CHEMOTHERAPY AND RADIATION TREATMENTS

Chemotherapy is a cancer treatment that uses drugs to destroy cancer cells. It is also called "chemo." Today, there are many different kinds of chemotherapy. So the way you feel during treatment may be very different from someone else.

Chemotherapy can be given in these forms:

Chemotherapy can be given in these forms: An IV (intravenously) A shot (injection) into a muscle or other part of your body A pill or a liquid that you swallow A cream that is rubbed on your skin

Different drugs cause different side effects. Although specific side effects may be predictable for certain classes of drugs, each person's experience with chemotherapy is unique. Talk with your doctor about specific side effects that you may experience or are experiencing. With most types of chemotherapy, the presence and intensity of side effects are not measures of how well the treatment is working. However, some side effects of targeted therapy do, in fact, indicate the medications effectiveness. Learn more about targeted therapy. Common side effects of chemotherapy include: Fatigue. Fatigue (a persistent sense of tiredness or exhaustion) is the most common symptom reported by patients receiving chemotherapy. Learn more about fatigue and how to cope with it. Sores in the mouth and throat. Chemotherapy can damage the cells that line the mouth and throat. The sores (also called mucositis) usually develop five to 14 days after receiving chemotherapy and can become infected. However, they usually heal completely when treatment is finished. Patients receiving chemotherapy who have poor diets and/or poor dental hygiene

increase their risk of mouth and throat sores. Learn more about managing mucositis and dental health during cancer treatment. Diarrhea. Certain chemotherapy causes loose or watery bowel movements. Preventing diarrhea or treating it early can help a person avoid becoming dehydrated (the condition when the body does not get the amount of fluids it needs) or developing other problems. Learn more about managing diarrhea. Nausea and vomiting. Chemotherapy can cause nausea (an urge to vomit, or throw up) and vomitinga risk that depends on the type and dose of chemotherapy. With appropriate medications, nausea and vomiting can be prevented in nearly all patients. Learn more about nausea and vomiting and about ASCOs guideline for preventing these side effects. Constipation. Chemotherapyas well as some drugs to treat nausea and vomiting, pain, depression, diarrhea, and blood pressuremay cause constipation, the infrequent or difficult passage of stool. Patients may also increase their risk of constipation by not drinking enough fluids, eating balanced meals, or getting enough exercise. Learn more about managing constipation. Blood disorders. Chemotherapy affects production of new blood cells in the bone marrow, the spongy, inner mass of the bone. A test called a complete blood count (CBC) will indicate the levels of red blood cells (RBCs) and white blood cells (WBCs) in the blood. An abnormally low level of RBCs results in anemia. This condition decreases the bodys ability to carry oxygen throughout the body, resulting in fatigue, dizziness, or shortness of breath. A lower than normal number of WBCs (called leukopenia) increases the bodys risk of infection. A second type of test, called a platelet count, measures the number of platelets (blood cells that stop bleeding by plugging damaged blood vessels and helping the blood to clot) in your blood. People with thrombocytopenia (a shortage of platelets) bleed and bruise more easily.

These conditions can be treated with medications that stimulate the bone marrow to make more blood-forming cells that develop into RBCs, WBCs, and platelets. Learn more about managing anemia, infection, and thrombocytopenia.

Nervous system effects. Some drugs cause nerve damage, resulting in one or more of the following nerve- or muscle-related symptoms:

Tingling Burning Weakness or numbness in the hands and/or feet Weak, sore, tired, or achy muscles Loss of balance Shaking or trembling Stiff neck Headache Visual problems Walking problems Difficulty hearing Clumsiness

These symptoms usually decrease when the chemotherapy dose is lowered or treatment is stopped; however, in some cases, the damage is permanent.

Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer

cells are found (internal radiation therapy, also called brachytherapy). Radiation therapy is often used in combination with surgery or chemotherapy or both. People who cannot have surgery may have stereotactic body radiation therapy (SBRT). In SBRT, high doses of radiation therapy are targeted to the cancer. One form of SBRT that may be used to treat tumors that have spread to the brain is called gamma knife radiosurgery. This is a radiation treatment (rather than surgery) that uses a machine to target radiation beams from many different angles all focused on the tumor area. Radiofrequency ablation Radiofrequency ablation uses a small needle inserted through the skin and into the tumor. Energy passes through the needle into the tumor. This heats and kills cancer cells. It also closes up the little blood vessels in the area so there is less bleeding. Laser therapy Laser therapy uses a narrow beam of very intense light to destroy cancer cells. Laser therapy usually is used as a palliative care to remove tumors that block the airway. Laser therapy does not cure lung cancer. Photodynamic therapy Photodynamic therapy (PDT) uses laser light and a special light-activated substance (Photofrin) to kill cancer cells. It is approved for palliative treatment to destroy tumors that block the airway but it does not cure the lung cancer. Few lung cancers are treated with this therapy. Surgery is still the standard treatment for early-stage lung cancer. In clinical trials, PDT appears to help relieve coughing, shortness of breath, and coughing up bloody mucus. Additional research is being done. Cryosurgery Cryosurgery (also called cryoablation) freezes the tumor and kills it. Cryosurgery for lung cancer is experimental and is being used only in certain clinical trials. Cautery

Cautery is used to burn (cauterize) and remove tumors that block the airway.

Brain Metastases Cancers arising outside the brain in such diverse organs as the lung or breast can travel through the blood vessels to grow in the brain. Tumors that have spread in this fashion are known as metastases. Metastases may be discovered before or after they cause symptoms; a CT scan or an MRI are the tests most frequently used to diagnose brain metastases. Brain metastases may develop at different times (early or late) in the course of the disease in different patients. Whole brain irradiation is frequently prescribed for patients with brain metastases. This treatment uses radiation to treat the visible lumps of tumor and the presumed invisible tumor deposits that are so small they may not be seen on even a sensitive MRI scan. Therefore, large areas of the brain may be treated to stop the spread of the tumors. Symptoms caused by tumors metastatic to the brain usually respond to whole brain radiation therapy; different studies have reported response rates of 50 to 70 percent. The Radiation Therapy Oncology Group (RTOG) performed randomized studies that showed a course of 10 treatments over two weeks to give a total dose of 30 Gray (the same as 3000 centiGray or 3000 rads, to use older terms) was as good as more extended courses of radiation therapy that give higher doses. In some situations, a shorter or longer course of treatment than two weeks may be preferable. For patients who have a single brain metastasis that is removed surgically, whole brain radiation therapy was found in a randomized study to give great improvements in preventing cancer from regrowing in the brain and in prolonging survival. Stereotactic radiosurgery can be combined with whole brain radiation therapy for brain metastases. The whole brain radiation therapy will treat the visible metastases and any presumed microscopic tumor deposits as well. This is possible because whole brain radiation therapy is given as a low dose to a larger volume and targeted to the tumor and the area of possible tumor spread, while stereotactic radiosurgery is a high dose given to a very small volume and targeted only within the tumor

itself. The two treatment techniques can be thought of as complementary in achieving control of metastases to the brain. Whole brain radiation therapy can cause shrinkage of visible brain metastases, sometimes making them more amenable to stereotactic radiosurgery or microsurgery. The addition of whole brain radiation therapy to stereotactic radiosurgery can decrease the possibility of additional metastatic lesions and decrease the chance that visible lesions treated with radiosurgery may have recurrences after radiosurgical treatment. Omission of whole brain radiation therapy for brain metastases is slightly controversial, but this is an area of ongoing intensive research. Recently, some investigators have tried stereotactic radiosurgery alone without whole brain radiation therapy for selected patients with brain metastases to avoid causing the side effects of whole brain radiotherapy. Because whole brain radiation therapy can be given at a later date to these patients if their metastases are not controlled by the radiosurgery, this strategy may relieve symptoms effectively while not adversely affecting survival.