How Does Chemotherapy Work?
Your guide to this common cancer treatment
Chemotherapy drugs are very powerful medications that kill cancer cells or prevent them from multiplying and spreading. Often referred to simply as chemo, this treatment is one of the most effective tools we have to battle cancer, but it can take a toll on the body and is associated with some negative side effects.
Rocky Mountain Cancer Centers provides the most advanced cancer treatments available to thousands of patients every year throughout Colorado. Here are some of the most frequently asked questions about chemotherapy.
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There are more than 100 chemotherapy drugs on the market today, and your medical oncologist may recommend using one or a combination of drugs during your treatment.
In some cases, chemotherapy alone is enough to rid the body of cancer, but it’s more commonly used in conjunction with other treatments, such as radiation or surgery. It all depends on the size and type of your cancer.
Different types of chemotherapy are used to:
- Rid the body of cancerous cells
- Slow a cancer’s growth and keep it from spreading
- Reduce the chances cancer will return
- Kill cancer cells that have metastasized, or spread to other parts of the body
- Ease cancer symptoms
Chemotherapy has been around since the 1950s and it remains one of the most effective treatments for many types of cancer. The more you know about the treatment, including the different chemotherapy types—including targeted therapy and immunotherapy —how chemotherapy works, and what to expect, the better prepared you will be to undergo chemotherapy treatment.
The type of cancer you have, as well as the size and location of your tumor will influence the decision to include chemotherapy in your treatment plan, as will other considerations, including genetics, health history, and personal health goals. At Rocky Mountain Cancer Centers, our board-certified medical oncologists create all treatment plans — including those that include various types of chemotherapy and immunotherapy — based on proven medical research and national standards of care. If you have been diagnosed with cancer, we can coordinate with your referring physician — whether your primary care physician or surgeon — to create a treatment plan for you and keep them in the loop every step of the way.
To understand how chemotherapy works, it’s important to first understand cancer cells. Cancer cells are abnormal cells that grow and divide at a rapid rate, destroying surrounding normal cells and tissue.
Cancer doctors who specialize in this form of therapy — called medical oncologists — will develop a treatment plan that includes one or more types of chemotherapy drugs, or cytostatics. Cytostatics work by attacking the DNA of fast-growing cells to kill them or prevent them from dividing. Cytostatics, however, cannot distinguish between fast-growing cancer cells and other fast-growing normal cells so it will attack both. Some fast-growing normal cells include blood cells, cells that line the mouth, and cells that cause hair to grow. Because chemotherapy can attack those normal cells, it can cause unwanted side effects, including fatigue, nausea, and hair loss.
All of the more than 100 chemotherapy drugs on the market today are designed to attack cancer cells, but they don’t all work the same way. Some attack the DNA within the cells to kill them off, while others cut off blood supply to the cells to keep them from growing and dividing. Because cancer cells are adaptable and can learn to go around these drugs, more than one chemotherapy drug may be prescribed at a time or drugs are prescribed in succession to maximize their effects on cancer cells.
Chemotherapy drugs are traditionally and most commonly given intravenously (into a patient’s veins) in a clinical setting. Various forms of oral chemotherapy, however, which can be self-administered at home by taking a pill, are available depending upon cancer type. Your healthcare provider will discuss if this is an option for you. If you are prescribed oral chemotherapy, Rocky Mountain Cancer Centers provides in-house dispensing of oral chemotherapy drugs, meaning you don’t have to travel to a pharmacy to get your prescription filled. Plus, by filling your prescription at your point of care, our specially trained cancer pharmacists can assist with prior authorizations, financial assistance, counseling, dispensing the drugs, following up, and refills.
Immunotherapy are drugs that stimulate the body’s own immune system to battle cancer. Although immunotherapies began to be used officially in the late 1990s, some believe the concept dates back more than 100 years to when doctors first noticed that some cancer patients went into remission after their immune system fought a fever.
Currently, there are more than 900 immunotherapy clinical trials. Immunotherapy drugs are developed to work with specific types of cancers, so not every cancer patient qualifies for immunotherapy.
There are three main types of immunotherapy drugs:
- Monoclonal antibodies are proteins that attach to certain proteins in cancer cells, marking where the immune system should attack.
- Checkpoint inhibitors block a protein on cancer cells that stop the immune system from attacking.
- Vaccines made up of cancer cells, partial cancer cells, or antigens enhance the immune system
Immunotherapy is typically administered through an IV every two to four weeks. Immunotherapy tends to have fewer side effects than traditional chemotherapy, but they do continue to have side effects.
Researchers are also developing increasing numbers of targeted therapies . Whereas traditional chemotherapy drugs attack all fast-growing cells in the body, targeted therapies have the ability to identify and attack just cancer cells. This means less damage to healthy cells and fewer side effects.
