Chemotherapy for cancer: treatment, recovery after
Chemotherapy is one of the main methods of treatment of human malignancies. It uses special drugs that either destroy cancer cells or cease their division.
Most of us know that chemotherapy is a very dangerous and complicated method of treatment, and the necessity of its implementation in cancer patients is well-founded concerns and anxiety. Patients and their relatives heard about the possible side effects, but the consciousness draws the prospect of hair loss, disorders of the gastrointestinal tract, a significant deterioration of health and the need to change their way of life. Fearing side effects, patients can and do refuse chemotherapy, but do not forget that it is not always possible to get rid of diseases only by surgery or radiation, which, moreover, also have certain risks.
We will try to understand what is actually is a chemotherapy, how to behave with and how to reduce possible adverse effects of this treatment.
The essence of chemotherapy is to appoint a specific medication with toxic activity against cancer cells or even non-poisons. The effect of these drugs is reduced either to the destruction of tumor cells or inhibition of their division in the process of tumor growth. The first group of drugs having a cytotoxic effect, the second – cytotoxic (cytostatic).
One of the major differences between chemotherapy from other types of medical treatment is an inevitable effect of drugs on healthy cells, especially rapidly dividing (skin cells, mucous membranes of the gastrointestinal tract, respiratory and urinary output). Analog of chemotherapy is considered to be antibiotics capable of destroying bacteria. However, if the bacteria are structurally much simpler and greatly different from the human tissues on biochemical properties and a set of receptors, the cancer cells are descended from once healthy human, but because somehow bear in themselves signs of the cloth in which originated. In the treatment of antibiotic will destroy the cells of bacteria, without affecting the organ tissue, while chemotherapy will inevitably affect not only the tumor. Any toxin that damages the cancer cell, will also damage and healthy with similar metabolic processes and a set of proteins. Thus, fighting with a clone of cancer cells with chemotherapeutic agents, it is impossible to prevent harmful effects on healthy tissue, and this is the main difficulty in conducting such treatment.
Chemotherapy is assigned based on the individual characteristics of the patient, his age, condition of the liver and kidneys, as well as the sensitivity of tumors to specific drugs. Dosage prepared especially carefully to avoid the extreme risk of complications from the treatment. In some cases, do an effective amount of the chemotherapeutic agent cannot be administered to the patient, because it will exceed the allowable level of toxicity and can even lead to death, so doctors are forced to limit the treatment duration, and number of chemotherapy cycles and the dose of used vehicles.
It is worth noting that, despite the relatively high risks and the certainty of side effects, chemotherapy has a number of advantages and undeniable advantages, which do not allow to reject it the majority of patients of oncological clinics. In addition, certain types of tumors such as hematological malignancies (tumors of the hematopoietic tissue), are systemic in nature, therefore, to remove the tumor surgically or locally irradiate it is not possible, and chemotherapy in such cases is the only true treatment option, giving the opportunity to heal or prolong the life of cancer patients.
Thus, considering that the mortality rate from malignant tumors in the absence of treatment reaches almost 100%, and more gentle alternative to chemotherapeutic agents is currently lacking, doctors and patients have to put up with possible complications and side effects in order to stop tumor growth.
The benefits of chemotherapy in the treatment of tumors
Despite the high toxicity of chemotherapy in Oncology has a number of undeniable advantages and qualities that justify its designation:
- The ability to remotely affect the organs with possible metastatic lesions, as well as on individual tumor cells entering the bloodstream;
- The destruction of cancer cells after radical surgical treatment, which could remain in the hearth of tumor growth and give subsequently relapse.
The introduction of intravenous drugs or ingestion of lead to hit them in the flow and spacing throughout the body. This means that the impact will be systemic and metastasis, and even individual cancer cells that managed to escape from the primary tumor node, will be destroyed, regardless of where they had to walk through the blood or lymph. This explains the necessity of chemotherapy in the presence or suspicion of metastasis (spread) of the tumor to other organs and tissues.
