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Medical & Radiation Oncology
What is chemotherapy?
Chemotherapy is the use of medications to fight cancer. Chemotherapy drugs interfere with cancer cells' ability to grow or multiply. There are different groups of drugs that act on cancer cells in different ways. Because of the way chemotherapy drugs work--interfering with the cells' growth machinery--some normal cells may be damaged as well. The most susceptible normal cells are the blood cells, hair follicles, and the cells lining the mouth and intestines.
What are the side effects of chemotherapy?
The side effects of chemotherapy vary depending on the medications chosen. Different drugs have different effects, but almost all chemotherapy agents will increase the risk of infection, bleeding and anemia. And, they almost all cause a feeling of lethargy or lack of energy that can last for one to two weeks. Some drugs can cause hair loss, while others can promote sores in the mouth or nerve damage. We recommend you discuss the specific agents, their potential benefits and side effects with your medical oncologist.
Which agents are used in treating pancreatic cancer?
For treating pancreatic cancer, the most commonly used agents are gemcitabine (GemzarŽ), docetaxel (TaxotereŽ), cis-platinum (PlatinolŽ), 5-fluorouracil (5-FU), and mitomycin C. Gemcitabine, docetaxel, 5-fluorouracil and mitomycin C all can cause low white blood cell count which can lead to a life-threatening infection, a low red blood cell count causing weakness and shortness of breath, and a low platelet count which can increase the risk of bleeding.
Cis-platinum most commonly causes nausea, anemia, and kidney problems, sometimes leading to kidney failure.
Hair loss is common with docetaxel and mitomycin C.
Nerve damage causing tingling, numbness, and difficulty walking can be seen with docetaxel and cis-platinum. Other side effects can also occur.
The chances that one will get any or all of these side effects depends on individual sensitivity to the drugs, the dose and schedule of the drug used, the combination of drugs selected, and other medications prescribed to help prevent side effects.
How is chemotherapy given?
Although some chemotherapy agents can be ingested and absorbed through the digestive tract, most are very poorly absorbed and must be given intravenously.
This is usually done through a needle into one of the veins of the arm.
If the agents will irritate the veins, if the infusion must be given over many hours or days, or if the patient has veins that are hard to access, a venous catheter may be placed in a surgical procedure usually performed under sedation.
A small tube is permanently placed into a large vein, typically one underneath the collarbone.
The end that provides access may be buried under the skin as an inch-and-a-half bump, or may have a cap coming out of the chest wall.
Central lines make the administration of chemotherapy a little easier, but increase risk of infection.
Under some circumstances, the chemotherapy may be administered directly into the abdomen, called intraperitoneal therapy.
It often requires placement of a port into the belly.
The agents used to treat pancreatic cancer are most frequently given intravenously.
If a vein in the arm is used, a small needle is placed into the vein.
Most patients experience some discomfort while the medicine is flowing into the vein caused by the substance necessary to keep the medicine in solution.
If 5-flourouracil is used, the vein will often darken and become more noticeable.
How are central catheters cared for?
There are three major types of central catheters--a percutaneous central line (PIC line), an implanted port (Portacath), and a central line that is external (GROSHONG®, BROVIAC®, HICKMAN®).
A PIC line is placed for up to three days before it must be changed. It is used for short term infusion of chemotherapy and venous access, usually when the arms' veins are too small.
The thin tube of a Portacath is inserted by surgery into a large vein in the chest.
A small metal disk with a silicone bubble sits just under the skin to allow the medications to flow into tube, and thus the vein, from a needle inserted into the bubble.
Once the incision heals, the system needs to be accessed at least once a month to keep the tubing open.
An external central line is similar to a Portacath, but the end of the tubing is not implanted beneath the skin and protrudes slightly from the chest wall.
Thus, for access to the vein, the capped end of the tube, not the patient, is stuck with the needle.
These tubes are more easily removed than the Portacath and are often used when chemotherapy treatments will only last a few months.
All central catheters carry a risk of infection and must be meticulously cared for by someone familiar with the care of central lines.
They should be flushed with saline or heparin solution to avoid blockages from forming.
Care must be taken each time the catheter is accessed to avoid infection;
if it should become infected removal is usually necessary.
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