Targeted therapies, also called precision medicine, attack the genetic molecules—usually proteins—that allow cancer cells to survive, multiply and spread. There are many different forms of these medications, with the most common targeting cancer cells by:
- Blocking mutated proteins that create cancer cells
- Turning off the chemical signals that allow cancer cells to grow and divide
- Preventing blood vessels from feeding cancer cells, causing them to die
When you are referred to Rocky Mountain Cancer Centers, your medical oncologist and a team of cancer specialists will develop a personalized treatment plan based on many factors, including:
- Type and grade of your cancer
- Size and location of your tumor
- Sensitivity of surrounding tissue
- Genetic components
- Family history
- Your age, overall health and medical history
- Your treatment goals and preferences
Rocky Mountain Cancer Centers has provided expert medical oncology treatment to thousands of patients throughout Colorado for more than 25 years. Our physicians are board-certified, and some of our physicians specialize in particular types of cancers or blood diseases.
We have 20 cancer treatment centers throughout Colorado. RMCC’s 13 primary clinics offer on-site laboratory and testing services, medication dispensing (pharmacy), genetic counseling, and supportive care.
Factors to consider when choosing a chemotherapy center include:
- Experience: When it comes to choosing a provider, experience counts. Look for a medical oncologist who specializes in treating your type of cancer, and then schedule an appointment to discuss your diagnosis. At Rocky Mountain Cancer Centers, we have been treating patients since 1992.
- Timeliness: Once referred, we try to accommodate all new patients within 24 to 48 hours.
- Location: You’ll be making a lot of visits during your treatment cycle, so choosing a cancer center near you is important. RMCC has 20 locations throughout Colorado.
- Affordability: Rocky Mountain Cancer Centers is the largest community-based cancer network with clinics throughout Colorado. This allows us to offer our services more cost-effectively. Learn more about the importance of a community-based cancer network.
- Amenities: At Rocky Mountain Cancer Centers, our spacious infusion bays are bathed in natural light. Large windows offer tranquil views, and amenities like WiFi access and recliners, make treatment sessions more comfortable for you and any guests (over age 16) you choose to bring with you.
- Insurance: Be sure to check that the facility accepts your insurance. Rocky Mountain Cancer Centers’ dedicated Patient Financial Counselors work one-on-one with you to understand what your insurance plan will cover, what you will be responsible to pay, and what financial aid is available.
- Innovation: New cancer treatments are being developed all the time. Rocky Mountain Cancer Centers is typically conducting dozens of active clinical trials at any given time. As part of the US Oncology Research network, one of the largest community-based oncology research programs in the United States, we provide access to the latest, most promising drugs and treatments for many types of cancer.
Rocky Mountain Cancer Centers is the largest community-based cancer center network in Colorado. Once a person is diagnosed with cancer, he or she most often is referred to Rocky Mountain Cancer Centers by his or her primary doctor. Patients also are referred to us by cancer surgeons following surgery to remove the cancer tumor.
Rocky Mountain Cancer Centers also offers second opinions at any stage in your treatment. Often second opinions can help reassure you of your treatment plan. Some patients choose on their own to obtain care at our centers either because of our expertise, our physician reputations, our participation in clinical trials, or convenience.
Regardless of how you come to Rocky Mountain Cancer Centers, you can rest easy knowing that we:
- Develop all treatment plans based on validated medical research
- Provide access to the most up-to-date drugs and cancer treatment techniques
- Coordinate our care closely with your other physicians and keep them apprised of your treatment plan, condition, and follow-up care
In some cases, chemotherapy will be the only treatment needed, but often it’s used in conjunction with other treatments, such as surgery, radiation therapy, or a combination of the three.
Chemotherapy may be administered before, during, or after these other treatments to help their chances of success.
- Neoadjuvant chemotherapy is delivered before surgery with the goal of shrinking a tumor or stopping the spread of cancer to make surgery less invasive and more effective.
- Concurrent treatment is when chemotherapy or immunotherapy is administered at the same time as radiation.
- Adjuvant chemotherapy is administered after surgery to kill any remaining cancer cells with the goal of reducing the chances of recurrence.
A medical oncologist is a cancer specialist who considers many factors of your cancer diagnosis and all types of available treatments, then creates a personalized treatment plan. This physician, who serves as the quarterback of your Rocky Mountain Cancer Centers team, will determine if chemotherapy is an appropriate treatment for you based on many factors, among them the type of cancer, stage, size of tumor, location, and personal factors. Your medical oncologist will oversee planning your chemotherapy, determining which drugs will be used, the appropriate doses, the timing and many other factors based on treatment guidelines from the National Comprehensive Cancer Network.
But your medical oncologist does not work alone. He or she is part of a team that offers expertise from many different areas. If you are having more than one type of treatment, your medical oncologist will work closely with the rest of your cancer team, including radiation oncologists and surgeons, to coordinate your care.
A specially trained and experienced oncology nurse will administer your chemotherapy during treatment sessions, monitor your health throughout the treatments, answer questions and help you manage side effects.
When you begin chemotherapy depends on how chemotherapy fits into your treatment plan. If you are having other treatments, such as surgery or radiation, chemotherapy may be used before, alongside, or following those treatments.
If your treatment plan calls for chemotherapy prior to other treatments or is the only treatment in your plan, you can expect to start within a few weeks of your diagnosis. We will help you set up your chemotherapy appointments at the most convenient Rocky Mountain Cancer Centers site at the time you meet with your care team to go over your treatment plan.
