What is Chemotherapy? Its Treatment and Side Effects

Chemotherapy is a special form of drug treatment aimed at stopping or destroying the growth and reproduction of cancer cells that multiply uncontrollably in the human body and damage healthy tissues.

Chemotherapy is a special form of drug treatment aimed at stopping or destroying the growth and reproduction of cancer cells that multiply uncontrollably in the human body and damage healthy tissues.

This article has been created by Prof. Dr. Şeref Kömürcü, Prof. Dr. Serdar Turhal, and Assoc. Prof. Dr. Yeşim Yıldırım to provide general information about chemotherapy and answer frequently asked questions.

For what conditions is chemotherapy used?

• As a primary treatment for cancer, given alone
• To eliminate remaining cancer cells after surgical treatment
• To shrink the tumor and prepare the patient for surgery and radiation therapy
• In advanced-stage cancer patients, to reduce cancer symptoms and improve the patient's quality of life (palliative care)

How does chemotherapy work?

1. It can completely destroy cancer cells.
2. It can slow down the growth of cancer and prevent its spread.
3. In advanced-stage cancer patients, it can eliminate pain and the sensation of pressure caused by the tumor.

What is the duration and frequency of chemotherapy?

The doses, administration methods, and duration of chemotherapy drugs vary depending on the type of cancer. Additionally, the treatment duration and frequency may change based on the patient’s age, general health status, the extent of the disease, and any non-cancer health issues. Therefore, different treatment regimens may be applied, even for patients with the same diagnosis. In chemotherapy protocols, a rest period typically follows a treatment cycle. Considering these factors, treatments may be administered daily, weekly, bi-weekly, every 21 days, or every 28 days.

How is chemotherapy performed? How is it administered?

Preparing the patient for chemotherapy:

Most chemotherapy drugs are administered intravenously. If accessing veins repeatedly becomes problematic, a catheter can be placed for the patient, or a port can be inserted into one of the neck veins.
Before chemotherapy, the patient's liver function tests, kidney function tests, and complete blood count are done. Tests to evaluate the patient's heart function are also performed.
Before starting chemotherapy, it is advisable for the patient to visit a dentist and treat any dental infections if present, as chemotherapy drugs can weaken the body's ability to fight infections.
The possible side effects of chemotherapy are explained to the patient. Those who wish to have children in the future may consider freezing eggs or sperm. Preparations for hair loss may also be made.
Before starting chemotherapy, it is discussed whether the patient will be able to continue working and whether they will need help at home.

How is chemotherapy administered?

• Infusion: The drugs are placed in a serum and administered intravenously using a pump.
• Orally: The drugs can be taken in capsule or tablet form.
• Subcutaneously: It can be administered via an injection under the skin.
• Chemotherapy drugs can be directly applied to the tumor area, for example, in the abdominal cavity, the pleural space surrounding the lungs, between the vertebrae, or inside the bladder.
• Chemotherapy drugs can also be directly applied to the blood vessels feeding the tumor.

Where is chemotherapy treatment administered?

Chemotherapy should be administered in hospitals or chemotherapy units. It is not suitable to be administered at home.

How do doctors determine chemotherapy drugs?

The first rule when selecting chemotherapy drugs is the type of cancer. Some chemotherapy drugs are effective for many types of cancer, while others are specific to only one type of cancer. The second rule is the chemotherapy drugs the patient has previously received. Based on this, the doctor determines the medication. The last factor is the patient’s general condition, the evaluation of organ function suitability, and the presence of any other conditions such as diabetes, heart disease, or liver disease. Chemotherapy drugs are determined by medical oncologists.

Are other medications used during chemotherapy?

Supportive medications may be recommended to reduce the side effects of chemotherapy drugs. Other medications used for conditions like high blood pressure, heart disease, diabetes, or infections generally do not have a negative effect on chemotherapy, and the patient can continue using them. However, some medications may interact with chemotherapy drugs, which could reduce the positive effects or increase side effects. Therefore, all medications used should be reported to the oncologist planning the chemotherapy.

What are the side effects of chemotherapy?

The most common side effects are:

• Nausea
• Vomiting
• Diarrhea
• Hair loss
• Loss of appetite
• Fatigue
• Fever
• Mouth sores
• Pain
• Constipation
• Bruising on the skin
• Bleeding

Less common side effects include:

• Lung tissue damage
• Heart problems
• Infertility
• Kidney problems
• Nerve damage (peripheral neuropathy)
• Risk of developing a second cancer

What should be considered after chemotherapy treatment?

