Common Chemotherapy Questions and Answers 1. What is chemotherapy? Chemotherapy refers to the treatment of tumors with drugs. So far, it has become one of the three main means of tumor treatment, along with surgery and radiation therapy. Chemotherapy began in the 1940s of this century, when a few patients with leukemia and lymphoma were treated with nitrogen mustard and achieved amazing efficacy, which is considered to be the beginning of modern tumor chemotherapy. By the end of the 1960s, most of the currently used chemical drugs had been discovered, and began to recognize the importance of tumor cell kinetics and chemotherapeutic drug pharmacokinetics, for the tumor cell proliferation cycle of each link, the selection of different chemotherapeutic drugs, which resulted in the production of a combination of several drugs chemotherapy program. In the 1970s, more tumors had more mature protocols, and after the 1980s, the emergence of new drugs with different mechanisms of action made tumor chemotherapy more colorful, and the concept that chemotherapy can cure some tumors has been universally accepted, and people no longer regard chemotherapy as a palliative treatment for advanced cancers, but pursue to cure tumors with chemotherapy. 2.What is the status of chemotherapy in current tumor treatment? At present, tumor treatment emphasizes on comprehensive treatment, which means that according to the patient’s physical condition, pathological type of tumor, invasion range and development tendency, chemotherapy should be applied reasonably with existing therapeutic means (e.g., chemotherapy, chemotherapy, chemotherapy, chemotherapy, chemotherapy). It means that according to the patient’s physical condition, pathological type of tumor, scope of invasion and tendency of development, the existing treatment means (including surgery, radiotherapy, chemotherapy and biotherapy) should be applied reasonably, so as to increase the cure rate substantially. The main role of chemotherapy in this has three main aspects. Firstly, as a radical treatment means, chemotherapy can achieve better curative effect for hematopoietic malignant tumors and some solid tumors, such as leukemia, malignant lymphoma, choriocarcinoma, seminoma, etc. Secondly, it is used as a postoperative adjuvant chemotherapy, because surgery and radiotherapy are local treatments, which can cure some tumors that are more confined and tend to disseminate very little, but can not prevent or reduce the metastasis from afar, whereas chemotherapy belongs to the systemic treatment, which can Chemotherapy is a systemic treatment, which can kill the residual cancer cells or tiny metastatic foci in the body, so that a considerable part of the tumors that are easy to spread can be cured. For example, the 5-year survival rate of osteosarcoma is only 20% after single surgical treatment, and most of the patients fail to be treated because of lung metastasis and other distant dissemination, but the survival rate of 5-year can be increased to 60%~80% by adopting preoperative or postoperative chemotherapy; and then, for example, in the case of breast cancer, especially in the case of patients with a higher number of metastasis to the axillary lymph nodes, if chemotherapy is not available after surgical treatment, then chemotherapy will be used. If chemotherapy is not available after surgery, most patients will have distant metastasis and the disease will become incurable, on the contrary, postoperative adjuvant chemotherapy can greatly reduce the risk of distant metastasis; thirdly, chemotherapy can be used as a palliative treatment for patients with advanced tumors, prolonging patients’ survival and improving their quality of life. For example, patients with advanced multiple myeloma often suffer from severe pain due to multiple bone destruction, lose their ability to take care of themselves, and are often accompanied by fever and infections, which results in extremely poor quality of life and a median survival period of 3~11 months. The median survival period is 3~11 months. After adopting chemotherapy, the patient’s symptoms can be improved very quickly, and the survival period is prolonged, and the median survival period can be more than 2 years, and a few patients with good therapeutic effect can even reach 7 years or more. It can be seen from the above that chemotherapy as a systemic therapy occupies an increasingly important position in comprehensive treatment. With the development of various new drugs and the progress of basic research, chemotherapy will become one of the most active fields of research in the future, and the scope of application will be more and more extensive. 