Cancer & Chemotherapy

What causes Cancer

Cancer is considered by the World Health Organization (WHO) as one of the leading causes of deaths around the world. At present, there are no definite cure for treating cancer, although there have been great advances in the field of cancer research. Cancer can be explained as a physical state in which the cells of the tissues grow and divide indefinitely without the normal proportion.

When looking at the human body through a microscopic perspective, we know that the body is composed of trillions of cells, each performing specific functions that allow the body to maintain its live state. Each cell is programmed by its DNA to undergo division, to increase in size and number, forming the various tissues and organs that comprise the systems of the body.

In a situation when the DNA is mutated, that is, when the sequence is changed because of a mutagenic agent like a toxin or harmful substance or something else genetic, the cell divides uncontrollably. This unregulated growth in the number of cells makes them lose their normal function, thus forming a mass called a tumor. A tumor serves no useful function in the human body, rather it competes with other healthy cells and tissues for the nutrients that the body absorbs. When the growth of a tumor progresses to critical levels, a person become afflicted with cancer. This could happen in two stages namely aggressive and invasive. In the invasive stage the cancerous tissues are spread to the other adjacent tissues thereby complicating the disease. These are some of the properties that distinguish a normal cancer from a benign tumor where the growth of tissues is limited and does not spread to other parts.

Cancer Facts and Statistics

It is a fact that a cancer can affect any age group and even a fetus. Other than humans it is also commonly found in the animals and plants as well. But it is observed that the risk of getting cancer increases with the increase in age. Cancer is classified as per the location of the origin and the histology, it may include various types like breast cancer, blood cancer, lung cancer and even brain tumor. As of 2007, the American Cancer Society released statistics enumerating the types of cancer that are the leading causes of deaths in the United States. There are about 160,000 estimated deaths for both male and female lung cancer patients in this year. Next on the list is colon cancer, which causes the deaths of about 52,000 patients. Following closely are leukemia, breast cancer, and prostate cancer. Most of the cancers can be treated and cured completely. It mainly depends on the recognition phase and the nature and extent of the therapy done.

Cancer Treatment

The various options of treatment can include chemotherapy, radio therapy and surgery. Recent researches have unveiled certain target drugs which could control the growth and spread of the cancerous tissues and in many cases cure the disease completely. In cases of surgery it is done by the complete eradication of cancer without much damage to the other body parts. There have also been alternative treatments such as herbal medicines, meditation, healing touch therapy, and many others that are often recommended for patients to reduce the pain and fatigue that are involved with cancer.

Cancer - Chemotherapy

One of the most common treatments being used to battle cancer is chemotherapy. Over the last few decades chemotherapy has been found to be a safe and fastest method of treatment in all types of cancer. Chemotherapy treatments for cancer can be better explained as the treatment using a combination of various drugs. These types of procedures use various chemical agents to help suppress and possibly cease the growth of cancerous cells in the patient. Chemotherapy uses the principle of working against the cell division of cancer thereby alleviating and curing the disease. These drugs are capable of destroying the cancerous cells and tissues. This type of targeted destruction also affects the other fast growing cells like hair growth and intestinal lining. These properties cause the drugs to have a certain side effects and leave the doctor to take a decision of choosing a regime which is best suited for the patient.

Cancer Chemotherapy Drugs

The many kinds of chemotherapeutic agents used in modern medicine have the capacity to prevent cancer from spreading, but in some cases, can affect healthy cells in the process. There are many known side effects of chemotherapy, which may manifest through bone marrow cells or blood cells, although this is not immediately applicable to all cancer cases.

As an example, one of the most recommended chemotherapy treatments for breast cancer is AC, which is a combination of the drugs Adriomycin and Cytoxan. AC is given intravenously to the patient for four sessions, each with a three week interval. For lung cancer, some combinations of drugs widely used are carboplatin and paclitaxel, or cisplatin and vinorelbine tartrate. Some lung cancer treatments include radiation therapy along with the drugs.

The principle of chemotherapy allows it to be effective where the cell growth and division is rapid like in the case of a blood cancer making it a very effective treatment option. But in the cases of cancer where the cell growths are slow, chemotherapy may be ineffective.

