During Treatment

Chemotherapy is a systemic therapy and is a common type of cancer treatment. You may hear chemotherapy referred to as "chemo". Chemotherapy uses different kinds of medicines to kill cancer cells.

There are more than 100 types of chemotherapy medicines. Depending on your cancer, your chemotherapy treatment may include one medicine or combine many chemotherapy medicines.

Many people may be worried about getting chemotherapy. But learning about what chemotherapy is, how it works and what to expect may help you feel less fearful. Chemotherapy can be used on its own or with other treatments like radiation therapy. The treatments you get, and in what order you get them, are based on details about your cancer.

Chemotherapy can be used to:

• Kill cancer cells
• Slow the growth of cancer
• Keep cancer from spreading
• Help manage cancer symptoms, like pain
• Cure cancer

The goal of your chemotherapy treatment will depend on details about your health and your cancer. Ask your medical oncologist (a cancer doctor trained in giving systemic therapies) what the goal of your treatment is.

Chemotherapy kills cells that multiply or grow quickly, like cancer cells. Unlike radiation therapy and surgery, which can target specific areas, chemotherapy works throughout the whole body. That is why chemotherapy is called a systemic therapy. Chemotherapy travels through your blood to reach cells over your entire body, or system.

Chemotherapy destroys cancer cells, but it also damages normal, healthy cells. These are the normal cells most likely to be damaged from chemotherapy:

• Blood cells
• Cells in the gut
• Cells in the mouth
• Hair cells
• Reproductive cells (cells that are needed to produce children)

The damage to normal, healthy cells is the reason for many of the side effects of chemotherapy. Normal cells that are damaged can be repaired or replaced when new healthy cells grow. Because normal, healthy cells can be replaced, most side effects are short-term and will go away after chemotherapy ends.

Each person reacts in their own way to chemotherapy. Even people who are taking the same kind of chemotherapy may react in different ways. Talk to your medical oncologist (cancer doctor) or nurse about what side effects to expect.

Side effects depend on:

• The type of chemotherapy you will get
• The dose (amount) you get
• How your body reacts to the chemotherapy

The most common side effects of chemotherapy are:

• Cancer-related fatigue
• Low blood counts
• Nausea (feeling like throwing up) and vomiting (throwing up)
• Diarrhea (loose or watery poo)
• Constipation (trouble having a poo)
• Mouth sores
• Hair loss
• Skin and nail changes
• Brain fog (trouble thinking)

There are many ways to prevent or reduce some of these side effects. Speak to your cancer care team about what you can do to manage side effects of chemotherapy. The Cancer Journey Planner includes a Side Effects Tracker (page 69) to help you track your side effects. Visit the Princess Margaret Patient & Family Library for more information.

Learn more about chemotherapy and what to expect:

• Learn more about the Systemic Therapy Unit
• Watch the Chemotherapy Overview Class video

Radiation is a common treatment for cancer. Radiation therapy uses high energy x-rays to kill cancer cells. Radiation therapy is called a local treatment. Local means the radiation affects the part of the body that is being treated. Radiation may be combined with other types of treatment.

Radiation therapy can be used to:

• Kill the cancer cells
• Slow the growth of the cancer
• Help manage cancer symptoms, like pain

The goal of your radiation treatment will depend on details about your health and your cancer.

There are 3 different ways to get radiation therapy:

• External beam radiation therapy: External beam radiation therapy uses machines that aim radiation beams directly at the cancer.
• Internal radiation therapy: Internal radiation therapy, also called brachytherapy, places radiation inside your body or close to your cancer.
• Ingested or injected radiation therapy: Ingested or injected radiation therapy uses a pill (ingested) or a needle (injected) to deliver the radiation.

The side effects you may get from radiation treatment depend on the type of treatment you have and where the treatment is done in your body. Ask your cancer care team what side effects you can expect from your radiation treatment. The Cancer Journey Planner includes a Side Effects Tracker (page 69) to help you track your side effects.

Learn more about radiation therapy and what to expect:

• Learn more about the Radiation Therapy Centre
• Watch the Radiation Therapy patient education videos

Surgery is a type of treatment in which an area of the body is cut open to remove cancer.

Cancer surgery can be used to:

• Prevent cancer
• Diagnose cancer
• Stage cancer
• Treat cancer

Some people may have a high risk for cancer. If you are at high risk, your doctor may suggest surgery to help reduce and prevent the risk of cancer. This type of surgery is called preventative or prophylactic surgery. During surgery, a surgical oncologist (a surgeon trained in cancer surgery), may remove the body tissue or body part that is likely to develop cancer. Even though there is no sign of cancer at the time of surgery, removing the tissue or body part before it can develop cancer helps prevent or reduce the chance of cancer.

