Chemotherapy

Chemotherapy is one of the methods of treating malignant tumors, which is based on the use of certain drugs. These drugs belong to the group of cytostatics - that is, drugs that suppress the process of cell division. 

The oncologists of the Sofia * center of the Medicina clinic use drugs of a new generation, which have a significantly lower toxic effect. This makes the chemotherapy course easier to tolerate. We follow international standards not only in prescribing, but also in preparing chemotherapy drugs.      

Chemotherapy drugs can be injected into the body in different ways: as an intravenous infusion or in tablets. One way or another, they enter the bloodstream and act on all tumor foci in the body. This is the method of choice if the tumor has already spread beyond the primary focus and there are metastases, but it can be used as part of combination therapy and in the case of local tumors. The course of treatment can be different in duration, but as a rule it is several days, after which a break is taken.

After several courses, the oncologist evaluates the effectiveness of the treatment and, if necessary, corrects the scheme. 

In order to minimize side effects, some chemotherapy drugs are administered very slowly, over several hours. There are modern systems for long-term regimens that allow the patient not to be "tied" to the drip, but to move around during treatment. Sometimes patients who have bad veins and are planning long-term treatment are fitted with a special device - a port - through which chemotherapy drugs can be injected regularly.

Chemotherapy is used in the treatment of many cancers, but in some cases it is especially effective - for example, for tumors of the blood system. In other cases, it is used as part of a comprehensive treatment - for example, to prevent tumor metastasis. Some chemotherapy regimens include several drugs at once, which helps maintain the overall effectiveness of the regimen and reduce the side effects of each drug used. Sometimes chemotherapy drugs are injected topically (for example, into the bladder)  

If you have been prescribed chemotherapy

  • Be attentive to your condition. Be sure to tell your healthcare provider or family doctor if your condition has worsened, i.e. fever, shortness of breath, pain, skin changes, mouth inflammation or bleeding
  • Pay attention to the injection sites. If pain, redness, or swelling appear at the injection site, tell your doctor.
  • Make a list of medications you take regularly (such as drugs for high blood pressure or diabetes) and show it to your doctor.
  • After chemotherapy, you should definitely be under medical supervision. Don't miss your appointment!
  • In some cases, chemotherapy can lead to an increased susceptibility to infectious diseases. The doctor can determine this based on the results of control laboratory blood tests. If this happens, avoid crowded places (theaters, airports, concerts, large shopping centers), do not contact people who are coughing or sneezing. A simple cough or runny nose can turn into a serious illness for you during this period. If you have a fever, you should contact your healthcare professional immediately.
  • Vaccinations against infectious diseases are contraindicated during chemotherapy and for several weeks after its completion. Due to suppression of the immune system, they often do not give the desired effect, while the risk of side effects increases.
  • The drugs used in chemotherapy can lead to problems with the development of eggs and sperm. In this regard, it is recommended to take contraceptive measures during chemotherapy and for about one year after its completion. Discuss this issue or your desire to have a baby with your doctor. By the way, your disease is not contagious. Even with intimacy, it is not passed on to your partner. In this respect, you need not worry.
  • During chemotherapy and after the course, many patients complain of increased fatigue and decreased performance. Consider this when planning your time. You can rest or play sports at this time.
  • You should not drive on your own during chemotherapy.
  • You are suffering from a serious illness. Psychological problems are often associated with this. Perhaps you have fears, anxiety about your future, depression. Don't be afraid to talk to your doctor about this. Currently, there are many services that provide specialized psycho-oncological counseling and are able to help you.

When is chemotherapy prescribed?

Depending on the type of cancer and the goals of treatment, chemotherapy is given in different ways. The treatment of so-called solid tumors or systemic diseases is carried out with the aim of curing the patient (therapeutic chemotherapy), prolonging life or alleviating the symptoms of the disease (palliative chemotherapy). Solid tumors are localized tumors that can be felt or visualized on examination (for example, ultrasound, x-rays, computed tomography, magnetic resonance imaging), such as carcinomas (tumors that develop in the tissues of the glands, skin, or mucous membrane membranes) or sarcomas (tumors developing in bone or soft tissues, as well as in nerve tissues and blood vessels). Systemic diseases are cancers that affect the entire body, such as leukemia (a disease of the blood or hematopoietic cells in the bone marrow), Hodgkin's disease or malignant lymphoma (a disease of the lymphatic system).

However, in some cases, cytostatic chemotherapy is prescribed without the presence of a visible tumor (adjuvant chemotherapy), for example, after an operation in order to prevent recurrence of cancer or delay it as much as possible.

In the presence of single malignant nodules, chemotherapy is often prescribed on the eve of elective surgery to remove them in order to reduce their size (induction or neoadjuvant preoperative chemotherapy).

How does chemotherapy work?

Medicines (cytostatics) are produced from plants or fungi, as well as chemically. They prevent cell division and therefore have the strongest effect on rapidly and constantly growing tissues, such as, for example, malignant tumors. In this way, tumor growth can be prevented and the disease can be brought under control. With chemotherapy, the tumor may shrink (partial remission) or disappear completely (complete remission). Depending on the disease and the stage of its development, there is also the possibility of a complete recovery.

