Chemotherapy Information

Investigations

Before a complete diagnosis can be given there are a number of tests/investigations that will be carried out, these are very important as some also assess your general health, and may effect the planning of your treatment.

These tests will also assess the extent of your Cancer, this is called staging and may show whether it has spread to other parts of the body, this may take a few extra days and may appear to delay treatment starting, but it does not mean that the doctors are expecting to find anything, it is important information so that the doctors can choose the right treatment for you.

Some of these investigations will be repeated, at different stages of treatment so they can keep a check on how treatment and any side effects, which may occur.

Some of these will also be carried out routinely at intervals after treatment has finished.

Anyone undergoing a diagnosis of cancer will have some or all of the following investigations.

If you do have any concerns before any test there is always someone who you can talk too, a Nurse or Play Specialist they are there to help you through your treatment.

Biopsy

This is normally a small operation, which may be carried out under a general anaesthetic, if you have a tumour/lump: A tumour is a malignant cancer. Some biopsy are done by inserting a small needle through the skin, either way the doctor will remove a sample of tissue, which will be examined by the Histology department, this will tell what type of tumour/cancer it is.

Blood Tests

These are carried out at diagnosis and through out treatment, on diagnosis they will either use a small needle in your hand or use a Canular which may stay in while

you’re in hospital, or until diagnosis has be confirmed.

Blood samples are sent to the different Labs for different test. The Haematology department where blood cells are counted, and also monitor the effects of treatment. A Microbiologist to check for infections, this is called a blood culture.Your blood will also be examined to measure other information such as Kidney and Liver function.

Bone Marrow Aspirate

Some Cancers affect the Bone Marrow, this will be carried out to tell if it is affected or not. A needle is put into the hip and some of the marrow is removed and examined by the Laboratory. This test is usually done using a General Anaesthetic, but some times may be done using a local Anaesthetic.

Lumber Puncture

In Cancers which effect the blood or lymph systems such as Leukaemia & Lymphomas. Malignant cells may be found in the fluid around the spinal cord. This is a procedure for removing a small amount of spinal fluid, which is carried out under a General Anaesthetic using a fine needle in the lower back again this is sent to the Laboratory for testing for any infection in the C.N.S (Central Nerves System) They may also use this procedure to administer anti-cancer drugs either to prevent or cure C.N.S disease.

X-rays

These are pictures taken using radiation for diagnosis and staging, an x-ray can show a tumour that looks different to normal tissue. They may x-ray your Bones, Chest or Abdomen and may use a special dye that is injected into your blood this will help to get clearer pictures.

Ultrasound Scan

Is a special machine that directs sound waves, which you cannot hear, at your body. These are then converted into pictures these will show a difference between normal tissues and tissue which has a cancer present. They may use Ultra sound on your abdomen or heart.

Echo (Echocardiogram)

An Echo is the term for a scan when scanning your heart, which is using same sound waves as an Ultra Sound it is carried out to see that everything is functioning correctly. This is important to know before treatment starts, as some of the drugs you will be taking are harmful to the heart muscle.

C.T. Scan (Computerised Tomography)

A CT scan takes pictures of soft tissue; the CT machine can take lots of pictures at many different angles using a camera inside a rotating drum, which rotates around you while you are lying on the bed. This can take a while but it depends on how much of your body they wish to scan. They sometimes use a dye injected into your blood to help get a clearer picture, this may make you feel warm but this is normal.

MRI Magnetic Resonance Imaging

This is a scan that uses an intense magnetic field to produce images of your internal organs. The MRI scan takes a series of cross section pictures of your body, it can pick up the difference between normal and cancerous tissue.

A MRI scan can take many pictures while you lay on a bed in a machine that is like a tunnel, some people find the machine to be a freighting and it can be quiet noise but it can take some time to do the pictures it will depend on how much of your body they wish to scan. But the process is pain free, they will give you some head phones to listen to some music which should help.

Bone Scan

This scan may be used if it is expected that you may have a bone tumour or to see if it has spread to other parts of your bone. It will involve having a small radioactive substance injected into a vein, and then when you lie on the scanning bed it will help to show any abnormal areas in the bone.

GFR

This is a test to check your Kidney Function, which is carried out sometimes before you start any treatment and will also be carried out during treatment at different intervals. This first involves having a special dye into a vein, either using a Canular or a butterfly needle. If you have a Central Line Or Port-a-Cath the Nurse will then take some Bloods from your line about 1hour and 2hours later.

Treatment

Your Doctor will decide which drugs will be the best at killing your cancer cells. There are a lot of different drugs and a special program of treatment will be made to suit your particular type of cancer. These drugs may be given as pills or tablets or via an injection so that they circulate throughout your body, so that you don’t have to have lots of injections, but sometimes injections may be needed.

Low Blood Counts

Red Cells

Low red cells, is called Anaemia, you may feel tired and have no energy, these normally recover on their own but some times a blood transfusion is required. Red cells also carry oxygen around your body.

Low white cells is called Neutopenia and that means that you may pick up an infection and not be able to fight the infection normally these again should recover on their own, but if you show signs of a temperature, you may need to spend more time in hospital where you will be given Antibiotic to help prevent more serious infection.

Platelets

Platelets help the blood to clot, A low platelet count is called Thrombocytopenia, if these are low you may bruise easily or if you cut your self it may take longer before it stops bleeding, again these recover on their own, but sometimes a platelet Transfusion is required to help.

