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2014-08-21

Chemotherapy
What is chemotherapy?

Chemotherapy is a cancer chemichal treatment that destroy malignant cells.

These are often referred to as cytostatic, cytotoxic, anti-tumor or antineoplastic drugs. Name chemotherapy is used because this treatment the growth of malignant cells is controlled by chemical means. He is the founder of chemotherapy German researcher Paul Erlich (1854th-1915th), who applied the chemical agents in the treatment of infectious diseases (salvarasan in the treatment of syphilis). The first modern chemotherapeutic agent in the treatment of tumors was poison nitrogen mustard agent, applied 1943rd year in the treatment of Hodgkin's disease. In recent decades, more than 50 types of cytostatics used in the treatment of over 200 different malignant tumors.

How chemotherapy works?

Normal cells in the body grow, divide, and die under control. The tumor occurs when the body loses that control, and the cells continue to divide uncontrollably and produce new cells.  Cytostatics destroy malignant cells inhibiting their growth and division. These drugs do not act selectively, then only the malignant cells, but can also damage healthy cells in the body, especially those that divide rapidly: blood cells, mucous membranes of the digestive tract, reproductive cells, hair follicle. It is damaging healthy cells causing unwanted side-effects of chemotherapy. Damaged cells usually regenerate after cessation of chemotherapy.
Since cytostatics in different ways arrests the cell cycle, in order to improve the anti-tumor effect is often given at the same time two or more drugs. This is called polychemotherapy or combined with chemotherapy.

How is chemotherapy administered?

Chemotherapy may be used alone, or in combination with other methods (either before or after surgery or radiation, or even during radiation). If administered before surgery - called neo-adjuvant chemotherapy. In the case of cytostatic agents are usually administered to patients whose tumor mass is too large or too tightly bound to the surrounding healthy tissue, to facilitate surgical removal of the tumor. Further, when chemotherapy is administered after surgery - called adjuvant chemotherapy. Adjuvant chemotherapy is generally starts within a month of surgery. It is used in cases where the tumor is reduced (could not be entirely removed), or when all visible tumor is removed, but there is a residual risk, invisible to the naked eye cells (micrometastases or mikropresadnica). The objective is to destroy the possible micrometastatic foci of disease and thereby reduce the risk of recurrence, ie recurrence. Chemotherapy administered concurrently with radiation called chemoradiotherapy. Chemotherapy is also used in advanced cancer, and there are usually aimed at prolonging life, relief of disease symptoms and improve quality of life for patients. Also called palliative chemotherapy and is usually applied as long as the therapeutic response. In the treatment of malignant tumors with a high risk of relapse, apply high doses of cytostatics in order to achieve a better therapeutic response. Because high doses of cytostatics destroy the bone marrow, in these cases it is necessary and transplant - marrow transplantation. This is achieved by providing a so-called. blood stem cells are collected from bone marrow or peripheral blood of the patient before therapy visokodozažne or of another person (a donor) with corresponding cells.

What chemotherapy can do?

Depending on the type and severity of the cancer, chemotherapy may have different aims:

· Cure cancer: some are curable cancers (eg, testicular cancer, Hodgkin's disease, acute lymphoblastic and myeloid leukemia), and is considered to be a cure achieved when the patient does not present malignant cells;
· Control cancer: this is achieved by slowing the growth of tumors and the destruction of cells that can spread to other parts of the body from the underlying tumor;
· Alleviate symptoms and prolong survival in patients with advanced metastatic disease.

Which drugs are used in chemotherapy?

The choice of cytostatics is important to several factors: the type of malignant tumor localization, staging, effects on normal bodily functions and the general condition of the patient. How often and how long it will be applied to the individual patient chemotherapy depends on the type of cancer, the goals of treatment with cytostatics applied, the response to the therapy and side effects. Neither treatment cannot begin without the consent of the patient. Before the start of chemotherapy, checks the weight and height to calculate the exact dose of the drug.

 SIDE EFFECTS:

General side effects, given the time of reporting, divided into acute (during chemotherapy and the next few days) and chronic (can be fixed).

