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Chemotherapy
 
Chemotherapy is a systemic therapy; this means it affects the whole body by going through the bloodstream. The purpose of chemotherapy and other systemic treatments is to get rid of any cancer cells that may have spread from where the cancer started to another part of the body.
 
Chemotherapy is effective against cancer cells because the drugs love to interfere with rapidly dividing cells. The side effects of chemotherapy come about because cancer cells aren't the only rapidly dividing cells in your body. The cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant, rapid division. This means that the chemotherapy is going to affect them, too.

Still, chemotherapy is much easier to tolerate today than even a few years ago. And for many women it's an important "insurance policy" against cancer recurrence. It's also important to remember that organs in which the cells do not divide rapidly, such as the liver and kidneys, are rarely affected by chemotherapy. And doctors and nurses will keep close track of side effects and can treat most of them to improve the way you feel.

Chemotherapy is the use of drugs to treat cancer. Before surgery, chemotherapy may be used both to reduce the size of the breast tumor and to destroy cancer cells wherever they may be. After surgery, chemotherapy works throughout your system to kill cancer cells that may have spread throughout your body. Here's how this systemic treatment works.

Your body's normal cells grow and divide in a controlled manner. Cancer cells, however, grow and divide in total chaos—without any control or logical order. Chemotherapy works by stopping the growth or multiplication of cancer cells, thereby killing them. There is a possibility that you may worry that chemotherapy will kill normal cells, too, and there is that possibility. However, remember that these drugs work best on cells that divide rapidly—namely, cancer cells. This makes chemotherapy particularly effective against cancer.

When used as systemic therapy right after surgery, chemotherapy has another advantage: being in the right place at the right time. Let's say that cancer cells have broken away from the primary tumor, and that these relatively young and small clusters are now located somewhere in your body. These single cells or small clusters have plenty of nutrients and oxygen, and they are dividing quite rapidly (by contrast, with larger tumors the cells are crowded together, there isn't enough food to go around, and the cells don't have the energy to grow). This is perfect timing for chemotherapy because, remember, chemotherapy works best on rapidly dividing cells. And this is why cancer cells are much more sensitive to chemotherapy than normal cells.

A "cycle" of chemotherapy refers to one time or one "round" in which you go to the doctor and receive the medication. A "course" of chemotherapy refers to all the cycles in your entire treatment. Depending on the drug (or drugs) you receive, you may have anywhere from four to eight cycles of chemotherapy during an entire course.

What Is Radiation Therapy?

Radiation therapy (sometimes called radiotherapy, x-ray therapy, or irradiation) is the treatment of disease using penetrating beams of high energy waves or streams of particles called radiation.

Many years ago doctors learned how to use this energy to "see" inside the body and find disease. You've probably seen a chest x-ray or x-ray pictures of your teeth or your bones. At high doses (many times those used for x-ray exams) radiation is used to treat cancer and other illnesses.

The radiation used for cancer treatment comes from special machines or from radioactive substances. Radiation therapy equipment aims specific amounts of the radiation at tumors or areas of the body where there is disease.

How Does Radiation Therapy Work?

Radiation in high doses kills cells or keeps them from growing and dividing. Because cancer cells grow and divide more rapidly than most of the normal cells around them, radiation therapy can successfully treat many kinds of cancer. Normal cells are also affected by radiation but, unlike cancer cells, most of them recover from the effects of radiation.

To protect normal cells, doctors carefully limit the doses of radiation and spread the treatment out over time. They also shield as much normal tissue as possible while they aim the radiation at the site of the cancer.

What Are the Goals and Benefits of Radiation Therapy?

The goal of radiation therapy is to kill the cancer cells with as little risk as possible to normal cells. Radiation therapy can be used to treat many kinds of cancer in almost any part of the body. In fact, more than half of all people with cancer are treated with some form of radiation. For many cancer patients, radiation is the only kind of treatment they need. Thousands of people who have had radiation therapy alone or in combination with other types of cancer treatment are free of cancer.

Radiation treatment, like surgery, is a local treatment — it affects the cancer cells only in a specific area of the body. Sometimes doctors add radiation therapy to treatments that reach all parts of the body (systemic treatment) such as chemotherapy, or biological therapy to improve treatment results. You may hear your doctor use the term, adjuvant therapy , for a treatment that is added to, and given after, the primary therapy.

Radiation therapy is often used with surgery to treat cancer. Doctors may use radiation before surgery to shrink a tumor. This makes it easier to remove the cancerous tissue and may allow the surgeon to perform less radical surgery.

Radiation therapy may be used after surgery to stop the growth of cancer cells that may remain. Your doctor may choose to use radiation therapy and surgery at the same time. This procedure, known as intraoperative radiation, is explained more fully in the "External Radiation Therapy section."