Central Line

A central line is a long plastic tube which is goes into your body and sits inside one of the large veins that take blood to your heart, the other end will come out of your body through your chest and the skin will heal around it. You will need a small operation so that the Doctor can position the tube in the right place and you will be given a general anaesthetic so you go to sleep whilst this is being done. After the operation you will also have a small cut on your neck as this is where the tube first put in, but the Doctors will stitch this up and it should heal after about a week.

Central Line - Single.

Double Line has a dressing on after fitting, removed after 4 weeks but will still needs supporting with tape.

Central Line - Double.

This is a blood transfusion. This is given through an IVAC machine.

After your operation you may have a dressing over your line, if you have had a double line then this dressing will be quite large and may have to stay on for a few weeks. If you have a single line then you may use a clean white dressing to cover up the exit point. You must not get your central line wet for the first 4 weeks after your operation. But after this you may get it wet and even go swimming so long as you prepare it properly, your Nurse will tell you how to do this. You may also like to wear a small bag around your neck to put the end of the line in or you can tape it to your chest or some girls tuck it into a crop top or bra.

Having a central line put in only takes about 40 minutes and can stay in throughout the whole of your treatment and it will mean that you don’t have to have loads of injections although you may still need to have a few.

These are what platelets look like (yellow bag). Clear bag contains fluids.

This is a blood transfusion. This is given through an IVAC machine.

Now you’ve got a central line in it can be used to give you drugs or fluids, take blood samples or even give you more blood should you need it. Also because of the way that the line is made it is very secure so you don’t have to worry about it falling out.

Central Line - Single.

This is a small scar where they have inserted the Central Line or Portacath. This fades after a short while.

There is only a small lump under the skin, which you can see, when the Portacath is not being used.

The Port-a-cath needle is only fitted when required for treatment.

You do need to take care of it though and whilst you are in hospital the Nurses will flush the line with water to keep it clean, then when you go home this will be done by a Community Nurse or your Mum or Dad or you may help out once you have been shown how.

The Drugs

The drugs that are used to kill the cancer cells are very powerful and can make you feel quite unwell whilst you are taking them. Not everyone reacts the same way to drugs and you may or may not experience all the side effects. The nurses and doctors will be able to help you to cope with the side effects and can give you medicines to make you feel better. Here is a list of all the different cancer killing drugs, how they are taken and how they can make you feel unwell.

Short Term Side Effects

Bone Marrow Suppression

Chemotherapy drugs cause bone marrow suppression. Your bone marrow is the area inside your bones and it is responsible for producing the cells that make up your blood, these are red blood cells which carry oxygen around your body, white blood cells which fight infection and platelets which help your blood to clot if you cut yourself. Having less white blood cells can mean that you can get infection more easily and your body will find it harder to fight off infections as well, this is known as being Neutropenic. You can get infections from germs that live on your skin or in your gut and from other people. Most infections can be treated by anti-biotics through your central line but more serious infections such as measles or chicken pox may need extra treatment in hospital.Taking your temperature regularly can help you monitor in case you get an infection, this will be done for you in hospital. You will be shown how to take your temperature in case you feel unwell whilst at home.

If your red blood cell or platelet amounts are too low you can have a blood or platelet transfusion to top them up. Regular blood tests will be done to monitor your blood.

Hair loss

A lot of the drugs that are used can make your hair fall out. This is temporary and will grow back once treatment has stopped. You can get wigs but most people prefer to wear hats or head scarves.

Loss of appetite, sickness and weight loss

Chemotherapy can make you feel sick and you may not feel like eating much. You can get anti-sickness drugs from your Doctor. If you are finding it hard to eat and keep your weight up the nursing staff and dieticians will give you advice on how this can be done. If you do feel like eating it is important that you have a balanced diet with plenty or carbohydrate to keep your energy levels up and protein to help you make new cells, carbohydrate is in foods like bread and potatoes and protein is in foods like fish, meat and dairy products. Your weight should go back to normal after treatment.

Sore mouth

Looking after your mouth whilst you are having treatment can mean that you avoid serious mouth problems. You should drink plenty and check your mouth every day for sores or ulcers. Have frequent dental check ups and tell your dentist that you are having chemotherapy. If your mouth is really sore you can use a sponge mouth care stick to gently clean or apply mouthwashes to it.

Tiredness and Feeling Low

Through out treatment you may feel very tired at time, if this happens rest when you can, but try and accept this as apart of you illness and be positive, do the things you like to do when your energy returns.

This can also lead to you feeling very low, you feel frightened, and your life has changed, you feel very alone, but you may also want to just shut everyone out, as they don’t know how you feel.

But your not alone, you will meet other teenagers in hospital who also have cancer, it may not be the same type, but they are going through the same as you a New experience, some of them have long finished their treatment but most of them at some time have felt or are feeling the same as you.

So talk to them they can help you and you can help them.

And remember your family and friends are there to support you. So tell them how you feel. You are the same person, you have not changed so don’t isolate yourself and let your illness take over.

Top Tips

• Take a day at a time.
• Nurses help you through treatment listen to what they say.
• Don’t be afraid to ask questions.
• Don’t do too much at once.
• Say if anything is wrong.
• Cut your hair short it makes losing your hair, not as bad.
• Keep in touch friends.
• Rest when you need to, but have fun be a normal teenager.
• Keep busy on the ward with fun things to do it go so much quicker.
• Talk to others especially other teenagers on the ward.
• Be positive.