Breast Cancer Chemotherapy

One of the most common causes of death from cancer for both men and women is Lung cancer. It occurs most commonly between the ages of 45 and 70. Lung cancer is more common in women now than in the past because more women are smoking cigarettes.

Lung cancer that originates in the cells of the lungs is called primary lung cancer; however, cancer may also spread (metastasize) to the lung from other parts of the body. Metastatic cancers spread to the lungs most commonly from the breast, colon, prostate, kidney, thyroid gland, stomach, cervix, rectum, testis, bone, and skin (melanoma).More than 90% of primary lung cancers start in the bronchi (the large airways that branch off the trachea to supply the lungs).

Cigarette smoking is the cause of about 90% of lung cancer cases in men and about 80% of cases in women. The greater the quantity and duration of smoking, the greater the risk of developing lung cancer. About 10 to 12% of all smokers eventually develop lung cancer.

A small proportion of lung cancers (about 10% in men and about 5% in women) are caused by substances encountered or breathed in at work. Working with asbestos, radiation, arsenic, chromates, nickel, chloromethyl ethers, mustard gas, and coke-oven emissions has been linked with lung cancer. The risk of contracting lung cancer is greater in people who are exposed to these substances and who also smoke cigarettes. Air pollution causes about 1% of lung cancer cases.

The symptoms of lung cancer depend on its type, its location, and the way it spreads. Usually, the first and most common symptom is a persistent cough. People with chronic bronchitis who develop lung cancer often notice that their coughing becomes worse. If a lung cancer grows into underlying blood vessels, it may cause severe bleeding.

A lung cancer may grow into the heart, causing abnormal heart rhythms, blockage of blood flow through the heart, or fluid in the pericardial sac surrounding the heart. Symptoms of lung cancer that usually arise later include loss of appetite, weight loss, fatigue, and weakness.

Lung cancer may also spread through the bloodstream to the liver, brain, adrenal glands, spinal cord, and bone; less commonly lung cancer may spread to other parts of the body.

Diagnosis

A doctor explores the possibility of lung cancer when a person, especially a smoker, has a persistent or worsening cough or other lung symptoms (such as shortness of breath or coughed-up sputum tinged with blood). Sometimes a shadow on a chest x-ray of someone with no symptoms provides the first clue, although a shadow on an x-ray is not proof of cancer. A chest x-ray can detect most lung tumors, although it may miss small ones.

A computed tomography (CT) may show small nodules that do not appear on chest x-rays. CT can also reveal whether the lymph nodes are enlarged; a biopsy of enlarged lymph nodes is often needed to determine if inflammation or cancer is responsible for the enlargement.

Chemotherapy: Chemotherapy, sometimes coupled with radiation therapy, is the treatment of choice for small cell carcinoma of the lung. This is because the cancer has almost always spread to distant parts of the body by the time of diagnosis. In about 25% of people, chemotherapy substantially prolongs survival. Without chemotherapy, only half of the people with small cell carcinoma survive 4 months. With chemotherapy, there is a four-to fivefold increase in survival. People with small cell carcinoma of the lung who have been responding well to chemotherapy may benefit from radiation therapy to the head to treat cancer that has spread to the brain, even though the spread is early enough that no symptoms are apparent and nothing abnormal can be seen on a CT or MRI of the head.

The effectiveness of chemotherapy alone is very limited for no small cell lung cancer. In metastatic no small cell lung cancer, some people survive significantly longer when given chemotherapy than if they had not received it.

There are variety of care settings wherein chemotherapy is administered. Most of the cancer patients receive systemic chemotherapy in an ambulatory care setting or in a day care unit designed to care for patients requiring lengthy infusions. Admission in Hospital is reserved for patients who require intensive monitoring or are acutely ill. The shift to outpatient ambulatory care services has grown out of the need for more efficient and economical health care.Exposure to cytotoxic drugs is known to be potentially hazardous to the health. Cytotoxic drugs may enter the body by three possible routes: Inhalation, Ingestion and Skin contact. These are most likely to occur with injectable agents during either their preparation or administration. Therefore, to prevent the risk, adequate precautions must be taken by a pharmacist while admixturing chemo drugs.

