Chemotherapy

Today, chemotherapy plays a major role in the treatment of cancer, usually for the treatment of malignant tumors. How the therapy works, what side effects occur.


Chemotherapy plays an important role in cancer treatment today.

The term "chemotherapy" describes any treatment of diseases with drugs that inhibit the growth of cells and kill the cells. The origin of chemotherapy lies in the development of chemical substances to combat infectious diseases. Even today doctors speak of the use of antibiotics against bacteria or drugs against viruses and fungi of chemotherapy.


Chemotherapy in cancer treatment
Today, however, the term chemotherapy is mainly used to designate a treatment for cancer . This includes the treatment of malignant tumors with chemical substances that interfere with the growth cycle of the cancer cells and thus affect their growth and division.
The drugs used are called cytostatic drugs (Greek kytos = cell, statikos = to a halt), colloquially referred to as "cell toxins". They have a particularly good effect on cells that are currently in the propagation phase and are dividing. Because cancer cells usually share much faster and more often than healthy cells, they are very sensitive to the effects of cytotoxic drugs.
Chemotherapy is used to cure the disease (curative) or to delay the course of the disease and relieve discomfort (palliative). It takes place in tablet form or by infusion, outpatient or inpatient.

Chemotherapy works throughout the body
The development of chemotherapy for the treatment of cancer has been groundbreaking. For the first time, it has been possible to treat advanced stages of the disease in which there are already daughter tumors, so-called metastases, in organs. This is possible because, in contrast to surgery or radiotherapy,chemotherapy works throughout the body, ie systemically. The active ingredients are transported via the blood into almost all organs and body tissues. It can also destroy cancer cells that have spread beyond their place of origin.
For cancers that affect the whole body - such as blood cancer ( leukemia ) - chemotherapy is often even the only or main treatment. In addition, local (local) chemotherapy is now possible, in which the cytostatics are brought directly to the tumor by means of special techniques (for example by means of a vascular catheter during chemoembolization), such as liver cell cancer or bladder cancer.

treatment costs

The costs of chemotherapy in the context of cancer are usually covered by the statutory health insurance. If the hair falls out during or after the chemotherapy, the costs for a wig can also be reimbursed by the health insurance.

In which types of cancer chemotherapy is used
For many cancers, chemotherapy, as the sole treatment option or in combination with other therapies, plays an important role, for example in:
  • breast cancer
  • colon cancer
  • pancreatic cancer
  • Head and neck cancer
  • bladder cancer
  • lung cancer
  • leukemia
  • lymphoma
The decision as to whether or not chemotherapy is appropriate will be based on current guidelines based on clinical trial experience. At the same time it is possible to test the sensitivity of the tumor tissue to the proposed chemotherapy in individual cases. If it turns out that a tumor is resistant to the agents, alternative chemotherapeutic agents or alternative therapies must be considered.
The same applies to certain types of tumors, such as connective tissue tumors in the digestive tract (gastrointestinal stromal tumors, GIST ), which generally do not respond sufficiently to chemotherapy. In these cases, an operation or other form of treatment (administration of certain medications) may be more promising.

What is important before chemotherapy
Before initiating chemotherapy, the physician and the patient must evaluate the benefits and side effects expected from the treatment. For example, if there is still a desire to have children in young patients, appropriate measures can be taken in advance (for example, taking and preserving eggs or sperm).
In addition, the basic physical condition of the patient is examined in order to identify pre-existing illnesses and to assess risks. Recommendations for general measures, for example on nutrition, are given which can improve the state of health during the therapy. Likewise, preventive medical measures can be taken so that certain side effects such as nausea or vomiting do not even occur.
Temporarily, severe disability or reduced ability to work may be requested for the period during chemotherapy and for special ailments thereafter .

This is how the chemotherapy works
Chemotherapy may be done with curative, that is, healing, intention, or in palliative care to delay the disease and relieve symptoms. It is administered in tablet form or as infusions . Often, chemotherapy is complementary to other therapies, especially surgery. Before a surgery is a neoadjuvant therapy, after the surgical intervention for an adjuvant therapy.

Chemotherapy before surgery (neoadjuvant): Allow surgical removal
For some tumors, pre-surgery chemotherapy, called neoadjuvant chemotherapy, is recommended to reduce the size of the tumor. This often makes it possible for him to operate on him, or the chances of success of the procedure are improved by chemotherapy.
In some cases, such as advanced cancers and cancers affecting the whole body, such as leukemia, chemotherapy can also be used as the sole treatment.


