How is chemotherapy given? Is Chemotherapy is painful?
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Chemotherapy can be given
• Orally, by mouth, in pill, capsule, or liquid form (PO)
• Intravenously, either injected into a vein as a shot (IV
push) or as a fluid drip (IV or IV drip)
• Intramuscularly, by injecting it into a muscle in the arm,
buttocks, or thigh (IM)
• Subcutaneously, with an injection beneath the skin (SQ)
• Intra arterially, by injecting it into an artery (IA)
• Intrathecally, by injecting it directly into the spinal fluid
(IT)
• Intracavitarily, by injecting it into the pleural space
(lung) or into abdomen (for fluid accumulation)
How is the method of administration decided?
Some drugs can be given only in one or two ways. Adriamycin,
for example, can be given only intravenously or intra arterially. If the drug can be given in different ways, the
decision will hinge on the necessary dose, preferences of
the doctor and the patient, what kind of cancer it is, and so
on.
Can drugs be given directly into the bloodstream without
putting the needle into your vein each time?
There are several different ways this can be done, especially
for people who need to have drugs or other fluids
injected often into the bloodstream. The doctors may insert
an indwelling catheter, implant a drug delivery system or
use a pump to give the drugs.
How does the indwelling catheter work?
The doctors insert one end of a catheter a thin silicone
rubber tube into a larger vein or artery deeper inside the
neck, chest or abdomen. The other end comes out through
a small incision in the skin. Drugs or fluids are injected or
infused through the end of the catheter and then go directly
into the bloodstream. This device can be left in place for
days, weeks or even months.
How is a drug delivery system inplanted?
The system is placed completely under the skin, usually
on the chest. It consists of two parts a portal, a small stainless
steel chamber, and a catheter, a thin flexible rubber
tube. One end of the catheter is placed in a vein or artery
inside the body and the other end is firmly attached to the
portal with a special lock. The operation takes from 30 minutes
to an hour. Both parts of the system are placed completely
under the skin. There is no permanent opening.
Drugs and fluids can be put directly into the bloodstream
through a simple injection through the skin.
Can pumps be implanted to give chemotherapy drugs?
Physicians at a number of hospitals are using infusion therapy
as a treatment. This method, known as intra arterial
infusion, uses either an external or internal pump to give
the drugs. It delivers high concentrations of the drug to a
specific target unlike the intravenous (IV) infusion, which
distributes the drug throughout the entire body. An external
pump can be used, but it restricts the person's activities.
How does the internal pump work?
The size of a hockey puck, the internal pump is like a balloon
that is sensitive to pressures within its own walls. The
pump is implanted in the body. The drug can be delivered
at an even rate over time. Since the pump is inside the
patient's body, the patient can carry on normal activities.
When the drug supply is used up, it is refilled by injecting
more drug through the skin into the pump. The pump is
being used for liver, head and neck, and brain tumors.
Is Chemotherapy is painful?
It depends upon where and how it is being given. If you
are taking it in pill, capsule, or liquid form or applying it
as an ointment, it is no different from taking any other medicine
in the same form. If you are getting a drug which is
injected into the muscle, it is like getting a vaccination or
penicillin shot. You usually feel a pinprick. If you are taking
a drug which needs to be injected in the vein, the process
takes longer than the muscle injection but does not usually
involve pain. It is similar to having blood drawn for a blood
test. A needle is put into the vein under the skin and the
drug is pushed in or drips into the body from an intravenous
setup. The time of the whole procedure varies from 2 minutes
to 1 or 2 hours. Some people having certain drugs
injected say they feel a temporary burning sensation in the
area of injection. Others feel warmth throughout the body.
Some patients say the needle insertion hurts. With a few
drugs, extreme care must be taken when they are administered
intravenously.
What determines how the chemotherapeutic drug will be
given to me?
It depends upon the kind of drug being used, the kind of
cancer you have, the extent of the disease, and the location
of the cancer. For example, some drugs are given by IV
(injection into the vein) because they reach the bloodstream
better and thus reach the cancer cells better this way. IV is
a way of making sure that the correct amounts of the drugs
are carried to all parts of the body where the cancer maybe growing. Some drugs are made only in a form which can
be given in one manner.
Does one particular drug ever stop being effective in a
particular patient?
Yes, sometimes the drugs lose their effectiveness against
the particular cancer. Scientists believe that in some cases
the cancer cells are multiplying more quickly than the drug
can kill them. Other times the doctors have to reduce the
doses or stop giving the drugs entirely because they are
producing side effects on the patients. Sometimes the cancer
cells have undergone change and are now able to survive
and even grow rapidly in the presence of the oncedestructive
drug. When this happens the cells are called
"drug resistant."
How do cells become drug resistant?
Cancer cells often find ways to avoid a drug's effect and
"turn off" its anticancer activity. If that happens, doctors
usually try to overwhelm the resistant cancer cells by introducing
new drugs or combinations of drugs. Unfortunately,
for some reason, cancer cells are often able to resist
these new agents as well, even drugs they haven't encountered
before or drugs that have different structures and
mechanisms of action. Researchers have found that some
cancer cells, through genetic changes, "learn" to produce
large amounts of an enzyme that overrides a drug's usefulness
and allows the cancer to grow again. In other cancers,
the cell membrane changes in a way that allows it to block
the entry of the drug into the cell or reduce the time the
active drug remains in the cell. Some cancer cells show
increased amounts of a certain protein on the cell membrane
which may influence the way a drug enters or leaves
the cancer cells.
What kind of research is being done on drug resistance?
Many studies are being conducted in this field. Researchers
have found ways to overcome drug resistance in cells grown
in the laboratory. Several of these approaches are now being
used on patients in clinical trials. These include different
ways of administering drugs, such as alternating treatment with different combinations or injecting the drug directly
into a region like the abdomen in order to increase the local
concentration of drug delivered to a cancer site.
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