I'll start from afar. Last week, to keep me from being sad, my friend gave me a new wig - dark brown. I went through almost all the chemo as a blonde, and now, so that the doctors from the chemotherapy department would not recognize me, I dressed up as a brunette, put on glasses, changed my jacket and jeans to a white coat and boots and walked around the bushes - because with all my gratitude to them, I don’t want to I don’t want to see them in the near future so much that I don’t even want to say hello. I don’t meet chemotherapists, but the security guards at the parking lot where I park my car are surprised and compliment me every day. Today I heard - “You just blossomed in Lately!" - I just smile. The current doctor, seeing the results of the blood tests, raises his eyebrows - “Hemoglobin 130? Leukocytes 3.9? Well done! "
What is wrong here and how is it connected? Yes, almost nothing, except for the fact that a week ago I completed the 6th course of PCT.
When I was informed that I needed to undergo an adjuvant course of chemotherapy, I not only could not understand the word “adjuvant,” but I also could not pronounce it, and the word “chemotherapy” plunged me into such despondency that I was ready to go chew fly agaric mushrooms just to avoid there.
They put me in the department by cunning, took me by surprise and took advantage of my confusion. I went for a consultation and was immediately admitted to the hospital. I honestly tried to escape - having successfully found no one in the department (those who don’t look, don’t find) - neither the head nurse nor the doctor, I cheerfully began to move towards the exit. I didn’t know then the secret paths through the bushes and backyards, so I was caught by the doctor from the clinic, taken by his arm and taken back to the clinic. He quickly found everyone, they gave me a bed, showed me the ward and introduced me to the attending physician. Well, then I decided that now I could definitely go home, but I heard, “Go and lie down in the room!” - “How??? I’m not ready!” “You will never be ready,” the doctor prophesied and he was absolutely right - all six times when it came time to go on an IV, I was completely unprepared. If it weren’t for our leaky state budget, due to which there are never any medicines, even though they are prescribed for cancer patients, then they would have treated me right away - I have no doubt about it. But since it was only the month of May, the state budget was still being discussed, and oncology was waiting - they can always wait, they are used to it.
But I had my first detailed conversation about what an adjuvant is, chemotherapy, what they will do with me, what drugs, how it happens, what can happen, what happens, what doesn’t, and it seemed to me that something was not being told to me and They are hiding something from me. According to the doctor, all this is not difficult, most of it is well tolerated and there is no need to worry about anything at all, that everything will be fine. I foolishly believed it all and... that’s how it happened. This is the power of suggestion! Just last week he admitted that he actually seriously doubted that I would be able to cope with all this, but thank God that he was stoically silent for five months and continued to smile and kept promising to lower the dose, and I kept acting like a fool, honestly word.
So what was I so afraid of initially and why did I want to escape so much? . From films and books, I got the impression that this is something terrible and after it people are simply no longer residents, but complete goons. I also thought it was like this scary procedure and I will vomit and swear for six months and will be completely disabled and will not be able to take care of myself.
Who cares what it is and what it is eaten with.
I had a FAC regimen - “red chemistry”: one dropper, then a 21-day break, analysis, if everything is ok - the next one, and so on 6 times.
I was afraid that it would be bad while on the drip - it wasn’t, since the first thing they instilled was a bottle of premedication with various antiemetic and antiallergic drugs - after that I felt calm. One time I felt nauseous from the premedication - it happened, yes - but I think that day my roommates told me I had a “sick headache” and the ondasetron was Ukrainian, I didn’t experiment with it anymore.
I was afraid that it would feel bad right away after the IV - no, it didn’t, I quickly got up, got into the car and drove home. Having made sure that I was fine after the first one, I drove to the remaining five courses myself.
I was afraid that I would feel sick and vomit a lot and constantly - I felt sick for the first three days, but I only vomited on the first day and not during all courses. Until the third day I saved myself with pills, then I switched to injections. I got used to ondasetron, but even after the 6th, I was injected 4 times three times a day for just two days, then I managed on my own.
I was afraid it would be bad all the time. It was bad for three days, then there was weakness for up to a week, but by the 6th day it was already quite bearable. For two weeks I just walked in a relaxed mode.
I was afraid that it would be very bad. It happened, but somehow it wasn’t so much that it was just “horror-horror.” It’s just poisoning with intoxication and the drugs are the same to relieve it.
I was afraid that I wouldn't be able to take care of myself. Well, for the first couple of days they came to help so that I wouldn’t be scared or bored - but not all the times and it didn’t last long.
I was afraid that I wouldn't be able to work. I didn't want to work. I could, but at work there was chaos, confusion and vacillation, it was hot outside, I felt good and I took a vacation for myself. No one died without me. In addition, the doctor explained to me that after chemotherapy, after two weeks, blood counts drop and there is no immunity, and in offices there are air conditioners, dry air, people with viruses and it’s easy to catch a cold. And by the way, once a week I did go out and got sick under the air conditioning - I was quickly treated and didn’t take any more risks.
I was afraid it would take a very long time. When I came to the first one, there was a mother with her daughter - she had the sixth one and I said how envious I am, and I still have so long. And then they said - “You won’t notice how time will pass, an IV, then you go away for a week, then a couple of weeks go by quickly - you do your business, then take tests and the next one" - it turned out exactly the same. During the week while I was leaving, some things piled up, then I did them, then tests, then. ..
I was afraid that my hair would fall out immediately. No, I shaved my head after the second one - the first two I had short hair. They started to fall out on the 15th day, but there were still some - then I just got tired of hair everywhere.
I was afraid that the medicine would get under the skin past the vein and there would be necrosis. Got it. Was. There was inflammation in that place, it still hurts, it heals, but slowly, but not so much that it was “horror-horror”
I was afraid...to lose weight! I lost two kg. Yes, with an initial weight of 47, weight 45 the difference is already noticeable, but I’ll catch up.
I was afraid that after chemotherapy the blood would not be restored and by the sixth day I would be dead (the doctor was also afraid of this). I recovered all six times and finally came to radiation therapy with indicators within the normal range.
I was afraid that it would get worse each time and there would be a cumulative effect. Did not have. The sixth was almost the same as the first, and the first was the lightest and in a reduced dose.
I was afraid that I would have to spend the night in the department. They let me go home the first time and didn’t offer to stay there anymore.
I was afraid that it would be prohibitively expensive. Expensive, but uplifting.
