Details on the chemotherapy

I thought that some of you may be interested in the more technical details of Ali's treatment - but then again many of you may not.

I know I didn't know much at all about chemotherapy right up until last week. I still don't know much but I know a lot more than I did then. It seemed to be one of those things that would be interesting to learn more about if I had the time or could find the right person to ask. Anyway, here goes my version of how it all fits together.

How it works
Chemotherapy is considered a body-wide (systemic) treatment, it travels through the whole body. In Ali's case, this means the chemo drugs will work on the cancer in the breast and the liver.

The chemo targets cells that rapidly divide, such as cancer cells. Part of the problem here is that there are three other main areas in our bodies where there are rapidly dividing cells. The chemo can damage or kill cells in each of these areas resulting in side effects.

Blood
This is where the immuno-deficiencies may come into play. White blood cells have a life span of 13-20 days (red cells can go up to 120 days). By switching off production through chemo, the body can experience low counts of white blood cells which reduces our ability to fight infection. Any signs of infection will get us a fast ticket through the emergency room.

Hair
For Ali, her hair will fall out. I mentioned in an earlier post that she's looking at wigs already. She reckons they only cost about 2-3 hair cuts and argues that I'm getting a good deal as the wig should last much longer than that. She also tells me that she tried a blonde one on but it just didn't suit her complexion (there goes that idea!).

The hair should grow back once treatment stops.

Gastrointestinal tract
This can play games all through from the mouth right down to the other end. Rather than dig into the details on this, if you're interested, it's probably best you look this up yourself.

The Drugs
The two operative drugs that will be prescribed to Alison are:

• Doxorubicin
• Cyclophosphamide

Duxorubicin
This drug works to stop the process of duplication through affecting the DNA. We're told that the liquid that is injected is red in colour so it will be quite interesting to see. Also, I read somewhere that it costs nearly $1.1m per kg to make (not sure how true or recent this bit is).

See below for the chemical structure (just a little something I threw together).

Cyclophosphamide
This one scared me at first, I thought the doctor and nurse both said psychophosphamide. I didn't think Ali needed any 'psycho' drugs and in my mind there where all sorts of images of Ali on the rampage. Luckily, this is not the case and I'm OK with them using cyclophosphamide.

This drug works to slow the growth of the cancer and interestingly, is carcinogenic itself. It is manually injected rather than relying on a gravity fed drip feed or automated pump. The reason for this is that if the canula slips out of the vein, the drug can cause necrosis of the surrounding tissue (the nurse we were speaking to assured us that he had seen this only twice in well over 20 years of experience).

See below for the chemical structure.


The Process
Ali will turn up in the morning and been seen by her medical oncologist who will check her general health and the blood test results (most likely taken the Friday before), with a particular eye on white blood cell count. If all's good, the chemo proceeds.

This will begin by the nurse inserting a canula into her arm which will be used for administering all the drugs. First off the rank will be anti-nausea drugs. Two types of anti-nausea are provided through the drip feed. I'm not so sure on which ones are used but I think it is Ondansetron and Palonosetron. These work in various ways to trick the mind and body into believing that the chemo drugs are not harmful. This part takes about 30 min.

Next, the chemo drugs above will be administered. These will take probably another hour and a half to work through. So all up, Ali should be at the clinic for probably three hours.

When released, Ali will be sent home with a small cocktail kit of pills to help manage any further headaches or nausea.

It was interesting to hear that they use different types of anti-nausea drugs after 1-2 days as it will be different reactions causing the nausea once this period has passed.

Post treatment
Ali is most likely to be feeling nauseas and tired during that first week. Her white cell blood counts will probably be low during the latter part of the second week to the middle of the third week, and thus be most susceptible to infections during that stage.

Hair will probably go close to the time when she is due to go back for her second treatment.

After three weeks, we start all over again. It does sound like we're in for the full six-cycle treatment.


Hopefully this has been interesting, educational and useful to you all. At the very least, it should give you some idea of what will happen with the chemo and a very basic, but hopefully correct, understanding of what goes on.

How it all actually affects Alison, given that every person has their own tolerances and different reactions, is yet to be seen.