What is chemotherapy and how does it work?

Chemotherapy is a type of systemic therapy that involves the use of medications to treat cancer. These medications are either taken orally or delivered intravenously using a needle. Drugs are usually given intravenously (IV) to treat testicular cancer. These medications go throughout the body and target cancer cells for destruction. This method is mostly used to break apart tumours and kill cancer cells. Chemotherapeutic medications are prescribed to patients by oncologists based on the spread of the disease, the patient's tolerance, and the type and stage of the cancer.

How is chemotherapy administered ?

Chemotherapy is administered in a series of cycles. The number of therapy sessions and chemo cycles required are determined by the medications employed.

  1. Oral Chemotherapy

It  refers to the administration of medicines through the mouth. They have a protective covering that may be broken down in the stomach, allowing the medicine to be absorbed by the intestines and stomach.

2. Intravenous

Chemotherapy is most usually provided in this way. The medications are injected into the veins using this procedure. This enables for rapid drug circulation in the bloodstream, which transports the medicine to the tumour.

  • Cannula : A cannula is a tiny, thin tube that is briefly inserted into the veins of the forearm.

Small pressure pumps are utilised to give the medicine at a slower rate with a portable infusion pump.

  • Port-a-cath: This system is utilised in patients who require continual or frequent administration and eliminates the discomfort caused by other systems.
  • Central Lines (Tunnelled Catheters): These are put in the centre of the chest through the skin. They are put into the superior vena cava after being pushed through the subcutaneous tissue. The catheters feature lumens or openings that allow blood samples to be taken while medications are administered.

CHEMOTHERAPY TREATMENT FOR TESTICULAR CANCER

Chemotherapy is frequently administered in cycles. After each cycle, the patient is given time to recuperate from the medications' side effects. The following are the authorised testicular cancer chemotherapy drugs:

Cisplatin

It is one of the most commonly used and prescribed medications for the treatment of testicular cancer. It is a platinum-containing chemotherapy medication. To inhibit cell development, the medication is taken alone or in conjunction with other treatments. It acts by preventing DNA replication, resulting in the death of rapidly reproducing cells.

Bleomycin

This medicine is injected intravenously, into the muscle, or under the skin to treat metastatic testicular cancer. It should be given slowly, over the course of 30 minutes. Because the medicine can have negative side effects, the patient's condition is frequently checked before prescribing it.

Ifosfamide

It is an anti-cancer medication that is used to treat recurrent testicular blood cancer and germ cell tumours. It is administered intravenously. It's one of the most secure treatments for testicular cancer.

Etoposide (VP-16)

It  is an anticancer medication that is usually given intravenously and only occasionally taken orally. It must be injected into the veins with extreme caution, as rerouting might cause tissue injury. The drug breaks DNA strands by blocking their re-ligation by generating a ternary complex with DNA and the topoisomerase II enzyme.

Paclitaxel

It is a chemotherapy medication that is exclusively used intravenously to treat testicular cancer. It must be administered with extreme caution, as it may cause tissue damage. It's used to keep cell division and growth under control.

Vinblastine

It  is a slow-release injectable medication that is used to inhibit the progression of testicular cancer.

Testicular cancer treatment using a combination of chemotherapeutic drugs:

Chemotherapeutic medicines are frequently used in combination with one another. Here's where you can learn more about chemotherapy medicines. These medications have a greater influence on cancer treatment. Combining the medications also improves the chances of survival.

  • BEP (or PEB) is a bleomycin, etoposide, and cisplatin combination. Seminomas and nonseminomas are both treated with it.
  • VIP is a drug that combines Etoposide and cisplatin and is used to treat metastatic testicular cancer.
  • EP includes Etoposide and cisplatin in a combination in this medication. It's frequently used to treat seminomas and nonseminomas in stages IB and II.

CHEMOTHERAPY SIDE EFFECTS

Chemotherapy is a method that tries to eliminate cancer cells, but it also damages a lot of healthy cells, resulting in side effects. The effects differ from person to person and treatment to treatment, as well as the patient's tolerance levels and medical history.

The most prevalent short-term impacts are as follows:

  • Hair loss is a common problem.
  • Sores in the mouth
  • Appetite loss.
  • Vomiting and nausea
  • Diarrhea
  • White blood cell count is low (makes the patient prone to infections)
  • Platelet count is low (leads to easy bleeding and bruising)
  • Red blood cell count is low (causes anaemia and fatigue)

Chemotherapy's long-term negative effects in the treatment of testicular cancer include:

  • Cisplatin and ifosfamide can cause renal failure, which can lead to kidney damage.
  • Cisplatin, paclitaxel, and vinblastine have a negative impact on the peripheral nervous system, causing neuropathy. The hands and legs, particularly the fingers and toes, become numb and tingly as a result of this.
  • Cisplatin has an effect on the ears, resulting in hearing loss.
  • Bleomycin has an effect on the lungs, causing shortness of breath and trouble breathing during vigorous activity.
  • Chemotherapeutic medicines cause an increase in heart rate and blood pressure.
  • The body's ability to make sperm is reduced during testicular cancer treatment, leading to infertility.
  • Chemotherapy can cause serious testosterone abnormalities in the body.
  • Ifosfamide has an effect on the bladder, causing it to haemorrhage.

Most short-term adverse effects fade away during the recovery period, but in a few cases, they can lead to more serious issues. Patients must struggle with long-term side effects for the rest of their lives. They can, however, lessen the severity with which the pharmaceuticals affect the patients by exercising adequate health care and visiting the doctor on a frequent basis.

DOSAGE AND SURVIVAL RATE

The dosage is determined by the diagnostic results, tolerance levels, and the patient's overall health. Chemotherapy is usually given in three to four rounds for stage II testicular cancer and two or three cycles for stage I. Testicular cancer that has fully metastasized in stages II and III will require a greater dose of chemotherapy or maybe a combination of chemotherapeutic agents. The doctor should be informed about the patient's previous medical history, mental and physical strength, and allergic reactions before commencing chemo. This aids the physician in determining the most appropriate medicine and dosage for the patient.

Chemotherapy as a testicular cancer treatment has a 5-year survival rate of 73 percent.

PRECAUTIONS

Patients must be monitored on a frequent basis during treatment. To cope with the impacts, they must maintain a healthy lifestyle.

  • Unpleasant-tasting foods must be avoided.
  • It is a legal requirement to exercise on a regular basis.
  • Dosage should be modified and monitored after therapy based on tolerance levels.
  • You must eat 6-8 modest, healthful meals per day.
  • It's critical to stay hydrated.
  • Take careful care of your skin.
  • In the event of a low blood cell count, a blood transfusion is required.
  • All of the meds you're taking have to be prescribed by a doctor.
  • Vaccinations should be avoided.
  • Patients must keep a detailed medical record.