1. Nutrition during and after chemotherapy:

   While chemotherapy kills cancer cells, it also damages healthy cells. During and after chemotherapy, patients often experience various nutritional problems. The most common nutrition-related issues are:

2. Loss of appetite
3. Altered taste sensation, inability to detect the smell of food
4. Constipation
5. Diarrhea
6. Dry mouth
7. Lactose intolerance (developing intolerance to milk and dairy products)
8. Nausea, vomiting
9. Weight loss
10. Swelling in the throat, difficulty swallowing
11. Abnormal weight gain

• Nutritional recommendations for patients receiving chemotherapy:
• Keep healthy foods and beverages in your fridge.
• If you experience nausea after chemotherapy, you can eat crackers. Ginger ale, ginger tea, lemon, lemon tea, and mint can help soothe your stomach.
• If you're experiencing loss of appetite, try eating smaller meals 5-6 times a day instead of 3 large ones.
• If the smell of cooking food bothers you, find a helper to cook for you.
• Try to consume liquid foods throughout the day in small sips. However, avoid drinking too much liquid before meals as it may suppress your appetite.
• Be careful to get enough protein.
• Eat nuts.
• Consume plenty of fresh vegetables and fruits.
• Focus on using olive oil.
• Try to make mealtime enjoyable. Set beautiful, appetizing tables and spend time with your loved ones. During meals, try to clear negative thoughts from your mind.
• Experiment with preparing foods in different ways to adjust to changes in taste.
• If the taste of water changes, you can drink mineral water or add lemon to your water.
• If constipation develops after chemotherapy, consume high-fiber foods and stay active.
• If you notice a tendency to gain weight, reduce the fat content in your food.
• If you experience diarrhea due to medications, focus on eating bananas and potatoes, and drink plenty of water.
• If you have mouth sores after chemotherapy, avoid spicy foods. Rinse your mouth with saltwater after meals.
• Avoid excessive caffeine consumption.
• Do not use vitamins or herbal supplements without consulting your doctor.
• You can consume red meat, fish, and turkey in a balanced manner.
• It is best to avoid sugary foods as much as possible.

How to relieve pain after chemotherapy in cancer patients?

Sometimes, patients experience pain in their muscles and joints after chemotherapy. Chemotherapy may have side effects on the musculoskeletal system. After treatment, muscle weakness, numbness in the arms and legs can also occur. In such cases, you can use the painkillers recommended by your doctor and take a warm shower. If you are losing balance due to pain while walking, you may temporarily use a cane.

When does hair loss due to chemotherapy begin?

Hair loss usually starts 2-3 weeks after chemotherapy. Hair typically begins to regrow 1-2 months after completing chemotherapy. The amount of hair loss can vary depending on the medication and the individual. In some medications, no hair loss occurs, while in others, complete hair loss can happen. You can use hats, scarves, or wigs to manage hair loss.

What should patients receiving chemotherapy generally pay attention to?

• Every patient undergoing chemotherapy should know how to measure their temperature at home. Fever indicates an infection and requires seeing a doctor.
• Chemotherapy patients should avoid close contact with people around them and stay away from those who are infected.
• If they smoke, they should quit and avoid environments with smoke, dust, or poor ventilation.
• Fruits and vegetables should be thoroughly washed before consumption. Drinking water should be clean and safe. Milk should be boiled well, and meals should be cooked properly.
• They should make sure to drink plenty of fluids.
• If possible, they should avoid eating out at restaurants.
• During chemotherapy, if the nails are cut and there is a skin cut, bleeding may take longer to stop. It is recommended to avoid using razors while shaving and not to cut nails too short.
• If a tooth extraction is necessary during chemotherapy, the doctor should be informed.

How appropriate is it to resort to "alternative medicine," "natural methods," or "herbal solutions" in cancer treatment? Are there any methods you recommend in addition to treatment?

The cancer treatment process can lead to stress, exhaustion, or affect your relationships with people around you and your emotional well-being. There are various programs and methods available that can help you manage these issues. You can benefit from these methods by sharing any relaxation programs you wish to apply with your doctor and checking whether there are any concerns for you. Examples of such practices include massage therapy, biofeedback, physical or breathing exercises, and yoga. Additionally, sharing with family, close friends, and support groups for cancer patients is very important.

You will likely be suggested various non-medical treatment methods by many people around you. We recommend not using any of these suggested methods without first consulting your doctor to learn whether they have a scientific basis. The methods you assume to be harmless may reduce the effectiveness of your actual treatment or damage your organ functions.

Is it possible to work during chemotherapy?

Some patients may continue to work during chemotherapy, but since factors such as the type of treatment, potential side effects, and the work environment may vary, patients should discuss this process with their doctors before making a decision.

Can you go on vacation during chemotherapy?

Taking a vacation during chemotherapy may sometimes be possible, but this depends on the side effect profile of the chemotherapy, the frequency of treatments, and any additional health conditions the patient may have.

Can you get pregnant during chemotherapy? Can chemotherapy be given when a tumor is detected during pregnancy?

In general, chemotherapy can suppress ovarian function in patients, leading to the cessation of periods or delays. However, there is still a risk of pregnancy. Therefore, we recommend using birth control for patients undergoing chemotherapy; otherwise, the fetus may be exposed to toxic agents, and the pregnancy may need to be terminated.

Can a woman undergoing chemotherapy breastfeed?

Cancer can be diagnosed during pregnancy. In such cases, factors like the stage of cancer, the type of tumor, and whether the person wishes to continue the pregnancy play a major role in decision-making. Chemotherapy is never administered during the first trimester of pregnancy, as organ formation of the fetus is not yet complete. After the second trimester, some chemotherapy drugs may be given. As a general approach, if cancer develops in the first 3-4 months of pregnancy and urgent treatment is required, termination of the pregnancy is preferred. In the last 1-2 months, based on the disease's condition, the development of the fetus may be accelerated, and treatment can begin after an early delivery. During other months, the decision should be made together with the family, considering the spread of the disease and the urgency of treatment. Breastfeeding is not recommended for patients undergoing chemotherapy.