In the case of surgical removal of the tumor almost always there is a probability of abandonment of isolated cancer cells in the body, especially in tumors of large size, involving adjacent organs and tissues. Even one tumor cell is able to give rise to a million new, so it is important to get rid of cancer in all possible ways. Appointment after surgery, chemotherapy destroys those cells, and thereby prevents relapse (adjuvant chemotherapy). In addition, chemotherapy before surgery helps to reduce the mass of tumor tissue, which facilitates the work of the surgeon in its subsequent removal.
Given the positive effects of chemotherapy for cancer, you should not immediately reject this treatment because of fear of adverse consequences. Your medical oncologist will not only select the optimal scheme, but will also help to deal with the side effects of drugs and explains how to improve health in the treatment process.
Drugs for chemotherapy and methods for their use
The drugs used for chemotherapy, are many and varied, and classification and their mechanism of action challenging for the layman. In General, they are able to block certain biochemical processes, enzymes, stages of division of tumor cells, thereby becomes impossible or the reproduction of the vital functions of cancer cells. Usually administered several medications with different mechanisms of action (chemotherapy), the choice of dosage and method of treatment by the doctor-oncologist, and for the majority of tumors developed a standard schema and protocols that include a certain set of drugs.
Chemotherapy lasts from one to several days, followed by a break for a week – month, then the treatment is repeated. The average patient needs 6-8 courses that take 3 to 9 months in total, usually the treatment lasts about six months. Continuous infusion of chemotherapy drugs is generally not practiced due to their high toxicity and risk of side effects and complications.
The patient who has chemotherapy, are interested in how will be administered the drug, the extent to which can disrupt the well-being and how correctly to lead. The most effective is the intravenous way of administration of medicines when installing the system for infusion into a Central vein. It provides a less influence of toxic substances on the gastrointestinal tract and peripheral vein, and the risk of thrombophlebitis and painful nausea is greatly reduced. Taking medications orally in pill form is easier for the patient, possible in the home, but the efficiency is lower, and the frequency of side effects from the gastrointestinal tract, above.
In an attempt to reduce the toxicity of chemotherapy drugs, scientists have proposed to place them in liposomes – microscopic balls with a lipid wall, inside of which is a drug in aqueous solution. Liposomes, reaching cancer cells, penetrate, while to a much lesser extent striking healthy tissues of the body. An example of such a liposomal preparation of doxorubicin, administered by intravenous infusion.
Fundamentally new and very promising area for drug treatment of cancer is the so-called targeted therapy, in which the drug acts specifically on certain structures or processes peculiar to cancer cells, slows the growth of blood vessels in the tumor, etc. the Frequency and likelihood of side effects is reduced tenfold, and the patient can take the pills without changing your usual lifestyle. This alternative to standard treatment offers hope for izlechennosti cancer in the future.
Intravenous medications and ingestion have systemic effects, but may also local application in the form of ointments, applications, local injections. For example, for tumors of the skin, bladder, mouth, this method is quite effective.
Chemotherapy can be performed in isolation from other types of treatment (for example, in tumors of hematopoietic tissue), or in combination with surgery or radiation. If the patient is weakened, the tumor is large, tumor metastases, surgical operation is unnecessary or even dangerous for the patient, and to alleviate the suffering, improve and prolong the lives of cancer patients can be used chemotherapy. At the same time, if the patient’s condition allows, the chemotherapy is carried out before or after surgery. Chemotherapy after surgery aims to remove cancer cells that might remain in the area of tumor growth, as well as need to prevent relapse.
Radiation therapy may be combined with the introduction of chemotherapy. Irradiation acts locally at the growth of the tumor, whereas chemotherapy exerts a systemic effect and, as mentioned above, prevents the metastasis and recurrence of cancer.
Neoadjuvant chemotherapy (before surgery) reduces the size of the tumor, and also creates more favorable conditions for subsequent radical treatment (e.g. for bone marrow transplantation).
Chemotherapy in some cases may require the patient in the hospital. This is due to the high risk of complications and undesirable side reactions, when the assistance of personnel may be required at any time. At an acceptable level of toxicity of drugs the patient is being treated on an outpatient basis.
Video: chemotherapy, which hits the target (TC «Rain» on targeted therapy)
A few examples…
Chemotherapy for breast cancer, which is most common among women occupies a leading position worldwide, can be carried out both before and after surgical treatment. Modern drugs and their usage allows not to change a habitual way of life, and the treatments to come in any time (day hospital). In all cases, necessarily assigned to the antiemetics, so do not be afraid of distressing nausea and vomiting. An important achievement of modern medicine is the ability to determine tumor sensitivity to specific chemotherapy, which greatly increases their effectiveness.
