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Questions to Ask Your Doctor
Questions and Answers About Chemotherapy
Author: Sharon Thompson, RN, OCN
The Johns Hopkins Department of Gynecology and Obstetrics
Kelly Gynecologic Oncology Service

What is the purpose of chemotherapy after surgery?
How is chemotherapy given?
How does chemotherapy work?
What side effects will I have?
Will I lose my hair?
How can I protect myself from infection?
How often will I receive chemotherapy?
Where will the chemotherapy by given?
How long will the chemotherapy take?

What is the purpose of surgery followed by chemotherapy?
The purpose of the surgery is to remove as much disease as possible. Surgeons refer to this as debulking. Optimal debulking means there is no disease bigger than 1 cm left behind. Surgeons will try to leave no visible disease, if possible. Chemo given after the surgery is designed to kill any cancer cells that are in circulation that surgery may have missed.

How is chemotherapy given?
Although most chemotherapy is given intravenously, some drugs may be taken by mouth or put directly into the peritoneal cavity. Your physician will determine which route is best for your type of cancer. Many times, intravenous chemotherapy is given through a temporary catheter or port placed in a patient's chest.

How does chemotherapy work?
Chemotherapy is treatment of cancer with strong chemicals. It usually is systemic (involving the whole body) or can be targeted to specific areas. The goal of the chemo is to get rid of any cells that remain after surgery, shrink tumors before surgery, destroy cells that have spread to other parts of the body or control tumor growth.. Chemotherapy works by interfering with the growth and reproductive process of cancer cells.

Chemo is designed to go after rapidly dividing cells. Unfortunately, these drugs can also attack rapidly dividing normal cells such as hair follicles and cells of the digestive and intestinal track. As a result side effects can occur.

What side effects will I have?
It is hard to predict what side effects a patient will have. Every person doesn't get every side effect and some people get few. In addition the severity of the side effects varies greatly from person to person.

Generally, the most common side effects are hair loss, nausea and vomiting and fatigue. Medications can be given before, during and after each treatment to minimize side effects such as nausea, vomiting and diarrhea. Other side effects include anemia , low white cell or low platelets. These conditions can make you fatigued or put you at risk for infection and/or bleeding. There are other side effects that are drug-related. Your doctor or oncology nurse will describe these to you.

Although most of these side effects will resolve once the treatment is over, occasionally chemo can cause permanent damage.

Ask your doctor to walk you through the process and explain the side effects. Remember if you have any side effects report them to your doctor or oncology nurse. There are many new drugs that can be given to help alleviate your symptoms.

Will I lose my hair?
Chemotherapy can cause hair loss all over the body. For many women this can be very traumatic. How we see ourselves and how we want others to see us is often linked to our hair color and style. Hair loss can cause a wide range of emotions from anger to grief.

Many woman create a ritual before undergoing chemo. They invite close friends over and shave their heads. It makes losing the hair for them more manageable as they feel they have taken control.

Consider a wig before treatment begins. Pick one out that closely matches your hair color. For free wigs contact the American Cancer Society in your community. Some insurance companies will even pay for wigs as they may be considered a head prosthesis. Check with your insurance company and if necessary have your doctor write a prescription.

Other hair coverings include scarves, turbans and hats. Because they come in many colors and shapes they can be used to help you express your style. Look for them in department stores.

How can I protect my body from infection?
Chemotherapy can reduce the number of white blood cells making it easier for you to develop an infection. Your white blood cell count will vary throughout treatment. When it is at its lowest you will be more susceptible to infection.

Good hygiene is key. Wash your hands frequently with warm, soapy water. Stay away from people who are sick. Cut your nails carefully. Clean cuts or scrapes right away and use an antiseptic ointment. Take a warm (not hot) bath or shower every day. Drink plenty of fluids. Do not clean cat litter boxes or pet cages. Wear protective gloves while gardening.

Call your doctor if you have any of the following symptoms:

  • Fever over 100
  • Chills
  • Sore throat
  • Redness, tenderness or swelling around a cut or IV site
  • Coughing, shortness of breath
  • Diarrhea, especially if it is bloody
  • Burning pain when urinating

How often will I be given chemotherapy?
Chemotherapy agents can be given according to many different schedules. Your doctor or oncology nurse will keep you informed of the scheduling needs. Unfortunately, the need may arise for unplanned appointments in the event of severe side effects.

Where will the chemotherapy be given and how long will it take?
Most chemotherapy is given in the oncology outpatient clinic, although a few regimens may require a short hospital stay. Each regimen is different in length of infusion. Discuss this with your doctor or oncology nurse for your specific regimen.

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