What is Chemotherapy?
What are Targeted Drug Therapies?
How Does Chemotherapy Work?
Cancer Staging
Self-help During Chemotherapy

What is Chemotherapy?
Chemotherapy is medicine that is used to treat cancer by stopping the cancer from growing and spreading to other parts of the body. Depending on the type of cancer and the stage (see cancer stages below), chemotherapy treatment can be used for different goals, including:

• To cure the cancer. Cancer is considered cured when the patient remains free of evidence of cancer cells for five years or longer.
• To control the cancer. This is done by keeping the cancer from spreading; slowing the cancer's growth, and killing cancer cells that may have spread to other parts of the body from the original tumor.
• To relieve symptoms that the cancer may cause. Relieving symptoms such as pain can help patients live more comfortably.

Sometimes chemotherapy is the only treatment a patient receives. More often, however, chemotherapy is used in addition to surgery, radiation therapy, and/or biological therapy to:

• Shrink a tumor before surgery or radiation therapy. This is called neo-adjuvant therapy.
• Help destroy any cancer cells that may remain after surgery and/or radiation therapy. This is called adjuvant chemotherapy.
• Make radiation therapy and biological therapy work better.
• Help destroy cancer if it recurs or has spread to other parts of the body from the original tumor.

What are Targeted Drug Therapies?
Hughes Cancer Center offers all of the latest chemotherapy treatments designed to destroy cancer cells including the new targeted drug therapies ? drugs that attack only cancer cells, leaving most normal cells unharmed. Targeted drug therapies can be more effective and cause fewer side effects than standard chemotherapy drugs.

There are several types of targeted drug therapies including: Signal Transduction Inhibitors, Monoclonal Antibodies, Radiolabeled Antibodies, Anti-Angiogenesis and other targeted drug therapies including Targeted Chemotherapy and Targeted Hormonal Therapies. Below is a brief description of each of these types of targeted drug therapies:

• Signal Transduction Inhibitors are small molecules that affect the internal metabolism of the cancer cell making it hard for the cell to continue to function. Signal transduction inhibitors (STIs) target cancer at the molecular level to prevent cell growth by blocking inappropriate signal transduction and cause the death of cancer cells. Some of these drugs in use at the Hughes Cancer Center include Iressa, Erbitux and Gleevec.
• Monoclonal antibodies act as carriers, irradiating cancerous cells for hours or days at a time. Monoclonal antibody therapy is a passive immunotherapy because the antibodies are produced in large quantities outside the body (in the lab) rather than by the immune system. This type of therapy can be effective even if the immune system is weakened. Some of these medicines used at the Hughes Cancer Center include Rituxan, Herceptin and Campath.
• Radiolabeled Antibodies combine Monoclonal antibodies with radioactive agents. The goal of this combination is to bring additional killing power (radiation) to the malignant cells and affect fewer normal cells. Radiolabeled antibodies are designed to target a unique trait on the surface of cancer cells. Zevalin is the radiolabeled antibody medicine commonly used at the Hughes Cancer Center.
• Anti-angiogenesis are drugs that target the cancer cell?s supply line of blood and nutrients or target the endothelial cells that regulate blood vessel wall growth. Antiangiogenesis treatment uses drugs to stop tumors from developing new blood vessels. Without a blood supply, tumors can't grow. In this category, the Hughes Cancer Center uses the drug Avastin.
• Other Targeted Drug Therapies include targeted chemotherapy and targeted hormonal therapies. Targeted therapies are intravenous treatments that target a particular malignant cell. Xeloda is the primary targeted chemotherapy drug used by the Hughes Cancer Center and the targeted hormonal therapy drugs used include Arimidex, Femara and Aromasin.

How does Chemotherapy work?
Chemotherapy medicines can destroy cancer cells, but sometimes they can kill healthy cells, too. Normal cells in your body grow and die in a controlled way. When cancer occurs, cells in the body that are not normal keep dividing and forming more cells without control. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying. Healthy cells can also be harmed, especially those that divide quickly. Harm to healthy cells is what causes side effects. However, these cells usually repair themselves after chemotherapy.

Some of the healthy cells that chemotherapy can affect are the blood cells. There are three types of blood cells: red blood cells, white blood cells, and platelets.

• Red blood cells carry air from the lungs to all the different parts of the body. When chemotherapy lowers the number of red blood cells, the body does not get enough oxygen, which causes the person to feel weak and tired. This is called anemia. You may be aware of medicines currently advertised to help grow red blood cells.
  
• White blood cells fight germs that make people sick. When the body has too few white blood cells because of chemotherapy, the person has neutropenia. People with neutropenia may have a harder time fighting off sicknesses, which often cause them to run a fever. There are also medicines available to help grow white blood cells.
  
• Platelets are cells that create a plug, or a clot, at the site of an injury to stop bleeding. A person with very low platelets has thrombocytopenia. People with thrombocytopenia (very low platelets) caused by chemotherapy (or other conditions) may find it takes much longer to stop the bleeding when they injure themselves. The may also bruise a lot. Bruises are actually bleeding that happens under the skin. There are medicines available to grow platelets.