Chemotherapy for lung cancer is possibility of using targeted agents containing antibodies (specific proteins) to specific receptors of the tumor. This helps to minimize side effects and to provide treatment as efficiently as possible, achieving long-term remission.
Treatment with chemotherapy in stomach cancer is not independent values, since these tumors are not sensitive to such effects, but the combination of chemotherapy with radiation or surgery can give good results.
These examples show that not all tumors chemotherapy may be equally effective, so it is very important individual approach, taking into account characteristics of cancer cells in each case.
The side effects of chemotherapy and methods of overcoming them
Perhaps one of the main reasons for the alarms of oncological patients is the possibility of adverse side effects from receiving chemotherapy. Although modern pharmacology offers a very effective tool in reducing the toxicity through rational regimens, routes of administration and characteristics of chemical structure, yet completely avoid the effects of chemotherapy will not work.
The severity of symptoms of the toxic action of anticancer funds depends not only on the specific drug, but the patient’s condition, presence of comorbidities, and emotional readiness for treatment. It is no secret that patients waiting have certain negative consequences of chemotherapy are more at risk of their appearance, therefore to predict, as will change the treatment health cancer impossible side effects can be highly pronounced or almost absent.
Along with the search for new highly effective and less toxic drugs, scientists are developing and drugs that reduce painful symptoms of chemotherapy. Thus, modern antiemetics can be reduced almost to a minimum one of the most painful effects of the treatment.
If necessary, chemotherapy is very important the participation and moral support from loved ones, as well as the delicacy and tact of strangers (co-workers or even people on the street). If the family most often included indirectly in the treatment process, helps and supports the patient, then from everyone else to expect understanding and tact is necessary not always, but in the meantime, cancer patients are very vulnerable psychologically. These conditions often determine the susceptibility of patients to depression, stress, excessive feelings that are not conducive to positive treatment outcome. If you have some psychological problems, it makes sense to talk to a therapist or even to undergo medical treatment.
Nausea and vomiting
Most often, patients undergoing chemotherapy complain of nausea and vomiting. This is due to the high toxicity of drugs and their action on the mucosa of the gastrointestinal tract, the liver and the vomiting center in the brain.
The more the patient is afraid of these symptoms, the worse is able to control the nausea, the more likely poor health in the treatment. In addition, unfavorable factors are considered female gender, young age, liver pathology and brain, alcohol during treatment, as well as violations of water and electrolyte metabolism, often accompanying cancer. The dosage of the injected material also plays a role: the higher it is, the more likely the development of nausea and vomiting.
Modern chemotherapeutic agents have a less pronounced emetogenic (provoke vomiting) effect than those that were used 10-15 years ago, and the possibility of receiving highly effective antiemetic drugs throughout the treatment gives the patient a chance at all to avoid the painful symptoms.
What to do in case of nausea and vomiting?
First of all, when there are any changes being you need to tell your doctor, because to choose an effective drug against nausea and vomiting can be difficult, here the individual approach is important and even method of «trial and error».
Directly on the days of chemotherapy and throughout treatment you need to follow the simple rules:
Hair loss, changes in skin and nails
Hair loss, deterioration of the skin and nails are frequent during chemotherapy. In women these symptoms may cause severe psychological discomfort to the point of depression, because appearance does not change for the better, but people easily notice the negative effects of treatment. Men have less to suffer psychologically from these side effects, but to look after themselves during treatment necessarily patients of both sexes.
Hair loss often accompanies chemotherapy, but not all drugs cause this. Since the cells of hair follicles are divided and constantly updated, in the treatment they become very vulnerable. Maybe thinning hair, thinning, and in some cases complete baldness, and it affects not only the head, but other hairy areas of the body.
Hair loss starts after 2-3 weeks of starting treatment, and after it they grow back again. Of course, any threat to the life or health of baldness is not responsible, but the problem is quite relevant for most patients, especially women, for whom appearance and hairstyle are very important. In addition to personal worries about changes in appearance, patients experience discomfort and excessive attention from others, because hair loss is often other indications for cancer.
