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Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. These drugs work in a wide variety of ways and are all very different from each other. To confuse things even more, we often put drugs together in different combinations. So not only are the individual drugs all different from each other but the combinations are also different. And all this before we even think about doses. This means that there is no one description that will cover everything. Some Chemotherapy is given in tablet form, there is no need to stay in hospital and there are virtually no side effects. At the other extreme, some treatment is given in hospital by intravenous drip and side-effects are sometimes severe. The doctors and nurses should have told you what to expect in your particular case and, if you didn't take it all in, then good information is available on the Web: CancerBACUP, Cancer Research UK, and the US National Cancer Institute.

Chemotherapy works by killing cancer cells. Unfortunately some normal cells are also killed, and this is where many of the side-effects of Chemotherapy come from. The cancer cells cannot repair themselves as well as the normal cells and so, over time, the normal cells will fully repair themselves but the cancer cells won't. We need to allow time for the normal cells to repair themselves, and this usually takes between 2 and 4 weeks. This is why Chemotherapy is scheduled the way it is - to allow normal cells time to recover, knowing that the cancer cells won't. It's a bit like cutting the grass. Good grass grows better than weeds so, if you cut your lawn regularly, you end up with a better lawn.

Chemotherapy doses are usually calculated individually and the calculation is based on how big you are. The best guide to your size is your surface area - which can be calculated for your weight and height. This why we measure your height and weight before Chemotherapy. We also need to make sure your blood count is normal before treatment. Your bone marrow is a factory which makes blood cells. Many drugs used in Chemotherapy will temporarily affect the ability of the marrow to produce cells. We are particularly interested in the white cells (which fight infection) and the platelets (which help the blood to clot) as these are more vulnerable to the effects of Chemotherapy than the red cells. Some drugs cause specific side effects on other organs, such as the heart and the kidneys, and so, sometimes we need to do other blood tests or heart tests to monitor these changes.

If everything checks out properly then the drugs are prescribed by the doctors, checked by the pharmacy and then delivered to the ward or the day unit. Most Chemotherapy has to be made up fresh and so there may be a delay between you arriving at the unit and your drugs being ready. This is because everything has to be done properly and carefully, with checks all along the way, and all this takes time. Once everything is ready, then your drip is put up using a needle into a vein in your forearm. The jag at the beginning stings a bit but this is only for about 30 seconds. Once the drip is properly in place you don't feel anything, except a bit encumbered by the tubing and the drip stand itself. An electric pump controls the drip. This has a chargeable battery which means that you can push the drip stand around with you if you want to take a walk round the room. If you are staying overnight then you will have treatment either lying in your bed or sitting beside it. If you are coming as a day patient then you will be treated sitting in an easy chair, usually these recline so that you find a position that is comfortable and snooze or read your way through treatment.

The doctors and nurses in the Chemotherapy unit will explain everything to you and they will make sure that you are given tablets or injections to help damp down any side-effects associated with the treatment. Modern anti-sickness drugs are very powerful and, nowadays, we can usually control most of the symptoms associated with even the very powerful forms of Chemotherapy. When it is time to go home, you will be given a supply of drugs to take away with you. Some of these may be part of the Chemotherapy, others will to be to help with the side effects. The nurses will explain to you carefully what is what. You will also be given a number to call if you feel unwell between times. Sometimes the lack of white cells can lead to blood poisoning. The risk of this happening is greatest 10 to 14 days after Chemotherapy. The problem is not common but, if it happens, it needs to be treated rapidly with antibiotics. The symptoms are usually shivering, feeling hot and cold, and having a temperature. If these symptoms develop you should contact the hospital straight away.

Most people go through Chemotherapy without any major problems. The word "Chemotherapy" carries with it a lot of psychological and emotional baggage. For many people it is just disruptive and, frankly, a little boring. If you are frightened at the prospect of Chemotherapy then it is often helpful to have a chat with the nurses from the unit. They may even be able to put you in touch with someone who has had similar treatment in the past, just so you can hear, from the horse's mouth as it were, that Chemotherapy isn't really as bad as you might be thinking.