I was afraid... it’s hard to describe this fear, but it was very strong, that no one would take into account whether I was bad or not, that they would prescribe what should be done and then do what you want. They talked to me for a long time before the appointment, found out all the nuances of how I react to the drugs, waited until my critical days were over, no one pushed me anywhere, did a trial in a reduced dose, then gave me a full dose, warned me about everything possible consequences, with each side effect I had to call and get advice on how to relieve it, maintenance medications were immediately prescribed. When I didn’t have time to recover, we waited for my body to catch up on its own. I learned that many drugs that are prescribed do not stimulate the production of leukocytes, but provoke the release of leukocytes from the body’s reserves into the blood - thus essentially “falsifying” the blood test, and the body is depleted.
I was afraid of stomatitis, dermatitis and killing my liver, since I am a severe allergy sufferer, I have had chronic stomatitis since childhood, and my liver after hepatitis and with cholecystitis. But it wasn’t.
I was afraid that there would be an artificial menopause right away, but I had my period until the sixth.
I was afraid that I would need to give injections, and I had no one to do it. I learned to stab myself.
I was afraid that there wouldn’t be enough veins, since they are very thin, in my opinion, and that they would be put in the brush. There were once problems with the veins, they turned out to be not so thin and we didn’t reach the hands, but in the wrists and a little higher it almost didn’t hurt.
There was something else, but I don’t remember right now. Because everything is forgotten quickly. I didn’t know, I wasn’t afraid, but it happened - the memory became worse, the veins were fragile, neuropathy, but somehow everything was decreasing little by little. In addition, I had some pleasant bonuses - my skin became better and my eternal irritation and peeling went away, my nails began to grow quickly and became stronger than they had been for a long time, while my periods were regular and painless - previously they were very problematic. During this time I also slept and became calm and calm.
Who else was afraid of what before the first chemistry?
Is it true that chemotherapy is “outdated”? Because it does more harm than good? Have progressive clinics been treating cancer for a long time without “chemistry”? Commented by a resident of the Higher School of Oncology of the National Medical Research Center of Oncology named after. N.N. Petrova Katerina Korobeynikova.
Myth one: chemotherapy is ineffective
In support of this opinion, they refer to a study cited on the Internet by Harvard University professor John Cairns, allegedly published in Scientific American and the Journal of Clinical Oncology in 2004, that in fact chemotherapy only helps 2.3-5% cases. But it is “chemistry” that causes “tumor resistance, which is expressed in metastases.”
Photo from verywell.com
About the myth
To talk about the effectiveness of chemotherapy “for cancer”, it is necessary to clarify that the concept of “oncology” includes many different diseases.
There is neuroblastoma in children or uterine chorionic carcinoma. They can be completely cured with chemotherapy. (Cure means that the person has no relapses for 5 years).
There are tumors that are highly sensitive to chemotherapy - Ewing's sarcoma, cancer prostate gland, cancer Bladder. With the help of chemotherapy, they can be controlled—cure is possible, or at least long-term remission can be achieved.
There is an intermediate group - stomach cancer, kidney cancer, osteogenic sarcoma, in which tumor reduction from chemotherapy occurs in 75-50% of cases.
And there is cancer of the liver and pancreas. These tumors are insensitive to drug therapy, but they are now treated with other treatment methods - surgery or irradiation. And then there is blood cancer - a concept that patients call acute leukemia and lymphomas. They generally develop according to different laws.
Even with advanced stage cancer with metastases, the prognosis depends very much on the specific subtype of tumor you have.
For example, the hormone-sensitive subtype of breast cancer, even with metastases, can be controlled very well.
Therefore, drawing any conclusions about “chemotherapy for cancer in general” is simply incorrect.
Recently, the approach to treating cancer patients has become increasingly individualized. Quite a long time ago they said: “You have cancer - what a horror!” - then: “You have cancer of a certain organ - this is bad.” Now the doctor will carefully look at the “passport” of the tumor from histochemical and immunogenetic markers and the characteristics of the tumor, which was given to the patient during histological examination (such a study of the tumor is now included in the examination standards) and, depending on this, will choose treatment tactics.
About the source
— About the study " Harvard University Professor John Cairns", which you mention, I'm hearing for the first time. The only currently practicing doctor named John Kearns, who was found on the Internet, is a neurologist-radiologist who deals with brain problems. And all his articles are devoted specifically to the brain and MRI; he wrote nothing at all about chemotherapy.
It is possible that we are talking about the British doctor and molecular biologist John Cairns, who retired in 1991 - he was born in 1923. Kearns is the author of Cancer: Science and Society (1978) and Matters of Life and Death: Perspectives on Public Health, Molecular Biology, Cancer, and the Prospects of the Human Race (1997).
He studied cancer and worked in various laboratories in the UK and Australia. He was a professor at the Harvard University Graduate School of Public Health from 1980 to 1991. But the years of life and work of John Kearns indicate that in his works he referred to survival statistics of the 1970-1980s, and published in scientific journals in the early 2000s I couldn’t.
And if we are talking about this particular John Kearns, then we can only talk about outdated research in oncology.
The situation was different in the 1970s, and the effectiveness of drugs has changed greatly since then. The Journal of Clinical Oncology is not one of the modern authoritative publications. And important breakthrough studies that provoke scientific debate are published in several publications. What is suspicious here is not even that the data were published in one journal, but that the scale of this publication is not so large for such loud statements.
"Scientific American" is American popular science magazine. It provides popular science articles and reviews about science in general, not just medicine. And there is no trust in it as a publication that publishes the results of scientific research.
A similar skeptical study about chemotherapy was recently published by the portal geektimes.ru. It says “between 2009 and 2015, 48 different anticancer drugs were approved. Of these, 10% are effective, and 57% had no effect at all.” The name of the researcher was given - Hussein Nasi.
I started looking into it, found the original article, and it turned out that the researchers assessed only two parameters - five-year survival rate and quality of life. But at the same time they mixed very different diseases into one pile - stomach cancer, lung cancer, and oncohematology - blood cancer. But the indicators for these tumor locations are very different, the mechanism of action of the drugs is also very different, and a sign of the effectiveness of the drug will be different survival rates. But the researchers just got the “average temperature in the hospital.”
