What is chemotherapy? Chemotherapy is the use of medicines or drugs to treat cancer disease. It is used to to help in the destruction of cancer cells. The treatment is sometimes called “chemo” can kill cancer cells tht have spread to parts of the body far away from the original tumor. The most common chemotherapy drugs act killing cells that divide rapidly, which is one of the main properties of most cancer cells. Chemotherapy also includes the use of antibiotics or other medications. For more information, please visit our “What is Chemotherapy” page.
How is chemotherapy treatment administered? Most chemotherapy is delivered intravenously, although a number of chemotherapy treatments may be be administered orally. In some cases, targeted chemotherapy is used, which allows for the delivery of medication into a specific area.
What is the goal of chemo? How chemotherapy will be administered will depend on the type of cancer and and how far it has spread – the stage. Typically chemotherapy is intended to achieve the following results: cure the cancer, keep the cancer from spreading, slow the growth of cancer, kill cancer cells that may have spread to other parts of the body or relieve symptoms caused by cancer. Your doctor will talk to you about the goal of your chemotherapy before you start treatment.
What are some common chemotherapy side effects? Please note that every person does not get every side effect and that some people get few, if any chemotherapy side effects. Many newer treatments and medications may prevent or reduce side effects. The most common side-effects are: hair loss, fatigue, diarrhea or constipation, nausea or vomiting. Other less common side-effects may include: dry skin or rashes, anemia (low red blood cell count), infection (low white blood cell count), muscle and nerve problems, mouth sores or bleeding.
The severity of these side-effects vary greatly from one person to another. Your doctor and nurse will discuss with you which side-effects are most common with your chemo, how long side effects might last, how bad they might be and when you need to call our office about them. Your doctor may be able to give you medicines to help prevent some of these side-effects before they even begin. For more information on chemo side effects, please visit our “Chemotherapy Side Effects” page.
What is neoadjuvant chemotherapy? “Neoadjuvant” or “Induction” chemotherapy is chemotherapy given prior to surgical removal of a tumor. By killing all or part of the tumor, it permits a smaller operation and makes a limb-sparing surgery safer by preventing tumor recurrence. Chemotherapy is usually continued after surgery. This is essential to kill any remaining tumor cells at the surgical site as well as elsewhere in the body. Most bone sarcomas, such as osteosarcoma and Ewing’s sarcomas, are treated with neoadjuvant chemotherapy and limb-sparing resection. With this combination, 95% of our patients have been able to successfully undergo limb-sparing surgery and avoid amputation.
How does radiation therapy work? Radiation therapy destroys cancer cells by directing a high-energy beam to the cancer site with minimal harm to the healthy cells. Radiation therapy is one of the most common treatments for cancer. Radiation does not affect cancer cells right away. It takes days or weeks of treatment before cancer cells deteriorate. Radiation continues to affect cancer cells after radiation treatments are complete. Radiation treatments are given daily, Monday-Friday, for a period of time prescribed by your doctor, the radiation oncologist.
Will I be able to drive to my radiation appointments? Most people can get to daily treatments without help. If you are not feeling well, you may need to ask a family member or friend to take you to your treatment. Let us know if you are having problems with transportation
Will I have side effects from radiation therapy? Yes. Your radiation oncologist will discuss this with you. Radiation therapy is given to a specific area of the body. Both the cancer cells and other rapidly dividing cells in the treated area are affected. Healthy cells have the ability to recover over time while the cancer cells are permanently damaged. As a result, side effects may occur to the area of the body being treated. These side effects will be monitored and managed as needed.
What happens if I miss a treatment? It is important that you receive your radiation treatments consistently, as scheduled. We strive to accommodate every patient’s schedule preference to the best of our ability. If you need to miss a treatment you should call [insert Radiation Therapy Department phone number] and ask to speak to a radiation therapist, or the receptionist to reschedule. Ultimately, you will receive the number of prescribed treatments required by your radiation oncologist.
What is sarcoma? Sarcomas are malignant tumors that arise from musculoskeletal system tissues such as bone, muscle or connective tissue.
What is the difference between a benign tumor and a malignant tumor? Malignant tumors (“cancers”) are capable of spreading to other parts of the body whereas benign tumors cannot spread. Some benign tumors are called “aggressive” because they can destroy nearby bones and soft-tissues yet do not spread to other body sites.
