Administering Cancer Chemo Drugs: What You Need to Know
There are many types of chemotherapy medications and delivery methods. Depending on your type of cancer and response to treatment, you may be given one or more types of medications that are administered in one or multiple ways. The following is a list of the types of delivery methods for chemo drugs:
Intra-Arterial
Intra-arterial chemotherapy is used to deliver high doses of chemotherapy medications directly to a tumor, while minimizing exposure of the drugs to healthy tissues. This is done through a catheter inserted in the artery that feeds the tumor. The medication may be delivered through a temporary catheter that is inserted by a radiologist and removed after the chemo drugs are given, or through a catheter that is connected to a pump that is surgically implanted in the subcutaneous tissue of the skin, which releases the chemo drugs into the artery. The pump is surgically removed once chemotherapy treatments are discontinued.
Intraperitoneal
Intraperitoneal chemotherapy delivers chemotherapy medication through a catheter directly into the abdomen. This form of chemotherapy is sometimes used for cancers located in the abdominal area such as ovarian cancer. Intraperitoneal chemotherapy delivers large amounts of chemotherapy medications directly to the cancer cells, while leaving healthy, non-cancerous tissue in the rest of the body unexposed to the drugs. Intraperitoneal chemotherapy may be administered through a temporary catheter that is inserted and removed with each treatment, or through a permanent catheter that is kept in place for multiple treatments and removed when chemotherapy treatment is discontinued.
Intrapleural
Intrapleural chemotherapy is administered through a chest tube into the the pleura (the lining of the lungs). It is used to treat cancers such as pleural mesothelioma. Intrapleural chemotherapy delivers chemotherapy medication directly to the cancerous tissue, leaving healthy tissues in the rest of the body untouched.
Intrathecal
Intrathecal chemotherapy is used when the medication needs to reach the cerebrospinal fluid. This form of chemotherapy is administered through a a procedure called a lumbar puncture or spinal tap. During the procedure, a doctor uses a small needle to administer a small amount of chemotherapy medication into the subarachnoid space in the spinal column.
Intraventricular
Like with intrathecal chemotherapy, intraventricular chemotherapy is used when the medication needs to reach the cerebrospinal fluid. With intraventricular chemotherapy, a small device called an Ommaya reservoir is inserted in the subcutaneous tissue underneath the scalp during a surgical procedure. A catheter connected to the Ommaya reservoir is inserted into a ventricle in the brain. Chemotherapy medications are injected through the scalp into the Ommaya reservoir by a nurse or doctor. The Ommaya reservoir is removed through another surgical procedure when it is no longer needed.
Intraveneous
Intraveneous chemotherapy, also called chemotherapy infusions, delivers the medication into a vein, which circulates the anti-cancer drugs throughout the body. Administering cancer chemo drugs is most commonly done intravenously.
Intravenous chemotherapy is commonly administered through an IV. With an IV, chemotherapy medication is delivered through a small needle that is inserted in a vein – usually in your hand or arm – but other veins may be used. After the medication is administered, the IV needle is removed. The process of administering the medication through an IV can take a few minutes to a few hours.
Small amounts of chemo drugs may be given through a single injection. The injections is given using the same type of syringe that is used to give vaccinations and other shots in your doctor’s office. The injection may be administered in a muscle or fatty area in your arm, leg, hip, or abdomen.
Other ways of administering chemotherapy drugs intravenously are through a catheter, PICC line or Port-a-cath (also known as a Mediport). The catheter, PICC line or Port-a-cath is inserted into a vein through an outpatient procedure and remains in place for weeks or even years, depending on the treatment plan and type of catheter or line used. Catheters and PICC lines are useful for continued chemotherapy treatments over an extended time period. Sometimes a pump is hooked up to a catheter to allow the chemotherapy medication to be delivered slowly over a period of days in a home setting.
An advantage to lines or catheters such as the the Port-a-cath, is that they are connected to the vein. The medication is inserted into the catheter or line, instead of the vein, eliminating the need to repeatedly puncture the vein with continued treatments.
Intravesicular
Intravesicular chemotherapy is used for some types of bladder cancer. This form of chemotherapy, injects the medication directly into the bladder through a catheter, where it affects cancerous cells in the bladder, without touching healthy tissues throughout the rest of the body. During intravesicular chemotherapy, a catheter is inserted into the bladder through the urethra. Chemotherapy medication is injected through the catheter, into the bladder; after which, the catheter is removed. The patient is not allowed to release the contents of their bladder for two hours. After two hours, the patient is allowed to urinate and release the chemotherapy medication from the bladder.
Oral
Oral chemotherapy medications may be given in pill, capsule or liquid form. The oral chemotherapy medications are often coated in a protective coating to keep the drugs from dissolving until they reach the stomach where gastric acid dissolves the protective coating. Some oral chemotherapy medications contain an extended-release coating, which breaks down slowly once in the stomach to allow the medication to release over a period of time, instead of all at once.
Topical
Topical chemotherapy medication comes in a cream or gel form and is used for some types of skin cancer. The cream or gel is rubbed directly into the area of skin affected by the cancer.
Gliadel Wafers
Giladel wafers are dissolvable wafers that contain carmustine. The wafers are used in the treatment of malignant glioma, a form of brain cancer. They are implanted near the surface of the tumor after initial resection or for recurrent tumors. The wafer dissolves over a period of two to three weeks, slowly releasing the anti-cancer drug, carmustine.
Disclaimer
This article is for educational purposes only and is not meant to be an all-inclusive or exhaustive resource on chemotherapy delivery methods, nor is it meant to act as or replace medical advice.
References
Physicians’ Cancer Chemotherapy Drug Manual; Edward Chu, Vincent T. DeVita, Jr. M.D.; 2009
Pediatric Oncology Nursing: Advanced Clinicial Handbook; Deborah Tomlinson, Nancy E. Kline; 2009