Myth two: for a number of diagnoses, life without chemotherapy is longer than with chemotherapy
Photo from time.com
The Internet says that this was proven by certain Doctor of Medical Sciences Alan Levin and Professor Charles Mathieu. And “in fact”, the majority of patients receiving chemotherapy die from “chemotherapy”, and not from cancer.
— I have not found any supporting information that doctors with such names (they exist, but they are not oncologists) expressed such an opinion.
Today, Russia, like European countries and the United States, is gradually moving towards evidence-based medicine standards. In this system, all evidence is assessed on a certain scale. And least of all trust the arguments from the “Professor Ivanov said” series.
IN evidence-based medicine necessary detailed descriptions various cases of cure, reliable, confirmed by certificates and documents.
A more serious level of arguments is meta-analyses, that is, the combination of several small studies that have already been conducted into one, when their results are added and counted together.
And finally, a very serious argument is the results of a randomized clinical trial. The number of patients there varies, but in most cases there is a placebo-controlled group that is treated according to the standard, but without the new drug.
Such a study is carried out using a “double-blind” method - for the purity of the results, neither the patient nor the researcher observing him knows what particular combination of drugs this or that patient is receiving, or whether there is a new added drug among his medications that is being tested.
Thus, the statements of individual experts should be treated with caution.
Photo from npr.org
Chemotherapy is a treatment. And like any treatment, it has side effects. They happen from any medications, they happen after surgical operations.
Chemotherapy itself also varies depending on the goal. Preoperative chemotherapy is used until surgery to reduce the size of the tumor as much as possible and make surgery as gentle as possible.
Target postoperative“chemistry” - to remove individual tumor cells that may still be circulating in the body.
Is there chemotherapy? palliative. It is used when the tumor is advanced, with multiple metastases, and it is impossible to cure the patient, but it is possible to slow down further progression and try to control the tumor. In this case, chemotherapy is intended to give the patient time, but, as a rule, it accompanies him to the end. And then it may seem that the patient died not from cancer, but from “chemotherapy,” although this is not the case.
In addition, during preoperative or postoperative chemotherapy, doctors often observe the patient not only at the moment when he receives droppers with drugs, but also between courses. Therefore, deaths are rare.
Who cares for an oncology patient?
In Russia, we are increasingly moving towards a practice where the decision on how to treat a patient is made by multidisciplinary commission. It includes a chemotherapist, a surgical oncologist, a radiologist, a radiologist and a pathologist (a pathologist, a doctor who determines the types of tumor).
Special meetings of such teams occur in large federal centers; if the patient is being treated in a less progressive dispensary, before starting treatment he will see each of these doctors separately.
Myth three: chemotherapy causes irreparable damage to the liver, hematopoietic system, nervous system and mucous membranes
“Chemotherapy really affects a person’s basic life support systems.
The main mechanism of action of chemotherapy drugs is their effect on the cell division mechanism. Cancer cells divide very quickly, therefore, by influencing cell division, we stop the growth of the tumor.
But, in addition to the tumor, there are many other rapidly dividing cells in the body. They are present in all systems that are actively renewed - in the blood, in the mucous membranes. Those chemotherapy drugs that do not act selectively also act on these cells.
After chemotherapy, the patient's blood counts drop as expected. Usually the peak of the decline occurs on the seventh to fourteenth day, because the “chemistry” just affected all the cells that were in the peripheral blood, and new ones Bone marrow I haven’t had time to work it out yet.
The fall occurs depending on the drug that was used; Some of them act primarily on platelets, others on leukocytes and neutrophils, and others on erythrocytes and hemoglobin.
Chemotherapy treatment occurs in cycles. Depending on the chemotherapy regimen, a person may receive, for example, three days of chemotherapy drips, and the next one will be 21 days later. This period is called “one cycle”; it is given specifically so that the patient’s body recovers.
Before each new chemotherapy session, the patient’s condition is monitored, they look at what happened to him during this period - they do a clinical and biochemical analysis blood.
Until the person has recovered, a new cycle of treatment does not begin.
If, apart from a decrease in blood counts to a certain level, nothing “bad” happened in the interval between “chemo treatments,” the blood picture will restore itself. An excessive drop in platelets creates a risk of bleeding; a patient with such indicators is given a platelet transfusion.
If the leukocytes, which are responsible for immunity, have dropped, and a person has become infected with some kind of infection, a cough begins, a runny nose, or a fever, antibiotics are immediately prescribed so that the infection does not spread. Typically, all of these procedures are done on an outpatient basis.
In between chemotherapy courses, the patient is treated by an oncologist from the regional oncology clinic or clinic.
Before the very first cycle of chemotherapy, the patient must be explained everything possible complications, tell about each drug and its effects; and the patient can consult with his or her oncologist.
Weighing the risks is the starting point of chemotherapy. The doctor and the patient are choosing between the damage that chemotherapy can cause and the benefit that can follow - namely, extending life, sometimes by decades.
This is a key point in deciding whether to use chemotherapy: if we understand that when prescribing a particular drug, the success rate will be lower than the side effects, there is simply no point in using it.
The main complications of chemotherapy:
- drop in blood counts
- liver damage
- ulceration of the mucous membranes and associated nausea and diarrhea
- hair loss and brittle nails.
This effect is explained by the fact that cytostatic chemotherapy acts not only on tumor cells, but on all rapidly fissile body cells. When the effect of the drug ends, cell division resumes and the damaged areas are restored.
Also, certain drugs that have a toxic effect on the body have specific complications. (Some chemotherapy drugs are made on the basis platinum is a heavy metal).
Toxic chemotherapy drugs can cause a number of neurological symptoms- headaches, insomnia or drowsiness, nausea, depression, confusion. Sometimes there is a feeling of numbness in the limbs, “pins and needles”. These symptoms disappear after the drug stops working.
Myth four: metastases grow not from unremoved areas of the tumor, but from “cancer stem cells”, which “chemistry” still does not kill
Photo from independent.co.uk
“The reasons for the occurrence of metastases in different tumors are very different; we do not yet know how exactly metastases occur. The only thing we know now is that there are no “cancer stem cells”. A tumor in its different fragments and metastatic cells is a very heterogeneous formation, all the cells are different, they quickly divide and mutate quickly.
But in any case, chemotherapy affects all metastases, wherever they are. The exception is metastases in the brain, where not all drugs penetrate.
In these cases, special treatment is prescribed, or special injection of drugs into the spinal canal.