3.What kind of tumors is chemotherapy more effective for? After the efforts of scholars from various countries in recent years, the current cancer chemotherapy has achieved good therapeutic effect on some tumors. Tumors that can be cured by chemotherapy include: choriocarcinoma of epithelium, seminoma of Bongmaru, malignant lymphoma, acute leukemia in children, rhabdomyosarcoma, neuroblastoma, nephroblastoma, these tumors are sensitive to chemotherapeutic drugs, and the cure rate is more than 30%, and if the lesion is still in early stage, the cure rate can reach 90%. Tumors that can prolong survival through chemotherapy include acute granulocytic leukemia, adult acute lymphoblastic leukemia, small-cell lung cancer, osteosarcoma, and their cure rates range from 5% to 30%. Although some tumors can not be cured by chemotherapy, but it can make the patient’s symptoms relieved, such as advanced breast cancer, bladder cancer, prostate cancer, multiple myeloma, endometrial cancer, renal cancer, melanoma, head and neck cancer, and chronic granulocytic or chronic lymphocytic leukemia, etc. Some of these patients can survive for a long time with the tumors after chemotherapy, and the quality of their life can be improved. 4.What are the reasons for chemotherapy failure and what should be done after failure? There are three main reasons for chemotherapy failure. Firstly, in terms of patients, the patients’ own bone marrow function is poor, or the function of other important organs such as heart, liver, kidney, lungs, etc. is incomplete, and the general condition is too poor to tolerate chemotherapy; secondly, in terms of tumors, the tumors are too big and have primary or secondary resistance to chemotherapy drugs; thirdly, in terms of drugs, they are not selective enough, and are ineffective or inefficient for the slow-growing or temporarily in the dormant stage of the cancer cells. Most of the drugs cannot pass the blood-brain barrier to the brain tissue, forming a “refuge” for cancer cells, and the most effective way of using drugs has not been found yet. For the above reasons, corresponding measures can be taken. Firstly, actively improve the general condition of patients, provide symptomatic supportive treatment, and give colony-stimulating factor to patients with poor bone marrow function, so as to stimulate the differentiation and growth of bone marrow. Try to avoid the use of drugs that are toxic to damaged organs, such as patients with renal insufficiency, do not use platinum anticancer drugs; secondly, reduce the tumor load, reduce drug resistance, and consider surgical resection of large tumors that are still limited in lesions, i.e. “tumor reduction surgery”. Thirdly, fat-soluble drugs such as nitrosoureas and Wiman can be used or injected into the tube to make the drugs pass through the blood-brain barrier; in addition, interventional therapy can also increase the concentration of drugs in the lesion area. For the common drugs that have been widely used in clinical practice, the improvement of the route and method of drug delivery can also increase the local drug concentration, bioavailability and efficacy. For example, the oral dosage form of VP- 16 and 5-FU. The development and application of drugs with new mechanism of action can be effective for some recurrent refractory tumors, such as paclitaxel for recurrent ovarian cancer, new aromatic esterase inhibitors and paclitaxel for recurrent breast cancer, topoisomerase I inhibitor for advanced colorectal cancer, etc. The new combination chemotherapy program is also effective for tumors that have failed to recur. 5.Which patients are not suitable for chemotherapy and why? First of all, patients with unclear diagnosis are not suitable for chemotherapy as diagnostic treatment because chemotherapeutic drugs have various kinds of adverse reactions, which have certain damage to bone marrow, heart, liver, kidney and other organs; and sometimes chemotherapeutic drugs have certain effect on tuberculosis, benign reactive hyperplasia and so on. If we think that as long as the swelling shrinks after chemotherapy, it must be cancer, then it will cause a lot of misdiagnosis and bring undue pain and loss to the patients. For example, we have seen such a patient, due to mediastinal swelling, in the absence of cytology or pathology to confirm the diagnosis, according to the malignant lymphoma to give a sufficient amount of systemic chemotherapy, after the treatment of mediastinal swelling has shrunk, but not very obvious, and then changed to use a stronger chemotherapy program, resulting in the patient’s death of a serious adverse reaction, confirmed