Being treated with chemotherapy

You’ll usually have several sessions of chemo followed by a rest period of a few weeks. The rest period allows your body to recover from the side effects before you have more chemo.

The chemo sessions and the rest period together make up a cycle of your treatment. Your doctor or chemo nurse will tell you how many cycles you’re likely to need and how long it will all take. 

Having chemotherapy into a vein Back to top

Chemo into a vein can be given through:

• a cannula
• a central line
• a PICC line
• an implantable port (portacath).

Central lines, PICC lines and ports are used to take blood samples as well as to give you your chemo. They can stay in until your chemo is over, so you won’t need to have a cannula or needle put in your arm every time you have chemo. You can also have fluids, antibiotics or a blood transfusion through your line or port.

Your chemo nurse will show you how to look after your line or port and tell you what to look out for.

Cannula

This is a short, thin tube that your nurse or doctor will put into a vein in your arm or the back of your hand. Having it put in can be uncomfortable or a little painful, but it doesn’t usually take long. Your nurse may put some anaesthetic cream or spray onto your skin to numb the area first. Once the cannula is in place, your nurse will cover it with a see-through dressing to make sure it’s secure. 

Central line

A central line is a long, thin, flexible tube that goes through the skin of your chest into a vein. Central lines are sometimes known by their brand names, for example Hickman® line or Groshong® line. The end of the line will be on the outside of your chest, but your clothes will cover it. 

You’ll usually have a central line put in under a local anaesthetic  to numb the area first, but sometimes it’s done under a general anaesthetic (when you’re asleep and can’t feel anything). Your doctor or chemotherapy nurse will explain what’s going to happen so that you know what to expect. 

Your doctor will make a small cut in the skin near your collarbone and gently thread the tip of the line into a large vein just above your heart.

The other end of the line is tunnelled under the skin to reach the site where it comes out of your body (the exit site). You’ll have a chest x-ray to make sure it’s in the right position.

Around the central line there’s a small ‘cuff’, which you can feel just under the skin. Over about three weeks the tissue under your skin grows around the cuff and holds the line safely in place. Until this has happened you’ll have a stitch holding the line in place, which can then be removed.

PICC line

A PICC line is a long, thin, flexible tube that your doctor puts into a vein near the bend in your elbow. They gently thread it through until the end of the tube lies in a vein near your heart. (PICC stands for peripherally inserted central venous catheter).

You’ll have a local anaesthetic to numb the area so that you won’t feel anything . Once it’s in place, the PICC line is taped securely to your arm to stop it being pulled out.

A PICC line is very similar to a central line, but it’s intended to be in place for a shorter time and used for different chemotherapy regimes. Your chemo nurse will explain this to you.

Implantable port (portacath)

An implantable port or portacath is a long, thin tube that’s put into a vein near the bend in your elbow and has an opening (port) just under the skin on your chest or arm. It can be put in under a general anaesthetic (when you’re asleep and can’t feel anything) or using a local anaesthetic to numb the area so you don’t feel anything.

The tube is inserted (tunnelled) under the skin of your chest. The tip is inserted into a vein just above your heart, and the other end connects with the port under your skin in your upper chest. You’ll be able to feel a little bump under your skin where the port is, but nothing shows on the outside of your body.

Having chemotherapy into your cannula, line or port Back to top

You can have chemo into a vein through your cannula, line or port in different ways:

• As an injection directly into your cannula, line or port - sometimes with a drip (infusion) to flush the drugs into the vein.
• The chemo drugs can be dissolved in a bag of fluid and given to you as a drip that runs through a pump. The nurses set  the pump to give you your chemo over a fixed time, from 20 minutes to a few hours.
• As a drip on its own without a pump - the nurses set the rate and check it regularly to make sure it’s going at the right speed.
• Through a small pump attached to your line. These pumps are small enough to fit into a pocket, or can be carried in a bag or belt holster. The pump is set to give you your chemo over a few days, so you can go home with it. The nurses will show you how to look after it.
• If certain chemotherapy drugs leak into the area around the vein while they’re being given, they can damage the tissues. This rarely happens with a line but, although it’s uncommon, it can happen if a cannula dislodges and is no longer positioned in the vein correctly.
• If you notice any swelling, pain, stinging or redness during your treatment session, tell your nurse immediately. Or, if any of these problems develop after you get home, contact your chemo nurse or hospital doctor straight away.