Adequate precautions must be taken during admixture of cytotoxic drugs.

Wear latex powder free long cuff gloves while preparing chemotherapy drugs. Wear a gown that is low or non-permeable, long sleeve, cuffed and solid fronted and use aerosols free mask. Work over a suitable container to prevent the spread of any spillage. Prevent high pressure being generated inside sealed vials - when fluids are introduced an equivalent volume of air should be withdrawn or a venting needle with a hydrophobic filter may be used if available.

Ampoules should be directed away from the face and covered with a suitable pad or cotton when broken open. Diluent fluids should be introduced slowly into open-ended ampoules or vials, running it down the vessel wall and ensuring the drug powder is moist before shaking. When excess air is expelled from a filled syringe it should be exhausted into a pad and not straight into the atmosphere. If excess drug is to be expelled from a filled syringe it should be removed first and sterile cotton wool placed over the end of the syringe to prevent possible scatter of aerosol droplets. Luer lock fittings should be used in preference to push connections on syringes, tubing and I.V. sets. Label all prepared bottles and it is mandatory. Admix all cytotoxic drugs in biological safety cabinet (laminar air flow) that meets standards and it is inspected appropriately. Check the reconstitute or diluents for the particular drug and the concentration in which it is to be reconstituted.

A checklist must be kept ready before preparing the cytotoxic drugs. Name of the drug, company name, active salt, strength, expiry date, Patient name, age and patient ID number, number of chemotherapy cycle, approximate cost of the drug, Drug delivery route and access devices. The other things to be kept in mind are Solvent and its concentration in which it is to be mix, Infusion or diluent fluids (D5%W / NS / RL / DNS) with which to be mixed, Availability of drug delivery access and Cross marking of the pack and label of the vial / ampoule. Drug dose is to be administered according to body surface area and body weight.

Proper disposable management should be done. All the waste materials like syringe, needle, mask and gloves should be disposed carefully in cytotoxic disposal bags. Changes of gloves and mask should be done after each admixture process. The syringes should also change after each drug admixing. A standard procedure is to be made and followed for disposals of waste materials. The disposal bags should print with cytotoxic drug. Cytotoxic waste is highly hazardous and should never be land filled or discharged into the sewerage system. Disposal options include the following: Safely packaged but outdated drugs and drugs that are no longer needed should be returned to the supplier. This is currently the preferred option for countries that lack the facilities for incineration. Drugs that have been unpacked should be repackaged in a manner as similar as possible to the original packaging and marked “outdated” or “not for use”.

Full destruction of all cytotoxic substances may require temperatures up to 1200°C; Incineration at lower temperatures may result in the release of hazardous cytotoxic vapours into the atmosphere. The cytotoxic admixture should be done by a proper procedure in all the cancer institutes. This is the area where the pharmacist can utilise his knowledge of pharmaceutics. Working with cytotoxic drugs requires adequate knowledge and skill. Chemo drugs are very toxic for which proper care and precautions is to be taken while handling, preparing, administering and disposing.

Chemotherapy treatment is used as the primary treatment for colon cancer, or as adjuvant therapy along with surgery and radiation treatment. The course of chemotherapy treatment used will depend on the stage of the cancer, the health of the patient, and the doctor’s preferences.

One or more of drugs are used under Chemotherapy treatment to kill cancer cells. The anticancer drugs work by stopping the division and reproduction of cancer cells.

Chemotherapy may be used to:

Kill any cancer that remains after surgery

Control the spread or growth of tumors

Relieve cancer symptoms

During chemotherapy, drugs enter the bloodstream and travel throughout the body, so it is known as systemic therapy. Combination chemotherapy is when more than one drug is used at a time.

Chemotherapy is given by:

Direct injection into a vein (IV)

Catheter (such as a central line)

Pill form

Based on the patient’s condition, the doctor decides where to give the treatment and what drugs are being used. Treatment doesn’t always take place in a hospital inpatient setting and it may also be given in a doctor’s office, clinic, or hospital outpatient center.

Chemotherapy is often given in cycles with rest times in between to allow the body to regain strength. It is very important to stick with the chemotherapy cycle as prescribed by a physician in order to achieve the best possible results.

