Cancer

Chemotherapy

There are three main treatments for cancer and these are chemotherapy, radiotherapy and surgery. Which of these treatments are given depends on many things, particularly the type of cancer, where in the body the cancer is, what the cancer cells look like when examined microscopically and whether it has spread to other parts of the body.
 
Chemotherapy involves using anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be the main, and only, treatment or it can be used in combination with surgery, e.g. to reduce the size of the tumour before surgery. It can also be used together with radiotherapy. Some chemotherapies are given in tablet or capsule form, others by injection and some are given straight into the blood stream via a vein in your skin. If you have to be treated with intravenous (into a vein) chemotherapy drugs then instead of having to have repeated injections you can have a central venous line (a small flexible tube) sometimes called a ’Hickman line’ put into your arm, groin or chest. This can last for weeks or months and can save an awful lot of pain and trouble because you don’t need repeated jabs! These lines are often ’put in’ under general anaesthetic. The central venous line/Hickman line procedure was explained before the operation but some young people found the graphic explanation about how it is inserted rather off-putting especially if plastic dolls were involved in the demonstration!

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Hickman lines and portacaths (another way of getting fluids directly into the veins) can get infected, in which case antibiotics are used to treat the infection. Some young people pointed out that it is important to tell someone if the skin where the ’line’ goes in starts to feel hot or sore. The line usually stays in place for a few months after treatment, while routine blood tests are still needed.
 
An alternative is a ’Portacath’ which is about the size of a penny and is inserted under the skin. It is less intrusive than a Hickman line and you can carry on doing things like swimming.

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Another option is to have a PICC line inserted. One young man who was due to have a short course of chemotherapy after being diagnosed with stage 1 testicular cancer decided to have a PICC line inserted because he found it the easiest option. A PICC line is a special very thin tube which is put into a vein in your arm and then threaded up into a bigger vein. It should not hurt to have it put in as some local anaesthetic cream would be put onto your skin beforehand. The PICC line stays there all the time people are having chemotherapy and it means they don't have to have lots of injections for the chemotherapy drugs or needle pricks when they need to take a blood sample.

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Frequently chemotherapy is given after surgery to remove a tumour (although sometimes if you have a very localised cancer it can be cleared up with surgery alone). Chemotherapy can also be use to shrink the tumour before you have surgery in order to make the operation easier and more effective. 
 
Chemotherapy can make people quite sick and some need to stay in hospital throughout their treatment (which could last months) but others are able to go home in between treatments. Those that we interviewed who stayed at home during the chemotherapy had regular visits from a nurse to check they were OK. Not surprisingly most of the people we talked to preferred to be at home but some found it was reassuring to be in hospital.

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Keeping away from people with coughs and colds is often recommended during chemotherapy because the treatment can make you more sensitive to getting infections.
 
Chemotherapy drugs are usually given by infusions into one of your veins which can last from one hour up to several days. During the infusion it is possible to walk around with your ’drip machine’ which is on a stand which has wheels. Young people played pool, watched TV or wandered round chatting to other patients or the nurses. 
 
Treatments can make people feel extremely tired and are quite intensive so they are usually followed by a rest period of 2-3 weeks, to allow a person's body and blood cells to recover. How many courses people have will depend on the type of cancer but treatments, although intermittent, will usually cover a period of several months. A young woman with leukaemia even had chemotherapy for three years from the age of 14. 
 
For some, chemotherapy is given directly into the spinal fluid of the back via a ’lumbar puncture. This involves a needle being put into the skin of the back and pushed in between bony vertebrae into the fluid surrounding the spinal cord. It is normally done under local anaesthetic to minimise the pain.

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Young people described their ’treatment protocols’ as being a bit like a school timetable. The protocol printout lists in detail what drugs and injections are included in the treatment, when you need to take them and so on. Throughout treatment people will have constant tests to check whether their body is coping with the treatment and whether cancer cells are being killed off. If the tests indicate that cancer is resistant to the treatment doctors may decide to change to a different protocol. 

Individuals tend to react very differently to different forms of chemotherapy though for most of the young people we talked to there did seem to be the same side effect of having a low white cell count (neutropenia) in their blood after treatment. This tends to leave people open to infections. 

Unfortunately in some cases the combination of neutropenia and infections can delay the completion of treatment schedules. One person mentioned that it was very difficult to plan ahead, for instance for a holiday, because ’you never knew if your (treatment) schedule will run smoothly’.

Chemotherapy can seem a strange form of treatment because of its tendency to make you iller before it makes you feel better (See ’Unwanted effects of chemotherapy’). Even if it makes you feel iller when you are actually having it you may however feel better during the intervals between your treatments. Although it is hard to cope with, it can be comforting to know that the drugs are actually working and beating the cancer. However, one young man explained that he gave up his treatment at one stage.

Trying to stay as well as possible in other ways during chemotherapy is important. But most of the young people we spoke to found that they were unable to eat for a few days following chemotherapy. It was only when they were recovering in between their treatment schedules that they managed to eat something again. For these reasons their mums and other relatives tended to pay careful attention to their diets. 

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The young people we intereviewed were clear that parents and brothers and sisters provided invaluable support during treatment. Friends who kept in touch throughout your treatment could also be an important source of support. (See ’Impact on friends’).

Those young people with cancer who were treated as out-patients were often able to have a form of ’normal’ life - continuing to do their coursework, take exams and attend school or university. However this depended on how well they were feeling - and again they had to be continually aware of trying not to catch colds, flu or other infections (see ’School and work during and after cancer’).

Last reviewed November 2014.

Last updated November 2014.

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