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VASSILIOS BARBOUNIS MD, PhD Pathologist - Oncologist | Piraeus


Chemotherapy is a form of cancer treatment. Chemotherapy relies on the use of drugs to destroy cancer cells. It can be combined with radiation and surgical procedures. Chemotherapy has begun to be applied since 1950 and has since been successfully used in many forms of human cancer and has proven to be extremely successful in breast cancer.

How it works

Chemotherapy is usually administered orally in the form of pills or solutions, subcutaneously but the primary route of administration is intravenously, either by rapid administration or by continuous infusion. The frequency of administration may be every day or every week or every three weeks depending on the chemotherapy program selected.
A chemotherapy program may include the administration of various drugs alone or the administration of combinations of two, three or more drugs. Thus, we have monotherapy or combined polychémotherapy.
Chemotherapy can be given to a hospital, a clinic, a doctor's office or a patient's home. There are often interruptions for the recovery of the body between drug administrations.

How it is given
Η χημειοθεραπεία συνήθως χορηγείται από το στόμα με την μορφή χαπιών η διαλυμάτων, η υποδόρια αλλά ο κύριος τρόπος χορήγησης είναι ενδοφλεβίως είτε με γρήγορη χορήγηση είτε με συνεχή έγχυση. Η συχνότητα χορήγησης μπορεί να είναι κάθε ημέρα ή κάθε εβδομάδα ή κάθε τρεις εβδομάδες ανάλογα με το πρόγραμμα χημειοθεραπείας που έχει επιλεγεί.
Ένα πρόγραμμα χημειοθεραπείας μπορεί να περιλαμβάνει την χορήγηση των διαφόρων φαρμάκων από μονά τους η την χορήγηση συνδυασμών από δυο, τρία, η περισσότερα φάρμακα. Έτσι, έχουμε την μονοθεραπεία ή τη συνδυασμένη πολυχημειοθεραπεία.
Η χημειοθεραπεία μπορεί να χορηγηθεί σε νοσοκομείο, σε κλινική, στο ιατρείο ή στο σπίτι του ασθενούς. Συχνά υπάρχουν περίοδοι διακοπής για ανάκαμψη του οργανισμού μεταξύ των χορηγήσεων των φαρμάκων.

When given
Chemotherapy is given at various stages of the course of a malignant disease. Depending on the timing and relationship with other antineoplastic therapies, it is called preoperative when it aims to destroy cancer cells before they move and cause metastasis of cancer but mainly reduce the volume to allow for conservative surgery with a satisfactory aesthetic effect . When the treatment is administered, it measures the surgery to be called adjuvant and aims at destroying the cancer cells that may have escaped during surgery, resulting in a reduction in the risk of tumor recurrence. When the treatment is re-administered because the disease reappears, then it is designated as the 1st line, 2nd line, 3rd line depending on the order of administration, while when it is given to fight the symptoms, it is called comforting or palliative.

Drug types
Breast cancer chemotherapy drugs can be divided into different categories depending on their mode of action or their origin and chemical structure. Knowledge of the mode of action of chemotherapeutic drugs is important in determining potential side effects.

Alkylating agents
They cause permanent damage to the genetic material (DNA) of the cancer cells, leading them to death.

Antimetabolites are a family of drugs that interfere with the structural elements of DNA and RNA of cancer cells.

Anticancer antibiotics
These drugs affect both the structure of DNA and enzymes necessary for the reproduction of cancer cells.

Inhibitors of topoisomerase
These drugs interfere with a group of enzymes called localized and help the DNA strand to be divided into two, so that the cancer cells can be proliferated. They are not used in the treatment of breast cancer.

Inhibitors of mitosis
They stop cell proliferation in the mitosis phase and lead the cancer cells to death. Most have been isolated from natural sources such as plants or marine sponges.

Corticosteroids are drugs similar to hormones secreted by the human body. When used to treat cancer, they are considered chemotherapeutic drugs. In breast cancer sufferers, they are given as antiemetics to prevent nausea and vomiting from chemotherapy. Prophylaxis is also used to prevent serious allergic reactions before chemotherapy but also in patients with cerebral metastases.

Side effects

Chemotherapy, in addition to its desirable action, has side effects. These are distinguished in immediate effects occurring immediately after the treatment, late occurring after the first few weeks of drug administration and later when they occur months and years after the administration of the chemotherapeutic agents. The knowledge of the side effects makes the patient and his family environment able to cope with these unpleasant and sometimes dangerous situations or even improve the treatment conditions, always with the cooperation of the treating physician. The most common direct side effects (side effects) of chemotherapy are:

  • nausea and vomiting
  • payment and weakness
  • alopecia (hair loss from head hair)
  • stomatitis, gastritis, colitis
  • skin rashes.
  • allergic reactions
  • leukopenia and fever
  • anemia
  • thrombocytopenia and hematoma


More analytically, nausea and vomiting from chemotherapy were among the most unpleasant side effects in the past few years. Not anymore. In recent years, several drugs are available that effectively deal with these side effects by minimizing the minutes.
Hair loss (hair loss), although it is "not important" from the medical side, is one of the worst side effects for the patient. For most patients, they are associated with the image of their body ego and their loss is a significant alteration of this image. Not all chemotherapy drugs cause hair loss, and the most important thing is that hair almost always goes away, counts on the completion of chemotherapy. Hair loss usually begins within two to three weeks of onset of treatment and culminates within 1-2 months. Re-emergence of hair can begin before the end of chemotherapy. For alopecia (hair loss) there are no drugs to prevent it. There are few therapeutic options with medications that do not cause alopecia. The scalp cooling system offers some protection from alopecia in some patients.
Allergic reactions can not be predicted For some drugs that occur frequently, prophylaxis is quite effective.