When most people think of chemotherapy, they immediately think of troubling side effects such as nausea and hair loss. Fortunately there are many treatments to prevent or counteract the side effects that are most disturbing to cancer patients. Anti-nausea drugs may be given as a preventative measure to help with sour stomach and vomiting. Good oral hygiene including brushing with a soft toothbrush and flossing 3 times a day may help to prevent mouth sores and irritation.

Many chemotherapy drugs can cause diarrhea and constipation. With either side effect, it is important to drink plenty of water to either replace fluids lost, or to make stool pass more easily through the colon. Anti-diarrheals are not usually given as a preventative measure, but may be prescribed if troubling digestive problems persist.

After a cycle of chemotherapy, the doctor may want to follow-up with various tests to track the effectiveness of the treatment. Blood tests and X-rays are just two of the tests that may be used during follow up doctor visits to track the cancer and make further decisions on treatment. Chemotherapy is often used effectively in conjunction with other treatments such as surgery and radiation to send cancer into remission.

Hair loss due to due to chemotherapy is one of the most distressing side effects of chemo treatments.  As chemotherapy treatment affects all the cells of the body and thus hair loss happens.  The lining of the mouth, stomach, and the hair follicles are especially sensitive because those cells multiply rapidly just like the cancer cells. The difference is that the normal cells will repair themselves, making these side effects temporary. Hair loss does not occur with all chemotherapy.  It depends on the chemotherapy drugs and dosages. Hair loss may occur as early as the second or third week after the first cycle of chemotherapy, although it may not happen until after the second cycle of chemotherapy.   Hair loss can be sudden or slow.   Hair loss can happen anywhere and include hair that grows in eyelashes, eyebrows, and even pubic hair. In almost all cases of chemotherapy-induced hair loss and the hair will resume growth after treatments.  It may take from three to six months after therapy is completed or it may start growing back while receiving chemotherapy.  The new hair will have a slightly different color, texture, or curl.

There is no known prevention for hair loss due to chemotherapy is available currently.  Through the years, attempts have been made to reduce hair loss by using tight bands or ice caps.  These techniques were thought to reduce the blood flow to the hair follicles, thus limiting the chemotherapy exposure.  Unfortunately, these techniques did little more than cause headaches and have been abandoned in most settings.

The following are options to consider, the best option is the one that is most comfortable to the individual:

Short hair - Cut your hair short if hair loss is expected during chemotherapy.  Since hair often does not fall out evenly, some find losing short hair is less distressing.  Some people shave their heads once the hair begins to fall out.

Wigs can be purchased if interested; the best time to do this is before loosing any hair.  This helps the stylist create the best match.  Many insurance companies will pay for a wig, so be sure to have it written as a prescription from your doctor.  There are wig stylists who specialize in wigs for alopecia (hair loss).  Caps and Scarves - Some people find that the easiest and most comfortable options are caps and scarves.

Hair loss during chemotherapy treatments is almost an inevitable. If treatments go on long enough, the likelihood of losing hair is greater than the likelihood of not losing hair, and unfortunately that is something that just happens to be accepted. In some instances, chemotherapy hair loss prevention is an option. For shorter treatments, there are ways to try and stimulate the growth of the hair follicles.

It is better to consider alternatives to chemotherapy hair loss prevention. Hair pieces are a great thing for chemotherapy patients, as they are a great experiment. Use that time to consider the possibilities; many times after hair grows back from chemotherapy treatments, it grows in a different color or a different texture than it was before it fell out. That is exciting for some people, and it tends to make up part of the horrible experience of losing the hair in the first place. At that time, chemotherapy hair loss prevention is not an option anymore, and it is no longer necessary. Scarves are also a popular option in lieu of chemotherapy hair loss prevention. They come in different colors and styles and this can help to boost self esteem.