There are a number of drugs for chemotherapy, which differ in their mode of action and in the form of release (tablets, capsules, ampoules for injections, infusion solutions, in some cases - ointments). Sometimes several drugs are used simultaneously or in a specific sequence to achieve maximum effect. In this case, the treatment is carried out according to an individual plan (chemotherapy scheme), which is specially compiled for each individual patient. It establishes which drugs, in what dosage and for how long are used for a given patient. This therapeutic regimen is then repeated over time (chemotherapy course).

Sometimes different medications are prescribed for patients with the same or similar medical conditions. The chemotherapy regimen is developed not only on the basis of the diagnosis, but also based on the characteristics of the organism of each patient.

In the course of treatment, on the basis of regular examinations, the effect of drugs and their tolerance are checked. If the desired result cannot be achieved or if the side effects are too strong, changes are made to the chemotherapy regimen, i.e. different medications, a different dosage, or a different schedule are prescribed - or chemotherapy is stopped.

The intervals between treatment cycles are set based on treatment plans, which for some patients may not always be accurately followed. Depending on the tolerance of the drugs, as well as on the results of blood tests and examinations of other organs, for example, kidneys, lungs, heart, the intervals between treatment cycles may be longer or shorter. It is impossible to predict in advance how often a chemotherapy regimen should be repeated. Usually, 2 to 4 cycles are performed first. Depending on the effect and tolerability, then the question of whether it is advisable to continue this chemotherapy, whether to stop it, or to draw up another treatment plan is discussed.

What are the side effects?

Chemotherapy drugs are highly effective and target all rapidly multiplying cells. This applies not only to malignant cells, but also to cells of healthy tissues of the body (for example, hematopoietic cells of the bone marrow, cells of mucosal tissues or hair follicles). This can cause side effects that can be severe and even life-threatening.

You yourself can make a significant contribution to the early detection of side effects if you observe the reaction of your body and report it to your doctor. Most side effects can be relieved or prevented with accompanying medications.

The following tissues are most often affected:

• Bone marrow 

The number of leukocytes usually decreases. The consequence of a very strong decrease in it may be an increased susceptibility to infections. In this case, it is necessary to take precautions for some time and to carry out control examinations at short intervals. Sometimes, temporary isolation in a single room and the use of antibacterial, antiviral and antifungal drugs (antibiotics, antimycotics, virostatics, etc.) is necessary. The platelet count is also often reduced. A severe reaction can lead to a bleeding disorder (for example, with injuries) or cause increased bleeding (detected by red dots on the surface of the skin, bleeding from the nose, mucous membranes, or visual impairment).  

Long-term and intense chemotherapy can lead to a deterioration in red blood cell and hemoglobin counts.

In this regard, it is necessary to conduct regular laboratory blood tests. In some cases, it becomes necessary to transfuse blood or blood components. This is associated with the risks of infectious diseases, for example, in rare cases of viral hepatitis (liver inflammation), in extremely rare cases of HIV infection (consequence: AIDS) and / or causative agents of other diseases (BSE, variant of Creutzfeldt- Jakob disease), as well as unknown currently pathogens. Severe infectious diseases or severe bleeding in some cases can lead to cellular outcome. If the number of certain immune cells in the blood is significantly reduced due to chemotherapy, the risk of infections may be reduced by drugs that promote the growth of white blood cells. If necessary, you can also increase the number of platelets through transfusions of appropriate blood components. Vaccinations against infectious diseases during chemotherapy often do not lead to the desired result due to suppression of the immune system, however, there is an increased risk of side effects. In this regard, during chemotherapy, and in the weeks following the completion of her vaccinations are not recommended.      

• Digestive tract 

Previously, treatment with cytostatics often led to decreased appetite and nausea, up to vomiting. Currently, with the help of concomitant drugs, it is possible to alleviate or even completely eliminate such side effects.

Constipation may occur, leading to paresis of the intestine or intestinal obstruction, diarrhea, and inflammation of the oral cavity. The extent of these disorders depends on the specific drug. 

• Hair, skin 

As a rule, chemotherapy leads to hair loss (especially on the head, less often eyebrows, eyelashes, beard hair, pubic hair), which, depending on the preparation, can be complete or partial. After drug withdrawal, hair grows back. Your doctor may recommend that you wear a wig if necessary. Before starting chemotherapy, you can consult with a hairdresser to choose a wig that matches your own hair color. Some cytostatics cause growth abnormalities or changes in the pigmentation of nails on the fingers or toes, inflammation can develop, leading to reddening of the skin, blistering or abrasions (i.e. called hand and foot syndrome). Watch out especially for signs of bleeding on the skin surface (red dots) and allergic reactions (eg, redness, rash).