Chemotherapy after surgery (adjuvant): Reduce the risk of relapse
Only in the rarer cases is chemotherapy the sole form of treatment. Mostly it is used to support the operation or other therapies such as radiotherapy. The goal is to destroy all cancer cells that are still in the body . Experts have long suspected that many tumors, even at an early stage, form tiny secondary tumors in the body, so-called micrometastases, which due to their small size are not visible using imaging techniques. This is why chemotherapy is often used to treat early cancers to prevent disease relapse. Therapy takes place after surgery and is called adjuvant chemotherapy.

Often a combination of several active ingredients
In order to achieve as many cancer cells as possible in their different stages of reproduction, chemotherapy usually combines different cytostatics that intervene in different phases of the cell cycle. Examples of cytostatic agents are alkylating agents (cyclophosphamide), antimetabolites (methotrexate, 5-fluorouracil, gemcitabine, capecitabine), anthracyclines (doxorubicin, epirubicin) and taxanes (paclitaxel, docetaxel).

Therapy runs in cycles
Cancer chemotherapy is performed in treatment phases called cycles. Within one cycle, cytostatics are administered on one or more days followed by a treatment break lasting several days, weeks or months. It is intended to give the body the opportunity to recover from the strain of the treatment and to regenerate the actually healthy but damaged tissue.


In order to destroy also cancer cells, which were in a resting phase within a cycle and therefore not covered by the medicines, usually several cycles are carried out, on average four to six. But there are also chemotherapies that last until they have lost their effectiveness and the cancer cells have become insensitive (resistant). For example, in certain advanced cancers, when cure is no longer possible, but the course of the disease can be stopped by chemotherapy.

Chemotherapy outpatient and inpatient feasible
The cytostatic drugs are in most cases administered as infusions, in some cases it is also possible to take tablets. Therapy no longer needs to be done inpatient carein each case, often it is possible to do it on an outpatient basis at the respective wards of the hospital or at established oncologists. Monitoring of the treatment by an experienced oncologist or experienced clinical staff is, however, necessary to be able to respond directly to possible side effects and complications.

A special form: high-dose chemotherapy

A special form of chemotherapy is the so-called high-dose chemotherapy before a stem cell transplantation in certain forms of blood cancer and lymphoma (lymphoma). A three- to five-fold higher dose of cytostatics than usual is administered, which completely destroys the patient's bone marrow . The patients then receive previously secured own blood-forming stem cells (autologous stem cell transplantation) or the blood-forming stem cells of a suitable donor (allogeneic stem cell transplantation).

What are the side effects of chemotherapy?
Chemotherapy causes typical side effects. Particularly often affected is tissue whose cells divide quickly.
Chemotherapy targets all cells of the body that divide particularly quickly and frequently. These are not just cancer cells - they also affect other cells, such as the oral mucosa, gastric and intestinal mucosa, hair roots and bone marrow . The hematopoietic cells can also be affected.
Some side effects occur within hours or days after initiation of chemotherapy and disappear as treatment is over, while others may appear months or even years later. The extent of the side effects depends primarily on the type and dose of the drugs used and the duration of treatment. Also the physical condition of the patient plays a not insignificant role. Many side effects of chemotherapy can be prevented or at least alleviated by accompanying therapeutic measures.
Possible side effects of chemotherapy include:
  • Nausea, vomiting
  • Loss of appetite , diarrhea , abdominal pain
  • Inflammation of the oral mucosa
  • hair loss
  • Blood disorders: anemia (a deficiency of red blood cells, anemia) and coagulation disorders with increased bleeding tendency (low platelet counts)
  • Increased risk of infection (lack of white blood cells)
  • Severe exhaustion states (fatigue)
  • Disturbances of concentration and impairment of memory
  • Transient menopausal symptoms or the premature onset of menopause in women
  • Loss of reproductive function in men and women (infertility)
  • Increase the risk of further cancers


Complaints in the gastrointestinal tract
Nausea and vomiting are common side effects of chemotherapy. In about one third of the patients, the nausea occurs immediately after each treatment. But it can also start with a delay of a few days. Nausea and vomiting are perceived as a great burden by the patients and can also lead to serious damage to health, which endangers the success of the tumor treatment. For this reason, the use of so-called antiemetics, which can prevent or relieve nausea and vomiting, is now an integral part of chemotherapy.
Painful inflammation of the oral mucosa, also common side effect of chemotherapy, can be alleviated by special care measures such as rinsing with saline, sage or camomile solution.

