The treatment of cancer mainly involves surgery and or radiation (radiotherapy) and or chemotherapy. These are often used in various combinations depending on a range of factors such as the type of cancer, the extent of spread, the age and general health of the patient, the aim (cure or palliation), and more. Chemotherapy is a powerful and often-feared form of treatment and so it may be worthwhile discussing it in a bit more detail here.
All forms of cancer involve, at a cellular level, the excessive and uncontrolled multiplication of cells (a process called mitosis). Chemotherapy aims to stop or to reduce or to slow down this mitosis. Because mitosis is also a normal and essential process within the body, chemotherapy can cause a great many unwanted and quite-serious side-effects. The somewhat-crude and perhaps-cruel but fairly helpful analogy often made is that chemotherapy tries to kill the cancer but to stop short of killing the patient.
Chemotherapy, whether used alone or in conjunction with other options (mainly surgery and or radiation) maybe used in an attempt to cure the cancer and or in a palliative way where the objective is to improve quality of life (manage pain etc.) and sometimes, to prolong life (but recognising the limitations and that cure will not result). These distinctions are really very important. Proper professional oncology care should always make clear what the objective is. It is not easy to discuss terminal illness, but all patients deserve to know what sort of prognosis and outlook they face. If cure is unrealistic this should be known.
It is also worth noting that palliative chemotherapy can often be very valuable – prolonging life while improving quality of life is a great endeavour and often worthwhile. In this context the dosages and types of chemotherapy are usually tailored to minimise side effects since excessive side effects would negate the very point of palliative chemotherapy (quality of life). This is well understood by oncologists, who tend be among the most compassionate of doctors.
The main side effects of chemotherapy include suppressed immunity, weight loss, hair loss, anaemia, nausea, vomiting, and infertility. There are a range of other possible side effects but these are the most commonly seen.
Chemotherapy is usually administered intravenously (through a drip). This is often done on an outpatient basis (patient visits clinic for a few hours and returns home) but hospital admission may be required in more complex or severe cases or where side effects are severe. Some forms of chemotherapy can be taken orally, although this is less common.
As we live longer and longer cancer seems to become more common (there may reasons other than ageing but that is a separate discussion). As medical science advances, chemotherapy options expand. It becomes more and more likely that many of us will undergo this form of treatment at some point in our lives.
Chemotherapy is often a dreaded form of treatment since it implies a sinister diagnosis and is often associated with nasty side effects. But it can be lifesaving and or life-prolonging and or life-improving. It is important to understand the aims of chemotherapy and to discuss all aspects with your doctor (ideally a specialist oncologist).
Written by Dr Colin Burns