by autopsy of the mediastinal mass of the mediastinal lymph node nodule tuberculosis. Lessons such as these caution that chemotherapy is not a diagnostic agent or placebo, and should not be used arbitrarily, but must be confirmed by pathology or cytology and under the guidance of a medical oncologist before use. In addition, when some tumors can be cured by local treatment (surgery or radiotherapy), it is not necessary to add systemic chemotherapy. For example, for basal cell carcinoma of skin, the 5-year survival rate after radiotherapy reaches 90%; the 5-year survival rate after surgical resection is 80%, and if the diameter of the lesion is less than 2 cm, the 5-year survival rate is 100%. There are still central nervous system tumors, some head and neck cancers, etc., which often take local recurrence as the main problem. If the lesions have been controlled locally, systemic chemotherapy is not necessary. Of course, if the patient is old and weak, the liver or kidney function is not compensated, obvious anemia, leukopenia or thrombocytopenia, cardiomyopathy, infection and fever, etc., chemotherapy is not suitable for the patient, and it is necessary to improve the above symptoms first, or the patient can hardly tolerate it. 6.When should chemotherapy be stopped? If one of the following situations occurs during chemotherapy, the drug must be stopped for observation and necessary measures must be taken: frequent vomiting, vomiting after eating, or even vomiting bile, which seriously affects eating and leads to electrolyte disorders, such as potassium, sodium and chloride; diarrhea with watery stools, more than 5 times a day or bloody diarrhea, abdominal pain, which is manifested as dehydration and electrolyte imbalance; leukocytes drop to less than 3,000/microliter, or accompanied by infections. Fever, platelet drop to below 60,000/µl or accompanied by skin bleeding spots and other bleeding tendencies, such as bleeding gums, nosebleeds, puncture points that are not easy to stop bleeding, etc.; cardiac lesions, feeling of panic, palpitations, shortness of breath, rapid heart rate, or arrhythmia; toxic hepatitis, i.e., chemotherapeutic drugs damage to the liver cells resulting in increased aminotransferases, jaundice, and low-protein blood; toxic nephritis, with urinary oliguria, edema, and elevation of blood urea nitrogen or creatinine Chemical or radioactive pneumonia, some chemotherapy drugs such as pingyangmycin can lead to pulmonary fibrosis, patients feel dyspnea, cough, fever. For all the above situations, chemotherapy must be discontinued first, and then use other symptomatic supportive treatment measures, otherwise it will lead to life-threatening. 7. Are all patients treated with chemotherapy in advanced stages? No, they are not. It is because chemotherapy has gradually progressed from palliative treatment to radical treatment. The traditional tumor treatment mode: surgery→radiotherapy→chemotherapy→Chinese medicine, i.e., early surgery, medium-term radiotherapy, late chemotherapy and Chinese medicine, obviously cannot adapt to the needs of modern oncology. Comprehensive treatment is the current principle of tumor treatment, and with the continuous emergence of new effective chemotherapeutic drugs, the role of chemotherapy in comprehensive treatment is becoming more and more important. Some tumors sensitive to chemotherapy, such as leukemia, malignant lymphoma, choriocarcinoma, etc., can be cured by chemotherapy alone; if the tumor is too large and difficult to be removed surgically, chemotherapy can be used to fight for the chance of surgery when the tumor shrinks; postoperative adjuvant chemotherapy is indispensable in the treatment of breast cancer, osteosarcoma, testicular tumor, etc. Certainly, some patients with advanced tumors are also the indications for chemotherapy, and it can prolong the life of the patient or alleviate the pain of the patient. Therefore, the condition of patients with chemotherapy is not necessarily advanced; according to the type of disease and sensitivity to chemotherapy, patients with chemotherapy may be in the early, middle or late stage. 