Chemotherapy overview

What is chemotherapy?

Chemotherapy treatment for cancer started around 1941 when two clinicians tried using nitrogen mustard on patients with lymphoma. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. Chemotherapy may be used alone for some types of cancer or in conjunction with other therapy such as radiation or surgery. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.

While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and in some cases, prevent these symptoms from occurring, if possible.

How is chemotherapy administered?

Chemotherapy can be given:

  • As a pill to swallow.
  • As an injection into the muscle or fat tissue.
  • Intravenously (directly to the bloodstream; also called IV).
  • Intrathecally - chemotherapy given directly into the spinal column with a needle.

What are some of the chemotherapy drugs and their potential side effects?

The following table lists specific chemotherapy drugs and some of the side effects, however, each child may experience symptoms differently and at during different times of the treatment. Some side effects may occur early on (days or weeks) and some side effects may occur later (months or years) after the chemotherapy has been given. The side effects listed are not all the possible problems that may occur. Always consult your child's physician if your child is feeling anything unusual.

 

Chemotherapy drug Side effects (short-term and long-term)
L-asparaginase, Elspar - usually given IV drowsiness can occur during and continue for several weeks after treatment

nausea, vomiting, and cramping

allergic reaction: rash or increased breathing effort

increased blood sugar that is reversible but may require intervention
busulfan, Myleran - usually given orally fatigue, tiredness

dry mouth and lips

decreased appetite

hair loss (reversible)

nausea and vomiting

rash and itching

decrease in blood cell counts

darkened skin coloration

lung damage
carboplatin (Paraplatin) - usually given IV decrease in blood cell counts

hair loss (reversible)

confusion

ringing in ears and hearing loss

kidney damage
cisplatin (cis-platinum, Platinol, Platinol AQ) - usually given IV decrease in blood cell counts

allergic reaction: rash and increased breathing effort

nausea and vomiting that usually occurs for about 24 hours

ringing in ears and hearing loss

fluctuations in blood electrolytes kidney damage  
cyclophosphamide (Cytoxan, Neosar) - can be given IV or orally   nausea, vomiting, and abdominal pain

decreased appetite

hair loss (reversible)

bladder damage

fertility impairment

decrease in all blood cell counts

allergic reaction

lung disease with high doses

secondary malignancies (rare)  
cytarabine (ara-C, cytosine, arabinoside, Cytosar-U) - usually given IV and/or intrathecally (into the spinal column)   nausea, vomiting, and diarrhea

decreased appetite

abdominal pain

mouth ulcers several days after treatment

decrease in all blood cell counts

allergic reaction

fever

inflammation of the eyes

reversible liver damage  
daunorubicin (Cerubidine), idarubicin (Idamycin), doxorubicin (Adriamycin PFS, Adriamycin RDF, Rubex) - usually given IV   nausea and vomiting

hair loss (reversible)

fever and chills

mouth ulcers

red colored urine (not bleeding but a drug effect)

decrease in all blood cell counts

headache

heart failure  
etoposide (VePesid) - may be given orally or IV, teniposide (Vumon) - usually given IV  nausea and vomiting

hair loss (reversible)

decrease in blood cell counts

allergic reaction

mouth ulcers

low blood pressure

decreased appetite

diarrhea and abdominal pain  
hydroxyurea (Hydrea) - usually given orally   decrease in blood cell counts

nausea and vomiting

decreased appetite

diarrhea

drowsiness

fever and chills

hair loss (reversible)

darkening of skin pigmentation 
ifosfamide (Ifex) - usually given IV   confusion, rritability, and/or hallucinations

seizures

decrease in blood cell counts

hair loss (reversible)

kidney damage

darkening of skin pigmentation  
mercaptopurine (6-MP, Purinethol) - usually given orally  nausea and vomiting

decreased appetite

mouth ulcers

diarrhea and digestive tract ulcers

decrease in blood cell counts

darkening of skin pigmentation

skin rash

liver damage (reversible)
methotrexate (Folex, Mexate, Rheumatrex Dose Pack) - may be given IV, intrathecally (into the spinal column), or orally  nausea and vomiting

decrease in blood cell counts

mouth ulcers

skin rashes

dizziness, headache, or drowsiness

kidney damage (with a high-dose therapy)

liver damage

seizures 
thioguanine (6-TG, Lanvis) - usually given orally  nausea and vomiting

stomatitis

diarrhea

decreased appetite

decrease in blood cell counts (after several weeks)

rash

liver damage  
thiotepa (Thioplex) - usually given IV, intrathecally (directly into the spinal column), may be instilled in bladder, or injected into the tumor   headache, dizziness, fatigue, or blurred vision

nausea and vomiting

hair loss (reversible)

decrease in blood cell counts

allergic reaction

fever 
opotecan (Hycamtin) - given IV, irinotecan (Camptosar) - given IV  diarrhea

decrease in blood cell counts

hair loss (reversible)

nausea and vomiting  
vincristine (Oncovin, Vincasar PFS) - usually given IV, vinblastine (Velban, Velbe) - usually given IV  seizures

weakness

loss of reflexes

jaw pain

nausea and vomiting

hair loss (reversible)

diarrhea or constipation, abdominal cramping

decrease in blood cell counts

difficulty breathing