In order to prepare you for chemotherapy treatment, you may have the following tests:
- a 24-hour urine collection
- a MUGA scan (a scan which tells us how well your heart is functioning)
- CT scans
- Nuclear Medicine tests such as a Total Body Bone Scan, Gallium Scan and possibly a bone marrow aspiration.
Some or all of these tests will help us develop a good understanding for the extent of your disease and the best treatment options for you. Please inform the team of any allergies, current medications (prescribed and over the counter), if you might be or are pregnant, or breastfeeding. Always let your oncologist know of any changes in your medications at every appointment.
Chemotherapy drugs work by targeting dividing cells. Chemotherapy protocol usually requires that you stay in hospital for 3 to 5 days every third week, depending on your protocol.
Everytime you come for treatment, blood will be drawn. The dose/timing of your chemo may be changed based on blood counts or side effects. You may also be asked to have your blood drawn at a local lab during the weeks that you are not receiving chemotherapy to keep an eye on your blood counts. It is important you let the team know of any side effects you may be experiencing as they may be able to provide you with information and treatments that may help.
Chemotherapy is usually given through the vein. Often because of the harshness of the chemicals and the frequency of multiple infusions we recommend that you consider the insertion of a central line or central venous access device. These lines allow for safer administration of the chemotherapy drugs and can be used for blood taking. The two most common types of venous access devices are the PICC Line or a Port a Cath. The type of access that you will receive will depend on different factors which your team will discuss with you.
PICC stands for Peripherally Inserted Central Venous Catheter. These catheters are made from a soft, flexible material called silicon. The catheter is usually put in by the doctor in the interventional procedures room. Local anesthetic is used to numb the skin. Usually the catheter will be inserted into your vein so that the tip will be positioned near the heart. After confirming placement by X-ray of the position of the catheter, the outer portion of the line is secured to the skin. A sterile dressing will be applied over the exit site.
Care of your Line
Home care will be arranged to look after your PICC line. Should you develop an irritation to the adhesive dressing please let your homecare nurse or the team know.
- Your line must be flushed daily. When not in use your line must be flushed weekly.
- Dressing over the PICC line should be changed every seven days.
- It is very important that you do not immerse your PICC line in water.
- In order to shower, you must cover the entire dressing and line with an additional waterproof dressing. Seal the edges of your dressing with a waterproof bandage. Some suggestions to waterproof your line are to use plastic film wrap or a plastic bag. Should your dressing get wet despite your water-proofing, it is important you dry your arm well and replace the dressing as soon as possible.
- If your site should become extremely reddened or if you notice any drainage coming from the site notify your nurse immediately.
A port has two major parts: the port, a small chamber with a raised rubber top and a catheter, a hollow, soft tube. One end of the catheter is connected to the port; the other end is placed into a large blood vessel.
A port, unlike a PICC line, is placed completely under the skin. The procedure is just like the PICC line and is performed in interventional radiology under local anesthetic. A small dressing will be placed over the incision site for a few days until healed. The stitches usually are removed within a week or so. Once the dressing is removed the only thing you will notice is a slight bump where your port sits.
Often the doctor will allow several days for healing before using your port. To use the port, a special needle is inserted through the skin into the raised chamber/port. You may feel slight discomfort when the needle goes into the port. If this is truly uncomfortable, please inform a team member.
Care of your PortBecause your port is completely covered with skin when the needle is removed there is no further care needed. You may swim and bathe without any special care.
- Since the port sits under your skin, it is recommended you avoid full-contact sports
- When not in use, ports require flushing every month. This will be done before you leave the unit and at your follow up appointments once you have completed treatment.
- Your port is normally left in for a year after treatment before removal.
Common Chemotherapy Agents
- Doxorubin/Adriamycin- clear red liquid which is injected into a vein
- Etoposide or VP/16