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How Chemotherapy Works

A Guide to Chemotherapy and Its Administration
by

Jaskiran Khosa

on 1 May 2013

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Transcript of How Chemotherapy Works

How Chemotherapy Works An Interactive Guide to Understanding Chemo Cancer is the second leading killer in the United States and a growing cause of death in the developing world as well (1). Chances are we all have had some personal experience with cancer through our relatives, our friends, and even ourselves. In many cases, the first weapon in our arsenal against cancer is chemotherapy, and therefore, it is important to understand chemotherapy and how it is used to treat cancer. The purpose of this guide is to highlight the different goals of chemotherapy, how it is administered, and future experimental approaches in chemotherapeutic treatment. A document such as this could be found in a pamphlet at an oncologist’s office or hospital and is intended for the general, educated public. For Whom this Guide is Intended The human body is composed of 100 trillion cells, most of which will normally divide to give rise to new cells as seen in Figure 1. However, the risk inherent to cellular division is that each cell can potentially mutate into an uncontrollable, proliferating machine known as cancer (1). The human body, however, has many mechanisms in check to prevent such an unstoppable spread. But exposure to toxins, genetic predisposition, or perhaps even the normal aging process can dismantle these mechanisms and lead to the rapid propagation of mutant cells in a cluster known as a tumor. Tumors can spread, or metastasize, throughout the body via the lymph system or through the circulation of blood to proliferate in organs different from the organ of origin.

Often referred to as chemo, chemotherapy is a common
form of cancer treatment that uses cytostatics, which are
drugs designed to stop cancer cells from dividing unstoppably.
Chemo targets rapidly dividing cells, such as those found
in the hair, stomach lining, or surface of the skin by impairing
the cell division process, or mitosis. Introduction Every goal of chemotherapy essentially aims to rid the body of cancerous cells. The progression of cancer treatment requires different chemotherapeutic goals, some of which are described in the bubbles below (5). The specific goal in using chemo depends on the treatment plan according to the patient and physician. Goals of Chemotherapy Chemotherapy involves administering cytostatic medications usually through the infusion into a vein or oral consumption.

In each treatment session, infusion into a vein is often given through the hand or lower arm.

Usually these different drugs are given in combination to act on all parts of the body so that undetected cancer cells do not fly under the radar.

There are three types of administration methods: catheters, ports, and pumps. How Chemotherapy Works Figure 1: Mitosis. A single cell divides into two daughter cells in the normal life cycle of the cell. Cancer is the uncontrollable division of cells and chemotherapy is used to treat it. Some chemo drugs work to modify genes to prevent cellular replication, while others physically attack cancer cells (1). Catheters (see figure 2)

A catheter is a thin, pliable tube that a surgeon inserts into a large vein, typically in the chest for chemo administration. The catheter is open on one end to outside of the body so that chemotherapeutic drugs can be inserted into the body. The advantage to using a catheter during administration is that the tube serves a double function: injecting in chemo and drawing blood for routine blood tests. The potential disadvantage of catheters is the slightly higher risk of infection compared to other administration methods, but this can be lowered with cleanly maintenance of the catheter and its insertion site. Ports (see figure 3)

A port is a round, small disc composed of metal that is inserted below the skin and is pierced with a needle or catheter for administration of chemo. The advantage to using a port is that the needle can be left in place for multiple treatments that span more than one day; however, this does again carry the risk of infection, and therefore, must be kept as clean as possible. Pumps (see figure 4)

Pumps are typically connected to a port or catheter to control the rate of chemotherapy administration into the body. Pumps can be external or internal to the body. One of the advantages of the internal pump is that it can always be carried around, however, it requires invasive surgery to implant. People can also carry the external pumps around with them. Because both types of pumps are connected to either a port or catheter, pumps do carry a risk of infection as well and the pump itself along with the port or catheter must be kept clean to avoid bacterial contamination. Side Effects

Cytotoxic medications like those used in chemo attack not only cancer cells, but also healthy cells that are rapidly dividing such as those found in the hair and mucous membranes of the throat and digestive tract. Therefore, chemo can cause short-term side effects like hair loss, nausea, vomiting, and infections of the mouth.

