Chemotherapy

Chemotherapy means “drug (Cytotoxic) treatment” and is used as a term for treatment performed by administering cancer drugs that affect cancer cells. Depending on the type of cancer, the aims, side effects and duration of chemotherapy differ.

What is Chemotherapy?

Chemotherapy means treating cancer with drugs, the drugs used in chemotherapy prevent the growth and reproduction of cancer cells and damage them. Classical chemotherapies can be more effective when used alone or with some drug combinations, so chemotherapy courses may contain more than one drug.

In Which Diseases Is Chemotherapy Applied?

Chemotherapy is used to treat the disease according to the type and stage of cancer, to prevent the spread of the tumor, to slow its growth, to kill cancer cells that have spread from the organ where it started to other parts of the body, and to improve some symptoms of cancer. In some cases, it is the only treatment option. Depending on the stage of the disease, chemotherapy is applied consecutively or simultaneously with other treatments (surgery and radiotherapy). For example, chemotherapy can be applied to shrink the tumor before surgery or to prevent the proliferation and spread of cancerous cells that may remain in the body after surgery. The same applications apply before and after radiotherapy, chemotherapy can also be performed at the same time as radiotherapy.

Inhibition of Cancer Cell’s Growth Signals

‘Target-oriented smart drugs’, which are frequently used in all types of cancer, are used in two ways: oral pills or intravenously. These drugs, which are in the structure of small molecules or antibodies, attach to the growth receptors of the cancer cell and prevent the tumor from receiving a growth stimulus. Drugs with minimal or controllable side effects such as nausea and hair loss both offer an effective treatment option to the patient and increase the patient’s quality of life during the treatment process. In particular, smart molecules and targeted drugs are used in many types of cancer such as brain tumors, head and neck, lung, stomach, breast, kidney and prostate cancers. However, the presence of these drugs does not eliminate the existence of conventional chemotherapies. Smart drugs and chemotherapy are combined in some types of cancer.

Treatment Support with Immune System Cells

There are many cancer-fighting cells in the human body, but it is known that the activation of these cells can occur up to a point. Thanks to the immunotherapies, which have been mentioned frequently in recent days, the cells of the person’s own immune system are used for this. Thus, cancer is fought by using the person’s own immune system and defense mechanisms. This technique, called immunotherapy, aims to treat the disease by directing cancer-fighting cells in the human body to cancer tissue. Agents given to the patient in the form of serum and in 2-3 week periods yield successful results in malignant melanoma and lung cancer, which are very aggressive types of skin cancer. In addition, it is seen that immunotherapies, which can also be used in the treatment of kidney and lymph cancers, give successful results in many cancer types.

Molecular Treatments for Patients Without the Chance of Surgery

Molecular treatments that prolong life and improve the quality of life of patients for some types of cancer are among the important options for patients who do not have the chance to undergo surgery. Molecules that reveal the characteristics or weaknesses of the cancer cell reach the cancerous area when administered to the body through the mouth or vein. Treatments that minimally affect healthy tissues and destroy tumor cells with effective doses contribute to the regression of the disease and prolongation of life in liver tumors with beads containing microscopic radioactive high energy “yttrium-90”. Radioactive treatments are also used in the type of cancer called “neuroendocrine”, which can originate from many organs such as stomach, pancreas, intestine, thyroid and lung. Molecular therapies such as actinium and lutetium are considered to be one of the most effective treatment options for advanced prostate cancer and neuroendocrine cancers. Intravenously administered radioactive peptides bind to the targeted cells and emit a high amount of radiation, eliminating cancerous cells. These treatments are capable of stopping the progression of the disease in people who have no chance of surgery and who have extensive tumors. Radioactive iodine therapy is the most common of the “radionuclide therapies” known as “atom therapy” in thyroid cancers. This procedure is administered orally in the form of capsules or liquids after surgery to the vast majority of patients diagnosed with thyroid cancer.

How to Choose Chemotherapy Drugs?

The choice of drug in chemotherapy procedures is determined by the medical oncology specialist according to the type of tumor, prevalence, age, general condition of the patient and other existing diseases (such as heart disease, high blood pressure, diabetes, kidney disease). The doses and frequency of administration of the selected drugs should be decided by the medical oncology specialist. The duration and frequency of treatment is carried out depending on the scheme determined according to the condition of the disease and the patient. The frequency and duration are determined by the medical oncology specialist according to the response obtained with the treatment and the side effects. Generally, it is performed for 3 or 4 weeks, but in some treatment schemes, it is applied once a week or every two weeks.

The most important point about the timing of chemotherapy is that the treatment is done as regularly as possible and on time as the side effects allow. When the treatment intervals are extended without any need, this period may provide the tumor with the opportunity to recover and become stronger by gaining resistance to drugs. The tumor continues to grow and spread, the chances of curing the disease are reduced or difficult. Therefore, patients should proceed in line with the doctor’s recommendation regarding chemotherapy appointments. One of the requirements of the treatment process is that the patient does not change the treatment process during periods when he does not feel well and does not fail to take the necessary drugs to be used at home.