Chemotherapy can cause blood disorders
Disorders of the hematopoietic cells are initially visible only in changes in the blood count in laboratory studies. Symptoms such as persistent weakness and exhaustiondue to anemia (anemia, red blood cell depletion ), blood clotting disorders with increased bleeding tendency (reduction of platelets) and infections (reduction of white blood cells) are only manifested in severe blood disorders.
If fever , weakness or bleeding occurs during chemotherapy , a doctor should be consulted immediately. In severe blood disorders, therapeutic countermeasures can be initiated, such as the administration of growth factors that stimulate the formation of white blood cells (granulocyte colony stimulating factors), blood transfusions or the administration of a growth hormone that stimulates the formation of red blood cells (erythropoietin) and the Transfusion of platelets.

Hair loss
The hair loss often associated with chemotherapy is particularly problematic for women. There are no effective measures to prevent it.

Before starting the treatment, the patients can get a prescription for a wig, which is optimally adapted to their own hair. Such a medical wig is made of high quality synthetic hair that is virtually indistinguishable from human hair. As a rule, the hair grows after completion of the cancer treatment.

Persistent fatigue and fatigue
Conditions of prolonged fatigue and fatigue, also known as fatigue, are a common feature of cancer treatment. They can be a result of chemotherapy-related anemia. In such cases the health of patients with treatment of anemia improves.
Even after a long time after completing cancer therapy, fatigue can occur, the causes are still in the dark. Research has found that physical exercise and exercise can help.

Dysfunction of the ovaries due to chemotherapy
Chemotherapy can damage the ovaries, causing disorders in the menstrual cycle. An early onset of menopause with appropriate complaints is possible. This may even be temporarily desirable during breast cancer treatment , as it stops the formation of sex hormones (estrogens, progesterone ) that accelerate the growth of hormone-sensitive breast tumors.
Whether the ovaries recover after completion of the therapy and regain their full function depends mainly on the age of the patient and the type and intensity of chemotherapy. Often, however, chemotherapy is associated with complete loss of ovarian function. Therefore, women who want to have children should be given detailed information about new options for maintaining fertility despite chemotherapy before starting chemotherapy.

Other side effects of chemotherapy
In addition to the side effects mentioned, there are those that occur only with certain cytotoxic drugs. This includes damage to the heart muscle with a reduction in pumping power through the anthracycline drug group. This disorder is dose-dependent and should not be exceeded in anthracycline therapy.
The drug group of taxanes can cause allergic reactions as well as feelings, sensations of discomfort and tingling of the hands and feet. The cytostatic docetaxel may result in deformations of the fingernails and fingernails. The active substance cisplatin may cause hearing impairment .
Again and again in cancer patients disorders of concentration and impaired memory were found. The causes of the phenomenon known as "chemobrain" ("chemohirn"), which is usually only temporary, are still unknown. However, recent research indicates that it may not be chemotherapy, but mental factors associated with coping with the disease.
Chemotherapy can also promote the development of other cancers , especially leukemia (blood cancer).

Chemotherapy: Contraindications
Chemotherapy - yes or no? Among others, the tumor type and the cancer stage play a role in the decision. Whether and to what extent chemotherapy for cancer can occur depends essentially on the general condition, other illnesses and the age of the patient.

Because it is a stressful therapy that can cause many serious side effects, it is not feasible under all circumstances. For example, the use of anthracyclines requires particular caution when the patient is already suffering from heart disease, as further damage is to be expected as a result of therapy. Physicians and patient relations of their relatives must always weigh the benefits and risks of chemotherapy thoroughly before making a therapeutic decision.

Chemotherapy: aftercare

Once the treatment is complete, a follow-up of several years isrecommended. The distance between examinations will increase over the years. The aim of the aftercare is to notice a relapse early in order to initiate appropriate countermeasures. Because chemotherapy can be associated with long-term side effects , such as fertility disorders, increased risk of second cancer, regular visits to the doctor, even after surviving the disease, are essential for many patients.

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