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“Chemotherapy” is a scary word, and if you know someone who has had cancer, they may have told you that they felt even sicker while undergoing chemotherapy than they did with their cancer symptoms before they began chemotherapy. It usually is not possible to tell from looking at someone that they have cancer, but hair loss is a common and obvious sign that someone is undergoing chemotherapy, although it is now possible to reduce this and other chemotherapy side effects. Chemotherapy treatments seem a lot less scary when you consider that many illnesses can be cured or managed by taking prescription drugs for several weeks or more. Pharmaceutical drugs can cure bacterial infections and manage diabetes, mood disorders, and many other conditions. Chemotherapy and immunotherapy are the two main methods of treating cancer with medication. Most mesothelioma patients go through chemotherapy as part of their treatment plan, whether or not they also have surgery. Your medical team can answer all your questions about chemotherapy before and during treatment.
Why Do Doctors Use Chemotherapy to Treat Cancer?
Some types of cancerous tumors are easy to remove through surgery, but even after surgery, doctors cannot be sure that they have gotten rid of all the cancer cells. Whether those leftover cancer cells are on the edges of the tumor or circulating in the bloodstream, doctors need to get rid of them, or else cancer will spread throughout the body. For cancers that do not form solid tumors, such as blood cancers, chemotherapy is the only option. Likewise, some cancerous tumors are impossible to operate on because, if doctors performed the surgery required to remove them would cause serious or even fatal damage to one or more organs of the body. In some cases, oncologists recommend chemotherapy before surgery; when they do this, the purpose is to shrink the tumor so that they can then surgically remove it without damaging nearby organs. Even if it is not possible to destroy the entire tumor, chemotherapy can stop it from growing and slow or stop the spread of cancer, thereby reducing pain.
How Do Chemotherapy Drugs Work?
Most of the cells in the body are constantly replacing and recycling themselves. For example, none of the skin cells or blood cells in your body is one of the same cells that were present when you sat for your senior portrait before graduating from high school. Cells reproduce by dividing in half, but that does not mean that the number of cells in your body doubles again and again from the time you are born until the time you die. After a certain amount of time (the amount of time varies from one type of cell to another), the old cells self-destruct through a process called apoptosis. During apoptosis, instead of dividing into two viable cells, the cell disintegrates into tiny fragments, which then become a source of food for healthy cells. Apoptosis is sometimes called “programmed cell death,” but it is more like cell recycling and is a normal part of good health.
Cancer cells do not behave like normal cells. They continue to divide, but they do not go through apoptosis. Therefore, they can develop into tumors that can cause pain, shortness of breath, gastrointestinal symptoms, or other symptoms as they press on nearby organs. Cells from the tumor can split off and enter the bloodstream, where they can migrate to other parts of the body and form new tumors. The term metastasis refers to the spread of cancerous cells and tumors. If cancer has metastasized, this means that it has spread to more than one part of the body.
Chemotherapy drugs, which are usually administered intravenously in a hospital or outpatient oncology clinic, work by stopping cell division. They act on the cells that divide most quickly, namely cancer cells, which is why some cancer patients go into remission, which means that no signs of cancer are detectable on any diagnostic tests, after several months of chemotherapy treatments. They also destroy some non-cancerous cells that divide quickly, such as hair follicles, bone marrow cells, and the cells on the linings of the mouth and stomach. Your medical team will develop a chemotherapy treatment plan that enables them to destroy as many cancer cells as possible while minimizing the amount of harm to healthy tissues.
Common Chemotherapy Drugs Used for Mesothelioma
Chemotherapy remains one of the most effective treatments for mesothelioma. Patients who undergo surgery and chemotherapy survive longer than patients who undergo surgery without chemotherapy. The chemotherapy drugs that have accepted uses for the treatment of mesothelioma are pemetrexed (brand name Alimta), cisplatin, carboplatin, gemcitabine (Gemzar), and vinorelbine. Each patient who undergoes chemotherapy gets an individualized treatment regimen with one or more chemotherapy drugs. The timing of your treatments and the doses of your drugs will depend on your state of health, how your cancer responds to the chemotherapy drugs, and how severe your side effects are.
What Is Hyperthermic Chemotherapy?
The usual way of administering chemotherapy drugs is through an intravenous infusion so that the drugs travel through the bloodstream. More recently, some treatment regimens involve hyperthermic chemotherapy, where chemotherapy drugs at high temperatures are applied directly to the site of the tumor. This happens during surgery, while the patient is under anesthesia, and the drugs are usually applied to the site where a tumor has just been removed. The purpose of administering the chemotherapy drugs this way is so that the site of the tumor gets a higher dose of drugs, but there is less risk of severe systemic side effects.
Managing Side Effects From Chemotherapy
Chemotherapy drugs work by destroying cells in the body. In a perfect world, these drugs would be able to eradicate cancer without harming other cells in your body, but thus far, no chemotherapy drug has a perfect ability to destroy cancerous tissues while leaving healthy tissues unharmed. Since chemotherapy drugs affect tissues with rapidly dividing cells, they are most likely to harm the hair follicles, mouth, digestive organs, and immune system. Hair loss is a frequent side effect for patients undergoing chemotherapy; some patients lose hair not only from their heads, but also from their facial and body hair, eyebrows, and eyelashes. Because chemotherapy drugs harm the oral mucosa, some patients experience mouth ulcers or dry mouth. Patients may also experience gastrointestinal side effects such as nausea, vomiting, or diarrhea. They can also suffer damage to their fingernails and toenails. Because white blood cells and the tissues that produce them are also vulnerable to damage from chemotherapy, some patients suffer immunosuppression, characterized by a low white blood cell count. If you suffer this side effect, you might need to be hospitalized as a precaution, even if you do not develop an infection. Based on the results of your bloodwork, your doctors might need to adjust the doses of your medication and the timing of your treatments, based on what you can tolerate.
The good news is that your medical team will make every effort to reduce your side effects and help you cope with them. You will undergo frequent blood tests to measure your white blood cell count. Your doctor may also recommend supplementation with B vitamins or folic acid since chemotherapy drugs can interfere with the body’s ability to absorb these. To prevent hair loss and damage to fingernails and toenails, your medical team may provide mittens, booties, and a cap infused with cold liquid to keep your head, hands, and feet cold, since the cold temperature reduces the amount of chemotherapy drugs that can enter your hair follicles or nail beds.
It is important to be able to eat while you are following your treatment plan in order to maintain your health. Some chemotherapy drugs are more likely to cause nausea and vomiting, and the side effects of the newer drugs tend to be less severe than the older ones. In the 1980s, many patients quit chemotherapy or refused to start it out of fear of the severe gastrointestinal side effects of chemotherapy, but the field of cancer treatment is much more advanced than it was several decades ago. Your doctors can give you anti-nausea medications such as Zofran, either by adding it to the same IV infusion as your chemotherapy drugs or by prescribing pills for you to take after each IV treatment. Some people find cannabis helpful for relieving nausea associated with chemotherapy treatments; in fact, this was one of the first legally accepted uses for medical cannabis. Each state has its own medical cannabis laws, but most states with medical cannabis programs consider chemotherapy for cancer a qualifying condition.
Finally, although most mesothelioma diagnoses are in people older than 50, it warrants mention that chemotherapy can harm fertility in men and women. People who need chemotherapy but wish to preserve their fertility so that they can have children in the future should ask their doctors about fertility-preserving procedures. Men can freeze sperm samples, and women can freeze their oocytes (egg cells) or ovarian tissue before beginning chemotherapy so that they can conceive through in vitro fertilization (IVF) in the future.