In some cases, instead of surgery, doctors use radiation along with anticancer drugs (chemotherapy) to destroy the cancer. Radiation may be given before, during, or after chemotherapy. Doctors carefully tailor this combination treatment to each patient's needs depending on the type of cancer, its location, and its size. The purpose of radiation treatment before or during chemotherapy is to make the tumor smaller and thus improve the effectiveness of the anticancer drugs. Doctors sometimes recommend that a patient complete chemotherapy and then have radiation treatment to kill any cancer cells that might remain. When curing the cancer is not possible, radiation therapy can be used to shrink tumors and reduce pressure, pain, and other symptoms of cancer. This is called palliative care or palliation. Many cancer patients find that they have a better quality of life when radiation is used for this purpose.

What Are the Risks of Radiation Therapy?

The brief high doses of radiation that damage or destroy cancer cells can also injure or kill normal cells. These effects of radiation on normal cells cause treatment side effects. Most side effects of radiation treatment are well known and, with the help of your doctor and nurse, easily treated. The side effects of radiation therapy and what to do about them are discussed in the Managing Side Effects section.

The risk of side effects is usually less than the benefit of killing cancer cells. Your doctor will not advise you to have any treatment unless the benefits -- control of disease and relief from symptoms -- are greater than the known risks.

How Is Radiation Therapy Given?

Radiation therapy can be given in one of two ways: external or internal. Some patients have both, one after the other.

Most people who receive radiation therapy for cancer have external radiation . It is usually given during outpatient visits to a hospital or treatment center. In external radiation therapy, a machine directs the high-energy rays at the cancer and a small margin of normal tissue surrounding it.

The various machines used for external radiation work in slightly different ways. Some are better for treating cancers near the skin surface; others work best on cancers deeper in the body. The most common type of machine used for radiation therapy is called a linear accelerator . Some radiation machines use a variety of radioactive substances (such as cobalt-60, for example) as the source of high-energy rays. Your doctor decides which type of radiation therapy machine is best for you. You will find more information about external radiation in the next chapter.

When internal radiation therapy is used, the radiation source is placed inside the body. This method of radiation treatment is called brachytherapy or implant therapy. The source of the radiation (such as radioactive iodine, for example) sealed in a small holder is called an implant . Implants may be thin wires, plastic tubes (catheters), capsules, or seeds. An implant may be placed directly into a tumor or inserted into a body cavity. Sometimes, after a tumor has been removed by surgery, the implant is placed in the 'tumor bed' (the area from which the tumor was removed) to kill any tumor cells that may remain.

Another type of internal radiation therapy uses unsealed radioactive materials which may be taken by mouth or injected into the body. If you have this type of treatment, you may need to stay in the hospital for several days. See the internal radiation therapy section for more information.

Who Gives Radiation Treatments?

A doctor who specializes in using radiation to treat cancer — a radiation oncologist — will prescribe the type and amount of treatment that is right for you. The radiation oncologist is the person referred to as "your doctor" throughout this booklet. The radiation oncologist works closely with the other doctors and health care professionals involved in your care. This highly trained health care team may include:

  • The radiation physicist, who makes sure that the equipment is working properly and that the machines deliver the right dose of radiation. The physicist also works closely with your doctor to plan your treatment.
  • The dosimetrist, who works under the direction of your doctor and the radiation physicist and helps carry out your treatment plan by calculating the amount of radiation to be delivered to the cancer and normal tissues that are nearby.
  • The radiation therapist, who positions you for your treatments and runs the equipment that delivers the radiation.
  • The radiation nurse, who will coordinate your care, help you learn about treatment, and tell you how to manage side effects. The nurse can also answer questions you or family members may have about your treatment.

Your health care team also may include a physician assistant, radiologist, dietitian, radiation oncologist, physical therapist, social worker, or other health care professional.

Is Radiation Treatment Expensive?

Treatment of cancer with radiation can be costly. It requires very complex equipment and the services of many health care professionals. The exact cost of your radiation therapy will depend on the type and number of treatments you need.

Most health insurance policies, including Part B of Medicare, cover charges for radiation therapy. It's a good idea to talk with your doctor's office staff or the hospital business office about your policy and how expected costs will be paid.

In some states, the Medicaid program may help you pay for treatments. You can find out from the office that handles social services in your city or county whether you are eligible for Medicaid and whether your radiation therapy is a covered expense.

If you need financial aid, contact the hospital social service office or the National Cancer Institute's (NCI) Cancer Information Service at 1-800-4-CANCER. They may be able to direct you to sources of help. Additional sources of cancer information are described in the resources sectionRadiation Therapy

Chemotherapy Education



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