Chemotherapy (Chemo)
(Cytotoxic) Chemotherapy drugs - in essence, poisons - are usually injected into the bloodstream, but sometimes by mouth, to target cancers that have spread (metastatic cancers). "Chemo" is used to try and cure or reduce the cancer tumours. In the event that your treatment includes surgery, you may hear the terms Adjuvant chemotherapy (used after surgery to mop-up cells; or Neoadjuvant chemotherapy (used before surgery to reduce the size of a tumour).
Chemo is systemic and works by targeting rapidly dividing cells to kill them or stop them spreading. The drugs are unable to tell the difference between cancerous and healthy cells which is why, for example, some chemo treatments make the hair fall out or cause diarrhoea, (normal cells in the scalp and intestine have a high turnover). All chemotherapies have side effects and the side effects will affect different people in different ways. The cancer doctor (oncologist) will be balancing the chemo's toxicity with the potential benefit, and the “performance status” of the patient (including their tolerance of the drugs). Whilst side effects are inevitable, the doctor will seek to reduce them with additional drugs.
The decision to have chemotherapy needs careful consideration. It is a very personal decision that belongs to the patient; but the decision should be made with advice and support from healthcare professionals. They will advise on the benefits that can realistically be expected. (For advanced cancer patients see also the Decision-making guide).
Different cancer cells, and the processes involved in the spread of cancer, respond to different drugs. CUP patients are likely to have varied (heterogeneous) cancer cells. Because of their genetic variability, the tumour cells are not uniformly sensitive to cytotoxic drugs. A combination of drugs is therefore usual to get the best effect (and Oncologists are constantly trying out new combinations to improve treatment).
Patients receiving chemo should be given written information about their drugs and potential side effects. Information should also be provided about where to go in an emergency and who to contact by phone if problems arise (24 hours).
In short, there are many different chemotherapy options but to be most effective the treatment needs to be tailored to the (likely) site of origin - the primary site. There is an element of “hit or miss” with Chemotherapy. Every different mutation requires different treatment. Even if the primary site has been correctly deduced every patient is different and, rather like finding the right medicine for a chest infection, one “chemo” combination may be more effective than another; and one treatment may become less effective over time if a cancer is, or becomes, “chemo-resistant”.
You may wonder about the time gap between chemo sessions. The gap is calculated to allow time for the body to repair the normal cells but not the cancer cells.
Chemo treatment is used increasingly (a 60% increase between 2004-2008 in England and Wales) because there are undoubted benefits for many patients in terms of quality of life, remission, prolongation of life or cure.
CancerBackup have an excellent site giving details of specific chemo treatments.
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The National Chemotherapy Advisory Group is proposing wide-reaching changes in the way chemotherapy is prescribed and managed by the NHS.
See www.dh.gov.uk on Chemotherapy Services in England for consultation doc.
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