What Is Chemotherapy?

Chemotherapy (pronounced: kee-mo-thair-uh-pee), often just called chemo, is the use of medications to treat cancer. Cancer is a disease that occurs when cells in the body develop abnormally and grow in an uncontrolled way. Cancer cells tend to divide rapidly; chemotherapy works by interfering with this, thereby preventing the cancer from spreading — and sometimes even curing the disease by helping to get rid of all the cancer cells in the body.

How Is Chemo Given?

A pediatric oncologist (pronounced: on-kah-luh-jist), a doctor who treats cancer in kids and teens, will work with other health care professionals to decide on the type of chemotherapy treatment that's best for a cancer patient.

The many different ways that teens are given chemo medications include:

• Intravenously (IV). A needle is inserted into a vein and the medicine flows from an IV bag or bottle into the bloodstream. Chemo also can be delivered intravenously through a catheter, a thin flexible tube that is placed in a large vein in the body.
• Orally. The person getting treatment swallows a pill, capsule, or liquid form of chemo medication.
• By injection. Using a needle or syringe, the drugs are injected into a muscle or under the skin.
• Intrathecally. A needle is inserted into the fluid-filled space surrounding the spinal cord and the chemo drugs are injected into the spinal fluid.

Combination Therapy

Chemotherapy can be used alone to treat cancer or in combination with other cancer treatments, such as radiation therapy or surgery. Radiation therapy directs high-energy X-rays at the body to kill cancer cells and shrink tumors. Surgery helps to remove larger tumors, making the job of the chemotherapy easier. The kind of therapy someone receives is based on the type of cancer that person has and whether it has spread to areas outside where it started.

Most cancers in teens are treated with more than one chemotherapy drug; doctors refer to this as combination chemotherapy. For a lot of people, combination therapy improves the chances that their cancer will be cured — the cancer has less chance of building up a resistance to a combination of chemo drugs than it does to just one drug. (Resistance means that the cancer no longer reacts to that medication.) Another important strategy in treating cancer is giving a person repeated courses of chemo. This helps prevent the cancer cells from regrowing.

People who feel nervous about receiving chemo can ask about touring the hospital or clinic before treatment begins to help feel more at ease. They can also join a support group for teens and families coping with cancer.

When and Where Is Chemo Given?

A person can receive chemotherapy treatments at a hospital, cancer treatment center, doctor's office, or at home. Most teens receive theirs at a clinic or hospital and go home afterward. Sometimes, though, people who are getting chemo treatments may need to stay in the hospital so doctors can watch for side effects.

Some people receive chemotherapy every day; others receive it every week or every month. Doctors use the word "cycles" to describe chemotherapy treatments because the treatment periods are mixed in with periods of rest.

Common Side Effects

While chemotherapy works to treat cancer, normal cells — like hair cells, which also divide rapidly — can be affected, too. This can cause side effects, which are usually temporary and are different from person to person, depending on the person's age, the type of treatment, and where the cancer is located.

Some of the side effects of chemo are:

• Fatigue. It's quite common for people who are having chemotherapy to feel very tired. Some feel extremely tired all of a sudden and may be exhausted even after sleeping or resting.
• Discomfort and pain. Some people may feel a little discomfort when the catheter or IV needle is put in the skin. Chemo treatments may also cause nerve problems and burning, numbness, tingling, or shooting pain in the fingers and toes. Certain types of chemo medications also cause mouth pain, headaches, muscle pains, and stomach pains.
• Skin changes. People receiving chemo may find their skin becomes red, sensitive (especially to the sun), or irritated. Those who receive radiation therapy before having chemo might notice that the skin involved may turn red, blister, and peel once chemo begins. This is known as "radiation recall."
• Hair loss and scalp problems. Some people who get chemo lose their hair. It may become thinner and then fall out completely or in clumps. Some might lose hair all over their bodies, including the head, face, arms and legs, underarms, and pubic area. Most people who lose their hair during chemotherapy find that it grows back once treatment has ended, usually within 3 months.

Common Side Effects (continued)

• Mouth, gum, and throat sores. Chemotherapy may cause sores in the mouth and throat, or cause the gums to become irritated and bleed. A doctor may prescribe a mouth rinse or other products to reduce pain, dryness, and irritation. People who are receiving chemo should get regular dental checkups and follow their dentist's advice on how to brush their teeth during treatment.
• Stomach problems. People receiving chemo might feel sick, not feel like eating, or throw up during the course of their treatment. They may also have loose bowel movements or become constipated.
• Central nervous system problems. Chemo may cause temporary confusion and depression in some people.
• Kidney and bladder problems. Some chemo drugs can irritate or damage the bladder or kidneys.
• Blood problems. Having chemo may cause certain blood problems:
  
  Anemia. Having chemo can affect the red blood cells, which are made in the bone marrow and carry oxygen to the rest of the body. This can cause anemia (a low number of red cells).
  
