Chemotherapy means treatment with anti-cancer drugs given to destroy or control cancer cells. There are over 50 such different drugs.

Drugs may be given on their own or several different drugs may be given together. This is called combination chemotherapy.

Many types of cancer can be treated with chemotherapy. The aim of the treatment will depend on the type of cancer you have and how advanced it is. Chemotherapy is given:

• To cure the cancer: chemotherapy is given to destroy all the cancer cells
• To reduce the possibility of cancer coming back: chemotherapy is given to destroy any cancer cells which may be present in your body that are too small to detect. It is important to destroy these cells
• To control the cancer: chemotherapy is unlikely to cure the cancer but may prevent it from growing for some time
• To relieve symptoms: chemotherapy is given to shrink a tumour if it is causing any symptoms

Chemotherapy drugs enter your bloodstream and therefore reach all parts of your body. This is called systemic treatment (most radiotherapy and surgery treatments are called local treatments because they treat a specific part of the body).

Chemotherapy drugs destroy cancer cells by damaging them so they can’t divide and grow.

The drugs can also affect normal cells which are growing and dividing quickly. Damage to normal cells may cause side effects. These are usually temporary because healthy cells quickly grow back to normal.

Permanent damage is rare with most chemotherapy regimens.

Sometimes chemotherapy is used on its own for cancers that respond well to this treatment. However, chemotherapy is often used with other treatments, such as:

• Neo-adjuvant therapy: chemotherapy given before surgery or radiotherapy to shrink the tumour
• Adjuvant therapy: chemotherapy used to help destroy any cancer cells that may remain after surgery or radiotherapy. The aim is to reduce the likelihood of cancer returning in the future
• Peri-operative therapy: chemotherapy given both before and after surgery
• Chemoradiation: chemotherapy combined with radiotherapy
• Palliative chemotherapy: if the cancer has spread to other parts of the body, the chemotherapy drugs carried in your bloodstream can reach these cancer cells. The aim is to help relieve symptoms and slow the growth of the cancer

Chemotherapy drugs damage fast-growing cells. As well as destroying cancer cells, they also cause damage to normal cells. It is this damage to normal cells that may cause side effects.

Side effects can be acute or late. Acute (immediate) side effects occur during and immediately after treatment. Late (delayed) side effects develop after treatment has been going on for some time and may continue, at least for a while, after treatment is finished.

Everyone reacts differently to chemotherapy and some people may have no side effects at all. The side effects you may experience with your chemotherapy treatment plan will be discussed with you. For example, not all chemotherapy drugs cause sickness or hair loss, so do check what is relevant for you.

We can offer help for most side effects, so please tell your doctor or nurse if you feel any different from normal.

Remember: most of the side effects of chemotherapy are temporary and will disappear after your treatment has finished.

Urgent side effects

There are some side effects that need to be treated quickly and it is important that you do not wait until the next morning or after the weekend. If you are unsure as to whether your symptoms need urgent treatment, contact the hospital or your GP for telephone advice.

You must contact your hospital team or GP immediately if you develop any of the following symptoms:

• a temperature of 38°C/100°F or higher*
• shivering episodes*
• flu-like symptoms*
• gum or nose bleeds or unusual bleeding (if bleeding doesn’t stop after ten minutes of pressure)
• mouth ulcers that stop you eating or drinking
• vomiting (that continues in spite of taking anti-sickness medication)
• diarrhoea (four or more bowel movements more than usual or diarrhoea at night)
• difficulty with breathing

*signs of infection

It is important that you tell your hospital doctor if you suffer from any side effects or anything else unpleasant that may have happened to you since your last visit. Your doctor can help you by giving you medication to reduce or stop you from experiencing these side effects in the future.

Chemotherapy is most commonly given in one of two ways:

• by mouth (orally)
• by injection (intravenously) into a vein using a syringe or an infusion (‘drip’)

Occasionally, a drug may be injected into a muscle or under the skin. Sometimes it can be injected into your spine (intrathecal chemotherapy), lungs or bladder, if that is where treatment is needed. You may have one drug, several drugs or different drugs given at different times. You may have tablets or injections or both.

Oral chemotherapy

Some chemotherapy drugs can be taken as tablets or capsules, which means you can continue your treatment at home. You will still need to visit the outpatient department for regular check-ups.

How is chemotherapy given into a vein?

When chemotherapy is given intravenously (into a vein), it is given through a ‘venous access device’.

Types of venous access devices

There are several different types of devices available. These include:

• Cannula: a small tube which is put into a vein in your lower arm or the back of your hand. It is inserted at the beginning of each treatment and removed after the chemotherapy has been given. Once the cannula has been taped to your arm, the chemotherapy drugs can be injected slowly into the vein through it. Sometimes the drugs are diluted and given through a ‘drip’ (called ‘intravenous infusion’) into a vein in your arm.

Some treatment drugs cannot be given into the vein of the hand or the arm and can only be given through one of the central venous access devices described below:

• Skin-tunnelled catheter (sometimes called a Hickman line): a fine tube which is inserted through your chest into a large vein leading to your heart. It can be left in place for several weeks or months. As well as using it to give you fluids and drugs, it may also be used to take blood samples
• Peripherally inserted central catheter (PICC): inserted into a vein in your arm above the bend in the elbow, a PICC goes into the large vein leading to your heart. A PICC can be used to give you drugs and to take blood samples
• Implanted port: a device which is inserted under the skin into your body, usually on the chest. The port is made up of a portal body (or chamber) which is connected via a thin tube inserted into one of the body’s veins. A special needle is used to get into the chamber which can then be attached to a drip for injections, drips or blood tests

You may be able to choose the type of device you have, however your choice will depend on the type of therapy you are going to have, your physical condition and your lifestyle. Sometimes a choice isn’t possible.

How long does it take to give intravenous chemotherapy?

Depending on the drug or combination of drugs, each cycle lasts from a few hours to a few days.

Your doctor may recommend that your chemotherapy is given continuously at a lower dose, over weeks or months. This keeps a steady level of the drug in your bloodstream. You will receive the drug from a small infusion pump while you are at home.