Chemotherapy is a procedure used to treat cancer using drugs. It is given alone or combined with other treatments for better results.

How chemotherapy works for pancreatic cancer:

This procedure uses drugs to kill cancer cells by preventing them from growing and dividing. These drugs travel through the bloodstream, damaging the cancer cells.

Chemotherapy is used to shrink and prevent the growth of pancreatic tumours. It is one of the most important treatments for pancreatic cancer.

When can chemotherapy be given:

Depending on the stage of cancer, how far it has spread in the body, tolerance of the patient towards the drugs and general health of the patient, chemotherapy can be given:

  • Before surgery: To treat the cancer by shrinking the tumour to increase the chances of removing it.
  • After surgery: To minimize the probabilities of cancer coming back.
  • Locally advanced pancreatic cancer: To slow down the growth of the cancer that is spreading to the blood vessels near the pancreas.
  • Advanced or metastatic pancreatic cancer: Chemotherapy is used to cure the pancreatic cancer that has spread to other body parts also.

How Chemotherapy is given:

Chemotherapy is given in cycles. Depending on the drugs used, each cycle contains one or more treatment sessions followed by a rest period for the patient to recover and prepare himself for the next cycle.

Chemotherapy is given in many ways:

Oral Chemotherapy:

The drugs are taken orally. They come with a protective coating which can be broken down in the stomach, allowing the intestines and stomach to absorb the drug.

Intravenous:

This is the most commonly delivered method for chemotherapy. In this method, the drugs are injected into the veins and sometimes into the larger muscle. This allows rapid circulation of the drug in the bloodstream that carries the drug to the tumour. There are several ways of intravenous administration:

  • Cannula: A small, thin tube or cannula is inserted in the veins of the forearm which is fixed temporarily.
  • Portable infusion pump: These are small pressure pumps which are used to deliver the drug at a slower pace.
  • Port-a-cath: This is also known as an implantable port or a subcutaneous port. It is used for patients who require constant or frequent administration of chemotherapy. This system is used to eliminate the discomfort caused by other systems.
  • Central Lines (Tunnelled Catheters): These are placed through the skin in the middle of the chest. They are pushed through the subcutaneous tissue and inserted into the superior vena cava. The catheters have lumens or entrances that facilitate extraction of blood samples and giving the drugs simultaneously.

Drugs used in chemotherapy:

Following are some drugs used in the chemotherapy for pancreatic cancer:

Folfirinox:

This drug is a combination of 3 drugs – 5 FU/leucovorin, irinotecan and oxaliplatin. It is used in treating metastatic pancreatic adenocarcinoma. Folfirinox has severe side effects than the other drugs but has a very acceptable survival rate. Hence, it is given to only those patients who can tolerate with the side effects.

Gemzar:

This drug is approved for the treatment of unresectable pancreatic cancer. The drug is more effective in treating cancer when given after surgery, in what is known as adjuvant therapy.

Abraxane:

Abraxane (albumin-bound paclitaxel) is used in the treatment of one of the most common pancreatic cancer – metastatic pancreatic adenocarcinoma. It is given in combination with gemzar.

Onivyde:

This drug is used in treating metastatic pancreatic adenocarcinoma. Onivyde (irinotecan liposome injection) is given in combination with 5FU and leucovorin. The drug shows high survival rate in treating cancer when the treatment is followed by gemcitabine based therapy.

Side effects of Chemotherapy:

In the process of eliminating cancer, a lot of healthy cells are also affected, due to which side effects arise. These vary depending on the type of treatment given, dosage given, general health and tolerance levels of the patient. Side effects can be specific to the individual and vary depending on various factors.

The most common side effects that chemotherapeutic drugs cause during the treatment of pancreatic cancer are:

  • Change in taste and loss of appetite
  • Fatigue
  • Diarrhea or abdominal cramping
  • Hair loss
  • Hand/foot syndrome
  • Neuropathy
  • Mouth sores
  • Nausea and vomiting
  • Low blood cell count

Dosage and survival rate:

Though chemotherapeutic drugs have adverse side effects, they have a high survival rate in treating pancreatic cancer. Combination of chemotherapeutic drugs with other treatments like surgery, targeted therapy, immunotherapy and radiation increases the success rate of these drugs. When chemotherapy is combined with other treatments, a low dose of chemotherapy is given.

Care to be taken:

During chemotherapy, the patients have to be monitored continuously for them to cope-up with the effects.

  • Foods with unpleasant tastes have to be avoided
  • Observing the tolerance levels, dosage should be changed
  • Patients have to eat 6-8 small healthy meals everyday
  • Patients have to keep their skin moisturized and wear cotton socks and gloves to reduce skin peeling
  • Patients have to stay hydrated
  • Incase of abnormalities of blood cell count, transfusion and medication is required
  • Consulting a doctor is a must, in case of adverse side effects
  • Every medication that the patient takes must be prescribed by the doctor post examination

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