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Chemotherapy is the systemic (whole body) treatment of cancer with anticancer drugs.
The main purpose of chemotherapy is to kill cancer cells. It can be used as the primary form of treatment or as a supplement to other treatments. Chemotherapy is often used to treat patients with cancer that has spread from the place in the body where it started (metastasized), but it may also be used the keep cancer from coming back (adjuvant therapy). Chemotherapy destroys cancer cells anywhere in the body. It even kills cells that have broken off from the main tumor and traveled through the blood or lymph systems to other parts of the body.
Chemotherapy can cure some types of cancer. In some cases, it is used to slow the growth of cancer cells or to keep the cancer from spreading to other parts of the body. When a cancer has been removed by surgery, chemotherapy may be used to keep the cancer from coming back (adjuvant therapy). It is also helpful in reducing the tumor size prior to surgery (primary [neoadjuvant] chemotherapy). Chemotherapy can ease the symptoms of cancer (palliate), helping some patients have a better quality of life.
Chemotherapy may be used as the first line of treatment or it may be started after a tumor is removed. A variety of factors, including the type and stage of cancer, will determine the type of chemotherapy used.
Adjuvant chemotherapy refers to giving patients anti-cancer drugs after the primary tumor has been removed and there is no evidence that cancer remains in the body. It was first studied in the 1950s. This form of treatment initially gained popularity because it showed promise in improving the survival for patients with certain cancers. The theory was that adjuvant chemotherapy would attack microscopic cancer cells that remained after tumor removal. Adjuvant chemotherapy may be effective in some types of cancers, including breast cancer, colorectal cancer, osteogenic sarcoma, and Wilms' tumor.
A patient's response to adjuvant therapy is determined by a variety of factors, including drug dosage, schedule of drug therapy, and drug resistance. Toxic side effects and cost-effectiveness are other important issues. This area is undergoing further investigation.
Primary chemotherapy, also sometimes called neoadjuvant chemotherapy or induction chemotherapy, is the use of anticancer drugs as the main form of treatment. Chemotherapy can be the primary treatment with cancers such as these: certain lymphomas, childhood and some adult forms of Hodgkin's disease, Wilms' tumor, embryonal rhabdomyosarcoma, and small cell lung cancer.
Primary chemotherapy can also be used to treat tumors prior to surgery or radiation. In some cases, the tumor may be so large that surgery to remove it would destroy major organs or would be quite disfiguring. Primary neoadjuvant chemotherapy may reduce the tumor size, making it possible for a surgeon to perform a less traumatic operation. Examples of cancers in which primary chemotherapy may be followed-up with less extensive surgeries include: anal cancer, bladder cancer, breast cancer, esophageal cancer, laryngeal cancer, osteogenic sarcoma, and soft tissue sarcoma.
An advantage of primary chemotherapy is that the blood vessels are intact since they have not been exposed to surgery or radiation. Therefore, drugs can easily travel through the bloodstream toward the tumor. In fact, the therapy can improve the tumor's blood flow, making it more receptive to the impact of radiation. In addition, the use of chemotherapy before surgical removal of cancer allows the physician to assess the responsiveness of the tumor to the drug (s) used. Since not all chemotherapy regimens are equally effective, knowing how a particular tumor responds to the chemotherapy regimen prescribed can be an advantage in treating the disease.
Primary chemotherapy does have drawbacks. Some cancer cells may be drug-resistant, making the therapy ineffective. (Although discovering that the drug is ineffective minimizes the number of cycles of the drug that the patient must undergo.) The drug may not significantly reduce tumor size, or the tumor may continue to grow despite treatment. Furthermore, the initial use of a drug may lead to higher toxicity when chemotherapy is given later in the course of treatment.
Primary chemotherapy is becoming the norm in treating some patients with certain cancers, such as specific types of lymphomas, some small cell lung cancers, childhood cancers, head and neck cancers, and locally advanced breast cancer. Additional research using this type of chemotherapy is underway.
In most cases, single anticancer drugs cannot cure cancer alone. The use of two or more drugs together is often a more effective alternative. This approach is called combination chemotherapy. Scientific studies of different drug combinations help doctors learn which combinations work best for various types of cancers.
Combination chemotherapy provides a higher chance of destroying cancerous cells. An oncologist decides which chemotherapy drug or combination of drugs will work best for each patient. Different drugs attack cancer cells at varying stages of their growth cycles, making the combination a stronger weapon against cancerous cells. Furthermore, using a combination of drugs may reduce the chance of drug resistance.
When selecting the combination of drugs, a variety of factors are examined. It is important for each drug to be effective against the particular tumor being targeted. Toxicity must also be studied to be sure that each different drug used in a combination is not toxic for the same organ. For example, if two drugs are each toxic to the liver, the combination could be more damaging to that organ.
Author Info: Toni Rizzo, Rhonda Cloos R.N., The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Cancer, 2002
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