CHEMOTHERAPY

Chemotherapy is the treatment of cancer by means of drugs. Unlike irradiation, chemotherapy treats your entire body. It is given to kill abnormal cells, or to retard or prevent their growth. Multiple remedies are used which kill cancer cells in different ways. More than one remedy is sometimes given in combination, so that different ways are used to combat tumour cells. Chemotherapy makes cancer cells more sensitive to the effect of irradiation and therefore the two methods are often combined to obtain the best treatment for a specific cancer.

The chemotherapeutic remedies in the blood reach all the cells in the blood. The cells are destroyed. Cancer cells divide very quickly and absorb most of the chemotherapy, which then prevents them from dividing or growing any further. The abnormal cells die while the normal cells recover. The damaging of the cells may result in side-effects which are of a passing nature.

The effect of chemotherapy differs from person to person, the type of cancer which is treated and the drugs used.

HOW IS CHEMOTHERAPY ADMINISTERED

Different CTs are administered differently:

  • Intramuscular, as an injection in a muscle

  • Orally, as tablets

  • Intravenous, direct injections or as a drip

In almost all cases , chemotherapy treatment can be administered as an out patient, thereby preventing hospitalisation. Chemotherapy injections are not more painful than any other injection or blood test. If continuous venous access is required, or your veins are not accessible, you may be required to have a portocath inserted.

GENERAL INFORMATION RE:CHEMO

Special Examinations / Blood Counts

 

The blood count reflects the state of the bone marrow. Bone marrow forms new blood cells in the bones of the body and releases them in the blood stream where they can circulate and be examined. These cells play a very important role:

  • White blood cells fight infection

  • Red blood cells carry oxygen to the body parts

  • Blood platelets help with clotting of the blood

As the bone marrow cells grow quickly, they also absorb some of the chemotherapy and therefore it is necessary that your "blood count" is tested before every treatment. This examination must be conducted as close as possible to oyour appointment. The laboratory also needs a certain time to process the test results and we recommend that you have the examination done two to three days before your visit. 

It may happen that your treatment is postponed or the dosage is decreased due to your blood count being low. This is only an indication that the body is not yet ready to receive the next dose of chemotherapy, and this does not affect the result of the treatment of the illness. Except in cases of leukaemia, the blood count is not an indication of the status of the cancer. The blood count, however, is not the only factor that determines whether you can have treatment or not. Examination of the side-effects on other organs and the status of your cancer are also extremely important. It is, therefore, impossible to determine telephonically whether you should receive treatment or not, according to your blood count.

If the white blood cells are low you will be open to infection. You should avoid, as far as possible, persons with colds or other infections.

Other blood tests and x-rays

Other blood tests, x-rays and CAT scans are conducted to evaluate the status of the cancer. It takes the laboratory longer to make these results available so you must have these examinations done a few days before your visit. These include blood tests such as liver function tests and tumour markers.

Whenever the follow-up x-rays are done, it is always very important that the new x-rays are compared with the old x-rays. Direct comparison is the only way to determine if the cancer is improving, the status quo is maintained or the cancer is worsening. The radiologist taking the x-rays or doing scans is the best qualified person to make this comparison.

Pain control

It is completely unnecessary to endure pain. Painkillers must be taken regularly to obtain the best results. Take them as prescribed and not only when needed. If your own home medication does not bring enough relief, you can be admitted to hospital to bring the pain under control. After a couple of days you can continue at home with your own regime of pain control.

POSSIBLE SIDE-EFFECTS OF CHEMOTHERAPY
  • NAUSEA AND VOMITING

Some of the drugs can cause nausea and vomiting. The intensity thereof differs from person to person. An anti-nausea injection is always given in conjunction with the chemotherapy. There is also a variety of tablets, injections and suppositories that may be used to counteract nausea.

Diet can also play a role:

  • Eat lighter meals

  • Eat smaller meals more frequently

  • Avoid rich foods

  • Drink plenty of liquids, even if you don't feel like eating.

You should take tablets often while receiving treatment, as well as for a few days afterwards.