Over a period of time the cells attain resistance over the chemotherapy. Various researches are on the pipe line to avoid these drawbacks. It is also important to know the correct dosage of the drugs used in chemotherapy. If the dosage is less, it can lead to an ineffective treatment while the excessive dosage may be too much for the patient to handle where it can have a complete programmed cell death causing destruction to the functioning of various organs. However recently various stem cell harvesting and stem cell transplants have made it possible to inject high doses for an effective treatment without much side effects.

Cancer Chemotherapy Side Effects

Chemotherapy uses the principle of working against the division of cells where the cell growth and division is rapid like in the case of blood cancer. Therefore, other parts of the body where cell division is frequent is likely to be affected by chemotherapy. These parts include

The Mouth and Digestive System- the lining in these parts get renewed constantly
Hair- hair grows all the time
The Skin- which is constantly renewing itself.
Bone Marrow - which produces blood cells.

The specific side effects of a particular chemotherapy drug differ from each other. It is not necessary that a person undergoing chemotherapy, experiences every side effect that is listed here. The side effects may even be mild for some people. The degree of the effects vary as one progresses through the treatment, some disappearing when treatment stops.

Effects on Mouth

Chemotherapy can cause:

Mouth Ulcers or
Sore Mouth.

These side effects that tend to appear about 5 to 10 days after one starts treatment, are also called mucositis. These usually clear up within 3 to 4 weeks time, but some times get infected. Therefore, in case a chemotherapy drug is known to cause severe mouth ulcers, doctors prescribe mouth washes to be used regularly. If the mouth gets sore, it makes eating painful. If the condition becomes very painful, pain-
killers are prescribed to help get rid of the pain.

Certain chemotherapy drugs cause ones taste to change, which becomes normal once treatment is stopped. Food starts tasting bitter or more salty.

Effect on the Digestive System:

Sickness: Chemotherapy makes one feel sick. But not all drugs make one sick. It depends on:

The drugs the patient has been prescribed,
The dose and
The patients reaction to the drugs.

Sickness if caused starts a few hours or days after the chemotherapy. It lasts for a few hours or into the next day. Very rarely does it last for several days. Anti-sickness injections and tablets are prescribed depending on the need.

Controlling Sickness:
One should avoid eating food that have strong smell
Avoid fried and fatty food.
Drink lots of fluid to avoid dehydration
If eating makes one feel "heavy", eat several small meals every day.

Loss of Appetite - Chemotherapy makes ones feel sick and causes change in taste. These in turn causes loss of appetite. Also since chemotherapy makes one feel tired is makes a person not feel like eating.

Diarrheoa- Some chemotherapy drugs damage the digestive system lining and cause diarrhoea. Certain drugs cause severe diarrhoea. Under such conditions, its important to drink plenty of fluids to avoid dehydration. Doctors can prescribe tablets that slow gut and reduce diarrhoea. Soothing creams can be applied around the anus if the skin in this area break or gets sore due to diarrhoea.

Constipation - Certain chemotherapy drugs affect the nerve supply to the bowel and this causes constipation. Also some anti-sickness drug and painkillers cause constipation. Its advisable to drink lots of fluid and eat fresh fruits and vegetables. Mild laxatives might be used and its always better to treat constipation early. If there is any change in the bowel motions (constipation or diarrhoea), the doctor should be informed immediately. There are medicines to help deal with it.

Effect on Skin:
Chemotherapy may effect the skin. The skin might become
Dry ,
Discolored or Patchy
More sensitive to sunlight
Skin redness, skin sores and rashes, especially hands and feet.

Taking care of the Skin:
Report any rashes to your doctor immediately.
Use moisturizing cream to remove dryness. However take care not to use such creams on parts treated by radiation therapy, without your doctor's permission.
Use a high SPF sun block cream.
Avoid swimming since chlorinated water makes rashes worse.

Effect on Nails:
Chemotherapy causes the following effect on nails.

Growth of nails id slow
Marks appear on the nails.
Nails might start flaking.