For more information about anemia, neutropenia or thrombocytopenia caused by chemotherapy, ask your physician or oncology nurse, or call Pocono Hematology & Oncology at 570-420-2188.

Cancer Staging
Staging is the process of finding out how much cancer there is in the body and where it is located. Staging the cancer is a vital step in determining a patient?s treatment choices, and it will also give the patient?s healthcare team a clearer idea of the outlook for recovery. Cancers with the same stage usually have similar outlooks and are often treated the same way. Staging is also a way doctors can communicate with each other about a person?s case.

Staging can take time, and people are usually anxious to begin treatment soon. Do not worry that the staging process is taking up treatment time. Keep in mind that by staging the cancer, you and your healthcare team will know which treatments are likely to be the most effective before beginning the treatment. For additional information, please see the American Cancer Society?s webpage on Staging.

For most cancers, the stage is based on three main factors:

• the original (primary) tumor?s size and whether or not the tumor has grown into other nearby areas
• whether or not the cancer has spread to the nearby lymph nodes
• whether or not the cancer has spread to distant areas of the body

Some cancers of the blood, such as leukemias, are not formally staged because they are assumed to be in all parts of the body.

There is more than one system for staging. The TNM system is the one used most often. It gives three key pieces of information:

• T describes the size of the tumor, and whether the cancer has spread to nearby tissues and organs.
• N describes how far the cancer has spread to nearby lymph nodes.
• M shows whether the cancer has spread (metastasized) to other organs of the body.

Letters or numbers after the T, N, and M give more details about each of these factors. For example, a tumor classified as T1, N0, M0 is a tumor that is very small, has not spread to the lymph nodes, and has not spread to distant organs of the body. Once the TNM descriptions have been established, they can be grouped together into a simpler set of stages, stages 0 through stage IV (0-4).

In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious, widespread cancer. Stages 0-IV as well as the recurrent disease stage are described below:

Stage 0 or carcinoma in situ - Carcinoma in situ is very early cancer. The abnormal cells are found only in the first layer of cells of the primary site and do not invade the deeper tissues.

Stage I ? Cancer involves the primary site, but has not spread to nearby tissues.

Stage II ? Cancer has spread to nearby areas but is still inside the primary site.

Stage III ? Cancer has spread throughout the nearby area.

Stage IV ? Cancer has spread to other parts of the body.

Recurrent ? Recurrent disease means that the cancer has come back (recurred) after it has been treated.

After looking at your test results, your doctor will tell you the stage of your cancer. Be sure to ask your doctor any questions you might have about what the stage of your cancer means and how it will impact your treatment options.

Self-help During Chemotherapy
Four steps for you to help yourself during Chemotherapy

Tell your physician if you get any side effects from treatment. Be sure to report any of the following problems to your physician:

• Nosebleeds
• Feeling tired
• Constipation
• Sores in your mouth or throat
• Coughing a lot
• Feeling tingling in your fingers and toes
• Ringing in your ears
• Red dots under your skin
• Black and blue marks
• Feeling sick to your stomach or throwing up
• Loose or runny bowel movements
• A fever of 101 degrees of higher
• Losing your hair
• Losing or gaining 10 pounds or more

Ask your doctor before you take any other medicine. Chemotherapy uses drugs to fight your cancer. Taking other medicine during treatment can interfere with your treatment and cause problems. It is important that you always discuss medications with your physician BEFORE you take them. For best results:

• Tell your physician about all other medicines you take, even if they're for birth control or for routine ailments like headaches and stomachaches.
• Tell your physician about any medicines another doctor gave you or that you bought at the store.
• DO NOT take aspirin unless your physician approves it. Aspirin is also found in a lot of drugs, so ask the pharmacist if there's aspirin in any drug you're thinking about buying.

Take care of your health. Make sure you pay special attention to your health. All of the following are good recommendations to follow:

• Eat right.
• Keep your weight about the same.
• Try not to lose or gain.
• Drink lots of liquids.
• Take good care of your mouth, even if it is sore.
• Try to brush your teeth after every meal.
• Use a soft toothbrush and regular flavored toothpaste.
• If you can't brush, rinse your mouth with water.
• Stay away from people who have colds or the flu so you do not get sick.
• Have all the blood tests your doctor orders ?blood tests help your doctor monitor your health.

Talk about your feelings. Being treated for cancer can change the way you feel about things. It can make you feel sad or mad or scared. That's normal. But it can help to talk about it. Some people talk to their friends or family. Some talk to others who have had cancer or to a social worker or counselor. Your nurse or physician can tell you more about how to deal with the emotional issues surrounding cancer treatment. Many people also have questions about sex and birth control. Be sure to ask your nurse or doctor any questions you may have about these issues.

*Chemotherapy information courtesy of the National Cancer Institute, www.cancer.gov, and the American Cancer Society, www.cancer.org.