Chemotherapy

The introduction of chemotherapy in cancer therapy has completely changed the prognosis of advanced malignancies. Until several years ago, in fact, all those of neoplasms, that were not localized enough and that could not be irradiated or removed by surgery, had a fatal prognosis within a short period from diagnosis. The arrival of chemotherapy has made some neoplasms completely curable and in others is possible to obtain a consistent palliative effect followed by an extension of survival.

Chemotherapy drugs are antiproliferative drugs with cytotoxic action; they are drugs that interfere with cell proliferation and kill cancer cells.

In tumor therapy, chemotherapy can be administered alone as a single therapy, or in combination with radiotherapy or surgery.

Chemotherapy treatment has several purposes. Could be:

      • Curative

It aims to achieve tumor healing

      • Reductive (or neoadjuvant)

It aims to reduce the tumor mass before making surgery in order to make the surgery more effective.

      • Preventive (or adjuvant)

It aims to eliminate cancer cells that may have remained after surgery or radiation therapy.

      • Palliative

It is performed on patients who cannot fully heal and has the purpose to delay disease progression and increase survival.

      • Symptomatic

It aims to improve the symptoms caused by the tumor when it cannot be removed.

The method of administration of antineoplastic drugs are the follows:

      • Oral

The drug is taken by mouth in the form of capsules or tablets

      • Intravenous

The drug is injected directly into the vein

      • Intramuscular

The drug is injected into the muscle. This method of administration is used very rarely.

      • Subcutaneous

The drug is injected into the subcutaneous tissue. This method of administration is used only for a few drugs.

      • Arterial

The drug is injected into the main artery which sprinkle the tumor.

      • Intracavitary

The drug is inserted inside the body cavity where the tumor is present (e.g. bladder, pleura, peritoneum).

For many years the administration of only one type of drug (monochemotherapy) was considered the first choice treatment. Today the gold standard for most cancers is represented by polychemotherapy, i.e. the administration of multiple types of drugs.

The advantages of polychemotherapy are the following:

      • It has increased the percentage of complete healings
      • It has improved survival
      • It has reduced the serious toxicity episodes linked to the continuous administration of the same antineoplastic drug

Unfortunately, chemotherapy treatment is not free from side effects. Chemotherapy are drugs directed against cells that multiply rapidly, therefore, in addition to acting on cancer cells, unfortunately they also damage healthy cells with rapid replication (blood cells, hair bulbs cells and cells of the mucous of the digestive system).

Exactly for this reason, most of the side effects concern these organs and are:

      • Hair loss and nail alteration
      • Nausea, vomiting, diarrhea or constipation
      • Inflammation of the oral mucosa
      • Loss of appetite
      • Anemia and thrombocytopenia
      • Decreased immune defenses
      • Peripheral neuropathy manifested by tingling, impaired sensitivity and pain in the hands and feet
      • Asthenia

These disorders can be more or less intense. Often the patient is able to withstand the therapies well while many other times the toxicity is so strong that the chemotherapy treatment must be suspended or delayed.

Chemotherapy is contraindicated when:

      • Due to its characteristics, the tumor responds poorly to therapy (it is chemoresistant)
      • The tumor is in situ and has not spread to the rest of the body
      • Hematological values or other clinical conditions of the patient do not allow this
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