How Chemotherapy Is Given

Chemotherapy (also called chemo) uses drugs to kill cancer cells or slow their growth. But there is no single way to give it. The method your team chooses depends on your type of cancer, the drugs being used, and where the cancer is in your body.

Chemotherapy can reach your body in several different ways, and your team picks the one that fits your treatment.

Chemotherapy may be given in many ways. Some common ones are:

• Oral: pills, capsules, or liquids that you swallow.
• Intravenous (IV): the drug goes directly into a vein.
• Injection: a shot given into a muscle in your arm, thigh, or hip, or just under the skin in the fatty part of your arm, leg, or belly.
• Intrathecal: injected into the space between the layers of tissue that cover the brain and spinal cord.
• Intraperitoneal (IP): placed directly into the peritoneal cavity, the area that holds organs such as the intestines, stomach, and liver.
• Intra-arterial (IA): injected directly into the artery that leads to the cancer.
• Topical: a cream that you rub onto your skin.

Of all these methods, chemotherapy is most often given by IV.

There is a logic to that list. Most chemotherapy has to reach cancer cells anywhere in the body, so it goes into the bloodstream and travels everywhere. The other routes exist to put a drug where blood alone does not carry it well, or to concentrate it right where the cancer sits. Intrathecal delivery places it in the fluid around the brain and spinal cord. Intraperitoneal delivery bathes the surfaces inside the abdomen. Intra-arterial delivery sends it down the exact vessel feeding a tumor.

For IV chemotherapy, a nurse places a thin needle in a vein on your hand or lower arm. The nurse puts the needle in at the start of each treatment and removes it when treatment is over.

IV chemotherapy can also be given through a catheter or a port, and sometimes with the help of a pump.

A catheter. A catheter is a thin, soft tube. A doctor or nurse places one end in a large vein, often in your chest area, while the other end stays outside your body. Most catheters stay in place until you finish your chemotherapy. Catheters can also be used to give other drugs and to draw blood.

A port. A port is a small, round disc that a surgeon places under your skin during minor surgery. It is put in before your treatment begins and stays until you finish. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into the port to give chemotherapy or draw blood. This needle can be left in place for treatments given over more than one day. A port spares the veins in your arm over many months of treatment. The trade is a minor operation to place it, plus care to keep the site clean.

A pump. Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes in, which can let you receive treatment outside of the hospital. External pumps stay outside your body. Internal pumps are placed under your skin during surgery.

Watching for infection. With a catheter or a port, be sure to watch for signs of infection around the area and tell your care team if you notice any.

Oral chemotherapy is easy to think of as a lesser thing. It is not. Because you take it at home, the schedule is yours to keep, and a missed or doubled dose matters exactly as much as it would in an infusion chair. Ask how to store the pills. Ask what to do if you vomit soon after a dose. Ask whether anyone else in the house needs to avoid handling them.

There are many different chemotherapy drugs. Which ones are part of your plan depends mostly on:

• the type of cancer you have and how advanced it is
• whether you have had chemotherapy before
• whether you have other health problems, such as diabetes or heart disease

Your care team matches both the drugs and the method to your situation.

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor's office, clinic, or hospital. Outpatient means you do not stay overnight.

No matter where you go, your doctor and nurse will watch for side effects and help you manage them. If you receive chemotherapy at home through a pump, your team will teach you and your caregivers what to do and what to watch for.

Three practical questions are worth asking before the first visit. How long does each visit take, from arriving to leaving? Can you drive yourself home afterward? And is a port recommended for your particular regimen?

• Call 911 or go to an emergency department if your throat tightens, your lips or face swell, you wheeze, or you go faint during an infusion or in the hours after one. Tell the nurse at once if you are still in the chair.
• Ring your care team straight away, at any hour, if you record a temperature of 100.4°F (38°C) or higher, or you get shaking chills. The CDC treats a fever during chemotherapy as a medical emergency, because it may be the only sign of an infection that can turn life-threatening. If you cannot get hold of them quickly, go to an emergency department and tell the staff there that you are on chemotherapy.
• Call your care team the same day if the skin over a port or catheter turns red, warm, swollen, or starts to leak.
• Call your care team within a day or two if the vein or port site is still sore, firm, or discolored a day after the drip, or if a take-home pump alarms and you cannot sort it out.

Sources: National Cancer Institute: infection and neutropenia during cancer treatment, CDC: watch out for fever and Extravasation reactions, Holland-Frei Cancer Medicine.