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Frequently Asked Questions

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Chemotherapy

Cancer is a disease in which abnormal body cells divide uncontrollably and spread to other parts of the body. This is often caused by a mutation (change) in your DNA that happens over time. Cell division and multiplication is no longer controlled by the body and these cells may form tumours. Tumours can be cancerous or benign.
Benign tumours do not spread into or invade nearby tissues. Once removed, they usually don’t grow back, whereas cancerous tumours sometimes do.
It occurs when cancerous tumours spread into or invade nearby tissues and can travel to distant places in the body to form new tumours.
Oncologists are specialist doctors who diagnose, assess and treat cancer patients with chemotherapy or radiation therapy.

Depending on your type of cancer and how advanced it is, chemotherapy can:

Cure cancer—when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.

Control cancer—when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.

Ease cancer symptoms (also called palliative care)—when chemotherapy shrinks tumours that are causing pain or pressure.

Sometimes, chemotherapy is used as the only cancer treatment. However, more often you will get chemotherapy along with other treatments such as surgery, radiation therapy, targeted therapy, or immunotherapy, depending on the type of cancer.
  1. Make a tumour smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.
  2. Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.
  3. Help radiation therapy and immunotherapy work better.
  4. Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).

After receiving chemotherapy, you and your caregivers need to take special care to prevent contact with your body fluids. These fluids include urine, stools, sweat, mucus, blood, vomit, and those from sex. Your doctor or nurse will suggest home safety measures that you and your caregivers should follow, such as:

  • Closing the lid and flushing twice after using the toilet
  • Sitting on the toilet to urinate, if you are male
  • Washing your hands with soap and water after using the restroom
  • Cleaning splashes from the toilet with bleach wipes
  • Using gloves when handling body fluids and washing your hands after removing the gloves
  • Wearing disposable pads or diapers if incontinence is an issue and wearing gloves when handling
  • Washing linens soiled with body fluids separately
  • Using condoms during sex

The length of time that you and your caregivers need to follow these guidelines might differ depending on the policy where you receive treatment and the drugs that you receive.

Your doctor or nurse will tell you how long you and your caregivers need to practise these safety measures.

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

  • Your type of cancer and how advanced it is
  • The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)
  • The type of chemotherapy
  • How your body reacts to chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive one week of chemotherapy followed by three weeks of rest. These four weeks make up one cycle. The rest period gives your body a chance to build new healthy cells.

It is not a good idea to skip a chemotherapy treatment. Sometimes your doctor or nurse may change your chemotherapy schedule due to side effects you are having. If your schedule changes, your doctor or nurse will explain what to do and when to start treatment again.

Your doctor will choose the chemotherapy method that will be most effective against your particular type of cancer and cause the fewest side effects. You may receive chemotherapy drugs in one or more of the following ways:

  • Orally in the form of a tablet or capsule
  • IM (intramuscularly) Injection
  • Intrathecal (into the cerebrospinal fluid via spinal cord)
  • Intraperitoneal (usually done in theatre under anaesthesia) or into the bladder (intravesical)
  • IV (also known as “intravenous” – delivering liquid medicine through a tube into a vein)

Some types of chemotherapy can be given at home. Through instruction, you and your family members can learn how to administer chemotherapy in a pill form.

You may also be shown how to self-administer some supportive injections at home with a small syringe and needle similar to those that people with diabetes use to administer insulin.

In most cases, a nurse will administer chemotherapy in our clinic.

In other situations, it may be necessary to go to the hospital to receive treatment.

Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you are getting IV chemotherapy.

IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump.

Catheters – A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter.

Ports – A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than one day. Be sure to watch for signs of infection around your port.

Pumps – Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps are placed under your skin during surgery.

Chemotherapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are getting, and the dose.

Talk with your health insurance company about what costs they are prepared to pay. Questions to ask include:

  • What will my medical aid pay for?
  • Do I need to call my insurance company before each treatment for it to be covered? Or, does my doctor’s office need to call?
  • What do I have to pay for?
  • Is there a co-payment (money I have to pay) each time I have an appointment?
  • Is there a deductible (certain amount I need to pay) before my insurance pays?
  • Does my insurance pay for all my tests and treatments, whether I am an inpatient or outpatient?
  • Does my current plan cover treatment or should I upgrade my plan?

It is important to maintain a well-balanced diet while receiving cancer treatment. Avoid skipping meals as well as foods like carbonated cold drinks, fatty foods and in some cases dairy, which may exacerbate nausea. It is also very important to stay well hydrated as your kidneys need plenty of fluid to process and excrete the chemotherapy medicines.

If you are concerned about loss of weight or loss of appetite, please discuss with your oncologist and he/she could suggest a supplement or refer you to a dietician.

Science shows that exercising during cancer treatment eases fatigue, anxiety and depression while improving quality of life and physical and emotional wellbeing.

Your oncologist can advise you on what type of exercises you can do before, during and after treatment.