What to do when hair loss?
- Carefully wash hair with a mild shampoo, gently wipe, to prevent any damage, do not abuse the dryer.
- If the hair started to fall out, it is recommended to cut them short or to shave her head (watch out!).
- In the case of baldness is to wear a scarf or hat to protect sensitive scalp from external influences.
- To think about the necessity of wearing a wig in advance, even before the hair falls out so that the color matched the color of the hair of the patient.
As practice shows, in many cases, the speed and intensity of alopecia depend on the hair care before the start of chemotherapy.
Hair restoration will start in 2-3 months after the treatment, they can even change the color or the structure, but after some time everything will be back to normal.
Along with the hair, the negative effect of the chemo experience and the nails that begin to stratify, break, change color. To prevent such phenomena it is necessary to carefully monitor their condition, avoid nail Polish, homework with gloves, and medicine may offer a method for local cooling, which decreases the toxic effect of the treatment on the fingers due to narrowing of capillaries and slowing of blood flow.
The skin belongs to the well updated the bodies, so often also suffer during chemotherapy. Possible itching, redness, thinning of the skin, and pain. Proper care of skin is to carefully wash without a washcloth, use special creams and lotions, sunscreen when going outside. The clothes should be from natural fabrics, loose and comfortable.
Dysfunction of the gastrointestinal tract
The mucous membrane of the stomach and intestines is constantly being updated, the cells in her intensely divided and in chemotherapy quite often there are various disorders of these processes, accompanied by diarrhea, constipation, change of appetite.
Loss of appetite or change of taste of the foods are frequent, and the patient is very important role nutrition during chemotherapy, because weight loss, lack of vitamins and trace elements may further degrade already weakened by the tumor body. It is important to know the rules that will help to cope with the negative manifestations of treatment and provide the patient with adequate food and drinking regime:
Diseases such as cancer of the bowel, stomach, esophagus, pancreas, liver accompanied by significant impairments of digestion by themselves, so chemotherapy requires special care, and extra nutrition recommendations will give the doctor.
The effect of chemotherapy on the reproductive function
Because chemotherapy can compromise the fetal development, the childbirth at the time of treatment should be abandoned. Women should regularly visit the gynecologist and to use contraception. Men also need to be careful, because the chemotherapy causes damage to the sperm, and therefore a chance of malformations in the child. In addition, the semen may contain chemotherapy drugs, so to avoid their irritating effect on the mucous membranes of the genital tract have a partner, you should always use a condom.
A blood test during chemotherapy
The bone marrow is updated continuously, and produce new white blood cells, platelets, red blood cells, which deliver oxygen to tissues, immunity and hemostasis. Chemotherapy affecting continuously dividing cells almost always affects the bone marrow, and patients suffer from anemia (anemia), reduced immune protection from infections, bleeding.
Blood after chemotherapy is characterized by a decrease in the number of erythrocytes, leukocytes, and platelets, i.e., cells of all of sprouts of bone marrow. Patients experience weakness, dizziness, prone to infections, bleeding.
What if we reduced indicators of the General analysis of blood?
In anemia when the body lacks oxygen, it is recommended more rest, fresh air, sleep at least eight hours a day, and a day to have a little sleep-rest.
The diet should be filled with foods containing iron: red meat, beans, spinach, salad greens. Pharmacological correction of anemia consists of administration of iron preparations, and in severe cases, doctors resort to donor red blood cell transfusion.
At decrease in immunity due to a lack of leukocytes, should avoid hypothermia, crowds of people, especially during epidemics of seasonal infections to take vitamins and medicine can offer introduction of special growth factors that help to increase leukocytes after chemotherapy.
To correct the platelet count, the introduction of the platelet concentrate, and patients are encouraged to avoid injury, do not use hard toothbrushes and toothpicks, to carefully handle scissors, knives.
Rehabilitation after chemotherapy
Recovery after chemotherapy is very important in a comprehensive approach to cancer treatment. If the patients with early-stage tumors that have passed one or several courses of treatment, almost does not need rehabilitation, patients with multiple tumors, advanced stages of the disease, dysfunction of internal organs without rehabilitation treatment can not do. The above-described side effects such as nausea, stool disorders, hair loss, in fact, are protective reaction of an organism to ongoing chemotherapy and therefore only require high-quality training before the actual chemotherapy treatment and the appointment of symptomatic therapy.
