The Side Effects Of Chemotherapy

Chemotherapy is an important tool in our fight with cancer, and helps save many lives. However, it also has heavy side effects. Since it is a life saving measure, the side effects, however debilitating they may be, need to be endured. Knowing about them prepares the patient and their family in a better way to cope with them.
The Side Effects of Chemotherapy
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Chemotherapy usually refers to treatment of cancer by use of medicines, which selectively destroy the cancer cells. These chemotherapeutic drugs destroy the fast growing abnormal cancer cells, but while destroying them, these medicines also damage some normal cells, and in the process cause various unpleasant side effects in the body. These side effects are a major limitation in the use of chemotherapy, and often one of the most stressing part of cancer treatment for the patient.

Reason for Heavy Side Effects of Chemotherapy

The chemotherapeutic medicines interfere with the process of cell division, by which cells grow and multiply. Since the cancer

cells grow very fast, these medicines interfere in their growth and destroy them. Unfortunately, in the body, there are several type of normal cells that also grow and multiply faster than other cells, and hence also become a target for destruction by the cancer chemotherapy. These cells include red and white cells of blood, platelets, hair cells, skin, mucosal cells lining the inside of mouth, stomach and intestines and lymphatic cells involved in body immunity. Damage to these cells leads to the various adverse side effects that are associated with cancer chemotherapy.

Types of Side Effects Induced by Chemotherapy

These side effects are of three major types, immediate reversible side effects, long term side effects and organ toxicity affecting particular organs.

I. Immediate Reversible Side Effects

Most common side effects of cancer chemotherapy fall in this category. Needless to say that though not permanent, they are a very distressing experience, and seriously hamper the quality of life till they last. They include the following.

1. GENERAL SICKNESS - Damage to various cells within the body leads to a general feeling of sickness, which is particularly aggravated by the effects on digestive system.

2. NAUSEA & VOMITING - Nausea and vomiting result from the damage to the cells lining the stomach and the intestines and sensations of this injury sent to a certain 'vomiting center' in brain through the vagus nerve. It can be best managed by using 'ANTI-EMETICS' like DOLASETRON (ENZEMET), a serotoinin inhibitor and APREPITANT (EMEND), a substance P inhibitor, which block the carriage of this sensation to the emetic center and thus relieve nausea and vomiting.

3. DIARRHEA OR CONSTIPATION - Damage to the cells lining the intestines can lead to either diarrhea or constipation. It is best to manage it with changing dietary habits, using a lot of vitamins and dietary supplements.

4. MALNUTRITION & WEIGHT LOSS - Malnutrition results from inability to eat and digest normally due to injury to the stomach and intestinal lining. It is preferable to eat more often in small meals, and avoid fried spicy or flavored food. It may be preferable to eat semi-solid food with milder taste.

5. HAIR LOSS - Hairs being a fast growing part of the body are earliest to be effected. However, unlike hair loss of radiotherapy, the loss of hair in case of chemotherapy is temporary and usually reverts fully a few weeks after the chemotherapy is stopped.

Long Term Side Effects

These side effects persist even after the chemotherapy is completed, and may not fully revert back to normal even after years. Some of them may appear some months or years after chemotherapy.

1. BONE MARROW SUPPRESSION - It is a condition in which chemotherapy damages almost all stem cells of the bone marrow from which red and white blood cells are borne, leading to severe aplastic anemia, leucopenia or shortage of white cells in blood, and platelet deficiency. Untreated, the condition can become fatal and hence immediate treatment with blood transfusion is required, followed by bone marrow transplantation, which can be AUTOLOGOUS, i.e.. from own cells which are removed from the patient, multiplied and re-injected, or ALLOGENIC, i.e.. from another donor.

2. IMMUNOSUPPRESSION - The loss of immunity resulting from fall in white blood cell count is a somewhat milder form, which may not be permanent but can lead to severe infections that by itself can become a danger to life. Treatment consists of blood transfusion and synthetic growth factors, like FILGRASTIM which stimulate the growth of white cells.

3. SECONDARY NEOPLASMS - One risk of chemotherapy in all forms is the possibility of development of another kind of malignant tumor, in blood, or other organs, that may happen many years after chemotherapy.

4. PREMATURE MENOPAUSE - Damage to ovarian cells caused by chemotherapy can lead to a premature onset of menopause.

III. Organ Toxicity

1. CARDIOTOXICITY - Chemotherapy can also damage the muscles of the heart, and interfere with its functioning. The probability of cardiotoxicity (damage to heart) is reported to lessen with the use of a new medicine called TRASTUZUMAB (HERCEPTIN).

2. HEPATOTOXICITY - This is caused by the metabolic products which may cause damage to the liver cells in the process of clearing the metabolites of the medicine from the body. Certain chemotherapeutic drugs are more hepatotoxic than others.

3. NEPHROTOXICITY - Chemotherapy can also cause damage to the kidneys through which it is excreted out of the body. It is more common with certain agents like CISPLASTIN and CYCLOPHOSPHAMIDE.

4. OTOTOXICITY - Impairment of hearing is a specific side effect observed only with certain chemotherapeutic drugs like CISPLASTIN and VINCRISTINE. There is no treatment except withdrawing the culprit medicine and replacing it with a non-ototoxic option.

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