Looking after your line or port Back to top

The nurses will show you how to take care of your line or port. It might feel a bit complicated at first, but most people get used to it quite quickly. 

The line or port  will have to be flushed using a syringe and a small amount of fluid. This usually needs to be done a few times a week to keep it working and stop it getting blocked. You or your parents will be taught how to do it at home, or a district nurse can come and do it.

You’ll be able to have showers or baths, but make sure you keep your skin dry in the area where the tube goes in. Your nurse will give you waterproof covers to stop it getting wet.

You’ll also need to be able to recognise if anything’s wrong with your line or port, so that any possible problems can be picked up early and treated.

Possible problems

Most people won’t have any serious problems with their line or port. The main ones to look out for are blockages and infections. Contact the hospital straightaway and talk to your doctor or nurse if you have any of the following:

• any reddening, darkening or soreness of the skin around the line or port
• a high temperature - this is usually over 38°C, but may be lower depending on the advice you’ve been given by your doctor or nurse
• feeling shivery or unwell after your line or port has been flushed
• fluid leaking from the skin around the line or port
• pain or swelling in your chest, arm or neck.

If the port or line is infected, you’ll be given antibiotics straightaway to treat it. 

If the line or port is blocked because of a clot your nurse or doctor will inject drugs into it to help dissolve the clot. Sometimes the line or port may have to be removed, depending on how much of a problem there is.  

Taking the line or port out Back to top

When you’ve finished treatment and you no longer need the line or port, it will be removed. It’s usually removed under a local anaesthetic to numb the area around it, or sometimes under a short general anaesthetic. 

If you’re worried about having it removed, you can have some medicine to help you feel more relaxed (a sedative).

Your doctor or nurse will clean the area around the line or port, then make a small cut to gently release the cuff and gently remove the line or port. Although it can be uncomfortable it shouldn’t be painful, and it doesn’t take long. You’ll be able to go home once you’ve recovered. 

Having chemotherapy by mouth Back to top

Some chemo drugs are taken as tablets or capsules. After you swallow it, the drug is absorbed into your blood and carried around your body just like it is if you have chemo into a vein. It’s just as effective as other types of chemo.

You’ll be told when to take the drugs and whether to take them with food or not. You’ll also be told how to store them safely. It’s important to:

• take them exactly as prescribed
• let your hospital nurse or doctor know if you can’t take your tablets.

Having chemotherapy by injection into the spinal fluid Back to top

Having chemotherapy drugs into the fluid around the spinal cord is called intrathecal chemotherapy. This fluid is called cerebrospinal fluid (CSF).

In some cancers, such as lymphoma, leukaemia and certain brain tumours, cancer cells can pass into the CSF. To stop this happening, or to treat it if the cells have spread, chemo can be given directly into the CSF.

It can sound a bit frightening, but your doctor and nurse will explain it so that you know what to expect. They’ll make sure you’re comfortable, and you can have a relative or friend with you.

You lie on your side with your legs drawn up, or you sit up and bend over a table , supported by pillows. Your doctor uses a local anaesthetic to numb an area of skin over your spine. They then gently put a needle into the space between two of the bones in your spine and into the CSF. Your doctor injects the chemo through the needle into the CSF.

Although it isn’t usually painful, some people find it uncomfortable. The most common side effect is a headache that can last for several hours. To help prevent this, you need to lie flat for a few hours afterwards and drink plenty of fluids. Your doctor or nurse can advise you about which painkillers to take if you do get a headache.