One of the most serious side effects is myelotoxicity. This manifests itself as: an inability to produce white blood cells and mainly neutrophils. White blood cells protect our body from infections. Because of their reduced number due to chemotherapy, the body's defense is low. This situation may endanger the patient because it makes them vulnerable to microbial infections. For this reason, the patient is often asked to remain in relative isolation to consume only cooked foods and to take care of strictly hygienic conditions. Fever is a frequent manifestation of this condition which, when it occurs, requires immediate treatment.

Other manifestations of myelotoxicity are anemia. Red blood cells carry oxygen from the lungs to the rest of the body, providing the energy needed to function. During chemotherapy, a decrease in red blood cell production may occur, resulting in anemia which may be manifested by paleness in the skin, dyspnoea, weakness, malaise, cold intolerance.
The effect of myelotoxicity is also thrombocytopenia, Platelets help to stop bleeding in case of injury. Chemotherapy also affects their own levels, resulting in bruising on the skin and bleeding. this unpleasant condition occurs when the platelets have been significantly reduced in the patient's blood. The patient should be protected from cuts and small injuries and use a special toothbrush to prevent gum injuries. If not treated timely it can be life-threatening.


The list does not stop there. There is a possibility that unwanted effects may also be detected in other organs of the body. It is very important to report to the treating physician all the relevant symptoms in order to be treated promptly but also to make the necessary modifications to the treatment (change of medication, dosage form, mode of administration)
As a rule, most side effects are discontinued at the end of treatment, but there is a likelihood of late or long-lasting, and even permanent. The main ones are:


Amenorrhea and Steritis
Some of the drugs used in breast cancer can cause amenorrhea, which in some cases depending on the age of the patient may be irreversible. If the patient wishes to become pregnant after chemotherapy, if certain conditions are met, and with the consent of the therapist, he must take certain steps to preserve eggs and embryos for later artificial insemination.
Chemotherapy can affect sexuality, but it usually comes back when treatment is discontinued. It is necessary to take precautions against unwanted pregnancy. Chemotherapy is not a sufficient means of contraception.
Most anticancer medicines also affect the fetus if the patient receiving them is pregnant during treatment. Taking precautions against arrest is important to ensure the health of the fetus.

Tackle side effects
Each drug has its own side effects. These may be more or less serious depending on the general condition of the patient. It is very important that patients be briefed by their treating physician on the side effects that may occur. Information must be done before chemotherapy is started and the physician must be sure that it is understood.
The side effects depend on the type and dose of the drug administered. There are measures that the patient can take to avoid or mitigate the potency of the side effects of chemotherapy. It is very important to note that supportive treatment has been jumping and so there are suitable supportive medicines for most and more dangerous side effects such as pain, nausea and vomiting, and myelotoxicity.
Each patient, through a frank and open discussion with his doctor and his family, has to decide how many and what adjustments he will make to his eating habits, social life, work hours, and weight in his clothing even how it's fun and what are the effects of chemotherapy on the above. It is also important to inform their doctor about other medicines they are taking because there may be interactions between chemotherapy and some other medicines such as aspirin, asbestos or sleeping medicines.
Doctors are well informed about the possible occurrence of side effects and the best way to deal with them. Close monitoring of the patient receiving chemotherapy or admission to the hospital allows early treatment of the complications. Physicians use various methods and tests to evaluate the progression and response of the disease to the treatment as well as the patient's tolerance to chemotherapy.
The patient receiving chemotherapy should tell her doctor if she has fever, shivering, rash, swelling of the hands, feet or part of her face, vomiting, diarrhea, blood in urine or stools, bleeding or bruising, difficulty in breathing, headache and unexplained pain that is intense and lasting. Also, if pain, redness, swelling at the site of chemotherapy is administered intravenously, the doctor should be informed. There are local or general therapies that can help. Measures can also be taken to minimize the probability of causing the same problem again.

Breast cancer and pregnancy
Chemotherapeutic drugs when used at the beginning of pregnancy are at risk of causing congenital abnormalities. For this, if a woman is or is likely to be pregnant, she must inform her doctor. After the first trimester of pregnancy, certain anticancer medicines can be safely administered to both the fetus and the patient. For women who have already suffered from breast cancer and want to have pregnancies, there are no major contraindications. However, an exhaustive discussion must be preceded by their treating physician. Amenorrhea after chemotherapy is not a reliable method of contraception and women with breast cancer should always be aware of it.

Chemotherapy and family

The family and friendly environment of the patient ought to support her emotionally and support her psychologically during chemotherapy. At the same time, care must be taken to deal with the practical and everyday issues that one can take to strengthen the patient in his effort and which at no point falls out of psychological significance. Of course, it is important that the patient herself informs these people about her surroundings, thus relieving them of embarrassment and enabling them to contribute creatively to her painstaking effort.
Examples of active participation are the preparation of meals depending on the appetite and the possibilities of the patient, drinks in the intervals, or even the completion of tasks that the patient temporarily can not perform.
It is very important that the patient does not exclude family and friends from her test. Instead, it must often express its love and appreciation to them and the importance of participating. This will motivate them and protect them from the fatigue of carers.