Some of the commonly used chemotherapy drugs are:

Actinomycin D, Adriamycin, Alkeran, Ara-C, Avastin, BiCNU, Busulfan, Carboplatinum, CCNU, Cisplatinum, Cytoxan, Daunorubicin, DTIC, 5-FU, Fludarabine, Gemcitabine, Herceptin, Hydrea, Idarubicin, Ifosfamide, Irinotecan, Leustatin, 6-MP, Methotrexate, Mithramycin, Mitomycin, Mitoxantrone, Navelbine, Nitrogen Mustard, Rituxan, 6-TG, Taxol, Taxotere, Topotecan, Velban, Vincristine and VP-16.

Chemotherapy drugs are divided into several groups based on how they affect specific chemical substances within cancer cells, which cellular activities or processes the drug interferes with, and which specific phases of the cell cycle the drug affects. Knowing this helps oncologists decide which drugs are likely to work well together.

Alkylating Agents:

Alkylating agents directly damage DNA to prevent the cancer cell from reproducing. These drugs are active against chronic leukemias, non-Hodgkin lymphoma, Hodgkin disease, multiple myeloma, and lung, breast, ovarian, and certain other cancers.

Some examples of alkylating agents include busulfan, cisplatin, carboplatin, chlorambucil, cyclophosphamide, ifosfamide, dacarbazine, mechlorethamine (nitrogen mustard), melphalan, and temozolomide.

Nitrosoureas:

Nitrosoureas act in a similar way to alkylating agents. They interfere with enzymes that help copy and repair DNA. Unlike many other drugs, these agents are able to travel from the blood to the brain, so they are often used to treat brain tumors. They may also be used to treat Hodgkin and non-Hodgkin lymphomas, multiple myeloma, and malignant melanoma.

Examples of nitrosoureas include streptozocin, carmustine, and lomustine.

Antimetabolites:

Antimetabolites are a class of drugs that interfere with DNA and RNA growth and are commonly used to treat leukemias, tumors of the breast, ovary, and the gastrointestinal tract, as well as other cancers.

Examples of antimetabolites include 5-fluorouracil, capecitabine, 6-mercaptopurine, methotrexate, gemcitabine, cytarabine, fludarabine, and pemetrexed.

Anthracyclines and Related Drugs:

Anthracyclines are anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These agents work in all phases of the cell cycle. Thus, they are widely used for a variety of cancers. A major consideration when giving these drugs is the toxic effects they can have on heart muscle. For this reason, life time dose limitations are often placed on these drugs.

Examples include daunorubicin, doxorubicin, epirubicin, idarubicin, and mitoxantrone.

Topoisomerase Inhibitors:

These drugs interfere with enzymes called topoisomerases, which are important in accurate DNA replication. They are used to treat certain leukemias, as well as lung, ovarian, gastrointestinal, and other cancers.

Examples of topoisomerase I inhibitors include topotecan and irinotecan.

Examples of topoisomerase II inhibitors include etoposide and teniposide.

Mitotic Inhibitors:

Mitotic inhibitors are plant alkaloids and other compounds derived from natural products. They can stop mitosis or inhibit enzymes from making proteins needed for reproduction of the cell. They are used to treat many different types of cancer including breast, lung, myelomas, lymphomas, and leukemias. These drugs are known for their potential to cause peripheral nerve damage, which can be a dose-limiting side effect.

Examples of mitotic inhibitors include the taxanes (paclitaxel, docetaxel) and the vinca alkaloids (vinblastine, vincristine, and vinorelbine).

Corticosteroid Hormones:

Steroids are natural hormones and hormone-like drugs that are useful in treating some types of cancer (lymphoma, leukemias, and multiple myeloma) as well as other illnesses. When these drugs are used to kill cancer cells or slow their growth, they are considered chemotherapy drugs. They are often combined with other types of chemotherapy drugs to increase their effectiveness.

Examples include prednisone, solumedrol, and dexamethasone.

Miscellaneous Chemotherapy Drugs:

Some chemotherapy drugs act in slightly different ways and do not fit well into any of the other categories.

Examples include such drugs as L-asparaginase, hydroxyurea, dactinomycin, thalidomide, and tretinoin.

Colon cancer usually starts as small growths on the inside of the colon called polyps. It takes several years that these polyps to grow large enough to be seen during a routine colonoscopy and then it takes several more years for those polyps to become cancerous.

