What happens during chemotherapy

Chemotherapy can be carried out in many different ways, depending on your specific circumstances.

Your care team

Many hospitals use multidisciplinary teams (MDTs), consisting of a number of specialists working together to give chemotherapy treatment. This may include:

• medical oncologist a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy
• pathologist a specialist in diseased tissue
• haematologist a blood specialist
• psychologist who can provide support and advice about the psychological and emotional impact of chemotherapy
• clinical nurse specialist (CNS) who will offer you support throughout your treatment

You may also be assigned a key worker (this is often the CNS) who you can contact at any point during your treatment.

Deciding what treatment is best for you can often be confusing. Your care team will recommend what they think is the best treatment option, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the doctor in charge of your care.

For example, you may want to find out:

• what the purpose of your chemotherapy is for example,whether it's being used to cure your cancer, relieve your symptoms or make other treatments more effective
• what side effects you're likely to experience and whether anything can be done to prevent or relieve them
• how effective the chemotherapy islikely to be at curingyour cancer,or at least slowing it down
• whether any alternative treatments can be used instead of chemotherapy

Tests

Before chemotherapy begins, you'll probably needtests to assess your health to make sure youcan cope with any side effects. Tests may also becarried out during treatment to monitor your progress.

The tests you require will depend on the type of cancer you have.

Blood tests

In most cases, a Blood tests is carried out to assess the health of your liver and kidneys. This is important, because chemotherapy medicines will be broken down in your liver and kidneys. The medication can harm the liver, so it may not be suitable for youif you haveliver or kidney damage.

You'll also need a blood count to measure how many blood cells you have.

If you have a low blood count, treatment may be delayed until your blood count has returned to normal. This is because chemotherapy reduces the number of cells in your blood. In some cases, a blood transfusion may be required.

Regular blood tests may also be carried out during your treatment to monitor your liver, kidneys and blood count.

Scans

Scans can help to identify the best form of treatment and provide a reference point, so your progress can be checked during treatment.

Several different scans may be used, including:

• X-rays
• computerised tomography (CT) scans
• magnetic resonance imaging (MRI) scans

Your treatment plan

You'll need regular chemotherapy over a set period of time for it to be effective.

Your care team will draw up a treatment plan detailing how many sessions you'll need, how long the course should last, and how much time should pass between each session. It's common for there to be a break after each session, to allow your body to recover.

The treatment plan is known as a chemotherapy protocol. Chemotherapy protocols vary, depending on the type of cancer you have and how advanced it is.

Types of chemotherapy

Chemotherapy is usually given in one of two ways:

• as a tablet (oral chemotherapy)
• injected directly into a vein (intravenous chemotherapy)

However, chemotherapy medicine can also be given in other ways. It can be injected into the spine (intrathecal chemotherapy) and it can come as a cream that's applied directly to the skin.

The type of chemotherapy used will depend on the type of cancer you have and how advanced it is.

Oral chemotherapy

If you're in good health, you may be able to take your tablets at home. However, you'll still need to go to hospital for regular check-ups.

It's important that you only take your tablets on the days specified in your chemotherapy protocol. If you forget to take a tablet, contact your care team for advice. You should also contact your care team if you're sick shortly after taking a tablet.

Intravenous chemotherapy

Chemotherapy medicines are slowly released into a vein over a period of time. The time it takes to give one dose can range from several hours to several days.

Some people need a continuous low dose of chemotherapy medication over several weeks or months. If this is the case, you may be given a small portable pump that you can take home with you.

Intravenous chemotherapy can be given in a number of ways. You may get a choice, although this isn't always possible.

Cannula

A cannula is a small tube that's placed into a vein on the back of your hand or lower arm. Chemotherapy medicine is slowly injected through the tube into your vein. Once the dose of medication has been delivered, the tube can be removed.

Central line

A central line, also known as a skin-tunnelled catheter, is a fine tube that's inserted into your chest and connected to one of the veins near your heart. The tube can be left in place for several weeks or months, so that you don't have to have repeated injections. It can also be used to carry out blood tests.

Peripherally inserted central catheter

A peripherally inserted central catheter (PICC) is similar to a central line, except the tube is connected to your arm rather than your chest.

Implanted port

An implanted port is arubber chamber surgically inserted under your skin. It's connected to a vein with a soft plastic tube. Chemotherapy medication is given using a special needle placed through the skin into the chamber. The port is kept in place throughout the course of treatment.

Things to consider

During chemotherapy treatment, there are a number of important things you need to bear in mind.

Other medication

Check with your care team before youtake any other medication, including over-the-counter medicines and herbal remedies. Other medication could react unpredictably with your chemotherapy medication.

Pregnancy

You should avoid becoming pregnant while having chemotherapy. This is because many medications used in chemotherapy can cause birth defects.

You'll need to use a barrier method of contraception, such as condoms , while having chemotherapy and for at least six months after your treatment has finished.

Contact your care team immediately if you think you may have become pregnant while having chemotherapy.

Side effects

Chemotherapy usually causes severe side effects, such as hair loss , fatigue, nausea and vomiting. .