  Bleeding problems. Some types of chemo drugs can cause problems with platelets, which are needed to help blood clot. Platelet problems can make it easy for someone to bleed and become bruised. Blood transfusions are sometimes given to help remedy these problems.
  
  Increased risk of infection. In addition to red blood cell and platelet problems, people who get chemo may have lowered numbers of white blood cells, which are part of the immune system and help the body to fight infections. As a result, chemo patients are more vulnerable to infection. Because of their suppressed immune systems, it's important for them to avoid crowds and to stay away from people they know who have infections like colds or the flu. This doesn't mean that teens getting chemo need to hide in their rooms, though. Doctors encourage people who are getting chemo to maintain contact with friends. And, although they usually ask patients to check in before going to a place where there will be lots of people, doctors usually give teens the go-ahead to attend social functions. One way to help prevent infection is frequent hand washing.

Long-Term Side Effects

Because chemotherapy can cause long-term side effects (known as late effects), it is critical that people who have had cancer continue to get routine medical care even after their cancer has been cured. Depending on their treatment, people who have had cancer should get regular heart and lung exams, as well as blood tests for thyroid function.

It's important for anyone who's receiving chemo to tell nurses or doctors about side effects so they can help treat the problem. Doctors who treat people using chemotherapy aren't just working to cure cancer; they also want their patients to be as comfortable as possible while they're having chemo.

Getting Support

Chemotherapy can be frightening to think about. If you're one of the many people whose cancer is being treated with chemotherapy, your doctors, nurses, and other members of the cancer treatment team are there to reassure you before, during, and after chemotherapy.

You can also look for support from friends and family. Your friends make you feel good when you're healthy — so surrounding yourself with friends when you're sick is sure to be a pick-me-up. Phone and email are great ways to keep in touch, even if you're having a bad day. If you're afraid that your friends will feel weird or embarrassed, talk to a parent or nurse about some ideas on how to cope.

Taking Care of Yourself During Chemo

In addition to dealing with the many emotions you'll feel, you have to manage the physical stuff, too. Try these tips for chilling out more comfortably during treatment:

• Sleep long, sleep often. Your body needs plenty of rest to recover from chemotherapy. Scale back on strenuous stuff, and make time to get a good night's sleep every night.
• Focus on good nutrition. If you have nausea, vomiting, and diarrhea, your appetite's probably in the toilet, too. Try to stick to foods high in nutrients and eat a balanced diet to prevent weight loss and stay healthy. Several small meals may be easier to eat than fewer larger ones, and eating every few hours can prevent you from feeling too hungry. Skip fatty, greasy, fried, or spicy foods — things that may make you feel nauseated — and eat bland foods like crackers, toast, and popsicles that may be easier for your stomach to handle.
• Ask your doc about anti-nausea medication. If you feel sick to your stomach a lot, there are medications that can help relieve nausea.
• Get your doctor's OK before taking other medications. "Other medications" includes herbal medicines or over-the-counter drugs. The same goes for immunizations, such as the flu shot.
• Drink up. You may not feel like drinking, but clear broth, juices, and sports drinks can replace fluids lost through vomiting and diarrhea. Room-temperature beverages may be easier to drink than hot or cold liquids.
• Get on a medication schedule. If you're taking pain medication, getting on a schedule helps prevent you from missing doses — waiting until you feel pain can make it harder to control. If your pain persists or worsens at any time, talk to your doctor.
• Protect your scalp. To protect your head from sun exposure and irritation, wear soft hats and scarves. Until your hair grows back, you may feel more comfortable wearing hats, scarves, or wigs to school or other events. Use only mild shampoos and hair products.
• Practice infection protection. Wash your hands before eating, after using the bathroom, and after touching animals. If friends or family members have infections such as colds, the flu, or chickenpox, they should skip visiting until they're feeling better. It's also a good idea to avoid crowds. And don't worry about missing school. Home tutors can keep patients on track with their schoolwork at a manageable pace.
• Try to prevent bleeding. If you have blood-clotting problems, blow your nose and brush your teeth very gently to avoid bleeding.

Once you've finished chemo, it's still important to visit the doctor for follow-up appointments. During these checkups, the doctor will want to know how you're feeling and whether you're experiencing any side effects. He or she will also check to see whether there are any signs of the cancer coming back.

Undergoing treatment for cancer can be time-consuming, scary, and sometimes painful. But for teens who beat cancer, there may be a silver lining — cancer survivors are often tougher, have a greater appreciation of what life has to offer, and possess the courage and determination it takes to follow their dreams.

Reviewed by: Donna Patton, MD
Date reviewed: May 2010