Taking care of Nails:
Cover nail marks with nail polish. However, quick dry nail polishes makes the nail more dry. So avoid using them. Nail marks disappear over time. If the nail become dry and flaky, consider using nail oils or moisturizers.

Chemotherapy Hair Loss

This is the most famous side effects of chemotherapy. However, chemotherapy does not always cause complete hair loss. In fact it can be of the following types:

Hair thinning but hair loss remains constant.
Partial or patchy hair loss or
Complete hair loss.

Hair loss depends on factors like

The drugs one is prescribed.
The dose.
Patients reaction to drugs.

Certain drugs do not cause hair loss at all. But in certain cases, hair from other parts of the body such as eyelashes, eyebrows, underarms, hands/legs and even pubic area might fall off. Hair loss, if that occurs, starts within 2 to 3 weeks or some times a few days from the start of chemotherapy. The hair loss is gradual. Hair will go back after cancer chemotherapy treatment is over, but they might be a different color or curlier or softer. They will however, grow at the same rate as prior to treatment.

Taking care of hair loss:

There is nothing much one can really do but try to cover it up with a wig, scarves, caps etc.
Shaving ones head is now a days a statement and this will save one from the pain of seeing the hair fall off.
Use mild shampoos.
Avoid using chemicals on the hair like those used for coloring or perming.
Avoid using blow dryers, curlers or straighter.
Comb hair softly and do not comb it frequently.
To cure an itchy scalp, use oil.
Discuss with your doctor if other drugs that cause less hair fall can be used for the treatment.
A cold cap might be used.

Effect of Chemotherapy on the bone marrow

Bone marrow is the soft tissue found inside bones. It contains stem cells which produces the different types of blood cells. Bone Marrow can be either red marrow (producing red blood cells and platelets) or yellow marrow (white blood cells arise from these). As blood cells are rapidly dividing cells and chemotherapy targets such cells, the production of these is slowed down.

White Blood Cells: Since white blood cells have the shortest life span, these cell's count decreases first. The white blood cells are a part of the human immune system and help fight infections. Thus when their number decreases, one is more prone to infections. Therefore, one might develop

sore Throat or Cough
Passage of Urine.
These are symptoms of infection and the doctor must be informed immediately for urgent antibiotic therapy.

After each chemotherapy treatment, the WBC counts decreases. They are lowest at about approximately the mid point between treatment. This is also referred to as "nadir". When the WBC count decreases, one feels tired and some times even emotionally drained. However, after the nadir, the WBC count slowly increases again, finally becoming normal. Then after the next chemotherapy session they go down again. The WBC count is monitored regularly with the regular blood tests.

Since the WBC count decreases with chemotherapy, it becomes necessary to have antibiotics to fight infection during the treatment period. With infections that are chemotherapy related, the antibiotics are effective when they applied intravenously ( injected directly into the blood stream). If one is at the risk of some form of infection, the doctor might give preventive antibiotics in order to prevent these. If the WBC count decreases drastically, doctors may administer blood cell growth factor injections. The growth factor used is Granulocyte Colony Stimulating Factor (G-CSF) and is administered as a number of daily injections a few days after the chemotherapy session.

Platelets help in blood clotting and prevent bleeding. Reduction in the number of platelets causes the following:

One Bruises Easily.
Even Small Cuts and Bruises bleed lot and take long time to heal.

If the platelet counts becomes very low, platelet transfusion might be required. This is done in a hospital. Research to develop growth factors that will boost the number of platelets in blood is still going on.

Red Blood Cells:

RBC contain the vital element "hemoglobin" which carry oxygen to all parts of the body. Therefore, decrease in the number of RBCs causes anemia. This makes a person fell tired and also experience breathlessness. This is also treated by blood transfusion. The new RBCs in the blood carry the oxygen from the lungs to all other parts. Regular blood tests to checks the RBC count must be one on a regular basis.
An alternative to blood transfusion is using the red blood cells growth factor called Erythropoietin. This causes the bone marrow to produce more RBCs. This is also administered by injections under the skin. The number of injections required depends on the anemia level. However, in certain forms of cancer, Erythropoietin is not suitable.

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