Chemotherapy
Chemotherapy uses medicines that kill cells which divide quickly. Cancer cells are among the fastest-dividing cells in the body, which is why the approach works — but the same mechanism explains the side effects, because healthy fast-growing tissue is affected too (National Cancer Institute).
According to the NCI, chemotherapy is used with three broad aims. It may be given to cure a cancer outright, to reduce the risk of a cancer returning after other treatment, or to slow growth and relieve symptoms where cure is not the goal. It is also given before surgery to shrink a tumour, and after surgery to eliminate cells that may remain.
It is not a single drug. There are dozens of chemotherapy agents, used alone or in combination, at doses and intervals set by established protocols and then adjusted for the individual.
Treatment Planned Around Your Cancer
At Athira
At Athira, chemotherapy is planned within the wider medical oncology service and reviewed by the multidisciplinary tumour board before it begins. Where the tumour's molecular profile suggests a targeted or immune-based approach may work better, that is considered first — chemotherapy is recommended because it is the right treatment for a particular cancer, not because it is the default.
Most cycles are given in the day care unit, and supportive care is built into the plan from cycle one.
Understanding Chemotherapy
How Chemotherapy Works
Cells reproduce by dividing. Chemotherapy drugs interfere with that process — damaging the genetic material a cell needs to divide, or blocking the machinery of division itself.
Cells caught mid-division are the most vulnerable, which is why fast-growing cancers often respond well.
Why Side Effects Occur
The difficulty is that some healthy tissue also divides rapidly. The NCI specifically identifies the lining of the mouth, the lining of the intestines and the hair follicles as affected sites, which accounts for mouth sores, nausea, hair loss and fatigue.
Blood-forming cells in the bone marrow are also affected, which is why blood counts are checked between cycles.
Why treatment is given in cycles
A cycle is a period of treatment followed by a period of rest. The rest allows healthy tissue to recover while cancer cells, which repair less effectively, do not recover as fully. The number of cycles and the gap between them depends on the drug and the cancer.
How it is given
Most commonly by intravenous infusion. Some agents are taken as tablets or capsules at home; some are given by injection; a few are delivered directly into a body cavity or the spinal fluid, depending on the cancer.
Treatment Response
One point worth holding onto. The NCI is explicit that the severity of side effects does not indicate how well a drug is working.
Feeling relatively well does not mean the treatment is failing, and feeling unwell does not mean it is succeeding. Response is measured by scans and laboratory results, not by how you feel.
When Is Chemotherapy Recommended?
When your oncologist may consider chemotherapy
Chemotherapy may be recommended depending on the cancer type, its stage, its molecular characteristics and your general fitness for treatment.
The cancer type is known to respond well to chemotherapy — including many lymphomas, leukaemias, germ cell tumours and several common solid tumours
A tumour needs to be shrunk before surgery, to make an operation possible or less extensive
Surgery has removed visible disease but pathology suggests a risk of microscopic cells remaining
The cancer has spread and systemic control is the objective
It is being combined with radiation to make radiation more effective (concurrent chemoradiation)
Immunotherapy or targeted therapy is being given alongside chemotherapy as part of a combination regimen
Disease has progressed on a previous line of therapy
Diagnosis and Evaluation
Assessment before chemotherapy has two purposes: confirming that chemotherapy is the right choice, and confirming what dose the body can safely handle.
Tissue Diagnosis
Confirmed tissue diagnosis with histopathology, and immunohistochemistry where it affects drug selection.
Molecular and Biomarker Testing
Molecular and biomarker testing where relevant, to rule in or rule out targeted and immune-based alternatives before committing to chemotherapy.
Staging Imaging
Staging imaging — CT, MRI or PET-CT as appropriate — establishing a baseline against which response will later be measured.
Complete Blood Count
Complete blood count, since chemotherapy suppresses bone marrow function and adequate baseline counts are required before each cycle.
Kidney and Liver Function
Kidney and liver function tests. Many chemotherapy drugs are cleared by the kidneys or metabolised by the liver, and dosing is adjusted accordingly.
Cardiac Evaluation
Cardiac evaluation — typically an echocardiogram — before regimens containing agents known to affect heart function.
Height, Weight and Body Surface Area
Height, weight and body surface area, used to calculate dose.
Existing Medication
Review of existing medication, including supplements and traditional remedies, as some interact with chemotherapy drugs.
Fertility Discussion
Fertility discussion, for patients of reproductive age, before treatment starts rather than after.