• Sex glands 

Chemotherapy temporarily lowers sex drive (libido). In muzhchinchasto broken semyaobrazovanie. In this regard, the ability to conceive - depending on the drug - is most often limited temporarily, but sometimes for a long time or completely excluded. However, this does not lead to impotence (inability to have sex). If there is a desire to have children, in some cases, there is the possibility of freezing your own sperm before starting chemotherapy. However, insurance companies usually do not pay the costs of this procedure. In this regard, you should first consult about the possible financial costs. If after the completion of chemotherapy semen formation does not recover, frozen semen can be used for artificial insemination. During chemotherapy, conception of a child should be excluded.

In women, the menstrual cycle is disturbed, sometimes it is absent throughout the treatment. Sometimes menopause occurs prematurely (especially in women over 40), while the menstrual cycle does not resume after the completion of chemotherapy. If during treatment there are symptoms characteristic of menopause (for example, hot flashes, sweating), you should inform your doctor about it; he may prescribe medications for you to relieve your condition. Pregnancy is unacceptable during chemotherapy. To protect ovarian function in young women wishing to have children, the ovaries can be blocked with appropriate drugs (so-called GnRH analogues) during chemotherapy. It is also possible to freeze a woman's eggs before starting treatment and use them later for artificial insemination. If you wish, you can consult with a gynecologist specialized in this field. If simultaneous or subsequent hormonal therapy is planned for men with an oncological disease of the mammary glands, uterus, or prostate (prostate) in men, you should always contact an oncologist beforehand.  

• Nervous system 

First of all, tingling and / or cottony sensation may occur in the hands and feet. In addition, muscle weakness may be felt. In rare cases, muscle paresis is observed, and in extremely rare cases, paralysis of the facial or optic nerve. The feeling of weakness and paresis gradually disappear after the end of chemotherapy. This can take several months. Occasionally, discomfort and paresis do not go away for a longer time; in extremely severe cases, they remain forever. Some cytostatics also lead to changes in taste, chills, or muscle cramps. Short-term dysfunction of the nerve endings can cause constipation, which, if necessary, requires treatment. Temporary mental disturbances may occur.

• Damage to other organs 

In very rare cases, side effects affect other organs (eg, lungs, heart, kidneys, liver). However, the risk of injury to vital organs may be different, depending on the individual characteristics of each patient and used (s) of the drug (s). Severe organ damage may require additional treatment and, in some cases, be fatal. In particular, the risk depends on the dosage of drugs, the disease, as well as on concomitant and side diseases, as well as on additional treatment, such as radiation therapy. In order to identify at the earliest stage the effect of side effects on the following organs, before and throughout the entire chemotherapy, it is necessary to conduct regular studies of their functions, as well as appropriate laboratory blood tests:

Other side effects:

Long-term use of some cytostatics can increase the risk of recurrence of malignant tumors (for example, leukemia) after several

years or decades. First of all, this can happen if additional radiation therapy was performed.

• At injection sites (where the infusion needle was inserted), redness, pain, and swelling may occur. In addition, deeper damage to the skin or tissues can occur, often healing very slowly and requiring corrective surgery.

In extremely rare cases, hitherto unknown and therefore unforeseen side effects may occur.

Modern chemotherapy drugs are highly effective and can achieve success in the treatment of many oncological diseases. Many cancer patients who have undergone chemotherapy have been doing great for many years. But even after the completion of treatment, you need to be regularly monitored by a doctor in order to timely identify later side effects or relapses of the disease and take the necessary measures.

Doctors

Врач Aleksandr Shelepov
Traumatologist-orthopaedist
Aleksandr
Shelepov
Experience 11 year
Physician
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Врач Ekaterina Morozova
Pediatrician
Ekaterina
Morozova
Experience 17 year
Pediatric physician, PhD (Medicine), member of the Union of Pediatricians of Russia
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Врач Grigory Kulyasov
Prosthodontist
Grigory
Kulyasov
Experience 19 year
Certified dentist (Highest Category in prosthodontics), member of the International Academy of Advanced Interdisciplinary Dentistry (IAAID)
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Врач Ivan Shashenkov
Cardiologist, internist, pulmonologist
Ivan
Shashenkov
Experience 13 year
Physician cardiologist, member of the Russian Scientific Medical Society of Internal Medicine (RSMSIM), Russian Society of Cardiology (RSC), European Society of Cardiology (ESC), European Association of Cardiovascular Prevention and Rehabilitation (EACPR), European Respiratory Society (ERS), International EECP Society (IEECPS)
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Врач Mariya Grinberg
Dental therapist
Mariya
Grinberg
Experience 26 year
Physician-dental therapist, member of the International Dentistry Association (IDA)
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Врач Olga Berezhko
Internist
Olga
Berezhko
Experience 34 year
Board Certified General Practitioner (Highest Category), member of the Russian Scientific Medical Society of Internal Medicine
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Врач Sergey Bykov
Allergologist
Sergey
Bykov
Experience 16 year
Physician-allergologist (immunologist), PhD (Medicine), member of the Russian Association of Allergologists and Clinical Immunologists
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Врач Yury Chernov
MR imaging (MRI), SPECT
Yury
Chernov
Experience 41 year
Board certified physician (Highest Category in Radiology), member of the European Society of Radiology
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