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Medical Oncology

Chemotherapy is the treatment of cancer with drugs that can destroy cancer cells. These drugs are often called “anticancer” drugs. When combined with radiation, it is becoming more common to eliminate the need for surgery to remove the cancer. Unfortunately, chemotherapy cannot tell the difference between a cancer cell and some healthy cells. Chemotherapy targets not only the fast-growing cancer cells but also other fast-growing cells in your body. The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow, cells in the digestive tract (mouth, stomach, intestines, esophagus), reproductive system and hair follicles. Harm to healthy cells is what causes side effects. These cells usually repair themselves after chemotherapy, thus reducing long-term side effects.

Chemotherapy is administered directly into a vein, taken by mouth or as an injection. These drugs enter the bloodstream (called systemic therapy) and can reach cancer that has spread to organs beyond the head and neck. It may be used in several different situations:

  • Chemotherapy may be combined with radiation therapy instead of using surgery to control larger cancers that are confined to the head and neck region.
  • Chemotherapy is sometimes administered to shrink the cancer before surgery or radiation treatment. This is called neoadjuvant or induction chemotherapy. In some cases this makes it possible to use less radical surgery and resect (remove) less tissue.
  • Chemotherapy (often together with radiation) has also been used to reduce the severity of symptoms of cancers of the head and neck that are too large to be completely removed and which radiation treatment alone has not been able to control.
  • Chemotherapy may be administered in an outpatient part of the hospital, at the doctor’s office, or at home. Rarely, a hospital stay may be needed.

Cancer Drugs

  • Cisplatin is a platinum containing alkylating agent that stops or slows the growth of cancer cells by damaging the cell's DNA and prevents it from dividing. It is administered as an infusion into a vein.
    • Side effects: (Special note: Drink plenty of fluids and urinate frequently during the first 24 hours after receiving cisplatin to help with kidney function.)
      • Decreased blood cell count
      • Kidney impairment
      • Hearing loss and tinnitus
      • Nausea/vomiting
      • Numbness/tingling of fingertips and toes
  • Carboplatin is a platinum containing compound that stops or slows the growth of cancer cells by damaging the cell's DNA and prevents it from dividing. It is administered as an infusion into a vein.
    • Side effects:
      • Decreased blood cell count
      • Kidney impairment
      • Numbness/tingling of fingertips Nausea/vomiting
  • Oxaliplain (Eloxatin) is a platinum containing compound that stops or slows the growth of cancer cells by damaging the cell's DNA and prevents it from dividing. It is administered as an infusion into a vein.
    • Side effects:
      • Numbness/tingling/burning of the fingers, hands, toes, feet, mouth or throat
      • Decreased blood cell counts
      • Increased sensitivity to cold
      • Nausea/vomiting
      • Diarrhea
  • Paclitaxel (Taxol) is in the class of medication known as taxanes. It stops or slows the growth of cancer cells by stopping cell division or inhibiting the enzymes necessary to make the proteins necessary for cell reproduction. It is administered as an infusion into a vein.
    • Side effects:
      • Decreased blood cell count
      • Mucositis
      • Nausea/vomiting
      • Diarrhea
      • Tingling of the hands or toes
      • Hair loss
  • Docetaxel (Taxotere) is in the class of medication known as taxanes. It stops or slows the growth of cancer cells by stopping cell division or inhibiting the enzymes necessary to make the proteins necessary for cell reproduction. It is administered as an infusion into a vein.
    • Side effects:
      • Decreased blood cell count
      • Fluid retention
      • Nausea/vomiting
      • Diarrhea
      • Tiredness
      • Hair loss
      • Nail changes
      • Mucositis
      • Increased eye tearing
      • Rash/dry, itchy skin
  • Fluorouracil (5-FU) is in a class of medication called an antimetabolite. It interferes with the growth of a cancer cell by resembling a natural nutrient that a cell needs to grow. It is administered as an infusion into a vein.
    • Side effects:
      • Decreased blood cell count
      • Mucositis
      • Diarrhea
      • Hand-foot Syndrome (tingling, numbness, pain, redness, dryness, rash, swelling of hands and feet)
  • Capecitabine (Xeloda) is in a class of medication called an antimetabolite. It interferes with the growth of a cancer cell by resembling a natural nutrient that a cell needs to grow. It is administered as a pill to be taken by mouth.
    • Side effects:
      • Diarrhea
      • Nausea/vomiting
      • Hand-foot Syndrome
  • Methotrexate is in a class of medication called an antimetabolite. It interferes with the growth of a cancer cell by resembling a natural nutrient that a cell needs to grow. It is administered as an infusion into a vein.
    • Side effects:
      • Decreased blood cell count
      • Kidney impairment
      • Mucositis
      • Nausea/vomiting
  • Ifosfamide (Ifex) is an alkylating agent that stops or slows the growth of cancer cells by directly damaging the DNA of the cancer cell and prevents it from reproducing. It is administered by an infusion into a vein.
    • Side effects: (Special note: Drink plenty of fluids and urinate frequently during the first 24 hours after receiving Ifex to help with kidney function.)
      • Decreased blood cell count
      • Bladder irritant
      • Hair loss
      • Nausea/vomiting
  • Bleomycin is in a class of medication known as an antitumor antibiotic. It stops the growth of cancer cells by binding to cell DNA, making it unable to separate and by inhibiting RNA synthesis. It is administered as an infusion into a vein.
    • Side effects:
      • Pulmonary (lung or breathing) difficulties due to an allergic reaction or hypersensitivity
      • Skin redness/peeling
      • Thickening of skin and nails
  • Cetuximab (Erbitux) is in a class of medication called monoclonal antibodies that stops or slows the growth of cancer cells by binding to the epidermal growth factor receptor. It is administered as an infusion into a vein and is frequently given at the same time as radiation therapy.
    • Side effects:
      • Acne-like rash
      • Dry/cracking skin
      • Tiredness/weakness
      • Swelling or pain around fingernails or toenails
  • Mesna helps protect the bladder from the irritation of chemotherapy. It is administered as an infusion into a vein or as a liquid taken by mouth.
    • Side effects:
      • Flu-like symptoms
      • Diarrhea/soft stools
      • Nausea/vomiting
      • Dizziness due to low blood pressure

Prior to treatment, it is important that you tell your doctor the following:

  • If you have any allergies to medication
  • What medications (prescription and non-prescription), vitamins and supplements you are taking
  • If you have kidney, liver, lung or heart disease

Your doctor will order blood tests to monitor your blood cell counts before, during and after treatment.

There are ways to manage side effects. There are newer medications to effectively control immediate and delayed nausea and vomiting. Please talk with your doctor about the side effects you are experiencing and what might help.