There are even tumors in which it is impossible to find primary focus, - that is, all that we see in the body are metastases. But treatment is still prescribed, and in many cases it is successfully carried out.
Who makes the "chemistry"
“Oncologist” is a general name for a number of specialties. In Russia, upon completion of residency in the specialty “oncology”, a graduate can choose to become a chemotherapist - a specialist in drug treatment cancer, or an oncological surgeon - a doctor who operates only on cancerous tumors. A radiologist—a radiation therapy specialist—and a pathologist are separate specialties.
In the Western classification of doctors, they are all united by the specialty “medical oncologist”.
Myth five: chemotherapy is a method supported by the pharmaceutical industry.
In fact, there have been drugs that are more effective, harmless and cheaper for a long time, but they don’t talk about them, they are afraid of collapsing the pharmaceutical market
— It seems to me that this myth exists about other diseases, especially HIV.
“Alternative drugs” that cancer patients take are, at best, harmless herbs that have no noticeable effect. Unfortunately, it gets worse. For example, sometimes patients start drinking “miracle” medicines based on a mixture of different oils, because oil is very heavy product for the liver. As a result, the patient literally causes inflammation of his liver, and we cannot start a cycle of chemotherapy, because the “chemo” also affects the liver. And it’s good if the patient at least tells us what he took, and we can understand what made the situation worse. But treatment is ultimately delayed and its effectiveness decreases.
In addition, a number of new drugs for the treatment, for example, of breast cancer, are now based on plant components. For example, a drug trabectedin contains a specially processed extract from sea tulips.
So, sometimes the drugs that patients take as part of formal treatment are themselves “natural.”
As for the “giant money of the pharmaceutical industry,” some chemotherapy drugs, for example, methotrexate, are very old, long-developed drugs; they cost literally pennies. A decrease or increase in their production does not threaten any “collapse” or “rise in the industry.” In any case, patients in Russia receive drugs for oncology free of charge.
New drugs for cancer
Recently, in addition to cytostatics - chemotherapy drugs that act on the entire body, new drugs have appeared. This is a new generation of chemotherapy drugs - targeted drugs and drugs based on a fundamentally different principle of action - immunotherapy drugs.
Targeted drug is a medicine that does not act on the entire body, but specifically on tumor cells. It is important that molecules of a specific targeted drug can attach to the cell receptors of only a certain type of tumor. The specific tumor subtype is determined by genetic analysis during a molecular genetic study.
Immunotherapy affect the body's immune system and immune mechanisms tumors in its core. As a result, the body activates its own immunity, which begins to fight cancer cells.
However, in order to receive an immunodrug and a targeted drug, the patient must have a tumor with certain characteristics; these drugs do not act on all tumors, but on their specific mutations. The pathologist and molecular geneticist must write down the tumor passport in detail and write down in the prescription that the patient needs this particular drug.
Relatively new method — hormone therapy, but here the range of indications is even narrower - the tumor must be hormone sensitive. It is believed that breast and prostate tumors respond best to hormone therapy, although here too hormones can only be used for certain indications.
By the way, there is another myth associated with hormone therapy: it is most often used in the form of tablets, and patients believe that tablets are “not a cure” for a disease such as cancer.
Is it possible to do without chemotherapy?
If the tumor is sensitive and responds to immunotherapy or hormone therapy, treat the cancer patient without chemotherapy Can.
Without chemotherapy, hormones alone are sometimes used to treat, for example, breast cancer. Although it is clear that hormones are also not harmless, they have their own complications.
At the same time, we must understand: we invent new drugs, but cancer cells also mutate and adapt to them.
Even in a patient who earlier treatment without “chemistry” helping, the tumor can progress and become insensitive to the drugs that restrained its growth.
In this case, chemotherapy is used as emergency treatment.
For example, a patient with breast cancer for a long time takes hormones, and the tumor does not grow. She suddenly feels weak, metastases appear in the liver, and her condition worsens. general state, the blood test changes. This condition is called “visceral crisis.” In this case, we carry out several cycles of chemotherapy, return the body to a state where the tumor again begins to respond to hormones, and then the patient returns to the previous treatment regimen.
At the current level of development of oncology, we cannot do without chemotherapy at all.
But at the same time, we are developing a whole area called “accompanying treatment” - along with chemotherapy, the patient receives a whole set of drugs that can ease nausea, speed up the recovery of blood cells and normalize stool. So the unpleasant side effects of chemotherapy can be significantly reduced.
Daria Mendeleeva
- Experts from the University of Sheffield found that the protective forces human body may negate the benefits of cancer chemotherapy;
- It is now obvious to scientists that numerous leukocytes, responsible for wound healing, help malignant tumors increase in size after a course of “chemistry”;
- However, experts believe that such a harmful process can be stopped if a drug that inhibits the body's immune response is added to the chemotherapy cocktail.
Some tumors protect themselves from the harmful effects of chemotherapy drugs by exploiting the cancer patient's own immune system, report British researchers from .
University experts have discovered that when the immune system is “overloaded,” everything can, alas, be reduced to zero. Related to white blood cell activity: White blood cells, the shock force of the immune system, help tumors recover from drug damage. At the same time, the course of the disease worsens, and in many cases this leads to the rapid death of the patient.
However, this discovery is not too depressing for scientists; rather, on the contrary - the British believe that the process of “repairing” cancerous tumors can be stopped with the help of a medicine that suppresses the so-called. immune response.
In addition, doctors are counting on the help of immunosuppressants in reducing mortality among patients who tried to cure cancer with a course of chemotherapy (but it did not save).
An article about an experiment conducted at the University of Sheffield was published in the journal Cancer Research. It says that injections of a drug called “Plerixafor” (“Plerixafor”, also known as “Mozobil”) can slow down the process of recurrent tumor growth after a course of “chemo” in laboratory mice with cancer.
The same research group, led by Professor Claire Lewis, is currently preparing for a series clinical trials techniques to make sure that a drug that works on rodents will also help people with cancer problems. Especially for those who are contraindicated for surgery.
The study was funded by Cancer Research UK.
There are more than 100 various drugs Currently, the development of new cytostatic agents continues.
How optimal the chemotherapy method is for each specific case depends on many factors:
- type of cancer;
- location of the original tumor;
- degree of malignancy;
- spread of the tumor process;
- general health status.
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How is chemotherapy administered?
- radiotherapy;
- surgery;
- hormone therapy;
- targeted therapy;
- a combination of any of these methods.