Treatment and Care Approaches
Protocol-based regimens
Drug combinations, doses and intervals follow established international protocols for the specific cancer and stage, then are individualised.
Neoadjuvant chemotherapy
Given before surgery to reduce tumour size.
Adjuvant chemotherapy
Given after surgery to lower recurrence risk.
Palliative chemotherapy
Used in advanced disease to control growth and relieve symptoms, with dose intensity balanced against quality of life.
Concurrent chemoradiation
Lower-dose chemotherapy given alongside radiotherapy, coordinated between the medical and radiation oncology teams.
Combination with immunotherapy or targeted agents
Where the regimen calls for it.
Supportive protocols
Anti-emetics before and after infusion, growth factor support where counts are expected to fall, mouth care guidance, nutrition input and pain management.
Vascular access
For longer regimens, a central line or chemoport may be recommended to protect peripheral veins and make each session easier.
Personalised Cancer Care at Athira
A chemotherapy protocol is a starting point, not a prescription set in stone.
Dose is calculated
Dose is calculated from body surface area and then modified for kidney and liver function, age, blood counts and how the previous cycle was tolerated.
A patient who developed significant neutropenia may have the next cycle adjusted or supported with growth factors. Someone with neuropathy may have a specific agent reduced or stopped while the rest of the regimen continues.
Scheduling is planned
Scheduling is planned around real life where the protocol allows — around a work pattern, a caregiver's availability, or the journey into the centre.
Supportive care is individualised too
Nausea control is adjusted based on what actually happened last cycle, not on a standard order set. Nutrition and psycho-oncology support are offered as part of treatment.
The plan is reassessed
And the plan is reassessed at defined points. Response is measured; if a regimen is not delivering, the conversation about changing it happens promptly rather than after another two cycles.
Why Athira
Chemotherapy planned in context
Every regimen is agreed through the multidisciplinary tumour board, so that the sequencing of drug therapy with surgery and radiation is deliberate.
Alternatives assessed first
Precision oncology is one of Athira's four core commitments. Genomic and biomarker testing is used to establish whether a targeted or immune-based option exists before chemotherapy is recommended.
Experienced medical oncology leadership
Dr. Niti Krishna Raizada, Principal Director for Medical and Haemato-Oncology, brings 22 years of practice, a DM in Medical Oncology from the Cancer Institute, Chennai, and a BMT fellowship at Imperial College / Hammersmith Hospital, London.
Senior onco-nursing
Chemotherapy administration is a nursing discipline in its own right. Athira's day care unit is staffed by senior oncology nursing personnel.
Supportive and palliative care integrated
Symptom management is part of the treatment plan from the outset, in line with the centre's stated commitment to integrated palliative care.
A focused environment
As a specialist cancer and blood disorders centre, Athira's infusion services are not competing with general hospital demand.
Frequently Asked Questions
It depends on the drugs used. Some regimens cause complete hair loss, some cause thinning, and some cause none at all. Your oncologist can tell you what to expect from your specific regimen. Where hair loss does occur, it is almost always temporary.
Anywhere from under an hour to several hours, depending on the drugs and the pre-medication required. Your first session usually takes longest. The day care team will give you a realistic time so you can plan the day.
The infusion itself should not be painful. A cannula insertion stings briefly. If you feel burning, stinging or discomfort at the infusion site during treatment, tell the nurse immediately — that is exactly what they are watching for.
No. The National Cancer Institute states clearly that the severity of side effects does not indicate how well a drug is working. Response is assessed through scans and laboratory tests.
Most people can, though taste changes, nausea and mouth soreness may make some foods less appealing during certain parts of a cycle. Nutritional guidance is part of supportive care; raw or undercooked foods are usually avoided when blood counts are low.
Yes. Chemotherapy does not make you dangerous to be near. Reasonable precautions around bodily fluids for a short period after each dose will be explained to you. The greater consideration is infection risk to you when counts are low.
Yes. It is frequently combined with radiation, and increasingly with immunotherapy or targeted agents. Where surgery is planned, chemotherapy may come before it, after it, or both.
Contact the team straight away. Fever during chemotherapy can indicate infection at a time when your immune defences are reduced, and it is treated as urgent rather than something to monitor overnight.
Some regimens can affect fertility in both men and women. This should be discussed before treatment begins, while preservation options are still available. Raise it at your first consultation if it matters to you.
Many patients can, but some pre-medications cause drowsiness. For your first cycle it is safer to arrange for someone to accompany you until you know how you respond.
