The Different Ways You Can Receive Chemotherapy

Most of us know that chemotherapy, or "chemo," is drug treatment for cancer. Chemotherapy drugs are cytotoxic – meaning they work by killing the cancerous cells (via the American Cancer Society). Within the larger class of chemotherapy treatments for cancer, however, there are a variety of ways that specific medicines work. Health education on these details can help you or a loved ones know what to expect from the chemotherapy process and how to best plan for treatment.

Interestingly, chemotherapy has roots in the World War II era (via the American Cancer Society). It was discovered that mustard gas could trigger toxic cellular changes in servicemembers who had been exposed to it. The U.S. Army began studying anti-cancer measures (as protections against possible weapons) and found that a compound called nitrogen mustard could fight lymphoma, leading researchers to discover a family of chemicals called alkylating agents. Alkylating agents could, amazingly, damage the DNA of cancer cells, destroying them. Soon afterward, pediatric pathologist Sidney Farber showed that a substance closely related to folic acid could treat acute leukemia in children. From here, chemotherapy research and treatment continued to evolve into our modern protocols. There are a variety of ways that chemotherapy is administered today, according to the type and severity of cancer.

In October of 2022, the French National Centre for Scientific Research stated that a recent approach to subcutaneous chemotherapy may make it an increasingly realistic alternative to traditional intravenous chemotherapy. Subcutaneous chemotherapy means medication is injected into the tissue just under the skin, but not into veins or muscle. It's a simple process that doesn't require hospitalization the way IV therapy does. Unfortunately, because the ingredients that make chemo work are dangerous to the skin, subcutaneous chemo hasn't been used in the past, despite how much easier and more comfortable it could be for cancer patients. Researchers now know, however, that joining the active cancer ingredient paclitaxel with a water-friendly polymer can allow subcutaneous delivery to the bloodstream without causing skin irritation and toxicity. The Journal of the American Chemical Society has recently published research to this end, indicating that subcutaneous chemo could become a more common at-home cancer treatment in the near future. Early research has found subcutaneous chemo delivery to be more effective at fighting cancer than IV delivery in mice.

Intravenous (IV) chemotherapy is a common form of cancer treatment (via the Leukemia and Lymphoma Society). Intravenous chemo is delivered directly into the bloodstream via a needle inserted into a vein, and is administered by a medical professional. This is the stereotypical chemo treatment we so often see in film. Because irritation of the veins can occur with repeated injection, a central line or catheter is sometimes used to deliver drugs more comfortably. A port, a kind of catheter meant for long-term use, is another delivery option. A port is usually placed under the skin of the chest and is used not only for drug delivery, but also sometimes for blood draws and nutrition.

Intravenous chemo can be given through IV push, IV infusion or continuous infusion (via Drugs.com). IV push involves meds provided via syringe over the course of only a few minutes. Intravenous or IV infusion is what most people imagine when they picture chemotherapy, and is typically provided over minutes or hours from a plastic bag of chemotherapy solution, through tubing and into a catheter site. IV infusion is sometimes regulated by an electric IV pump. Continuous infusion is the same, except that it may last for one to several days.

If you've ever taken a college anatomy and physiology class and had to do a mammal dissection, you might recall the peritoneum, a thin layer of tissue lining the abdominal cavity. When cancers develop in the abdomen — for example in the ovaries, stomach, or appendix — intraperitoneal chemotherapy is sometimes employed (via Massachusetts General Hospital). Intraperitoneal chemo (IP) is provided in a hospital or clinic, and allows cancer-killing drugs to be infused directly into the area of concern (the abdomen, or more specifically, the intraperitoneal space) as opposed to traveling through the body systemically via injection into the veins. The chemo is delivered into the body through a port in the abdomen.

Intraperitoneal chemotherapy is often prescribed for ovarian cancer, in conjunction with surgery (via the American Cancer Society). IP chemo may be used if the number of remaining cancer cells is fairly small. The chemo will be absorbed into surrounding tissues, which is important to ensure treatment of other nearby areas where the cancer may have spread. Since IP chemo utilizes a stronger concentration of anti-cancer medication, it may cause local side effects such as nausea, abdominal pain, appetite loss, vomiting, or kidney damage. 

The Centers for Disease Control and Prevention (CDC) report that around 57,000 American men and 18,000 American women are diagnosed with bladder cancer every year. Researchers have found that bladder cancer risk factors include smoking and exposure to specific environmental chemicals. Smoking is a primary contributing factor, but genetic factors can also contribute to risk. 

Intravesical chemo is a form of cancer treatment drug delivery where a catheter is utilized to carry medication directly into the bladder (via the American Cancer Society). Sometimes hyperthermic intravesical therapy is used, meaning that the chemotherapy solution is first heated to improve efficacy. In general, intravesical chemo is an option that cancer doctors use after intravesical immunotherapy is unsuccessful, or if the cancer has grown to a more advanced stage by the time of diagnosis. Common chemo side effects are largely avoided because this is a direct delivery method — drugs are sent straight into the bladder instead of traveling through the entire body. Side effects that are most commonly reported include sensations of burning or discomfort in the bladder, or sometimes blood in the urine.

Brain cancers can be uniquely difficult to treat, since the blood-brain barrier blocks many forms of medication (via Columbia University Irving Medical Center). Neurosurgical researchers at Columbia University and New York-Presbyterian have recently tackled this issue with a new and innovative medical technology, the implantable chemotherapy pump. Although this treatment approach is still being researched, developed, and refined, it may be a game-changer in treating brain cancer. It would allow small amounts of chemo drugs to be released directly into the brain with minimal side effects.

Another chemo pump technology, originally developed at the University of Michigan, was innovated for the treatment of tenacious liver cancers (via University of Michigan). A Journal of Clinical Oncology research review found that patients with such implantable chemotherapy pumps lived two years longer than similar patients with none. The Gliadel wafer is another example of implantable chemotherapy (via Chemocare). After surgical removal of glioblastoma multiforme brain tumors, several dime-sized, dissolvable wafers are implanted. As the wafers dissolve, they release chemotherapy into the brain tissue over the course of weeks, killing residual cancer cells.

If you have any concerns about skin cancer or any other type of cancer due to family history or symptoms, talk to your healthcare provider. According to the American Cancer Society, evidence-based screenings are important for reducing your cancer risk and maintaining a healthy body. Talk to your doctor about any concerning symptoms and maintain regular checkups with primary care, and be sure to promptly schedule any screenings recommended by your doctor. Your family doctor may also educate and empower you with preventative health education on topics such as what aerobic exercise can do for your cancer risk, how to do a self breast exam, and foods that may help you prevent cancer. Research indicates that several lifestyle factors contribute to cancer risk, including long-term, chronic stress, use of alcohol and tobacco, the consumption of certain foods (such as fried items and red meat), a sedentary lifestyle, and exposure to radiation (such as sunlight). Be sure to ask your doctor for more information to aid in cancer prevention and healthy lifestyle, in order to build the healthiest future possible.