It is possible to carry out high-dose chemotherapy as part of a bone marrow or stem cell transplant.
Basic principles of chemotherapy
This treatment destroys cells as they divide into new cells. Body tissues are made from billions of individual cells. After the growth process is completed, the body's cells stop actively dividing and multiplying. The division process is resumed if damage needs to be repaired. From one cell two are created, then from two - four, from four - eight, etc.
In cancer, cells continue to divide until a large volume is created, which becomes a tumor. Because cancer cells divide much more frequently, chemotherapy is much more likely to kill them.
Some cytotoxic drugs destroy tumor cells by damaging their control center. Other medications interrupt chemical processes involved in cell division.
Chemotherapy drugs can enter the body in the form of intravenous injections, using droppers, tablets and capsules.
Cytostatic agents, penetrating the body, cover the entire body through the bloodstream. They are able to overtake a malignant cell almost anywhere in the body. This form of treatment is called systemic.
How chemotherapy works - its effect on the body
Cytostatic drugs damage cells during their division. At the center of every living cell is a nucleus that controls it. It contains chromosomes, which are made up of genes. These genes must be copied exactly every time a cell splits into two new ones.
Chemotherapy damages genes inside the cell nucleus. Some drugs hit at the moment of division, others - when copies of genes are created before division. Cells that are at rest - most healthy cells - will not be damaged. The patient may be prescribed a combination of chemotherapy drugs that cause damage to cells in the different stages division process. Using multiple drugs increases the chance of killing more tumor cells.
The fact that chemotherapy drugs destroy dividing cells helps explain the side effects. This treatment affects healthy tissues, whose cells are constantly growing and dividing. Examples of such cells are skin, bone marrow, hair follicles, and the mucous membrane of the digestive system.
- Hair always continues to grow.
- The bone marrow continually produces blood cells.
- The skin and mucous membrane of the gastrointestinal tract do not stop renewing.
Because these tissues have cells that are constantly dividing, they can be damaged by chemotherapy. But healthy cells will be replaced with new ones or restored. Most side effects go away at the end of treatment.
Does chemotherapy help with cancer and how effective is it?
The likelihood of curing the disease with cytostatic drugs depends on the type of cancer:
- Some types of malignant tumors can be cured with chemotherapy.
- With other types of cancer, fewer people recover.
There is a high probability of recovery after chemotherapy for testicular cancer and Hodgkin's lymphoma.
For other types of oncology, treatment with cytostatic drugs alone will not lead to complete relief from the disease. But it will be beneficial in combination with other methods of therapy. For example, for many people with breast or bowel cancer, chemotherapy after surgery reduces the risk of recurrence.
For other types of cancer, if recovery is unlikely, your doctor may suggest chemotherapy:
- to reduce the size of the tumor;
- relieve symptoms;
- increase life expectancy by controlling the progression of the disease or promoting remission.
Doctors use the term remission when talking about oncology. It means that after treatment there are no signs of cancer. There may be complete or partial remission.
Complete remission means there are no signs of the disease after scans, blood tests and other tests. Doctors also call this condition complete response.
Partial remission indicates that some of the pathological cells have been preserved. The tumor has shrunk but can be detected by scanning. Treatment can stop the progression of the disease or reduce the size of the tumor.
Doctors use another term - stable disease, when the tumor remains the same size or has increased slightly.
Chemotherapy prescription
- To reduce tumor volume to surgical intervention or radiation.
- In order to prevent the risk of relapse after surgery or radiation therapy.
- As monotherapy if the cancer type is sensitive to this treatment.
- To treat metastatic cancer.
Chemotherapy may be offered before surgery to reduce the size of the tumor. Thus, less volume will be needed surgical intervention, it will be easier for the surgeon to completely remove the malignant process. Shrinking the tumor through chemotherapy will also mean less radiation treatment. This treatment is called neoadjuvant. Sometimes doctors call it primary treatment.
Chemotherapy may be recommended after surgery or radiation. The main goal is to reduce the risk of the disease returning in the future - adjuvant therapy. Cytostatic drugs penetrate into all areas of the body and destroy malignant cells that have detached from the primary tumor before surgery.
Sometimes chemotherapy is scheduled at the same time as radiotherapy. The treatment is called chemoradiotherapy. Cytostatic drugs increase the effectiveness of radiotherapy, but also increase side effects.
Your doctor may suggest chemotherapy if there is a chance that the disease may spread in the future or has already metastasized. Chemotherapy is used because it circulates throughout the body through the bloodstream. This is a type of systemic therapy that helps destroy tumor cells anywhere. Surgery and radiation therapy known as local treatment, since they affect a certain area.
Sometimes abnormal cells break away from the original site and spread to other parts of the body through the bloodstream or lymphatic system. Having changed localization, they develop into new tumors - secondary foci or metastases. Chemotherapy drugs travel throughout the body, destroying any malignant cells that have spread.
The choice of drugs is determined by the type of malignant tumor. For different types Various cytostatic agents have been developed for cancer. Thus, the chemotherapy drugs needed to treat breast cancer that has spread to the lungs will be different from the drugs intended for cancer that originated in the lungs.
Why is chemotherapy not prescribed?
Some types of cancer are very sensitive to chemotherapy, others are not. In the second case, the doctor will not recommend treatment with cytostatic agents.
In addition, you must be reasonably healthy to undergo chemotherapy. Some people worry that they are too old, but it's not about age. Older people may have other health problems that may cause serious or long-term side effects. These problems may be a contraindication to chemotherapy. This method can also put stress on organs, such as the heart. Therefore, doctors check the condition of the heart, lungs, kidneys and liver before starting treatment. Assess the benefits and risks of therapy and discuss them with the patient.
Where does chemotherapy take place?
If the patient is prescribed chemotherapy drugs in tablets or capsules, they can be taken at home. You must visit the hospital regularly for checkups and blood tests.
When continuous, low-dose chemotherapy is required, the patient may use a portable pump. It is installed in a hospital and is the size of a small water bottle. The pump provides a constant dose of chemotherapy. You need to visit the hospital every few days to refill your pump or remove it.
Intravenous chemotherapy is carried out in a day hospital. The procedure can last from several minutes to several hours. Chemotherapy drugs can be administered through the following devices:
- Cannula – a small tube placed in a vein in the arm.
- A central catheter is placed in a vein in the neck (short-term) or chest (long-term).
