Chemotherapy Methods

Depending on the drugs to be given and the type of cancer being treated, that chemotherapy is delivered in various ways. These methods include: oral (PO), intravenous (IV), intramuscular (IM), targeted or regional and topical.

Oral Chemotherapy and Topical Chemotherapy

• Oral chemotherapy is given through the mouth, usually in pill, capsule, or liquid form. It is the most straightforward method and can normally be administered at home. Simple as the method may be, patient compliance is one of the biggest hurdles to successful chemotherapy.

  Some patients suffer symptoms of vomiting, extreme nausea, or diarrhea, influencing their acceptance of the drug and reducing their compliance to the guidelines related to dosage and frequency. Others have difficulty remembering how much and how often to take the medicine, whether to take it on a full or an empty stomach, etc. -- all details that greatly influence the efficacy of the chemotherapy.

  Topical chemotherapy comes in the form of a cream, ointment, or lotion and is applied directly onto the skin. This is a method usually used in the treatment of certain types of skin cancer.

Intramuscular and Intravenous

• The term parenteral is used to describe chemotherapy that is administered intravenously, intramuscularly, or subcutaneously. Intravenous chemotherapy is the most common form of the three. With intravenous chemotherapy, an infusion of drugs and saline is injected directly into the patient's bloodstream. Because IV chemotherapy is a systemic way of fighting cancer, every cell in the body is exposed to the drugs. The drug affects healthy cells as well as cancer cells.
  In IV chemotherapy, a small needle attached to a catheter is inserted into a vein, usually in the hand or lower arm. The catheter is attached to an IV-drip bag that is hung from a pole. The fluid is driven down by gravity.

  Intravenous chemotherapy's advantage is that the drug is distributed immediately into the blood. This however becomes disadvantageous when a patient has a high level of cancer cells in his peripheral blood. The quick effect of the drug on the cancer cells may cause excessive toxic debris that can overwhelm the body's capacity to rid itself of it. The liver, kidneys, and other organs may be subjected to intolerable stress that can impair their function and possibly prove fatal.

  Intramuscular chemotherapy entails injection into a muscle. Chemotherapy administered in this manner is absorbed into the blood less rapidly than chemotherapy administered intravenously, and its effects are longer lasting than IV.

  Subcutaneous (SQ or SC) is similar to intramuscular chemotherapy and entails injection of the drug under the skin. As in intramuscular chemotherapy, the injected drug diffuses gradually from the location of injection into the blood and lymphatic systems. This is definitely more advantageous than IV chemotherapy. Since the drug enters the circulatory system over a longer time period, the systemic toxicity that IV chemotherapy often brings is avoided. The reason intramuscular and subcutaneous injections are less frequently applied is because a great number of drugs irritate and possibly even damage muscle and skin tissue.

Regional

• Regional or targeted chemotherapy is administered when there is a need to direct the anti-cancer drugs to a precise area of the body. This is done in an attempt to concentrate the drug in the region of the tumor while minimizing the drug's effects on the rest of the body. Examples of regional chemotherapy include intra-arterial, intravesical, intrapleural, intraperiotneal and intrathecal.

  Intra-arterial involves injection of the drug directly to the artery that supplies blood to the area of the tumor. This is used with liver or leg tumors. Intravesical involves injection into the bladder. Often this is used for early stage of bladder cancer. Intrapleural involves injection into the chest cavity between the chest wall and the lungs. This is used for cancer that develops in the lining of the lung or in breast cancers that have spread to the membrane around the lungs and lining of the chest cavity. Intraperitoneal involves injection into the abdominal cavity. This is administered for some stages of ovarian cancer, some persistent colon cancers, and cancers of the appendix that have spread expansively within the abdomen. Intrathecal involves injection into the fluid surrounding the spinal cord and brain. It is used to treat cancers cells in the central nervous system.