The reason for colon cancer is unknown, but there are several risk factors that can increase the chances of developing this cancer. Some risk factors, such as age, cannot be changed while others, such as diet, can be modified and reduce the risk. The risk factors for colon cancer range from age to hereditary diseases.
The common risk factor for colon cancer is the age. Approximately 90% of all colon cancer cases are found in people aged 50 and above. Many of these cases have no other risk factors, making this the most important factor in developing this cancer. This is why many doctors suggest getting a colonoscopy as part of the annual medical exam starting at age 50.

Another risk factor for developing colon cancer is the family’s medical history and any hereditary diseases that may affect the development of colon polyps. If a member of your immediate family (parents, siblings, or children) has had colon cancer, you are more likely to develop it. The risk depends upon how many relatives have had it, how old they were when they were diagnosed and if the history spans multiple generations. This is referred to as a strong family history of colon cancer and may be caused by genetic mutations. If this is the case, then blood test to be conducted for any genetic mutations.

These genetic changes can cause several conditions, such as familial adenomatous polyposis (FAP), attenuated familial adenomatous polyposis (AFAP) and hereditary nonpolyposis colon cancer (HNPCC). All of these genetic conditions can develop into colon cancer, if left untreated. These conditions are rare and few of the people diagnosed with colon cancer actually have them.
The medical history of a family also contributes to risk of developing colon cancer. There are also certain diseases that can increase the risk of colon cancer, such as ulcerative colitis and Crohn’s disease.

The other risk factors are diet, exercise and habits. A high fat, high calorie and high protein diet has been shown to increase the chances of developing colon cancer. This type of diet may also contribute to another risk factor, weight. Lack of exercise also contributes to the risk. These risk factors can be minimized by making some simple changes such as eating more fruits and vegetables and beginning exercise. These two changes will help you lose weight and improve the diet. Smoking and drinking also contribute to colon cancer risk. Some studies have shown that smoking increases the chance of developing colon cancer. Alcoholics are also at an increased risk for colon cancer because of their alcohol consumption. Drinking more than 2 drinks a day increases the risk of colon cancer.

Cancer cells quickly adapt to toxic environments, they readily alter themselves to assure their continued survival, and they utilize biologic mechanisms to promote cellular immortality. These factors make cancer an extremely difficult disease to treat.

Chemotherapy drugs have a high rate of failure because they usually kill only specific types of cancer cells within a tumor or the cancer cells mutate and become resistant to the chemotherapy. Cancer chemotherapy could save more lives if the latest scientific findings were incorporated into clinical medicine.

It is impossible to design a single chemotherapy protocol that is effective against all types of cancer. The oncologist might need to administer several chemotherapy drugs at varying doses because tumor cells express survival factors with a wide degree of individual cell variability. This protocol conveys the findings from published scientific studies so that a cancer patient will have a logical basis to augment the effects of chemotherapy and also reduce the potential for side effects.

According to the National Cancer Institute , almost all normal cells grow and die in a controlled way through a process called apoptosis. Cancer cells, on the other hand, keep dividing and forming more cells without a control mechanism to induce normal apoptosis.

Anticancer drugs destroy cancer cells by stopping them from growing or dividing at one or more points in their growth cycle. Chemotherapy may consist of one or several cytotoxic drugs that kill cells by one or more mechanisms. The chemotherapy regimen chosen by most conventional oncologists is based on the type of cancer being treated. The goal of chemotherapy is to shrink primary tumors, slow the tumor growth, and kill cancer cells that may have spread (metastasized) to other parts of the body from the original, primary tumor. However, chemotherapy kills both cancer cells and healthy normal cells. Oncologists try to minimize damage to normal cells and to enhance the cell killing (cytotoxic) effect on cancer cells. Unfortunately, this delicate balance is not achieved.

Clinical studies show that for certain types of cancer chemotherapy prolongs survival and increases the percentage of patients achieving a remission. A partial remission is defined as 50% or greater reduction in the measurable parameters of tumor growth as may be found on physical examination, radiologic study, or by biomarker levels from a blood or urine test. A complete remission is defined as complete disappearance of all such manifestations of disease. The goal of all oncologists is to strive for a complete remission that lasts a long time–a durable complete remission, or CR. Unfortunately; the vast majority of remissions that are achieved are partial remissions. Too often, these are measured in weeks to months and not in years. Some types of cancer do not show any meaningful response to chemotherapy.

