Chemotherapy

Overview

When you are diagnosed with cancer, you and your doctor will work together to determine the best treatment for your disease. Your treatment may include surgery, radiotherapy (radiation), hormone therapy, immunotherapy, chemotherapy or a combination of several of these.

Chemotherapy uses specialized drugs either to kill cancer cells or to help manage side effects of cancer. Sometimes more than one of these drugs is combined to treat specific types of cancers. You might hear such combinations referred to as a “drug cocktail” or regimen.

What To Expect

How, when and what type of chemotherapy you receive will depend on your particular type of cancer and whether it is the first time you’ve had the disease or if your cancer has returned. You and your doctor will discuss and determine the best course of treatment.

Chemotherapy options may include:

Chemotherapy before surgery (neoadjuvant chemotherapy)

If surgery to remove your tumor is part of your care plan, you may decide to try chemotherapy prior to the operation to see if it will make the tumor smaller, thus leaving not as much cancer to remove or making it possible to avoid debilitating surgery.

Chemotherapy after surgery (adjuvant chemotherapy)

Giving chemotherapy after surgery may help kill any cancer that may not have been removed during surgery and help prevent the cancer’s return.

Concurrent chemotherapy

You and your doctor may decide to try chemotherapy in addition to another therapy such as radiation.

Chemotherapy alone

Taking chemotherapy alone is also an option and may be a good course for some situations.

How Will I Know if the Chemotherapy is Working?

If you have chemotherapy prior to surgery or concurrent with another therapy, it will be evident that it has been effective it the tumor has shrunk. There are four outcomes that doctors look for in cancer treatment:

• Complete remission – all evidence of disease is gone
• Partial remission – the bulk of the disease is reduced by 50 percent
• Stable disease – the tumor hasn't shrunk enough to call it partial remission and hasn't grown enough to call it progression. This is often a good outcome.
• Progressive disease – the tumor is clearly bigger (typically 25 percent) or there is a new disease site. If this happens, you and your doctor will discuss other options, including using a different chemotherapy combination to further treat the disease.

Why is Stable Disease Considered a Good Outcome?

As cancer treatment has evolved and become more effective, it has become evident that sometimes getting cancer to a chronic disease state, similar to diabetes, is a significant achievement. By getting you to a stable disease state you are not getting worse and the cancer is controlled. And while, like a diabetes patient, you are not necessarily being cured, your disease progression has been arrested.

You will of course continue to monitor your symptoms and the disease to ensure it isn’t getting worse, but you and your physician will outline a plan for continued care. You may in some cases need to continue treatment to maintain stable disease.

How is Chemotherapy Given?

Depending on your type of cancer, you’ll either receive chemotherapy intravenously (IV) or by mouth. Some regimens combine therapy by mouth and by IV.

If your chemotherapy is given by IV, you’ll either go to the hospital, the physician’s office, or self-administer at home.

Watch: What to Expect with Chemotherapy

Preparing For Your Chemotherapy

Your wishes about your cancer care are very important. What is the goal? Is it to cure the disease? To live longer than you would without treatment? To feel better and more comfortable? Or to control or stabilize the disease? You and your doctor will discuss these possible goals and outline a plan. And, like all plans, you’ll revisit and review your options throughout your care.

You’ll also want to discuss and prepare for possible side effects from chemotherapy. Be honest with your physician about potential side effects that you might find intolerable.

Questions To Ask Your Provider About Chemotherapy

You probably have a lot of questions about your cancer treatment. This is a big step with big decisions and you need to be comfortable and confident in your care. It can be overwhelming to discuss cancer and its treatment, so many patients bring along a notebook and pen to jot down the answers to your questions, or bring a trusted friend or loved one to listen and ask additional questions you might not think of.

Here are a few questions to get you started:

• Is chemotherapy my best treatment option? For my cancer, how does it compare with other therapies such as immunotherapy?
• How often and for how long will my chemotherapy treatments last?
• How likely is it to work?
• What are the side effects?
• What medications or other things can help prevent/lessen side effects?
• What should I do if I have a bad reaction to my chemotherapy?
• If I am giving my therapy at home, will I be trained on how to do it and is there phone support if I need it?
• How will going through chemotherapy affect my life? Can I still work?