Yes, many of our patients remain in their jobs and maintain a productive lifestyle during treatment. It is important to find the most effective balance of treatment to fight cancer, yet minimally impact our daily routines, including work. Most patients find working helps one cope and can be a good distraction. If you feel you cannot work, we are also able to make provisions for this.

You may experience side effects or none at all. This depends on the type and amount of chemotherapy you get and how your body reacts. Before you start chemotherapy, talk with your doctor or nurse about which side effects to expect.

We mentioned earlier that chemotherapy works by destroying cancer cells. Unfortunately, chemotherapy cannot tell the difference between a cancer cell and a healthy cell. Therefore, chemotherapy can cause side effects, especially those related to fast growing cells.

These are a few of the most common side effects:

  • Fatigue
  • Hair loss
  • Easy bruising and bleeding
  • Infection
  • Anaemia (low red blood cell counts)
  • Neutropenia (low neutrophil count)
  • Nausea and vomiting
  • Appetite changes
  • Constipation or diarrhoea

The length that you may experience side effects depends on your health and the kind of chemotherapy you get. Most side effects go away after chemotherapy is over, but in some cases it can take months or even years for them to go away. Sometimes, chemotherapy causes long-term side effects that do not go away. These may include damage to your heart, lungs, nerves, kidneys, or reproductive organs. Ask your doctor or nurse about your chance of having long-term side effects.

Doctors have many ways to prevent or treat chemotherapy side effects and help you heal after each treatment session. An example would be taking anti-nausea medication prior to and after treatment. Talk with your doctor or nurse about which ones to expect and what to do about them. Make sure to let your doctor or nurse know about any changes you notice, as they may be signs of a side effect.

  • High fever
  • Bleeding or unexplained bruising
  • Rash
  • Allergic reaction such as swelling of the mouth or throat, severe itching
  • Difficulty breathing
  • Pain

Only 5-10% of all cancers are inherited. It is very important to mention a family history to your oncologist, bearing in mind that a positive diagnosis does not mean your children/siblings will necessarily inherit the disease.

Screening helps to find health problems before symptoms appear and ensures treatment of the cancer in an earlier and more easily treatable stage. It gives a patient the best chance for successful treatment.

There are various tests that can be used to screen for cancer depending on the type of cancer. Examples of screening tests would be a mammogram to detect breast cancer or PSA in males to detect prostate cancer.

Each person responds differently to treatment. Your doctor will monitor you closely and schedule appropriate tests to evaluate the effectiveness of your treatment. Your doctor may keep your treatment the same or adjust your treatment depending on the results of your tests.

Your doctor may decide to send you for some investigations prior to starting your chemotherapy, such as scans, bloods, heart tests and more. You may need to wait for a few days for your medical aid to register you onto the oncology programme. Please note that there may be a waiting period (7-10 days), depending on your medical aid, from when your doctor prescribes the chemotherapy to commencement.

Radiotherapy

Radiotherapy is administered on an out-patient basis, meaning you will not need to stay overnight. Typically, a treatment will last for about 10 to 20 minutes.

Three-dimensional conformal radiotherapy (3DCRT) involves taking detailed digital images of a tumour and the surrounding normal structures (bones, organs, etc.) to deliver highly “conformed” (focused) radiation to match the shape of a tumour.

Intensity-modulated radiotherapy (IMRT) allows doctors to adjust the intensity of a radiation beam so that the tumour receives a very high dose of radiation, while minimising the exposure of normal tissue. Your clinical team uses three-dimensional scans of the target site to visualise the treatment “field” from many different angles. At each of these angles, the intensity of the radiation beam is modulated, and the shape of the beam is changed to match the shape of the tumour.

Volumetric modulated arc therapy is a form of IMRT where the beam is constantly rotated around the patient. This limits side effects and enables adequate treatment of the tumour.

It is the process in which the radiotherapy team plans the appropriate external (or internal) radiotherapy so that you will receive the exact dose of radiotherapy in the area to be treated.

You may need to wear a mould or mask on the part of your body that is being treated to help keep you still. This will be made before your treatment starts. It might feel uncomfortable, but you won’t have it on for very long.

A small, permanent mark (tattoo) may also be made on the skin to show the exact place the radiotherapy should be directed. Inform your radiotherapists if you’re worried about any part of the radiotherapy process. It’s important that you feel involved and comfortable to ask questions at any time. They will give you advice on how to care for your skin during treatment.

The planning team will contact you with a date and time once the planning process is complete. You will be given an appointment which could vary from 10 to 20 min.

You will be set up in the same position as you were scanned in. A set of verification x-rays will be done to verify you are in the same position. Once the x-rays are matched to the initial CT images, the treatment delivery process commences.

Your doctor and treatment team will advise you whether you will need a driver.

Unlike hair loss during chemotherapy, radiotherapy only causes hair loss in the area being treated.

If you receive external beam radiation you will not be radioactive.

Radiotherapy to the abdominal and head area may result in nausea. Nausea can be controlled with medication.

You will see your oncologist weekly, however if you are feeling unwell, do not hesitate to see your doctor.

Yes, if you are tired, take a rest. Listen to your body.