What is the difference between a carcinoma and a sarcoma? Most cancers (>90%) arise from “epithelial” tissues, such as the inside lining of the colon, breast, lung or prostate. These are referred to as carcinomas and usually affect older people. Sarcomas are tumors that arise from “mesenchymal” tissues such as bone, muscle, connective tissue, cartilage and fat. Sarcomas occur in young people as well as in adults and comprise less than 1% of all cancers. Sarcomas are named by the tissue of origin, for example “osteosarcoma” arises from bone, “liposarcoma” arises from fat and “chondrosarcoma” arises from cartilage.
What is tumor “grade”? In contrast to carcinomas, sarcomas are graded “low”, “intermediate” or “high-grade” by the pathologist. This corresponds to the probability of the tumor spreading to other parts of the body. Typically, only patients with high-grade tumors receive chemotherapy.
How do we make a diagnosis? In most cases, the patient’s history, examination and imaging studies will predict the diagnosis. However, a definitive diagnosis is not made until a biopsy is performed and tissue obtained for pathological examination.
What imaging studies are required? Most patients with musculoskeletal tumors will undergo more than one type of imaging study. The various imaging studies provide complementary information. Below is a list of the imaging studies we use:
● Plain radiograph (X-ray) Shows the overall appearance of bone tumors. Experienced Orthopedic Oncologists and Skeletal Radiologists can predict the diagnosis of a bone tumor with the plain radiograph since most tumors have a “typical” appearance on X-ray.
● Computed tomography (CT) Reveals the fine details of bone lesions.
● Magnetic Resonance Imaging (MRI) Reveals details of normal and abnormal soft tissues. It is also good at determining the extent of tumors inside of bones.
● Bone scan (Bone scintigraphy or Nuclear Medicine) A sensitive test of bone inflammation that can screen the entire skeleton at once. It is usually used to look for evidence of tumor spread to other bones. For the test, the patient is given an intravenous injection of a radiotracer compound. Then, at intervals following the injection, a special camera is used to record uptake of this radiotracer from the skeleton. Since bone inflammation can be due to fracture and infection as well as tumors, bone scan findings must often be confirmed with other tests or a biopsy.
● PET scan (Positron Emission Tomography) Similar to a bone scan in that a radiotracer is injected and that entire body is imaged. However, the level of detail in the image is finer and a PET scan is more sensitive for soft tissue lesions than bone scan.
● Angiography: An imaging study that shows only the arteries (and veins) in a part of the body. It is usually used in advance of surgery to reveal precise vascular anatomy. It is also very useful in determining the amount of tumor vascularity that usually corresponds to how quickly a tumor is growing.
What is radiation therapy? Radiation therapy is the use of carefully calibrated amounts of high-intensity radiation to kill tumor cells. It is usually used after surgical resection of tumors to kill any remaining cells. It is administered by radiation oncologists and given in brief, daily, outpatient treatments over several weeks.
What foods should I eat? Your first, best source for information about your diet during cancer treatment is your doctor. You also can talk to an oncology nutrition specialist who can help you understand your individual needs.
Eating a balanced diet with foods from all food groups will help you meet your body’s vitamin and mineral needs. Certain foods, such as citrus fruits, cruciferous vegetables, soybeans and green tea have been found to contain chemicals that have antioxidant activity, stimulate anti-cancer enzymes or act as a cancer inhibitor. However, breast and ovarian cancer survivors should first check with their physician before including soybeans, soy products or flax into their diet.
Most people with cancer require an increase in dietary protein, such as lean meats, beans, nuts and dairy. Powdered protein supplements are also helpful, especially when your appetite is decreased.
Fatty fish such as tuna, sardines, mackerel and salmon as well as almonds, walnuts and canola oil are good sources of Omega-3 fatty acids. These fatty acids enhance our immune function and are linked to weight gain and reduced muscle wasting during cancer treatment.
Should I take vitamin and mineral supplements? It’s important that you talk to your doctor before taking any supplements. There is no scientific evidence that dietary supplements or herbs can cure cancer or prevent reoccurrence. Some nutrients have shown no benefit when taken in amounts more than the body’s requirements. In fact, one large study demonstrated the risk of taking large doses of vitamins; patients receiving the vitamin supplement fared much worse than those who did not receive the supplement.
Taking large doses of one vitamin or mineral can cause deficiencies in another and can also interfere with other medications in addition to the chemotherapy.
Multivitamin and mineral supplements that provide 100% percent of the daily requirements are likely safe. However, they may not be necessary if you are eating a well balanced diet and maintaining your weight. A Registered Dietitian can evaluate your diet for deficiencies.