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Chemotherapy

Chemotherapy means using chemicals to treat disease.

In cancer, chemotherapy means medications that kill cancer cells or prevent their growth. Most (but not all) patients with lymphoma will have chemotherapy at some point during their treatment. Chemotherapy works to prevent lymphoma cells from multiplying and to remove or reduce the number of cancerous cells in the body. It is often part of a larger treatment plan, used in combination with other therapies such as radiation or biologic therapy.

How does chemotherapy work?

Chemotherapy is a systemic (affecting the whole body) therapy that targets and kills rapidly dividing cells in the body, such as cancer cells. There are also normal cells in the body which are rapidly dividing as well, and chemotherapy may damage these healthy cells. This is why chemotherapy can have side effects including hair loss, diarrhoea, nausea and vomiting.

Not all people experience side effects from chemotherapy and if side effects do occur they can often be mild and treated effectively.

Chemotherapy drugs work on the premise that cancer cells are always dividing whilst normal cells, even those that have a fast turnover rate, are most often found in the resting (non-dividing) state in the body, dividing only when necessary. Chemotherapy tries to exploit this difference between normal and cancerous cells, aiming to preferentially attack tumour cells as they divide.

Chemotherapy aims to exploit the difference between normal and cancerous cells by trying to attack only the tumour cells as they divide.

What are the different types of chemotherapy?

There are many different ways of attacking rapidly dividing cells and hence many different types of chemotherapy. Some chemotherapy drugs interact with receptors on the surface of cancer cells, some damage cell structures necessary for cell division and some directly target the cancer cell's DNA, the genetic material of the cell. Because these are all different ways of achieving the same result destruction of the cancer cells with chemotherapy drugs are often given in combination in order to attack the lymphoma cells from all possible angles to increase the odds of achieving remission.

Chemotherapy combinations are often referred to by the initials of the drug names in the combination. Two common combinations used in lymphoma are called CHOP and CVP.

CHOP is a combination of four drugs, namely, three chemotherapy medications and one steroid medication:

  • Cyclophosphamide
  • Doxorubicin (also called Hydroxydaunorubicin)
  • Vincristine (also called Oncovin)
  • Prednisone (the steroid medication)

CVP is a combination of two chemotherapy drugs and a steroid:

  • Cyclophosphamide
  • Vincristine (also called Oncovin)
  • Prednisone (the steroid medication)

Steroid medications are included in these treatments as they are effective therapies for lymphoma and can quickly get lymphoma symptoms under control.

The type of chemotherapy a person with lymphoma receives depends on various factors, including:

  • The type of lymphoma
  • The grade of lymphoma (e.g. whether it is an indolent or aggressive NHL)
  • The stage of lymphoma
  • Whether it's the first lymphoma treatment for the person or if the lymphoma has relapsed following prior therapy
  • The symptoms the person is experiencing
  • The overall health of the person including age, medical history and vitality (often referred to as the performance status of the person)
  • The recommendations of the medical oncologist
  • The choice and participation of the person in the treatment decision process

How is chemotherapy given?

Each dose of chemotherapy kills only a percentage of cancer cells. Chemotherapy is, therefore, often given in multiple treatment cycles in order to destroy as many cancer cells as possible. Treatments are scheduled as frequently as possible to minimise the growth of the tumour, often given in cycles where the treatment is given for a period of time (e.g. for one week) followed by a rest period where no treatment is given. The rest period allows the healthy cells to recover. Together, each period of treatment and rest is called a chemotherapy cycle. A full course of chemotherapy (the total number of chemotherapy cycles given e.g. six cycles) often takes several months.

Most chemotherapy treatments can be given in an outpatient clinic, so people can go home the same day. Chemotherapy may be given in different forms: pills, injections or intravenous administration (administered directly into the bloodstream over a period of time through a needle).

If you are going to be receiving multiple cycles of intravenous chemotherapy, your doctor may recommend having a venous catheter inserted. A venous catheter is a device, usually a flexible tube, which is inserted into a vein for easier administration of intravenous drugs. A central line is a more permanent catheter that is usually inserted into a large vein at the top of the chest. Both central lines and venous catheters can be left in place so you will not require a new needle with each intravenous treatment and these may also be used to transfuse blood products into a person or to easily remove blood for blood tests.

Sometimes, a cancer may be defined as chemosensitive or chemoresistant. A cancer that is chemosensitive means that the tumour is responsive to chemotherapy and the treatment is effective in killing the cancer cells, whereas a chemoresistant cancer means that the tumour does not respond to chemotherapy and an alternate treatment is required.

Patients are closely monitored when receiving chemotherapy as an intravenous administration.

Can the dose be reduced if I have a lot of side effects?

It is very important to try to maintain the highest tolerable dose during chemotherapy treatment. Studies have shown that reducing the dose or delaying chemotherapy treatments until side effects subside may decrease the likelihood of cure and the chances for long-term survival in some types of lymphomas. It is important for someone receiving chemotherapy to understand that changing the dose or treatment cycle to reduce short-term side effects may actually be harmful in the long run.

However, quality of life is valuable as well, and you need to decide whether the side effects are tolerable or not. It is important to make this decision in an informed way and understand the potential consequences of your choice.

What are the side effects of chemotherapy?

Many people are frightened by the side effects of chemotherapy. However, it is important to understand that:

  • Not all people who receive chemotherapy experience side effects
  • Side effects are not always severe, they can be mild
  • Different chemotherapy drugs have different side effects
  • Doctors are familiar with chemotherapy side effects and can treat them so they are less severe and, sometimes, even prevent them from happening altogether

Many of the side effects caused by chemotherapy are due to the effect the medications have on the healthy, non-cancerous cells of the body. The following table outlines the most common cell types affected as a result of chemotherapy, as well as the resulting side effects.

Chemotherapy Treatment Overview 

Cells Affected Associated Side Effects

Cells of the digestive system including the mouth, oesophagus, stomach and intestines/bowel

Mouth sores

Sore throat

Diarrhoea/constipation

Nausea

Vomiting

Changes in taste

Loss of appetite

Cells of the skin and hair

Cells of the skin and hair

Hair loss

Cells of the bone marrow: red blood cells, white blood cells and platelets

Decreased blood cell production (myelosuppression) including:

Anaemia (decrease in red blood cells)

Neutropenia (decrease in white blood cells)

Thrombocytopenia (decrease in platelets)

Being Informed

Useful Questions to Ask Before Receiving Chemotherapy

  • What chemotherapy will I be receiving?
  • What is the expected outcome of my chemotherapy?
  • What is the schedule (treatment cycle) and how long will I be receiving chemotherapy treatment?
  • What side effects will I experience? How serious are they? Can they be managed with treatment?
  • What should I do to try to stay healthy and strong during my treatment?
  • Can I come for my chemotherapy treatments alone or do I need assistance?
  • How is the treatment monitored to determine whether or not it's working?
  • What symptoms should prompt me to call the doctor's office?

From The DVD - "Your Journey of Lymphoma Treatments"

Related video: Chapter 5 - Treating Your Lymphoma