What Are the Side Effects of Chemotherapy?

Side effects due to chemotherapy drugs are usually seen with all drugs, but not every patient may experience these side effects. Some patient groups complete the process without experiencing changes in their general health status due to the effects of drugs during the treatment process. In order to control the side effects of chemotherapy, cooperation between the patient and the doctor and nurse is required.

Nausea and Vomiting

Nausea and vomiting may occur due to chemotherapy. This is due to the fact that some drugs affect the vomiting center in the brain and stomach movements, causing nausea and vomiting. It may be necessary to use some drugs to solve this problem and to prevent and reduce the occurrence of side effects before chemotherapy. Since the effect of the drugs will vary from person to person, it may be necessary to use more than one drug that relieves side effects. In order to pass the treatment process in the most comfortable way and to tolerate the side effects, the most appropriate method should be chosen together with the patient’s doctor and nurse.

Hair loss

Along with hair loss, which is a common side effect of chemotherapy, hair loss is also seen in other hairy parts of the body. Hair may start to shed 2-3 weeks after the first treatment, or it may be delayed. It is okay to use wigs, bandanas, scarves after hair loss. It is possible for the hair loss to disturb the patient mentally, so patients should not avoid sharing their feelings. The physician will give information about whether the drugs to be used will shed hair or not. It should be kept in mind that this side effect is completely temporary. After the chemotherapy treatment is finished, the hair and hair will start to grow again, and in some patients, the hair may come out thicker after chemotherapy. Patients should act with the guidance of their doctors about drugs and ice caps, which are thought to prevent hair loss.

Infection

During the period of chemotherapy, immunity weakens and the patient becomes vulnerable to germs.

Bleeding

Problems in the bleeding and coagulation system may occur due to cancer and cancer treatment. Rarely, when high doses are used, chemotherapy drugs can reduce the number of platelets (PLT) that cause blood clotting, so the patient may have an increased tendency to bleed.

How to Control Chemotherapy Side Effects?

Weakness

In the chemotherapy process, although it is not known for certain, fatigue, which is not thought to be due to a single cause;

• Good planning of daily activities,
• Light walking and exercise programs,
• Fighting pain and depression
• In this process, it can be controlled by methods such as taking plenty of fluids.

Intraoral Problems

With the effect of chemotherapy; Redness in the mouth, throat and gums and mouth sores may occur and intraoral problems called “mucositis” may occur.

In addition to the oral care solution recommended by your doctor, during the chemotherapy period;

• Using a soft toothbrush
• Gargling with warm carbonated water after each meal and before going to bed,
• Avoiding hard and crusty foods,
• Feeding soft foods.
• It is recommended to avoid hot foods.

Bleeding

• If red small spots and bruising occur on the skin,
• If blood is seen in the urine,
• If the color of the stool is black or white,
• If there is abnormal vaginal bleeding,
• If there is an increase in temperature, redness and swelling in the leg, the doctor should be informed.

Nutrition in Chemotherapy Treatment

Patients undergoing chemotherapy treatment should be well fed. Weight should be at a normal level and should be maintained, and a protein-rich diet should be preferred that will prevent the destruction of calories and body tissues. In this period, a healthy and balanced diet is very important in terms of controlling drug side effects, preventing infection and accelerating the healing of normal tissues adversely affected by the drug. “Good nutrition” is applying a balanced nutritional program that includes all nutrients, and this applies not only to cancer patients, but also to healthy people.

Which foods should the daily nutrition program consist of?

• Vegetables and fruits: two servings each
• Meat, chicken, fish, eggs: 3 servings
• Cereals: 4 servings
• Milk and dairy products: 2 servings
• Liquids (except tea, coffee): 8-12 glasses.

There is no need for excessive vitamin intake in people who have a sufficient and balanced diet. In fact, some vitamins and antioxidant drugs may interact with chemotherapy drugs. For more detailed information on nutrition, you can consult your doctor and dietitian.

What should be considered in a healthy diet during the chemotherapy process?

• Do not consume packaged ready or frozen foods.
• Avoid processed meat and meat products (such as salami, sausage).
• Avoid long-lasting (prepared with the UHT technique) milk and instant juices.
• Take care to consume vegetables and fruits that are suitable for the season.
• If you do not have digestive problems, consume 1 glass of milk and as much yogurt as you want (especially homemade yogurt) a day,
• Do not eat excessively sweet and syrupy foods.
• Include legumes such as chickpeas, lentils and bulgur in your diet at least 3 times a week.
• Consume protein-rich foods, especially without frying or smoking.
• Fish is an important nutrient. Have fish on your table at least one or two days a week.