Chemotherapy

"The Department of Medical Oncology performs great teamwork, which has allowed for various advances in oncology and the development of personalised medicine".

DR. ANTONIO GONZÁLEZ
DIRECTOR. MEDICAL ONCOLOGY DEPARTMENT

What is chemotherapy?

The term chemotherapy refers to the set of drugs used in the treatment of cancer whose aim is to prevent the reproduction of tumor cells and thus reduce the disease.

The drugs used in this type of treatment are called antineoplastic or chemotherapeutic drugs.

The frequency and duration of chemotherapy depends on the type of cancer, the objectives of the treatment, the drugs to be used and the way the body responds to them.

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When is chemotherapy indicated?

Depending on the sensitivity to chemotherapy, the tumors can be classified into three groups:

Chemosensitive: represents those tumours in which chemotherapy achieves a response in more than 50% of cases and a complete disappearance of the tumour in 15-20% of patients. Breast cancer, ovarian cancer, prostate cancer or small cell lung cancer are characteristic examples.
Chemotherapy: those tumors that disappear and are cured with chemotherapy such as Hodgkin's lymphoma, high-grade non-Hodgkin's lymphoma, testicular carcinoma or embryonic ovarian carnage.
Chemoresistant: those tumors where chemotherapy does not achieve a response in at least half of the patients and, therefore, survival is not significantly increased with chemotherapy. These include melanoma, hepatocarcinoma and kidney cancer.

Therefore, the objectives of chemotherapy depend on the type of tumor and its sensitivity to treatment, as well as the tumor stage or the stage of development of the disease in which it is found.

Depending on this, chemotherapy can be used for:

Cure cancer.
Prevent the cancer from spreading.
Slowing down the growth of the cancer.
Destroy cancer cells that may have spread to other parts of the body from the original tumor.
Relieve symptoms caused by the cancer.

Most frequent indications of this treatment:

Colorectal cancer
Breast cancer
Lung cancer
Prostate cancer
Other tumors...

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It may be necessary to begin treatment with chemotherapy

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How is chemotherapy treatment performed?

Chemotherapy is given in cycles, alternating periods of treatment with periods of rest. A cycle is the period of time from the administration of the treatment (and includes the rest period) until the next administration.

There are different ways of administering chemotherapy. The choice depends on the type of cancer, its location and, especially, the chemotherapy drugs to be used.

The most common route is intravenous, which is administered through a tiny plastic tube or catheter that is placed in a peripheral or central vein temporarily or permanently (picc or port-a-cath).

Other routes of administration are:

Oral: increasingly common in a growing number of tumor indications.
Intrathecal: the catheter is placed in the spinal canal.
Intraarterial: the drug is injected directly into an artery to treat a single area (such as the liver, arm or leg).
Intraperitoneal: inside the abdominal cavity.
Other: intramuscular, intralesional or topical.

During treatment, or after it has been completed, it is necessary to carry out studies to find out the tumour response to chemotherapy. Through them it is possible to know if the tumor has disappeared (complete response) or decreased (partial response), if it remains stable (stable disease) or if it has followed its evolution (disease progression).

The response of the tumor to treatment is independent of the number and intensity of side effects caused by the treatment.

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Depending on when the chemotherapy is administered we can talk about

Induction or neoadjuvant chemotherapy: Chemotherapy is administered first, before any local treatment such as radiotherapy or surgery, with the intention of reducing the amount of disease so that it is operable.
Concomitant chemotherapy: it is administered simultaneously to another treatment, generally radiotherapy, in order to boost its effect.
Adjuvant chemotherapy: it is performed in a complementary manner to another treatment, generally surgery, with the aim of reducing the risk of relapse of the disease.
Palliative chemotherapy: it is administered to patients with tumors that have developed distant metastases and the purpose of treatment is not curative.

Toxicity secondary to chemotherapy should be evaluated for severity, frequency, and duration.

The most common side effects are: nausea and vomiting, decreased appetite and weight loss (anorexia), hair loss or alopecia, diarrhea or constipation, fatigue (asthenia), mouth sores (mucositis), dry skin or dermatitis (acne), anemia, and increased risk of infection.

Side effects do not always appear and, when they do, are usually tolerable.

Currently, there are medications that allow these discomforts to be controlled and patients can lead a practically normal life while receiving treatment. On other occasions, it is necessary to slow down the pace of life and rest for a few days after the administration of the treatment.

The Medical Oncology Department of the Clinic has a Nursing Area that is specialized and in permanent contact with the patients to minimize these risks. In addition, it works together with the Palliative Medicine Service offering a global attention so that the survival and quality of life are maximum.

Where do we do it?

IN NAVARRA AND MADRID

The Department of Medical Oncology
of the Clínica Universidad de Navarra

Prevention and early detection are the most effective weapons we have in the fight against cancer. Therefore, together with the Genomic Medicine Unit, we have five programs: breast cancer, lung cancer, colon cancer, melanoma and prostate cancer.

We have a Day Hospital, with highly qualified staff, which offers specialized outpatient care to oncology and hematology patients.

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