Acute are: nausea, vomiting, fever, pain, allergic reactions, degradation of blood cells, renal complications. A few days to a few weeks after the administration of cytostatics may experience delayed acute side effects as a result of damage to healthy cells in the body. This is primarily due to damage to the bone marrow, which is the reduced production of red blood cells (erythrocytes), white blood cells (leukocytes) and platelets (thrombocytes). The consequences are anemia with fatigue and general weakness, susceptibility to infections and bleeding. The most common side effects associated with the digestive system include: inflammation of the lining of the mouth (stomatitis or mucositis) with sores in the mouth, inflammation of the lining of the esophagus, stomach and intestines, abdominal pain, diarrhea, constipation. Hair loss (alopecia) is a common side effect of chemotherapy, but all cytostatics not cause hair loss. Relegation hair can occur in all parts of the body, including the scalp, face (eyebrows and eyelashes), hands and feet, armpit and pubic region, gradually or in clumps. Hair grows after stopping cytostatic therapy, and some patients begin to grow even during treatment.

Weakness and fatigue

All people do not feel the weakness in the same way, and some do not even feel it. It is often described as a feeling of exhaustion and lack of energy. It can occur suddenly and last for a long time differently. Often you cannot eliminate any protracted rest.

How did you help?

You need to plan a time to rest, conserve energy for the important things, take a few short breaks, practicing short walks or gentle exercise, and eat a variety of healthy foods into smaller portions, drink plenty of fluids.

Nausea and vomiting

Today there are many drugs that can be eliminated or significantly reduced. When vomiting is better to take a suppository instead of pills, and in more pronounced symptoms may also injection.

How did you help?

· Drink plenty of fluids, often in small portions. Drink at least one hour before or after meals, not with meals. Drink herbal teas, green tea, red tea, etc., cold and unsweetened fruit juice, not aerated.
· Eat and drink slowly. Eat several smaller meals.
· Avoid hot foods due to a stronger smell and taste, sweet, fatty and fried foods.
· Good chew food to facilitate digestion.  Before chemotherapy to take a light meal, and if nausea occurs already during chemotherapy, avoid foods several hours before treatment.
· After the meal the rest, but do not lie down for at least two hours after a meal.
· If most pronounced morning sickness, eat dry food before getting up, for example, cereals, toast, crackers, etc.
· Take a hard candy or peppermint (if there are no problems with the oral mucosa).
· Do not wear clothes that easily entangles belly. With a feeling of nausea breathe deeply and slowly. Avoid smells that bother you.
· To occupy the attention of watching TV, talking, listening to music, etc.

Hair loss

No cause was all medicines, to the doctor warned. The hair usually falls out in a few weeks from the start of chemotherapy. Before falling may feel discomfort at the root of the hair.  The most common failure after extensive washing.  In fact, I can lose hair all over the body.  After completion of chemotherapy will grow again, sometimes a different color or quality.

How did you help?

Contact the family doctor who will issue a certificate of need fescue (CIHI based on this certificate covers most of the cost), and can be used cap, hat, etc. Before falling short hair was cut, and care use a mild shampoo, soft brushes and hair do not dry hot air, because it postpones the time-out.

Effects on bone marrow

Once a week should be controlled blood test to the time taken certain measures if there is a greater reduction in the number of cells in the blood.  Blood work most pronounced weakening in the second and third week after chemotherapy, and then quickly recovers.  Pronounced only in some people and more common in patients who have received a large number of chemotherapy. Further chemotherapy may not be received prior to recovery of blood counts.

· Anemia: Reduces the formation of red blood cells in the bone marrow with a consequent reduction in blood. The red blood cells carry oxygen, so their lack manifest as fatigue, weakness, shortness of breath, headache etc. In the case of major shortfall needed a transfusion, but very rarely. If there is already a shortage of iron, iron preparations will not help and there is no need to take them.

· Infections: Reduces the formation of white blood cells and increases the susceptibility to infections. The most common source of infection have a cold person with whom the patient comes in contact with the bacteria that are normally present in the body, which weakened body ca not overcome as usual. In the case of a sharp fall may be given drugs that stimulate the production of leukocytes in the bone marrow.

How did you help?

Frequently wash their hands and have a good wash after defecating. Bathe or shower daily and delete soft towels. Cherish the mouth. Do not cut cuticles. Wear protective gloves when cleaning, gardening, etc. Keep the injury. Avoid persons of which can infect people crowded places, particularly enclosed spaces, contact with animals and their dwellings and stagnant water. Do not eat raw meat, fish, seafood or eggs. Do not be vaccinated without the advice of a physician. Tell your doctor in case of any of the following symptoms: fever greater than 38 ° C, shivering, sweating; frequent and difficult urination or burning with urination; stronger cough or sore throat; vaginal discharge; swelling, and tension around the wound or anywhere on the body; pain or pressure in the sinus or ear; headache.