You’ll want to take some time to make any adjustments to your work or childcare schedule and other commitments before beginning treatment as chemotherapy often requires rest on treatment days and at least one day after your treatment. It is not recommended that you skip any days once you begin treatment, so it’s best to be prepared. One of our licensed oncology clinical social workers can help you understand the impact of chemotherapy on your life and make the necessary preparations.
Chemotherapy treatment plans vary greatly from patient to patient. Chemotherapy is administered in one or more cycles. A cycle consists of the number of treatment days (frequency) followed by a period of rest. For instance, you may have treatments every day for five days and then three weeks of rest to give your body time to recover. That’s considered one cycle.
The frequency, length of cycle, and number of cycles you receive will vary based on:
- Type, location, and stage of your cancer
- The goal of your treatment: whether it is to rid your body of cancer, slow the cancer’s growth and progression, or ease the symptoms of your cancer
- Type of chemotherapy being administered and dosage
- How well you respond to treatment
Keep in mind that while you will be given a treatment schedule, your doctor may decide to adjust it depending on how your body and the cancer is responding to treatment. As a patient, it’s important not to skip any prescribed treatments. If you experience severe side effects, call us. We have a physician on call 24/7 who can address your concerns and help you stay out of the emergency room.
After the initial meeting with your cancer team to discuss your treatment plan and answer your questions, you will be scheduled to attend a chemotherapy education class at Rocky Mountain Cancer Centers that will help you understand what to expect with chemotherapy treatment. You also will have the chance to meet privately with one of our dedicated cancer financial counselors about treatment costs, insurance, and financial aid.
What happens during your regular chemotherapy treatments depends on the type of therapy you will be receiving. Some chemotherapy drugs are administered through an injection, which takes only a few minutes. But most chemotherapy is delivered through intravenous infusion, which is an IV that delivers the medication in a slow, continuous manner into your veins. If you have been prescribed oral chemotherapy in pill form, you can have the prescription dispensed at Rocky Mountain Cancer Centers’ in-house pharmacy and you will take that at home.
Recent advances in chemotherapy have reduced the severity of chemotherapy side effects for patients. As with any medical treatment, the side effects of chemotherapy vary from patient to patient. At Rocky Mountain Cancer Centers, we use the most advanced chemotherapy medications available, which often have milder side effects. In particular, immunotherapy and targeted therapy typically have fewer or less severe side effects.
The most common side effects of chemotherapy are hair loss, weight loss, fatigue, and nausea, which may begin with your first treatment or may not show up for several treatments. They may worsen with each treatment. Your doctor will prescribe medication to help control nausea. It’s always a good idea to plan on resting after chemo to help with fatigue.
If you are a patient and are experiencing worsening symptoms from your treatment, such as those listed below, our medical professionals are available 24 hours a day, 7 days a week to help. We can assess signs and symptoms, schedule you for an in-office, same or next day appointment and help you avoid a trip to the Urgent Care, ER or unplanned hospitalization. In the event of a life-threatening emergency always call 911. Call us if you are experiencing:
- Chills or fever greater than 100.4
- Burning with urination, frequency, urgency, lower back pain (UTI)
- Productive cough with green, yellow, red, brown sputum
- Unmanaged diarrhea, constipation, nausea, vomiting
- Unmanaged pain
- Swelling, redness and pain on extremities
- Shortness of breath/chest pain
- Dizziness with changing position or lightheadedness
- Dark urine, less urine than normal, thirst, dry mouth (dehydration)
- Mouth sores, difficulty swallowing, frequent or sever heartburn
- Severe fatigue
Clinical trials are vital to advancing cancer care. They offer patients access to the latest treatment research and new ways to manage cancer symptoms and treatment side effects. They are the final step in the research process after scientists have completed trials in the laboratory for safety and effectiveness.
Cancer treatment research is an integral part of Rocky Mountain Cancer Centers’ mission, and our doctors and researchers participate in research for a variety of types of cancers and various types of treatment.
Through the US Oncology Research network, Rocky Mountain Cancer Centers participates in clinical trials that provide access to the latest, most promising drugs and treatments for many types of cancer. US Oncology Research has played a role in nearly 70 FDA-approved cancer therapies — approximately one-third of all cancer therapies approved by the FDA to date.
The federal government has enacted rules to ensure patient safety when participating in a clinical trial. However, because every patient is different, you’ll want to discuss the benefits and risks of clinical trials with your medical oncologist.
The National Cancer Institute recommends asking the following questions before enrolling in a clinical trial:
- What is the purpose of the trial?
- Why might the treatment be better than what’s available now? In what ways might it not be?
- How long will I be in the trial?
- What kinds of tests and treatments are involved?
- What are the benefits and risks of participating, and how do they compare to the standard treatment?
- May I choose to leave the trial if I’m not satisfied?
- Will I have to pay for the treatments and tests? If so, will my insurance cover the costs?
- How often will I need to come in for treatment and tests?
- Will I have checkups after the trial has ended? With whom?