Chemotherapy is the use of drugs to kill cancer cells or stop them from multiplying and spreading in the body. There are different types of cancer that can occur in different parts of the body. The different procedures in chemotherapy are aimed at delivering the drugs in the most effective way for each patient while minimizing adverse effects of treatment. The choice of procedure depends on the type of drug, the state of health of the patient, the type of cancer and the patient's preferences.
Systemic Chemotherapy Procedures
In advanced cases of cancer where the cancer has spread beyond the point of origin or primary site, systemic chemotherapy is used. This type of chemotherapy delivers the drug to all the systems of the body. The drugs can be given orally, in the form of pills or liquids or as injections into the muscle, veins or skin.
The most common way of delivering systemic chemotherapy is by using a large vein in the arm, chest or neck, a procedure called central venous catheterization. Central venous catheters, CVCs, are also called venous access devices according to the American Cancer Society, or ACS. Some of the CVCs do not require surgery for placement. These are preferred for short and intermediate-term therapy. Examples of CVCs that do not require surgical placement are the peripherally inserted central catheters, or PICC, like Per-Q-Cath, and midline catheters. The CVCs preferred for long-term chemotherapy are usually surgically implanted and secured, like the tunneled central venous catheter, implantable venous access port and implantable pump.
Regional Chemotherapy Procedures
When the cancer is localized or contained in a particular body cavity, a form of chemotherapy called regional chemotherapy is used. The aim in regional chemotherapy is to deliver the drugs directly to the cancer cells to minimize the adverse effects of the drugs on the rest of the body or nearby healthy tissue.
One procedure in regional chemotherapy is intra-arterial injections. In this procedure, the drug is injected directly into the artery carrying blood to the area of the cancer. Isolated limb perfusion used in treating advanced melanoma in a limb is an example of intra-arterial injection. Hepatic artery injection to treat liver cancer is another example of intra-arterial injection.
Intra-cavitary chemotherapy, involving the injection of chemotherapy drugs into body cavities to treat cancers that spread into the cavity or involve organs that are connected by the cavity, is another example of regional chemotherapy. Examples of such procedures include intra-pleural infusions to treat lung cancer or mesothelioma, intra-peritoneal infusions for cancer involving organs in the abdomen, intrathecal injections for cancers that spread to the brain and spinal cord and intravesical injections for cancer of the bladder.
Local Chemotherapy Procedures
Local chemotherapy involves delivering the chemotherapy drug directly to the area of the cancer. Topical chemotherapy is a form of local chemotherapy involving the use of creams, ointments and other preparations to apply drugs to cancers that appear on the skin or other body surfaces. An example of this is a cream containing 5-flourouracil used to treat early stages of skin cancer.
Injections into the tumor, called intratumoral injections, are also forms of local chemotherapy. Injections may be given directly into inoperable tumors to reduce the size of the tumor and improve the quality of life of the patient.
The Mayo Clinic describes the implantation of wafers containing chemotherapy drugs directly into the tumor. The wafers break down over time, gradually releasing the drug directly into the tumor. An example of this is carmustine wafers used to treat certain types of brain cancer.