It is highly desirable to know what drugs are effective against particular cancer cells before these toxic agents are systemically administered to the body. A company called Rational Therapeutics, Inc., performs chemosensitivity tests on living specimens of cancer cells to determine the optimal combination of chemotherapy drugs.

Chemotherapy can cause different side effects to different people due to different administration of different drugs and the dosage of drugs.

A particular drug may not be suited to some people but the same drug may be useful for some others. A lot depends on finding the right dose that will be effective against the cancer but still be tolerable for each person. The doctor has to monitor this aspect. Of course, drugs are available to somewhat manage and control these side effects. Some of the side effects of chemotherapy are:

Nausea and Vomiting: Some people never have nausea or vomiting. Others are nauseated every day of treatment. Some people have nausea that lingers more than a week beyond chemotherapy. However, these side effects can almost always be controlled, or at least substantially reduced, by a variety of drugs and lifestyle changes.

Hair loss: Chemotherapy may make hair loss completely, cause it to thin, or not affect it at all. The doctor will be able to tell how specific drug will affect hair. Most people’s hair will begin to grow after the treatments are over. It’s not unusual for the hair to come back in a different color or texture. Hair loss can occur on all parts of the body—not just the head. Sometimes it falls out right away, sometimes after a few treatments.

Fatigue and anemia: Many women experience fatigue after breast cancer treatment. This fatigue can range from mild to nearly debilitating. The fatigue is often the result of anemia, a condition caused when chemotherapy reduces red blood cell count.

Mouth sores: Chemotherapy can cause sores in the mouth and in the throat. These sores can easily become infected from bacteria and viruses present in the mouth. The drugs can also make mouth tissues dry or irritated and cause them to bleed.

Taste and smell changes: Chemotherapy may cause changes in taste and smell sensations. Foods may taste bitter or rancid, and it may develop an aversion to certain foods. Many women report that their food tastes metallic. This happens because chemotherapy alters the receptor cells in mouth that tell the brain the flavor tasted and the odor smelled. Sensations of taste and smell should return to normal several weeks after treatment has stopped.

Suppression of the immune system, infertility and diarrhea are also the side effects of chemotherapy.

Menopause and Fertility: During chemotherapy, the menstrual periods may become irregular or may stop altogether. If it is childbearing age, periods may come back once the treatment has stopped. But if it is close to menopause, the periods may never come back. That means that it will not only stop having periods, but also may not be able to conceive a child.

Apart from the above, there are other side effects which include fluid retention, rashes, irritated bladder, swelling and soreness of the mucous membranes, and numbness and aching of the joints, hands, and feet.

Use of anti-cancer drugs to kill cancer cells is referred as Chemotherapy. The doctor who determines the drugs and the dosage is known as a medical oncologist. Chemotherapy can be used for three major purposes: Adjuvant therapy: The goal is to prevent or postpone cancer from coming back after the initial surgery and radiation. Even when the cancer seems to be confined to the breast and lymph glands under the arm, there is a chance that cells may have already spread to other areas that cannot be seen. Chemotherapy is given to try and kill these cells. Neo-adjuvant therapy: Sometimes the cancer in the breast is so big that shrinking it first with chemotherapy may make it easier to do surgery and to treat metastatic disease. If the cancer shows up in parts of the body other than the breast and lymph glands under the arm, it is called metastatic disease. Chemotherapy can be one of the main ways to kill cancer cells that have spread to other parts of the body, and help woman live longer with good quality of life.

Some of the most common chemotherapy drugs used to treat breast cancer include the following: Anthracyclines: This class of drugs includes doxorubicin (Adriamycin), epirubicin (Ellence), and liposomal doxorubicin (Doxil); Taxanes: This class of drugs includes docetaxel (Taxotere), paclitaxel (Taxol), and protein-bound paclitaxel (Abraxane); Cyclophosphamide (Cytoxan); Capecitabine (Xeloda) and 5 fluorouracil (5 FU); Vinorelbine (Navelbine); Gemcitabine (Gemzar); Trastuzumab (Herceptin): This drug is only of use in women whose cancers have the Her2 gene.