- PICC line – view central catheter, which is installed in a vein in the arm.
- Portacath is a small device that is implanted subcutaneously in the central vein in the chest area.
You must spend several hours in the clinic. Tests precede treatment. Doctors need to see the results to make sure the therapy is safe for the patient. In addition, the solution is prepared for each patient by a pharmacist. The volume is calculated individually, depending on height, weight and general health.
Antiemetic medications may be necessary. Typically, the patient sits in a chair during treatment. If the procedure takes several hours, reading a newspaper or book is a good idea.
When therapy is required for several days and hospitalization is not needed, you can stay near the hospital, in a hotel, for example.
Chemotherapy in hospital
In certain cases, chemotherapy treatment requires a short stay in the hospital - overnight or for a few days. This may be due to the following reasons:
- The drug must enter the body slowly and under control.
- It is planned to administer several cytostatic agents over a period of hours.
- Monitoring is required during treatment to determine response to medication.
If high-dose chemotherapy is prescribed, hospitalization for several weeks will be necessary. This is because the treatment is intensive and has many undesirable consequences. Throughout the series after treatment there will be high risk infections for the patient. A hospital stay is important to reduce this risk.
Common names and brand names of chemotherapy drugs
Cytostatic drugs have common names– single and different brand or trade names.
For example, the original name is paracetamol, the brand name is Panadol or Calpol.
Chemotherapy drugs are manufactured by different companies, so they may have several brand names. For some cytostatics, the trade name is more common, for others it is not. Doctors can advise on this issue.
Names of combinations of chemotherapy drugs
Doctors often treat the disease with two or more drugs, and sometimes in combination with other drugs such as steroids or biological therapies. The names of the combinations are made up of the first letters of the names of the drugs - an abbreviation is used. Eg:
- C = cyclophosphamide
- H = doxorubicin
- = vincristine (Oncovin)
- P = prednisolone, steroid
Bisphosphonates - use and indications, mechanism of action, classification and list of drugs, features of treatment in Israel, possible side effects.
How does chemotherapy work for cancer: planning the treatment process (duration, cycles, what influences the choice), preparation for chemotherapy (diagnosis), changes to the plan, possible side effects.
Characteristics of the ways in which chemotherapy drugs enter the body - intravenously, intramuscularly, intraarterially, subcutaneously, in tablets, intrathecally, inside the cavity and tumor.
Organization of treatment in the best Israeli clinics with medical service Thebestmedic. Competent approach, responsible attitude towards each client, extensive experience in the field of medical tourism.
Chemotherapy in Israel will cost from $1,440 per session using effective treatment regimens from the best clinics and leading oncologists in the country with TheBestMedic.
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Chemotherapy for cancer is a treatment method that involves administering various medications to the patient.
In addition, after using chemotherapy, the patient will experience a number of side effects - hair loss, bleeding, nausea and others. Side effects appear due to the effect of drugs on healthy cells of the body. Another feature of chemotherapy for cancer is that for complete treatment it is necessary to undergo several courses, since a one-time administration of drugs will not give the desired effect.
- Complete or partial destruction of cancer cells.
- Cancer control - chemotherapy drugs slow down the growth of cancer cells, which allows you to control the process of their spread and destroy foci of metastasis in a timely manner.
- Chemotherapy relieves the painful symptoms of the disease. During treatment, the cancer tumor decreases in size and volume, which means it no longer puts pressure on neighboring organs and tissues and does not cause pain.
- Chemotherapy can be used as the only treatment for cancer or in combination with radiation therapy or surgery.
Does chemotherapy help?
Does chemotherapy help with cancer? actual question for patients diagnosed with cancer. The effectiveness of chemotherapy depends on the stage of cancer and its location, the patient’s age and individual characteristics his body. Chemotherapy can be used as the sole treatment or combined with surgery and other therapies to significantly improve the chances of recovery.
Chemotherapy drugs are selected individually for each patient. The choice of drug and the effectiveness of treatment depend on factors such as: the type of cancer, previous similar treatment, the presence medical disorders And chronic diseases. The treatment regimen depends on the purpose of the course of treatment. Thus, chemotherapy can be used to control cancer cells, alleviate symptoms of the disease, or completely destroy them.
In order for chemotherapy to help cure the disease, drugs are prescribed in courses with breaks. So, for example, after a week’s course of therapy, the patient is given a month’s break, and then several more repeated courses are given. Breaks are necessary for the body to create new healthy cells and tissues.
To make sure that chemotherapy is helping, the attending oncologist periodically conducts examinations and takes tests. The patient can determine the effectiveness of treatment by how he feels. Some patients mistakenly believe that if severe side symptoms begin after a course of treatment, then the treatment is effective. But this is not always the case, since each patient has an individual reaction to the drugs. And the effectiveness of treatment can only be determined after several courses of chemotherapy.
Indications for chemotherapy
Indications for chemotherapy depend on the type of cancer and its stage. Treatment is carried out in cycles that alternate with periods of recovery. A course of chemotherapy can last from three months to six months. There are a number of factors that influence the indications for chemotherapy, let's look at them:
- Peculiarities cancerous tumor, its size, stage of development, growth rate, degree of differentiation, expression, degree of metastasis and involvement of regional lymph nodes, hormonal status.
- Individual characteristics of the patient’s body, such as: age, localization of malignant cancer, the presence of chronic diseases, condition of regional lymph nodes and general health.
- Possible complications and positive effects of chemotherapy. The doctor assesses the risks, complications and likelihood of treatment effectiveness.
The indications for chemotherapy depend on the factors described above. But do not forget that the indications for this type of treatment are different in each specific case. Thus, chemotherapy will never be prescribed for patients with non-invasive cancer or in cases where the likelihood of tumor metastasis is very low or absent. In these cases, the patient is given hormone therapy. Chemotherapy is indicated in all cases of lymph node involvement. In this case, the size of the tumor does not matter.
Main indications for a course of chemotherapy:
- Cancers, the remission of which occurs only after a course of chemotherapy (leukemia, hematological malignancies, rhabdomyosarcomas, chorionic carcinomas and others).
- Prevention of metastasis and adjunct to other therapeutic treatments for cancer.
- Transferring the tumor to an operable state for more effective treatment, that is complete removal cancer formation.