The problems of blood clotting

This also leads to reduced platelet production in the bone marrow and consequently their number in the blood. The result is a tendency to bleed. Extremely rarely fall to very low values ​​when needed transfusions. Doctor needs to know if you notice any of the following characters: bruising, red spots on the skin, pink or red urine, black or bloody stool, bleeding from the gums or nose, bleeding from the vagina or long and heavy periods, headaches or vision problems, and feeling heat or heat in the arm or leg.

How did you help?

Do not take medicines that contain aspirin (Andol, aspirin, etc.) and alcoholic beverages, use a soft toothbrush, do not blow your nose too vigorously and watch the injury.

Problems with gums, mucous membranes of the oral cavity and pharynx

It can also cause inflammation of the lining of the mouth and throat that are painful and vulnerable, may bleed or be dry and sensitive. It is more common in patients who cannot eat because of nausea after chemotherapy. Damaged mucosa can become infected with bacteria normally present in the mouth or fungi. Therefore, it is important to pay special attention to oral hygiene, avoid hot or spicy foods more, acidic foods or juices and rough and hard foods. If your mouth is dry, drink more fluids, and often take little or hard candy, sugar-free.

Diarrhea

If it lasts longer than 24 hours or arising pains and cramps, should contact a doctor. In serious cases administered drugs against diarrhea and / or infusion. You need to drink as much tea, eating smaller and lighter meals that do not contain a lot of fiber (eg, rice, white bread, lowfat cottage cheese, yogurt, boiled potatoes, mashed, boiled white meat or fish) and bananas for potassium compensation. Do not take very hot or cold food, avoid sweet, bold, strong spices and milk.

Prison

Can it be caused by a cytostatic, anti-nausea and pain, as well as too little activity, lack of fluids and foods low in fiber. It should be easy to move and exercise and consult with your doctor about the possibility of taking a hot liquid, high fiber foods or cleaners, especially if you have low platelets or leukocytes.

Problems with the nerves and muscles

Some cytostatics cause weakness and muscle soreness, and some peripheral neuropathy - tingling in the fingers and toes, shuffling gait, loss of balance,  difficulty in grasping objects, hearing impairment, abdominal pain and constipation. Discomfort may take months, but eventually disappear.

Problems with the skin and nails

Possible redness,  itching,  dryness and increased sensitivity to the sun. The skin should be increased to nurture, to avoid the sun, use sunscreens with SPF Safeguards, long sleeves, etc. The nails may become darker, yellowish or brittle. Vein through which it can receive chemotherapy along its course to become dark or hard, it is not dangerous.  If cytostatic leaks from the vein, it can cause damage to surrounding tissue and therefore should immediately inform your doctor or nurse if you feel heat or pain in the hand while receiving the drug.

Effects on urinary system

After receiving ferrous medicines and urine will be colored while the drug is excreted from the body, which is normal. Some types of cytostatics can be toxic effect on the kidneys or bladder and, if it is received, before each chemotherapy need to collect urine for 24 hours and make urinary and blood tests that control kidney function. Always, especially after chemotherapy, should drink more fluids. The doctor should be informed if they feel pain or burning with urination, frequent urination or see blood stained urine.

Fluid retention in the body

It may be due to medications, hormonal changes or the tumor itself, as puffiness or swelling of the face, arms, legs or abdomen. Should consult with your doctor - you may need to avoid salt, or to introduce a diuretic that helps remove fluid from the body.

Flu-like symptoms

Can it cause some medications, the doctor will warn you - temperature, shivering, pain in joints and muscles, headache, weakness. Typically takes one to three days.

Effects on reproductive system

Chemotherapy can affect the sexual organs and sexual activity in men and women; this however is not mandatory.  Side effects that may occur depending on the administered drugs, patient's age and general health. Because of the possible adverse effect of cytostatics on the fetus, pregnancy during treatment can not advisable. It is advisable to use proven methods of preventing conception and during at least one year after completion of treatment.
To minimize or mitigate adverse effects related to sexuality, it is important to consider with your doctor all the questions and doubts and possible plans for pregnancy and educate yourself about the possibility of storing sperm in the so-called. sperm bank and women about the possibility of artificial insemination.

Late side effects of chemotherapy

Late side effects of chemotherapy include damage to the immune system, infertility, secondary tumors. Although pregnancy is possible during treatment is not recommended because cytostatics can cause birth defects. Therefore, women of childbearing age are advised application of a contraceptive method (usually the condom or diaphragm). For women with breast cancer are not suitable contraceptive pill. If cancer is detected in pregnant women, it may be possible to delay chemotherapy until birth. If, however, a malignant disease requires faster treatment, must estimate the possible adverse effects of chemotherapy on the fetus.