Diagnosing cancer means finding the cause of cancer. In some cases, surgery may be the only way to find out if someone has cancer and the kind of cancer. This is called surgical biopsy. During surgical biopsy, the surgeon removes a small piece of tissue called a sample. The sample is sent to the lab where it is tested to find out if the sample contains cancer and what type of cancer it is.

Staging cancer means finding out how much cancer there is and how far it has spread in the body. During surgery, the surgeon will remove tissue and lymph nodes near the cancer. The surgeon will have these tissue samples and lymph nodes examined in a lab to learn about the cancer. Knowing the stage of the cancer is vital to deciding treatment plans.

Surgery may be your main treatment if:

• The cancer is only in one part of the body
• The tumour or cancerous tissue can be totally removed

However, you may have other treatments like chemotherapy or radiation as well. During surgery, the surgeon will remove the tumour or cancerous tissue. The surgeon will also remove a small amount of normal tissue around where the cancer was (called the surgical margin). By removing some of the normal tissue, the surgeon can ensure that no cancer cells are left behind.

Sometimes, if not all the cancer can be removed, surgery is still done. The surgeon will try to remove as much of the cancer as possible. This is called debulking surgery. Your doctor may then treat the cancer that remains with radiation, chemotherapy or other treatments.

The side effects and risks you may have from surgery depend on:

• Where the surgery is done in your body
• The type of surgery
• Your overall health and fitness for surgery

Most side effects will go away after surgery, but some may be long term or permanent.

Possible side effects of surgery include:

• Sore throat
• Pain
• Nausea (feeling like you might throw up)
• Vomiting (throwing up)
• Bruising or bleeding
• Swelling
• Fatigue
• Scarring
• Impaired movement

It takes time to recover from surgery. You may feel tired or weak after having surgery. Before your surgery, your cancer care team will talk to you about how to deal with pain, and they may give you a prescription (medicine ordered by a doctor) for medicines to take afterwards. Tell your cancer care team if you have any side effects you think may be from surgery. Your cancer care team can help improve many side effects with treatment. The Cancer Journey Planner includes a Side Effects Tracker (page 69) to help you track your side effects.

Complementary therapies are used with standard cancer treatments. Standard cancer treatments are proven methods of treating cancer (for example, chemotherapy, radiation therapy, and surgery). Complementary therapies most often do not involve surgery or medicines. These therapies tend to be a natural approach to improving health and well-being.

Many people use complementary therapy during and after cancer treatment. People treated for cancer may use complementary therapy to:

• Relieve side effects of cancer treatment and stress
• Take an active role in improving their health and wellness

There are many types of complementary therapy. Some examples of complementary therapies include:

• Music therapy
• Natural and herbal products
• Acupuncture

Some complementary therapies can make your side effects worse or prevent your treatment from working. Talk to your doctor before you use complementary therapies. Your doctor can help you find a complementary therapy that is right and safe for you.

Alternative therapies are different than complementary therapies. Complementary therapies are used with standard cancer treatments. Alternative therapies are used instead of standard cancer treatments. Alternative therapies have not been proven to treat cancer. If you delay standard treatment to use an alternative therapy, the standard treatment may not work as well. Talk to your cancer care team if you are thinking about taking an alternative therapy.

Princess Margaret Cancer Centre is a research hospital. You may be asked if you would like to join a research study. This includes clinical trials. Cancer clinical trials involve people and are done to learn new ways to:

• Treat cancer
• Find and diagnose cancer
• Prevent cancer
• Manage symptoms and side effects of cancer or cancer treatment

Ask your doctor if there are any clinical trials you could be involved in. There may be a trial that is right for you. Being in a clinical trial or research study is always your choice.

Clinical trials follow rules to decide who can join the study. These rules are called "eligibility criteria". The rules vary for each clinical trial. Eligibility criteria may include your:

• Type of cancer
• Stage of cancer
• Specific features or characteristics of your tumour
• Your past treatments

Eligibility criteria make sure that:

• The research results are from a similar group of patients to help researchers understand the results
• You are not put at increased risk for side effects
• The research will include populations that are more likely to benefit

For more information about clinical trials, and what to consider when you join, visit Clinical Trials.

There are many websites that list current clinical trials. If you find a clinical trial you want to join, tell your doctor. Your doctor can help you know if the clinical trial might be a good fit for you.

• At Princess Margaret Cancer Centre: Clinical Trials
• In Canada and Worldwide: ClincalTrials.gov​
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