8. How to calculate the cycle and duration of chemotherapy? When doctors ask patients or their families about the number of cycles or duration of chemotherapy, most of them cannot answer correctly and often confuse the two. The correct calculation method is: from the first day of injection of chemotherapy drugs, to 21 days or 28 days, that is, 3 to 4 weeks called a cycle, in a cycle is not every day with chemotherapy drugs, usually the first 1 to 2 weeks of drugs, after 1 to 2 weeks of rest, the purpose is to enable the patient to take a short break, to be the bone marrow function to return to the normal level, but there are some chemotherapeutic drugs inhibit the bone marrow of the time is late, the recovery is slow, so the individual program needs 6 weeks to be counted as a cycle, so it is not necessary to calculate the number of cycles and duration of treatment. Individual regimens need 6 weeks to be counted as a cycle. A course of treatment means 2~3 cycles of continuous chemotherapy, and some tumors need 4~6 cycles of chemotherapy to be counted as a course of treatment. After a course of treatment, there is often a long period of rest, usually 2~3 months, which aims to restore or rebuild the immune function of the patient’s body, so that the patient’s organs can be fully regulated, and the doctor will also suggest the patient to use some drugs or nutritional drugs that can improve the immune function during this period of time. If the condition needs to enter the next course of chemotherapy. 9.What should I pay attention to when using chemotherapy? Most of the existing chemotherapeutic drugs, while inhibiting or killing cancer cells, also have toxic effects on normal cells in the body, especially bone marrow hematopoietic cells and gastrointestinal mucosal epithelial cells. The most common manifestations are reduction of white blood cells or platelets, loss of appetite, nausea, vomiting or diarrhea. Therefore, blood tests, including hemoglobin, white blood cells and platelets, should be performed at least once a week during chemotherapy. When white blood cells decrease, avoid going to crowded places to avoid increasing the chance of bacterial or viral cross-infection; if the white blood cell count falls below 2,000/microliter or accompanied by fever, it is best to go back to the hospital to be treated by a doctor. The risk of falling platelet count is to cause bleeding, should avoid bruises, and prefer to eat soft food, skin bleeding points should be promptly told to the doctor, there is no effective drugs to raise platelets, mainly rely on transfusion of fresh platelets. During chemotherapy, the diet should be hygienic, light, nutritious food, available better anti-emetic drugs, general symptomatic treatment can greatly reduce gastrointestinal reactions, and the individual differences between patients, nausea and vomiting degree varies, so do not equate chemotherapy and vomiting, avoid self-referential. In addition, attention should be paid to oral hygiene, and rinse the mouth after each meal to avoid mouth ulcers. If diarrhea occurs during chemotherapy, especially if it occurs more than 5 times a day, you should tell your doctor about it. Some chemotherapeutic drugs can cause hair loss, the patient or his family should be psychologically prepared, can prepare a good wig, generally 2~3 months after stopping chemotherapy can grow new hair, without causing long-term effects. In conclusion, chemotherapy drugs have various toxic side effects. Chemotherapy patients in the body’s immune function is low, so they should regulate their emotions, do not worry, distress or impatience, with the doctor to complete a good chemotherapy program. 10.How many cycles of chemotherapy are appropriate? How many cycles of chemotherapy should be done depends on the condition and type of disease. Generally speaking, for diseases suitable for adjuvant chemotherapy, such as pre-menopausal breast cancer, testicular cancer, soft tissue sarcoma and lung cancer, etc., when the primary tumor has been removed by surgery and no distant dissemination has been detected by clinical examination, in order to kill tiny metastatic foci in the body, it is necessary to carry out 4-6 cycles of chemotherapy, because a large number of clinical researches have shown that 4-6 cycles of regular and sufficient chemotherapy are sufficient to kill cancer cells that are sensitive to chemotherapeutic drugs in the body. Even if the remaining drug-resistant cells are treated with additional chemotherapy, it is difficult to extend the number of cycles. For the preferred types of chemotherapy, such as malignant lymphoma, small-cell lung cancer, etc., the suitable number of cycles of chemotherapy is when the tumor has completely disappeared and then 2 cycles are added, for example, if the tumor has completely disappeared after 4-6 cycles of chemotherapy, then 2 cycles are added, that is, the total number of cycles of chemotherapy is 6-8 cycles. However, sometimes for tumors with extremely high malignancy or tumors that are very easy to recur, the number of cycles can be increased appropriately, but it is not advocated to prolong the chemotherapy time without any limitation.