Chemotherapy Overview

NewYork-Presbyterian Hospital ranks in all ten pediatric specialties, and more than any other hospital in the metro New York area according to the 2013-2014 U.S. News & World Report Best Children's Hospitals rankings.

What is chemotherapy?

Chemotherapy is the use of anticancer drugs to treat cancerous cells. Chemotherapy has been used for many years and is one of the most common treatments for cancer. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. Chemotherapy may be used alone for some types of cancer or in combination with other treatments such as radiation or surgery. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.

While chemotherapy can be quite effective in treating certain cancers, chemotherapy drugs reach all parts of the body, not just the cancer cells. Because of this, there may be many side effects during treatment. Being able to anticipate these side effects can help you and your caregivers prepare and, in some cases, prevent these symptoms from occurring.

How is chemotherapy administered?

Chemotherapy can be given:

as a pill to swallow.
as an injection into the muscle or fat tissue.
intravenously (directly to the bloodstream; also called IV).
topically (applied to the skin)
directly into a body cavity

What are some of the chemotherapy drugs and their potential side effects?

The following table lists specific chemotherapy drugs and some of the side effects, however, each child may experience symptoms differently and at different times of the treatment. Some side effects may occur early on (days or weeks) and some side effects may occur later (months or years) after the chemotherapy has been given. The side effects listed are not all the possible problems that may occur. Always consult your child's physician if your child is feeling anything unusual.

Chemotherapy drug	Side effects (short-term and long-term)
L-asparaginase, Elspar - usually given IV	drowsiness can occur during and continue for several weeks after treatment nausea, vomiting, and cramping allergic reaction: rash or increased breathing effort increased blood sugar that is reversible but may require intervention
busulfan, Myleran - usually given orally	fatigue, tiredness dry mouth and lips decreased appetite hair loss (reversible) nausea and vomiting rash and itching decrease in blood cell counts darkened skin coloration lung damage
carboplatin (Paraplatin) - usually given IV	decrease in blood cell counts hair loss (reversible) confusion ringing in ears and hearing loss kidney damage
cisplatin (cis-platinum, Platinol, Platinol AQ) - usually given IV	decrease in blood cell counts allergic reaction: rash and increased breathing effort nausea and vomiting that usually occurs for about 24 hours ringing in ears and hearing loss fluctuations in blood electrolytes kidney damage
cyclophosphamide (Cytoxan, Neosar) - can be given IV or orally	nausea, vomiting, and abdominal pain decreased appetite hair loss (reversible) bladder damage fertility impairment decrease in blood cell counts allergic reaction lung disease with high doses secondary malignancies (rare)
cytarabine (ara-C, cytosine, arabinoside, Cytosar-U) - usually given IV and/or intrathecally (into the spinal column)	nausea, vomiting, and diarrhea decreased appetite abdominal pain mouth ulcers several days after treatment decrease in blood cell counts allergic reaction fever inflammation of the eyes reversible liver damage
daunorubicin (Cerubidine), idarubicin (Idamycin), doxorubicin (Adriamycin PFS, Adriamycin RDF, Rubex) - usually given IV	nausea and vomiting hair loss (reversible) fever and chills mouth ulcers red colored urine (not bleeding but a drug effect) decrease in blood cell counts headache heart failure
etoposide (VePesid) - may be given orally or IV, teniposide (Vumon) - usually given IV	nausea and vomiting hair loss (reversible) decrease in blood cell counts allergic reaction mouth ulcers low blood pressure decreased appetite diarrhea and abdominal pain
hydroxyurea (Hydrea) - usually given orally	decrease in blood cell counts nausea and vomiting decreased appetite diarrhea drowsiness fever and chills hair loss (reversible) darkening of skin pigmentation
ifosfamide (Ifex) - usually given IV	confusion, irritability, and/or hallucinations seizures decrease in blood cell counts hair loss (reversible) kidney damage darkening of skin pigmentation
mercaptopurine (6-MP, Purinethol) - usually given orally	nausea and vomiting decreased appetite mouth ulcers diarrhea and digestive tract ulcers decrease in blood cell counts darkening of skin pigmentation skin rash liver damage (reversible)
methotrexate (Folex, Mexate, Rheumatrex Dose Pack) - may be given IV, intrathecally (into the spinal column), or orally	nausea and vomiting decrease in blood cell counts mouth ulcers skin rashes dizziness, headache, or drowsiness kidney damage (with a high-dose therapy) liver damage seizures
thioguanine (6-TG, Lanvis) - usually given orally	nausea and vomiting stomatitis diarrhea decreased appetite decrease in blood cell counts (after several weeks) rash liver damage
thiotepa (Thioplex) - usually given IV, intrathecally (directly into the spinal column), may be instilled in bladder, or injected into the tumor	headache, dizziness, fatigue, or blurred vision nausea and vomiting hair loss (reversible) decrease in blood cell counts allergic reaction fever
topotecan (Hycamtin) - given IV, irinotecan (Camptosar) - given IV	diarrhea decrease in blood cell counts hair loss (reversible) nausea and vomiting
vincristine (Oncovin, Vincasar PFS) - usually given IV, vinblastine (Velban, Velbe) - usually given IV	seizures weakness loss of reflexes jaw pain nausea and vomiting hair loss (reversible) diarrhea or constipation, abdominal cramping decrease in blood cell counts difficulty breathing