With advanced forms of cancer, after a few dozen cycles of treatment, patients and their relatives are not the hair on the head and external aesthetics, since the fore more serious problems that require correction in a medical facility.
What are the complications after chemotherapy the most dangerous? First, it is a change of formula of blood: anemia by decreasing the level of red blood cells and hemoglobin, leukopenia, clotting disorder can be considered a reason for further treatment of the patient. Secondly, the toxic effect of chemotherapy on the liver, kidneys, heart, brain, may result in the violation of their functions during and after chemotherapy. Finally, serious mental disorders up to severe depression and even psychoses cause many cancer patients to the doctor-therapist.
Treatment after chemotherapy described above disorders may require:
- The appointment of iron preparations, vitamins, minerals, and transfusions of Packed red cells for anemia.
- Transfusion of platelets, plasma preparations with bleeding or injection of anticoagulants with increasing blood coagulability and tendency to thrombosis.
- Conduct in case of immunodeficiency and the accession of infectious complications of antimicrobial therapy and the placement of the patient in sterile conditions in severe cases.
- When violation of the liver is assigned disintoxication therapy, plasmapheresis, and at pathology of kidneys – hemosorbtion, hemodialysis.
- Depression, psychosis, suicidal thoughts (which often happens with cancer patients) require the assistance of a therapist or psychooncology (in specialized cancer clinics).
Important is good pain relief, especially in patients with metastases that chemotherapy was not carried out with the aim of complete cure and to relieve the painful symptoms.
To recover at home will help, where possible, active lifestyle, walking, socializing, good nutrition, taking vitamin complexes, as well as the activities you love. If condition allows, the patient may be allowed to work at the same place either transferred to lighter work, and their way of life will only help faster rehabilitation.
Promotes rapid recovery and good nutrition after chemotherapy, including high-calorie foods, vegetables, fruits, protein in sufficient quantity. Overall, diet does not differ from that which is to adhere to a cancer patient regardless of whether chemotherapy was performed or not, and its basic principles are described in detail in a separate article.
Folk remedies in the recovery process after chemotherapy may be applicable, but it is important to observe a measure and be sure to inform about the intention of their use the doctor. For hair care it is useful to use burdock, decoction of herbs (nettle, for example). In pathology of the gastrointestinal tract, suitable chamomile, fennel, sage, and for normalization of sleep and combat depression good teas from lemon balm, peppermint, Valerian.
A special place in rehabilitation is the recovery of the emotional balance and the inflow of positive emotions. It is very important part of loved ones that can not only help you in everyday challenges, such as cooking, going out, hygiene. Participation and moral support is sometimes even more important to the patient, as in the case of severe depressive disorders required the assistance of a therapist or psychiatrist.
For many patients topical the clinic, where it will undergo treatment. It is important to note that fundamental differences in the schemes and stages of therapy there, but the comfort, availability of expensive drugs and diagnostic methods may require a large amount of money. The cost of the course will vary widely depending on the type of treatment, the necessity of certain procedures and the number of used drugs, consumables, complexity of the operative intervention etc.
Free assistance to cancer patients can be provided in any public institution of health, and the chemotherapy drugs, which are taken home, will be discharged with a prescription oncologist. It is important not to lose time, therefore, the insurance policy can give an advantage to its owner when there are queues for research, etc. To receive a free cancer care it is only necessary to consult a doctor at the place of residence, which will direct further tests and treatment at a specialized cancer center.
Chemotherapy is an integral phase of the treatment of most malignant tumors, so do not refuse it for fear of side effects, because one scale is treated, and on the other the life. For cancer patients it is very important trust and mutual understanding with the doctor, and the advice of friends and relatives can hurt. Improved methods of cancer treatment, chemotherapeutic agents that act intentionally without damaging healthy tissue, the use of effective symptomatic therapy offer hope for successful treatment of malignant tumors in many patients, the main thing – not to lose time and to go to the doctor if any suspicious symptoms.