Complete remission of some cancers is possible with chemotherapy alone. In other cases, chemotherapy is combined with surgery and/or radiotherapy to remove remaining cancer cells.

In palliative chemotherapy where the cancer is in its advanced stages, the treatment aims to slow the progression of the cancer and manage the symptoms.

Chemotherapy treatment is usually carried out in repeating cycles. A cycle of treatment can be between 2-6 weeks, and repeated again depending on the progression and whether the doctor recommends a different dose or type of drugs.

Thus, keeping up with the treatment visits, and follow-up tests are important to help your loved one during the process.

Some individuals may be able to continue at work with some adjustments with their employers, while others may be more affected and find themselves unable to do so.

The process of chemotherapy treatment can be summarized as follows:

1. Preparation for chemotherapy
2. Administration of chemotherapy drugs
3. Assessment of treatment

How to Prepare for Your Loved One’s Chemotherapy

Chemotherapy tends to weaken the patient’s immune system, thus some adjustments may be required at home and in daily activities. For example, bacteria is often present in uncooked food, thus avoiding foods like sushi and runny eggs is recommended.

When going out, your loved one may have to put on a mask to minimize exposure to harmful bacteria and viruses in the environment.

Chemotherapy Can Be Done at Home

While home-based chemotherapy is still uncommon, it is possible for chemotherapy treatments to be done at home, saving travelling time, waiting time, and most importantly, reduces your loved one’s risk of infection as compared to visiting the hospital. Your loved one can also get adequate rest during the treatment.

Injections

Injected into the muscle or vein, this is usually done in 30 minutes.

Intravenous (IV) Drip

This is the case in most chemotherapy treatments, whereby the drug is infused gradually into the system over 2-4 hours. In some cases, it is administered into the veins over the course of a few days.

There are several ways in which the IV is inserted:

• A small tube into a vein of the hand or arm
• A central line into a vein of the chest via the neck or chest
• A peripherally inserted central catheter (PICC) put into a vein of the chest via the arm
• A portacath where a small chamber or reservoir sit under the skin at the end of the central line

Generally, a shower or bath will not interfere with the IV. However, do ensure that the central line or PICC does not get submerged underwater without a waterproof cover. Swimming pools may also pose a risk of infection, thus it is important to check with the doctor, if your loved one has the desire to visit the swimming pool.

Portable Intravenous Pumps

This is a convenient way of administering chemotherapy gradually via a small battery operated pump. The nurse at the hospital will usually teach you how to monitor the pressure of the pump. You will also be given advice on when to return to the hospital for fresh doses, or arrange for a nurse to visit your home.

Oral Drugs

Taken 1-3 times a day, it is important to keep a log of your loved one’s medication. Missing a dose could interfere with the effectiveness of the chemotherapy treatment.

If your loved one is prescribed oral chemotherapy, it is important to handle them safely to reduce accidental exposure and contamination. Some steps to handle the medication safely at home include:

• Washing your hands before handling the medication
• Using gloves
• Ensuring that tablets/capsules are swallowed whole and not crushed or broken
• Sealing the medication if storage in the fridge is required
• Using only the designated syringes or spoons

Follow Up Appointments

Follow-up consultations and tests can be expected between chemotherapy cycles to assess the effectiveness of the treatment. Blood tests are also offered at selected community centres and polyclinics.

Can I Supplement My Loved One’s Chemotherapy Treatment with Vitamins or TCM?

Some over-the-counter medications, herbal or traditional medicine can interfere with the effectiveness of the chemotherapy or make it unsafe.

Therefore, it is important to discuss this with your doctor before proceeding.

Vitamins and mineral supplements should also be discussed, while supporting your loved one with a nutrient-rich diet during this period.

Side Effects of Chemotherapy

• Nausea and vomiting
• Hair loss
• Fatigue
• Low white blood cell count thus being susceptible to infections
• Low blood platelet count
• Anemia
• Loss of appetite
• Bowel problems

Some of these side effects can be overcome medically via medication or with a blood transfusion. You may wish to keep a log of side effects that your loved one experiences, and follow up with the doctor at subsequent visits.

