How Chemotherapy Is Given

Oral Chemotherapy (taken by mouth)

Oral chemotherapy comes usually in tablet form (pills, capsules) but may also be in liquid form. Usually oral chemotherapy tablets are encased in a protective coating that is broken down by stomach juices. The chemotherapy drug is then released and absorbed by the lining of the stomach.

Not all chemotherapy drugs can come in tablet form as some medicines can be destroyed by stomach acid and some are unable to be absorbed into the patient’s body through the stomach lining or intestines. If the medicine is not absorbed, then it will simply pass through stools or urine and be ineffective. Some medications are too harsh to be taken orally as they cause damage to the stomach lining.

An example of an oral chemotherapy drug sometimes used for pancreatic cancer is Capecitabine used in the GemCap combination

Intravenous Administration of chemotherapy

This is the most common method of delivering chemotherapy as most drugs are easily absorbed into the bloodstream.

Intravenous administration of chemotherapy agents allows the drug to rapidly enter the body’s circulation from where it is carried into the blood stream. Doses can be given which last from a few minutes to a few hours – depending on the cancer and the drug used. Continuous infusions can even be given over a few days or weeks at a time. Sometimes portable infusion pumps are used which allows medication to be given at a slow continuous rate.

There are various methods used to deliver chemotherapy drugs intravenously.

Cannula:

A small,thin tube or cannula may be inserted into a vein in the forearm or in the back of the hand . This may be uncomfortable or even painful but this soon eases. The cannula, once inserted, is securely taped to fix it in place and the drugs are given through a drip. This is a temporary device which is removed after each individual treatment.

PICC Line

A PICC line (Peripherally Inserted Central Catheter) involves the placement of a thin flexible tube into a vein lodged in the crook of the arm. This tube is threaded through until the other end of the tube finds a place in a vein close to the heart. A special x-ray called fluoroscopy confirms that the PICC line is in the right place.

PICC lines are temporary and can remain in place from a few weeks to a few months.

This procedure is usually done under local anaesthetic by a specially trained nurse or doctor.

Central Lines (Tunnelled Catheters)

Central lines, known by trade names, Hickman® or Groshong® Lines, are placed through the skin in the middle of the chest. They are tunnelled through the subcutaneous tissue (the layer of tissue between the skin and the muscle) and inserted into the superior vena cava vessel at the entrance at the right atrium of the heart. These catheters can have multiple lumens (entrances) for medications to be infused or blood to be drawn.

Central lines are usually inserted under a general anaesthetic in an out-patients department. Central lines can stay in place for months or even years (though this is rarely the case). Central Lines prevent the need to have a cannula put into your veins each time you receive treatment. This may be very helpful if it is difficult to get needles into your veins, or if the walls of your veins have been hardened by previous chemotherapy treatment. Central lines can also be used with portable infusion pumps which allow medication to be given at a slow continuous rate.