Specific side effects are related to the application of certain cytostatics

Examples are heart damage (anthracyclines), liver (lomustine, L-asparaginase), lung (bleomycin, busulfan), urinary tract (cisplatin, ifosfamide), nervous system (procarbazine, vinca alkaloids), hearing (cisplatin) and a number of other .

Side effects of chemotherapy can be unpleasant, but must always be seen against the cytostatic ability to destroy cancer. Therefore it is very important to each of the patients detailed information about the therapy and possible side effects associated with certain anticancer drugs. Some side effects can be predicted and there are effective medications which can be mitigated or eliminated. The most commonly used drugs against nausea and vomiting (antiemetics), in the form of injections or tablets, and the so-called. growth factors, specialized proteins that are normally produced in the body, and is now produced in the laboratory: granulocyte growth factor stimulates formation of leukocytes and thereby reduces the risk of infection, and the other growth factor - erythropoietin stimulates the formation of red blood cells, which relieves the symptoms of anemia and the need for transfusions blood.

Sometimes patients think that chemotherapy is not effective if they do not have side effects, or if you have side effects that chemotherapy is more effective. That is completely incorrect, because the side effects vary greatly from person to person and from drug to drug, and are not a sign that you are cytostatic effective or not.

DRUGS THAT APPLY TO CHEMOTHERAPY:

Cytostatic agents fall into the following groups:

· Alkylating agents
· Antimetabolites
· Antitumor antibiotics
· Agents of plant origin

Alkylating agents

The first alkylating agent, sulfur mustard, was synthesized in the 19th century, and as a chemical weapon was used in the First World War. In the period between the two world wars was synthesized nitrogen mustard, which was first applied clinically 1942nd year and this year is considered the beginning of the development of modern chemotherapy of malignant tumors. Alkylating agents in a chemical structure having one or two alkyl groups which react with biologically important parts of the cell. Agents with two alkyl groups are more active.
In the group of bifunctional alkylating agents include:

· Nitrogen mustards (cyclophosphamide, ifosfamide, mechlorethamine, melphalan, chlorambucil)
· Ethylenimines and methylmelamines (thiotepa)
· Alkyl sulfonates (busulfan)
· Derivatives nitrosoureas (carmustine, lomustine, semustine, streptozocin)
· Triazenes (dacarbazine)
· Drugs with similar mechanisms of action alkylating agents (platinum complexes - cisplatin, carboplatin, and procarbazine)

The most cytotoxic effects of these drugs are disabled transcription and DNA replication, disruption of protein metabolism and enzyme activity.  Therefore, their effect similar effect of ionizing radiation. Resistance of tumor cells to alkylating agents is a result of increased DNA repair, cell permeability reduction for the drug and increase the inactivation of the drug.

Antimetabolites

Antimetabolites are synthetic drugs because of their chemical similarities with physiological substances block the creation of DNA and thus inhibit the growth of tumor cells and their cause irreversible damage. Tumor cells are more sensitive to the effects of these drugs because of the proven metabolic differences between normal and malignant cells.
Antimetabolites are the following:

· Folic acid analogs (methotrexate)
· Pyrimidine analogs (5-fluorouracil, 5-fluorodeoxyuridine, cytarabine)
· Purine (mercaptopurine, thioguanine, pentostatin, cladribine)

All these drugs act specifically in the S phase of the cell cycle. Applied in the treatment of acute lymphoblastic, myelogenous and lymphoblastic leukemia, non-Hodgkin's lymphoma, breast cancer, testicular or bronchi.

Antitumor antibiotics

These drugs are inhibitors of cell growth. Him belong anthracyclines (doxorubicin, daunorubicin), actinomycin, bleomycin, mitomycin, plicamycin.

Means of plant origin

The agents of plant origin for the treatment of malignant drugs are plant alkaloids (vinblastine, vincristine, vinorelbine, paclitaxel). These drugs bind to the mitotic spindle, stopping cell division in metaphase of mitosis and causing her death. Thus in literature you have drugs called metaphase toxins or poisons the mitotic spindle. Podophyllotoxin semi-synthetic drugs are isolated from the plant Podophyllum peltatum. In this group of drugs belonging to etoposide and teniposide. Damage DNA and its longitudinal splitting.