Chemotherapy for breast cancer
Chemotherapy for breast cancer is a complex treatment method. The purpose of this method is to slow down the process of cell development malignant formation in the mammary gland. As a rule, cytotoxic drugs are used for treatment. Chemotherapy can be used as a stand-alone treatment or used after or before surgery. Chemotherapy can prevent relapses of the disease and stop metastasis.
Chemotherapy for lung cancer
Chemotherapy for lung cancer is aimed at completely destroying cancer cells. Treatment with anticancer drugs can be used either as monotherapy or as part of a therapeutic anticancer complex. Chemotherapy involves several courses of administering cytostatics by drip. Chemotherapy drugs are selected individually for each patient. In addition to chemotherapy, patients are prescribed therapy to reduce the side effects of the drugs used.
Chemotherapy for stomach cancer
Chemotherapy for stomach cancer has several directions. So medications can be used after radical operations, for postoperative intraperitoneal therapy, before surgery, or as treatment for disseminated gastric cancer. Chemotherapy is carried out in a hospital setting, under the supervision of an oncologist. The drugs are administered intravenously and are used in tablet forms. The consequences of chemotherapy are devastating to the entire body, so the rehabilitation period after such treatment can last several years.
Chemotherapy for ovarian cancer
Chemotherapy for ovarian cancer is used to stop metastasis and prevent recurrence of the disease. Chemotherapy can be used before and after radical surgery to slow tumor growth, relieve painful symptoms and reduce volume surgical treatment. Chemotherapy drugs are administered intravenously, taken orally, or injected into abdominal cavity. There are many different drugs and treatment regimens, each of which has certain effectiveness and side effects. The oncologist selects the optimal treatment option for high chances full recovery patient.
Chemotherapy for colorectal cancer
Chemotherapy for rectal cancer takes place in a hospital setting, under the supervision of a chemotherapy oncologist. The doctor selects a treatment regimen, determines how many courses of chemotherapy are needed and monitors the patient’s condition during the treatment process. The drugs can be administered intravenously, but most often orally, that is, through the mouth. If chemotherapy is used for early stages diseases, this allows you to completely stop the oncological process and prevent its relapses in the future.
Chemotherapy for stage 4 cancer
Chemotherapy for stage 4 cancer is a method of treating the irreversible, uncontrolled process of spread and growth of tumor cells throughout the body. A properly designed chemotherapy regimen can prolong the patient’s life and significantly improve it. The survival rate of patients after chemotherapy for stage 4 cancer ranges from 30-70%, and life expectancy from six months to five years. It all depends on the type of tumor, presence concomitant diseases and the degree of damage to vital organs.
The key indicator of the effectiveness of chemotherapy for stage 4 cancer is five-year survival. This concept refers to the patient’s survival from the moment of diagnosis – stage 4 cancer. Let's look at the effectiveness of chemotherapy at stage 4 oncology, with various localizations cancer disease.
When chemotherapy is administered at stage 4 lung cancer, the five-year survival rate among patients is 10%. In addition to chemotherapy, radiation therapy may be used to relieve symptoms of the disease and reduce the size of the tumor. This allows you to significantly reduce the size of the tumor and destroy metastases in vital organs.
Chemotherapy for stage 4 liver cancer is effective for 6% of patients. At this stage, chemotherapy allows you to destroy some of the metastases. But classical chemotherapy is not effective in combating the source of the disease.
This disease during a course of chemotherapy for last stage, has a high favorable prognosis, 15-20%. Palliative chemotherapy is used for treatment, which allows to achieve stabilization of the course of the cancer.
At stage 4 cancer, chemotherapy is not effective. The five-year survival rate of patients ranges from 2-5%. Chemotherapy is used to alleviate the patient’s condition, reduce the size of the tumor, which compresses neighboring organs and tissues, and also to destroy metastases.
For stage 4 colon cancer, chemotherapy is used only after palliative surgical treatment. Patient survival is about 5%.
Chemotherapy is used to destroy metastases, relieve cancer symptoms, or after surgery.
For this disease, chemotherapy has positive result. Thus, the survival rate of patients at stage 4 cancer after a course of chemotherapy is about 30%. Of particular danger are metastases that disrupt the functioning of the liver, kidneys and lungs.
The effectiveness of chemotherapy is 8-9%. The danger of stage 4 cancer is that the process affects the pelvic organs.
The therapeutic effect of chemotherapy for stage 4 cancer depends on a number of factors. Thus, the effectiveness of treatment is influenced by the development of metastasis to the brain, dysfunction of vital organs, blood clotting disorders, pronounced pain syndrome, arterial thrombosis and other pathologies.
The main goal of chemotherapy for stage 4 cancer is to limit the spread of the tumor, reduce its growth rate, preserve the functioning of organs and systems, and also carry out prevention life-threatening complications.
Chemotherapy drugs
Chemotherapy drugs are anticancer drugs that destroy cancer cells and kill them. When treating cancer, two types of chemotherapy can be used. The first type is cancer treatment with one drug or monochemotherapy, and the second is treatment with several drugs or polychemotherapy. The second type of chemotherapy is more effective. Very often I combine chemotherapy with other treatment methods - surgery, radiation therapy.
There are many chemotherapy drugs and they all have a similar mechanism of action. Thus, the faster cancer cells divide and grow, the more sensitive they are to anticancer drugs and the more effective chemotherapy is. All chemotherapy drugs are divided into certain groups. There are anticancer agents that act on all phases cell cycle, drugs that are effective in a certain phase of cancer and cytostatics with a different mechanism of action. Let's take a closer look at some groups of drugs used in chemotherapy.
Alkylating agents
The drugs act on cancer cells at the molecular level. The most popular anticancer drugs from this group: Cyclophosphamide, Embiquin, Nitrosourea drugs.
Antibiotics
Some antibiotics have antitumor activity and effectively destroy cancer cells within different phases cell cycle.
Antimetabolites
Medicines block metabolic processes in cancer cells, which leads to their destruction. The most effective drugs from this group: Methotrexate, Cytarabine, 5-fluorouracil
Anthracyclines
Part medicine contains active ingredients that interact with DNA and destroy cancer cells. IN this group drugs include: Rubomycin, Adriblastin.
Vincalcaloids
Anticancer drugs on plant based. They destroy the division of cancer cells and destroy them. This group of drugs includes: Vinblastine, Vincristine, Vindesine.
Platinum preparations
The drugs contain toxic substances, elements of one of the heaviest metals. According to the mechanism of action, platinum preparations are similar to alkylating agents.
