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Chemotherapy may be given in different ways, depending on the type of cancer you have and the chemotherapy drugs used.
The most common ways chemotherapy can be given are:
Chemotherapy may also sometimes be given:
Your treatment may involve having chemotherapy in more than one way. For example, you may be given intravenous chemotherapy and chemotherapy tablets.
Chemotherapy given into a vein goes directly into the bloodstream where it can be carried to all areas of your body.
You may have your treatment given through:
The nurse or doctor will put a short, thin tube (cannula) into a vein in the back of your hand or your forearm and secure it in place with a see-through dressing. The cannula is removed after each treatment session.
Chemotherapy being given by injection into a cannula
You may find having the cannula put in a bit uncomfortable or painful, but it shouldn’t take long and any pain soon wears off. An anaesthetic cream or spray may be put on the skin to numb the area before the cannula is put in.
If you feel any discomfort or notice redness or swelling around the cannula, or along your arm, during or after chemotherapy let your nurse or doctor know immediately.
A central line| is a long, thin, hollow tube that is inserted into a vein in your chest. Hickman® and Groshong® lines are both commonly used types of central line.
A central line can be used to give chemotherapy intravenously and to take blood samples, so you won’t need a cannula or needle put into your vein while you have one in place.
It’s designed to stay in place for many months, throughout all your chemotherapy treatment sessions.
You’ll be given a general or local anaesthetic before the central line is put in. The doctor or chemotherapy nurse will explain the procedure to you. To begin with, the central line is held in place by stitches, tape or a specialist dressing. There is a small ‘cuff’ around the line which you can feel just under the skin. Tissue under your skin grows into the cuff and holds the line safely in place within about three weeks. If you have any stitches around the line these can then be taken out.
Once or twice a week the line is flushed with sterile saline (salt water), or heparin – a drug which prevents clotting. This is to keep the line open and stop it from becoming blocked. The nurses on the ward can teach you how to do this, or can arrange for a district nurse to visit your home and do it for you.
You can bathe or shower with a central line in, but you should avoid getting the area where the tube enters the skin wet – a plastic dressing can be used for this. Before you go home, make sure you’re confident about looking after your central line. If you have any problems, contact the staff in the chemotherapy clinic or on the ward for advice.
A central line
What to look out for when you have a central line
Two potential problems with central lines are blockage and infection. Most people won’t have any serious problems but if you notice any of the following changes it’s important to contact the hospital for advice straight away:
Most hospitals consider a temperature above 38°C (100.4°F) to be high, but some hospitals use a lower or higher temperature. The doctors and nurses at your hospital will tell you which temperature they use.
Removing your central line
Your central line will be taken out when you no longer need it. A doctor or nurse will do this for you, usually in the outpatients department. Your chest will be cleaned with antiseptic, and the line will be gently but firmly pulled until it loosens and comes free. This doesn’t usually take more than a few minutes, but can be uncomfortable.
Sometimes a small cut in the skin is made so that the cuff can be loosened. This is done under a local anaesthetic. A dressing will be put over the area where the line has been removed, and you’ll be asked to remain lying down for a short while until it’s certain that there is no bleeding.
A PICC line| is a long, thin, hollow tube. It is put into a vein in the crook of your arm and threaded up the vein until its tip sits in a large vein in your chest. Your doctor or chemotherapy nurse will explain how this is done. You’ll be given a local anaesthetic to numb the area before the line is put in.
Once it’s in place, the PICC line is taped firmly to your arm to prevent it being pulled out of the vein. It can stay in the vein for many months. As with a central line, it means that you don’t have to have a cannula put in when you have your intravenous chemotherapy. Blood samples can also be taken through the line for testing.
A PICC line
You’ll be able to bend your arm, bathe and shower, but you should avoid getting water on the area around the tube – a plastic dressing can be used for this. Before you go home, make sure that you’re confident about looking after your line.
As with a central line, a PICC line will need to be flushed regularly to keep it working. A district nurse can flush your line and change the dressing, or a relative or friend can be taught to do this for you. If you have any problems, contact the staff in the chemotherapy clinic or on the ward for advice.
The end of the PICC line comes out just below the crook of the elbow
The possible problems are the same as for central lines: blockage and infection.
An implantable port| is a thin, soft plastic tube with a rubber disc (port) at the end. It can be put in under a general or local anaesthetic. The tube is inserted into a vein until its tip sits just above your heart and the port lies under the skin on your upper chest. Once it’s in place you can feel and see the port as a small bump underneath the skin of your chest, but nothing shows on the outside of your body.
To use the portacath a needle is passed through your skin into the port to give medicines into the vein or take blood.
The skin over the port can be numbed with an anaesthetic cream first so you don’t feel any discomfort.
An implantable port
An implantable port can stay in place for several months, if needed. The possible problems are the same as for central lines: blockage and infection.
Some chemotherapy drugs are given as an injection directly into a vein (through a cannula or central line) over a few minutes. Sometimes a bag of clear fluid (a drip) is attached to plastic tubing connected to the cannula or line in your vein first. The chemotherapy is injected into a connection on the plastic tubing and flushed into your vein with fluid from the bag.
Chemotherapy drugs can be added to drip bags and given as infusions. Chemotherapy may be given as a drip infusion using gravity but is often given via an infusion pump. These pumps can be set to give a controlled amount of chemotherapy into the bloodstream over a fixed period of time.
Infusions may be given over varying times from 20 minutes to several hours depending on the type of drug and dose of chemotherapy.
