy: Port

If chemotherapy is administered via the venous system, a so-called port is often created. A port is a small metal or plastic chamber with a catheter that opens into a large body vein. This is used under the skin, usually below the collarbone, under local anesthesia. The port protects the vessel walls of the veins and the risk of the drug running into the tissue (extravasation) is reduced. After each dose of cytostatics, the doctor flushes the port so that no blood clots form there.

Once the port has been placed, it can withstand around 1,500 to 2,000 needle pricks, after which it usually has to be changed. After completing the chemotherapy, the patient can - in consultation with the doctor - have the port removed again, for which only a small outpatient surgical procedure is necessary.

What are the risks of chemotherapy?

Most cytostatics cannot differentiate between pathological cancer cells and healthy body cells and primarily attack cell aggregates with a high division rate. This is why there are some side effects. These can sometimes be brought under control with supportive measures, but in the worst case they are even life-threatening. Typical side effects are:

• Increased risk of infection
• Bleeding disorder
• Loss of performance and fatigue
• Nausea and vomiting
• Diarrhea
• Urinary tract infections
• Loss of eyelashes, eyebrows and scalp hair
• Organ damage to the liver, heart, kidney and nerve tissue

When cytostatics are administered via vessels, so-called extravasations are particularly feared. This means that the drug does not run into the vein, but next to it. This can lead to severe damage to the surrounding tissue, in the worst case to the death of the cells there. If necessary, the damaged tissue must then be cut out as part of an operation.

Chemotherapy side effects

You can read about the side effects that can occur and how they are treated in the article Chemotherapy: Side Effects.

What do I have to consider after chemotherapy?

After your chemotherapy, it is important that you have regular blood counts carried out by your family doctor or resident oncologist. In this way, he can recognize in good time whether the number of blood cells is normalizing and the risk of infections and bleeding is reduced. Until then, try to reduce your individual risk of infection: Avoid large crowds (subway, concerts and others) and carry a small hand sanitiser with you if necessary.

Tell your doctor straight away if you notice any symptoms, especially:

• fever
• Bleeding (bleeding gums or nose, blood in your stool or urine)
• shortness of breath
• dizziness
• Diarrhea

Chemotherapy diet

Many patients suffer from loss of appetite during treatment, not least because of the numerous side effects. In order to maintain your weight, you should eat several small meals a day. Whole food or light whole food is allowed, depending on your individual preferences. If necessary, you can seek advice from a specially trained dietician.

Some patients undergo a change in their individual preferences under chemotherapy and reject, for example, coffee, meat or citrus fruits, even if they liked to eat them beforehand.

Long-term effects of chemotherapy

Most of the side effects that you will experience during chemotherapy will resolve after the treatment is completed. However, there are some long-term effects that can occur long after therapy:

• Second tumors (years or decades later)
• Damage to nerves (impairment of fine motor skills, the sense of touch and touch)
• Premature menopause in women
• infertility
• Exhaustion (fatigue)

Also keep in mind that once cancer has been overcome, chemotherapy does not protect against the development of another, independent tumor in the course of your life. You should therefore continue to have regular cancer screening exams.

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