This is not a topic that majority of the people have deep knowledge of despite the fear, morbidity, mortality and devastation brought on families worldwide. Due the paucity of knowledge of cancer and the treatments thereof, a lot of misinformation and wrong decisions are made as there is a simple over-simplification and generalization of oral ‘tales’ heard about neighbors, friends and unknown patients with cancer. So, this piece is written essentially to demystify the myths that surround cancer and the treatment of various cancers with chemotherapy.

Cancer is a malignant condition that affects any organ or cell that grows including the head, toe, muscle, bone, nose, ear, colon, stomach, lung, prostate, pancreas, ovary, uterus, penis, lymph node, spleen, vagina and eye, to mention just a few. Due to the variety of organs that we have in humans with different characteristics, the cancers of the different organs are equally different, so is the chemotherapy regimen (‘chemo’) used to treat these cancers.

Chemotherapy comes in form of tablets, capsules, injections into the skin, muscles or by intravenous route . Chemotherapeutic agents are medications designed to treat cancers although some autoimmune conditions also benefit from a few chemo agents. Chemotherapy is generally used for other forms of treatment for cancers especially biologic, immunologic and hormonal agents.

Although drugs given by intravenous route are concentrated in the system better and faster and there is a guarantee that the drug has been delivered to the body, it does not mean the other forms of chemo administration are less efficacious.

Because the drugs are different, the side effects are different and there’s a need to do a few tests prior to initiating treatment and before each cycle of treatment.

Chemotherapy cycles and treatment schedules differ as some ‘chemos’ are given daily, some weekly, some every 3 weeks and some every 4 weeks. The first day of any chemotherapy administration is Day 1 . Some of the tests required blood tests to check red cells, white cells and platelets as these ensure that the body is able to tolerate the drugs as there are usually accompany reduced counts during which you can have severe weakness and fatigue. An echocardiogram or MUGA scan may be needed to estimate the ejection fraction of the heart prior to some drugs that have potential toxicity on the heart . This test (Echocardiogram)  may need to be repeated every 3 months to ensure that the heart function remains good and the chemotherapy treatment may continue to be used. Pulmonary function tests and tests to assay kidney and  liver functions are mandatory.

Side effects of drugs include,  but are not limited to, nausea, vomiting, low blood counts, fever, fatigue, weakness, diarrhea, loss of taste sensation, elevated liver enzymes, renal insufficiency, infections, respiratory symptoms, hair loss, heart toxicity,  early menopause, sterility, constipation and soreness in the mouth. Each of these side effects are brought on by different drugs, if I may further explain so that you do not get scared of treatment. Ironically, there are some drugs that do not produce any side effects in some patients.

The good news is that we have the medications to prevent a lot of these treatment side effects and simple procedures like giving adequate hydration before and after chemo may prevent renal insufficiency, giving injections like Granix and Neupogen also help to increase the white cells thereby preventing fever and infection.

Erythropoietin may also be used with caution  in some patients with anemia provided the iron stores are adequate. Young patients are advised to do sperm and egg banking prior to initiating chemotherapy as some drugs make cause permanent sterility although some patients recover their reproductive functions. All these things explained above are time consuming and can constitute a heavy financial burden especially in the developing countries where access to health insurance coverage is minimal, so adequate customized planning and treatment are necessary.

This is the first of many series and I’ll see you soon. Till then, Ciao!!!

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