  • DIARRHOEA AND CONSTIPATION

Many drugs can cause diarrhoea. If this occurs you must contact your Oncologist or GP so that medication such as Imodium or Interflora can be prescribed. Sometimes certain remedies cause constipation and it is important that you ensure that you regularly pass stools. Any laxatives of your choice can be taken for constipation. It is also advisable to pay attention to your diet.

If diarrhoea develops, you should eat less fatty foods (e.g. bacon or margarine on bread), drink more liquids, and eat calcium rich foods such as potatoes and bananas.

For constipation: you should drink more liquids, eat stewed or dried fruit, and add bran to diet.

  • UNPLEASANT TASTE SENSATIONS

Chemotherapy can cause unpleasant taste sensations. A healthy, balanced diet will help you cope with the treatment and the sickness. Good nutrition is a must, because patients who lose less than 10% of their weight during treatment have the best chance for recovery. If you experience a bad taste in your mouth, oyou can try the following:

  • Mint flavoured coffee and milkshakes

  • A zinc supplement

  • Soft peppermints or sugar-free gum

  • Snacks such as pickled onions and olives

Good nutrition tips:

  • Cancer patients need extra proteins and kilojoules; therefore you should include extra meat, fish, cheese, milk and eggs in your normal eating plan.

  • You should also include nutritious snacks, such as yoghurt, muesli-bars, soft fruit sweets, bananas and soft fresh fruit.

  • Patients on chemotherapy must try to drink 3 litres of liquids per day. Drinking nutritious drinks such as Complan, Nutren, milkshakes and fruit juices helps.

  • You should avoid rich and strongly spiced food such as curry

It is acceptable for you to take vitamins and dietary supplements throughout your treatment.

  • CYSTITIS (BLADDER INFECTION)

You must report any irritation of the bladder to your doctor, so that you can receive treatment if there is an infection. Fluid intake must be increased.

 

  • HAIR LOSS 

Why does it happen: Chemotherapy circulates in the blood stream to reach the cancer cells in order to kill them. The scalp has a very rich blood supply and this means that a lot of chemotherapy remedy circulates there. The roots of the hair are therefore exposed to a large amount of the treatment. Chemotherapy affects cells that grow more quickly than cells that grow slowly. Cells such as blood cells, mucous membrane cells of the mouth and intestines and cancer cells grow quickly and are more affected than other cells in the body. Hair also grows quickly and is therefore also greatly affected and can fall out in some cases. 

Who loses hair? It is not possible to predict who is going to lose hair and who is not. It depends on many factors and differs in every person. Factors playing a role are: how strong and thick the hair is to start with, how quickly the hair normally grows and how healthy the roots of the hair are. It does not only depend on the medicine used but also the dosage, schedule of administration, route of administration, speed of administration and different combinations of drugs. Many of these factors are determined by the patient's reaction to treatment and cannot be predicted.

When is the hair lost? This is also not predictable and differs from person to person. Hair loss can start one to two weeks after a single dosage of chemotherapy and reaches its maximum within two months in most treatment schemes. It is important to know that hair loss from chemotherapy is always only of a temporary nature. Hair often begins growing back while the treatment is still in  progress. At the latest, regeneration takes place starting one to two months after treatment is completed. There may be a slight difference in colour and texture of the hair which grows back. Hair may be slightly lighter or darker and is often more curly than before.

Handling: Hair loss is not always total. Often the hair thins out but the loss is not enough to be noticed cosmetically. Through good hair care and the use of a special shampoo, hair loss can often be kept to a minimum. If hair loss is temporarily bad, you may have to wear a wig. Our chemotherapy sisters can advise you on this.

  • SORES IN THE MOUTH OR THROAT

You should immediately report any sores in the mouth or throat - prescription medication may be necessary from your physician. (e.g. Mycostatin or Dakarin).

Tips to help if there are sores in the mouth or throat:

  • Wash out the mouth with 1 tsp baking soda in a cup of warm water four times per day

  • Avoid foods with lots of spices or that are highly acidic

  • Stop smoking

GAUTENG ONCOLOGY
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DR. FRANK MICHAELIS​

 

M.B.BCh (Wits) MMed Rad. (T) (Wits)

Oncologist / Onkoloeë