The adverse effects can be relieved, however, through an array of mechanisms that have evolved with chemo like antiemetic drugs for nausea and vomiting or antibiotics for infections. The severity of side effects experienced depends on the individual, but it is important to note that the hair, mucous membranes, and immune system will recover after treatment. Chemotherapy was originally developed from the observation that mustard gas used in the chemical warfare of World War II actually lowered red and white blood cell counts of those exposed. Interestingly, what once was as a weapon in warfare is now a valuable treatment to save lives. Researchers modified the mustard gas compounds and eventually discovered that intentional use of cytotoxic compounds could reduce the concentration of cancerous cells in the body, but at the cost of normal cells as well. However, chemotherapy remains one of our best tools against cancer and it does hold a promising future in which the medicine targets only cancerous cells instead of the whole body. The advances in chemotherapy thus far, from a simple injection to ports that people can use for treatment at home or anywhere, have already improved the lives of many cancer patients. Conclusion Resources

1 “How Chemotherapy Works.” Cancer Research UK : CancerHelp UK. Cancer Research UK, 7 Mar. 2013. Web. 15 Apr. 2013.<http://www.cancerresearchuk.org/cancer-help/aboutcancer/treatment/chemotherapy/about/how chemotherapy-works>

2 “Questions and Answers about Chemotherapy.” National Cancer Institute. National Institutes of Health. 29 June 2007.<http://www.cancer.gov/cancertopics/coping/chemotherapy-and-you/page2>

3 Trafton, Anne. “Why Chemo Works for Some People and Not Others.” MIT's News Office. MIT News, 18 Sept. 2008. Web. 15 Apr. 2013.<http://web.mit.edu/newsoffice/2008/cell-response-0918.html>

4 United States. Institute for Quality and Efficiency in Health Care. National Center for Biotechnology Information. U.S. National Library of Medicine, 15 Mar. 2012. Web. 15 Apr. 2013.<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0041062/>

5 Winstead, Edward R. “Busting a Myth About How Chemotherapy Works.” National Cancer Institute Publication 10.1 (2013): n. pag. National Cancer Institute. NCI Cancer Bulletin, 8 Jan. 2013. Web. 15 Apr. 2013.<http://www.cancer.gov/ncicancerbulletin/010813/page6>

6 Khosa, Jaskiran. “Goals of Chemotherapy.” Created by author. 16 April 2013.

7 "Sharing My Cancer Crapness." Web log post. Sharing My Cancer Crapness. N.p., 19 June 2012. Web. 01 Apr. 2013. <http://cancercrapness.blogspot.com/>

8 "Installing My Chemo Port - The Surgery, The Outcome, & Some Advice." Weblog post. What Is CLL - Living with Chronic Lymphocytic Leukemia. N.p., 6 Mar. 2013. Web. 30 Apr. 2013. <http://www.whatiscll.com/chemo-port/>

9 "Medical Minutes." Oncology Associates Cancer Treatment Specialists Omaha NE RSS. Oncology Associates, 2013. Web. 01 May 2013. <http://www.oacancer.com/patient-info/resources/video/medical-minutes/>
Curative

eliminate all cancer cells for a permanent cure Palliative

inoperable tumor; relieve symptoms or inhibit proliferation Neo-adjuvant

pre-surgery chemo to shrink excessively large tumors Adjuvant

post-surgery chemo to eliminate residual cancer cells; also prevents recurrence Figure 2: A catheter is an external device
used to inject chemotherapy into the body (9). Figure 3: An image of a port, a device used
to adminster chemotherapy (8). Figure 4: An image of a pump. This particular pump is fixed, whereas others are portable for on-the-go use (7).
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