They are usually given in 2-4 week cycles. In adjuvant and neo-adjuvant settings, they are usually given in combinations of two or more drugs. Single agent (one drug at a time) can be a good choice in treating cancer that has already spread to other areas.

Chemotherapy is given either by mouth or injected into a vein daily, weekly or every 2-4 weeks. The treatment plan is designed for particular condition. Sometimes, if a person’s veins are hard to find, it can help to place something called a “port-a-cath” (completely covered with skin and requires no care) or a “Hickman” catheter (hangs outside the chest and must be cleaned and flushed) in a large vein. These devices are inserted by a surgeon or radiologist and have an opening to the skin, allowing chemotherapy medications to be given. They can also be used to administer fluids or take blood samples. The catheters are placed on an outpatient basis using local anesthesia. Once chemotherapy is finished, they can be easily removed.

There are many different chemotherapy drugs, and combinations of drugs, used to treat breast cancer. Research is always being carried out to improve the effectiveness of chemotherapy whilst reducing the side effects.

Chemotherapy drugs can cause side effects, but these can usually be well controlled with medicines. Chemotherapy can reduce the production of white blood cells by the bone marrow. Chemotherapy can reduce the production of platelets, which help the blood to clot. Chemotherapy leads to anemic. Some chemotherapy drugs can make people sick and a few others make mouth sore. Some chemotherapy drugs may make hair fall out. Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many people become very tired and have to take things much more slowly.

Some types of cancer are cured by Chemotherapy treatment. Some general information is given here, about chemotherapy. Cancer refers to cancer, leukemia and lymphoma. Sometimes chemotherapy is used to treat non-cancerous conditions but often the doses are lower and the side effects may be reduced.

There are over 200 different types of cancer and over 50 chemotherapy drugs, which can be given in various ways. It is best to discuss the details of treatment with a specialist doctor, who will be familiar with particular situation and type of cancer. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells (including leukemia and lymphoma). Combination chemotherapy is administration of some of the chemotherapy drugs together among the 50 different chemotherapy drugs. The type of chemotherapy treatment you are given depends on many things, but particularly: the type of cancer, where the cancer started in the body, what the cancer cells look like under the microscope and whether the cancer has spread to other parts of the body.

Chemotherapy may be used alone to treat some types of cancer. It may also be used with other types of treatment such as surgery, radiotherapy, hormonal therapy, biological therapies, or a combination of these.

Prevention of cancer cells dividing and reproducing themselves is done by Chemotherapy drugs. As the drugs are carried in the blood, they can reach cancer cells anywhere in the body. They are also taken up by some healthy cells. Healthy cells can repair the damage caused by chemotherapy, but cancer cells cannot and so they eventually die. Different chemotherapy drugs damage cancer cells in different ways. Unfortunately, as the chemotherapy drugs can also affect some of the healthy cells in the body, they can cause unpleasant side effects. However, damage to the healthy cells is usually temporary and most side effects will disappear once the treatment is over.

Healthy cells in certain parts of the body are especially sensitive to chemotherapy drugs; these parts of the body include: the bone marrow (which makes blood cells), the hair follicles, the lining of the mouth and the digestive system.

Chemotherapy is usually given as a series of sessions of treatment. Each session is followed by a rest period. The session of chemotherapy and the rest period is known as a cycle of treatment. A series of cycles makes up a course of treatment. Each session of chemotherapy destroys more of the cancer cells, and the rest period allows the normal cells and tissues to recover. Chemotherapy is likely to destroy all the cancer cells and cure the disease in some type of cancer. Chemotherapy may also be given after surgery to destroy any cancer cells that remain. Chemotherapy may be given to shrink a cancer before another treatment such as surgery.

Chemotherapy can be used before an operation to shrink a cancer that is too large to be removed easily during an operation. Chemotherapy can be given to remove small cancer cells visible after the operation. Sometimes chemotherapy is given at the same time as radiotherapy. This is known as chemo radiotherapy.