Some types of chemotherapy are given as an infusion over a few days and can be given as an outpatient. The infusion is set up at the hospital so that you can go home with it.
At the hospital, a nurse puts your chemotherapy into a small pump and connects it to your central or PICC line. You go home with the pump, which is small enough to fit into a pocket, or can be carried in a bag or belt holster. When the infusion is finished there may be some fluid left in the pump. This may be normal as some pumps need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.
You, and perhaps a family member or friend, will be taught how to look after the pump. Some pumps are battery-operated and care has to be taken not to get them wet when you’re washing. Some pumps are disposable and are operated by a balloon mechanism or spring control. Your nurses or pharmacy staff will give you full instructions and should also tell you who to contact if you have any problems or questions.
If a drug leaks into the area around the vein while being given, this is called extravasation. It is uncommon but can happen if a cannula dislodges and is no longer positioned in the vein correctly. It rarely happens with a central line.
Your nurse will take care to prevent extravasation when giving you your chemotherapy. But, if you notice any swelling, pain, stinging or redness during your treatment session tell them immediately. Or, if any of these problems develop after you get home, contact the hospital straight away. Some chemotherapy drugs can damage the tissues and the sooner extravasation is dealt with, the better.
Oral chemotherapy is chemotherapy you take by mouth as tablets or capsules. It’s as strong and effective as other types of chemotherapy. After you take chemotherapy by mouth it’s absorbed into your blood and carried around your body just like intravenous chemotherapy.
You’ll be told when to take your chemotherapy tablets or capsules and will be given other instructions, such as whether or not to take them with food. If you can’t take your medicines for any reason or are sick after taking your tablets, contact your nurse or doctor at the hospital immediately for advice.
The drugs that you’ve been given by the hospital make up a complete course of treatment, and it’s important to take them exactly as they have been prescribed. Always read the labels on the boxes before you leave the hospital. If the instructions are unclear, ask your nurse, doctor or pharmacist. Not taking your chemotherapy at the right times can affect how well it works.
If you need further supplies of the chemotherapy or other medicines, your hospital doctor or specialist nurse will let you know where to get them from.
Oral chemotherapy can cause side effects and it’s important to be aware of these when taking your medicine.
When you have chemotherapy drugs at home there are things you need to be aware of, such as storing your drugs safely.
You can read more about having chemotherapy at home in our section about where chemotherapy is given|.
Some chemotherapy drugs are given by injection into a muscle. The doctor or nurse will explain the procedure to you. The drug is injected into the muscle of the leg or buttock. You may feel some pain or discomfort for a short time.
Some drugs can be given by injection just under the skin using a very fine needle.
Intrathecal chemotherapy is an injection of chemotherapy into the spinal fluid. In some conditions, such as some types of leukaemia| or lymphoma|, cancer cells can pass into the fluid which surrounds the brain and spinal cord (called cerebrospinal fluid or CSF). The best way of treating these cancer cells is by injecting chemotherapy into the spinal fluid because chemotherapy given in other ways doesn’t get into this area.
Before you are given intrathecal chemotherapy the doctor and nurses will do safety checks to make sure you are given only the medicines that have been prescribed for you. If you would like to, you can also check the drugs before they are given.
The treatment can be given in two possible positions. You will either be asked to lie on your side with your knees drawn up to your tummy and your head tucked forward, or to sit with your back to the doctor with your arms folded and supported by a pillow or over the back of a chair. It’s important that you stay still during the whole procedure.
The doctor numbs an area of skin over your spine with local anaesthetic and inserts a needle between two of the spinal bones into the CSF. This part of the procedure is called a lumbar puncture|. Once the needle is in position the doctor injects the chemotherapy into the CSF. They then take out the needle and put a small dressing over the skin where the needle was. The procedure takes about 30 minutes.
Having intrathecal chemotherapy isn’t usually painful but some people find it uncomfortable. The most common side effect it may cause is a headache that can last for several hours.
You will need to lie flat for a few hours afterwards to help prevent this. Drinking plenty of fluids will also help to reduce the chance of getting a headache. Your doctor or nurse can advise you about what painkillers to take if you do get one.
If you’re having intravenous chemotherapy on the same day as intrathecal chemotherapy this will be given first before you have your intrathecal treatment.
Intracavitary chemotherapy is the name for giving chemotherapy into a cavity in the body, such as the bladder. Drugs given in this way can cause some irritation or inflammation in the area they are given, but they don’t tend to cause side effects in other parts of the body.
To give the chemotherapy, a tube (catheter) is inserted into the affected body cavity and the chemotherapy is put in through the tube. It may be drained out again after a set period of time.
The most common use for intracavitary chemotherapy in the UK is to treat bladder cancer. Giving chemotherapy directly into the bladder is called intravesical chemotherapy. Our section about bladder cancer| has more information on this.
Chemotherapy can also be put into the abdominal cavity. This is called intraperitoneal chemotherapy. This method of giving chemotherapy is occasionally used to treat ovarian cancer or mesothelioma in the abdomen (peritoneal mesothelioma).
Intracavitary chemotherapy is sometimes used if there are cancer cells between the two layers of tissue (called the pleura) that cover the outside of the lungs. The chemotherapy is put in between the two layers of the pleura. This is called intrapleural chemotherapy.
Chemotherapy creams are used for some types of skin cancer|. They are put onto the affected area of skin in a thin layer and may need to be used regularly for a few weeks. They may cause some soreness or irritation of the skin in the affected area but don’t cause side effects in other parts of the body. While you are using chemotherapy creams you may need to wear a dressing over the affected area of skin.
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If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.