There is a lot of information on chemotherapy but it is easy for patients to drown in the details. I have several friends who are starting chemo or considering it and I thought I’d write down some simple answers to common questions. Note: this is not advice or information for specific patients but a general introduction to the ideas.This post is in honour of 007, the unbeatable secret accountant, who is getting ready to join the Terry Fox Challenge – after she finds out about options for chemo.
I have several friends around the world who are dealing with cancer diagnoses and they have had some general questions about the treatment options. None of them are science experts and instead of writing the same email to everyone, I thought I would try a general post.
Warning: this post is not advice for anyone and it is a general introduction to the topic. I won’t try to explain the specifics of any particular drug because that is beyond my level of expertise.
What is chemotherapy? Why take it?
It depends who you ask. Many patients will say, ‘poison’. But really, the term means ‘drug therapy’ although we generally use it in Canada to mean drugs to kill cancer cells. Please note that chemo is used in many diseases but I’ll focus on cancer applications as that is where most of the questions have started.
In cancer treatment, chemo is usually offered when there is a concern that there might be tumour cells that were not or can not be removed with surgery or radiation. For example, my grandmother had inoperable lung cancer so she took chemotherapy to shrink her tumours and help her breathe. Another reason to take chemotherapy is to knock down any new starter tumours. You see, tumours like to grow and if they run out of space in one area, they may send out a few cells to colonize new areas. Taking chemotherapy can attack these new spots before the new growth is big enough to see through various scans.
Old school chemo
The main way that traditional chemotherapy works is to kill fast growing cells. Tumours generally grow faster than the tissue where they started (how you get a bump or tumour) so you want to stop this extra growth. But a fast growing kidney cell (not an organ that grows a lot) isn’t necessarily that fast when compared to a skin cell. We shed our skin every 30 days (or so the local Science Centre tells me) and our skin divides and grows pretty fast. Other fast growing tissues are hair and gut/mouth linings. So, if you take a drug that kills fast growing cells, it can attack hair, skin, and gut linings = the common side effects seen in chemotherapy.
There are many ways that this older chemotherapy can work – including messing up the DNA of a cell. This can lead to mutations that give an increased risk of cancers in the future because some mutations stick around. But this is a long term complication and the most important thing is to survive the cancer and treatment.
My field of expertise is genetics and studying tumours has not only given us ways to help predict people’s risk of cancer but is leading to some therapies for specific cancers. Researchers have been comparing normal tissue to tumours and trying to develop specific drugs. One way of doing this is with monoclonal antibodies…I know, I said no mechanisms or jargon…basically, monoclonal means all the same and antibodies are neutralizing proteins. So, if you know a tumour makes something that normal tissue doesn’t have, an antibody can be used to target and destroy the cancerous tissue. Monoclonal antibodies are not technically chemo but they are often discussed as chemo by patients – and the basic mechanism can be visualized – so I included them in this post.
Again, there are many different ways that this newer targeting chemo can work and one of the issues is that you need to know what targets are available. Tumours aren’t static and the targets can change throughout the different stages.
So what to do?
Talk to your doctor and other members of the health care team. In Vancouver, the BC Cancer Agency has fantastic resources for patients and family members: counsellors, volunteer drivers, dentists, help with diet…please ask for help if wanted. Your doctor will have a suggested treatment plan to discuss with you. My one bit of true advice: write down your questions so that you won’t forget anything. Nothing is too silly to ask!
I hope this was helpful as a very brief introduction. To those who know more on the topic, please let me know if I said something incorrect.