Epipodophyllotoxins
Antitumor drugs that are synthetic analogues active ingredients mandrake extract. The most popular of them: Etoposide, Tniposide.
Each group of chemotherapy drugs has its own advantages and disadvantages. The oncologist selects drugs for treatment, focusing on the location of the cancer, the stage and type of cancer, as well as the patient’s age and characteristics of his body.
Contraindications to chemotherapy
Contraindications to chemotherapy, as well as indications for treatment, depend on the stage of cancer, the location of the tumor and the individual characteristics of the patient’s body. So the main contraindications to a course of chemotherapy are:
- Intoxication of the body.
- Metastasis to the liver.
- High bilirubin level.
- Metastasis to the brain.
- Cachexia.
The attending oncologist, after conducting examinations and studying test results, draws conclusions about the effectiveness of chemotherapy or prohibits the use this method treatment.
Side effects of chemotherapy
Side effects of chemotherapy are the main disadvantage of this type of treatment. Adverse symptoms appear due to the fact that chemotherapy drugs act on the entire body, affecting not only cancerous but also healthy cells of the body. Cells suffer from chemotherapy hematopoietic system and blood, gastrointestinal tract, nose, hair follicles, nails, appendages, vagina, skin, oral mucosa. But unlike cancer cells, these cells can recover. That is why the side symptoms of chemotherapy disappear after stopping the administration of drugs. Some chemotherapy side effects go away quickly, but others last for several years or take several years to become apparent.
The following are the side effects of chemotherapy:
- Osteoporosis is thinning and weakening of bone tissue. Side symptom occurs due to combination chemotherapy when using drugs: Cyclophosphamide, Methotrexate, Fluorouracil.
- Nausea, vomiting, diarrhea - chemotherapy affects all cells of the body. These side symptoms are caused by disturbances in the gastrointestinal tract, but the symptoms disappear after stopping chemotherapy.
- Hair loss (alopecia) – after chemotherapy, hair may fall out partially or completely. Hair loss can occur both at the beginning of treatment and after several courses of chemotherapy. Hair growth returns after treatment is stopped.
- Side effects on the skin and nails - some patients may experience rashes all over the skin, dryness, itching, peeling. Nails become brittle, and the skin is sensitive to temperature changes and mechanical damage.
- Fatigue and anemia are the most common side effects of chemotherapy. Fatigue and anemia occur due to a decrease in red blood cells.
- Infectious complications - chemotherapy significantly weakens the immune system, making it susceptible to various infections and viruses.
- Blood clotting disorder – most often caused by chemotherapy treatment for blood cancer. The main cause of the disorder is a decrease in the number of platelets in the blood. The patient develops bleeding and bruises on the body.
- Stomatitis - chemotherapy has a detrimental effect on the oral mucosa. IN oral cavity ulcerations and stomatitis appear. The wounds become open to any infection, fungi and viruses.
- Changes in taste and smell – chemotherapy may change the way you smell and taste. Many patients note the appearance of a metallic taste in the mouth. This happens due to the fact that there are taste buds, which transmit taste sensations to the brain. But due to the action of chemotherapy drugs, this process is disrupted.
- Effect on the reproductive system - chemotherapy causes menstrual irregularities and negatively affects the performance of the ovaries. As a result, a woman experiences temporary or complete infertility. This side effect also applies to men undergoing chemotherapy.
In addition to the side effects described above, sleep disturbances, temporary memory loss or deterioration are possible, hormonal disorders, insomnia or increased sleepiness, frequent headaches and other consequences of chemotherapy.
Complications of chemotherapy
Complications of chemotherapy occur very often, as a rule, with aggressive chemotherapy and a weakened patient’s body. The most severe complications chemotherapy, manifest as typhlitis, that is, inflammation of the cecum, anorectal infections and pneumonia. Let's take a closer look at each of the chemotherapy complications.
A very serious complication that manifests itself as minor abdominal pain. Peculiarity of this disease in that it progresses rapidly, causing inflammation of the cecum, gangrene or perforation. Among patients with cancer diseases, the mortality rate is high precisely from this side effect. The main task of an oncologist is to diagnose the disease in a timely manner and prescribe treatment.
Infection in the area anus occurs in 8% of patients undergoing chemotherapy. A complication may occur due to taking chemotherapy drugs by mouth. The disease affects patients with weakened immune system, the mortality rate for this lesion is 20-40%.
Inflammatory complications usually appear in patients with a weakened immune system. Timely diagnosis and treatment can prevent death this complication chemotherapy.
Nutrition during chemotherapy
Nutrition during chemotherapy is aimed at restoring the body and maintaining its normal functions. So, balanced diet should include such product groups as: protein, bread and cereal, fruit and vegetable and dairy groups.
Chemotherapy adversely affects the digestive and gastrointestinal tract. It is because of this that patients begin to have problems with nutrition. The main rule for recovery and maintenance of the body during cancer is a balanced diet. Regular meals will help alleviate the side symptoms of chemotherapy and other treatments. Let's take a closer look at each of the food groups that should be included in the diet of a patient with cancer.
- Protein products - during chemotherapy treatment, it is recommended to consume soy products, meat, liver, fish, eggs, legumes. All of these foods are rich in protein, B vitamins and iron.
- Dairy products – lactic acid products have a beneficial effect on the gastrointestinal tract of patients and overall well-being. It is recommended to consume kefir, milk, cheese, butter, yogurt, yogurt and other dairy products.
- Fruits and vegetables – During chemotherapy, patients should consume both cooked and raw vegetables and fruits. It is recommended to make salads, juices, fresh juices, and eat dried fruits. Don’t forget about greens, which can be added to all dishes.
- Bakery Products and Cereals – Patients with cancer should consume a variety of cereals, grains and cereal products.
Before each course of chemotherapy, the patient should have a snack. It is not recommended to take medications on an empty or overloaded stomach. During chemotherapy, it is necessary to exclude spicy foods, as well as fried and fatty foods from the diet. But after a course of chemotherapy, food should be plentiful in order to restore strength.
Chemotherapy for cancer is an effective treatment method that destroys cancer cells, reduces the volume of malignant tumors and fights long-term complications. lymph nodes. Chemotherapy is selected individually for each patient. The effectiveness of this type of treatment depends on the stage of cancer, the degree of damage to the body and other individual characteristics of the patient’s body.
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