When to Seek Immediate Medical Attention

Chemotherapy tends to lower the production of white blood cells, which increases the risks of infections. A fever, cough, or cold may even become severe. Seek immediate medical attention if your loved one exhibits symptoms of an infection, and inform the attending doctor on duty that he/she is undergoing chemotherapy.

Signs of an infection include:

• A temperature of 38℃ and above
• Chills
• Severe cough or sore throat
• Burning pain when passing urine
• Persistent diarrhoea
• Shortness of breath

References

1.Today Online (2017, July 31). Chemo at home helps cancer patients cut disruptions to daily life. Retrieved from https://www.todayonline.com/singapore/cancer-treatment-home-or-go.

2. The Straits Times (2016, October 2). What You Should Know About Chemotherapy. Retrieved from https://www.straitstimes.com/singapore/health/what-you-should-know-about-chemotherapy.

3. Singapore General Hospital (2018, April 3). Cancer – Treatments. Retrieved from https://www.ndcs.com.sg/patient-care/conditions-treatments/cancer/treatment.

4. Medical News Today (2017, December 14). What You Need to Know About Chemotherapy. Retrieved from https://www.medicalnewstoday.com/articles/158401.php.

5. National University Cancer Institute of Singapore (2012, December). Chemotherapy – A Guide for Patients and their Families. Retrieved from https://www.ncis.com.sg/Cancer-Support/Caregiver-Information/Documents/Chemotherapy-Eng-hi-res.pdf.

6. Cancer Research UK (2017, November 15). Chemotherapy Pumps. Retrieved from https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/how-you-have/into-your-vein/pumps.

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional

(As most uterine cancers develop from the endometrium, the term “endometrial cancer” may sometimes be used interchangeably with uterine cancer although there are differences)

Although abnormal vaginal bleeding may not always be indicative of cancer, those at a higher risk of developing uterine cancer should consider going for annual screenings. If detected at an early stage, the five-year survival rate for uterine cancer is as high as 95%.

Risk Factors of Uterine Cancer

• Obesity
• Diabetes
• Women who have never been pregnant
• Women who had their first periods by age 12; and women who have undergone menopause after age 55
• Irregular or infrequent menstrual periods of less than 4 times a year
• Women with Polycystic Ovarian Syndrome (PCOS)
• Family history of uterine cancer
• Personal history of breast or ovarian cancer
• Hormone Replacement Therapy that involves only Oestrogen
• Use of contraceptive Intrauterine Devices (IUDs)

Signs and Symptoms

The most common symptom of uterine cancer is unusual vaginal bleeding. While vaginal bleeding is not always a sign of cancer, it is recommended that a doctor be consulted as this could indicate other problems as well.

Unusual vaginal bleeding includes:

• Bleeding after menopause
• Bleeding between menstrual periods
• Abnormally heavy periods

Other signs of uterine cancer are:

• Vaginal spotting
• Pink or white water vaginal discharge
• Vaginal discharge that has a foul odour
• Pain during or after sexual intercourse
• Painful urination
• Pelvic pains

Screening and Diagnosis

Women who are at higher risk of developing uterine cancer should consider going for annual screenings of uterine cancer with transvaginal ultrasound and endometrial biopsy by the age of 30-35.

Primary evaluation in the doctor’s office may involve a pelvic examination to detect lumps or unusual findings, as well as an ultrasound scan to identify abnormalities in the uterus.

Endometrial Biopsy

A thin tube is inserted through the cervix into the uterus to obtain a small amount of uterine tissue. This biopsy is necessary to confirm the diagnosis of uterine cancer.

Dilatation and Curettage (D&C) may also be performed to remove the uterine tissue for testing, to determine the progress of uterine cancer prior to treatment

Treatment for Uterine Cancer

1. Surgery

This is the most common form of treatment for uterine cancer that removes the uterus and cervix. If the cancer has spread, the ovaries, fallopian tubes and lymph nodes may be removed too.

2. Radiotherapy

This can be used in all stages of uterine cancer, where high-energy rays target the cancer calls. It may also be introduced before surgery, or after to remove remaining cancer cells.

3. Chemotherapy

Usually given after surgery, drugs are administered either intravenously (IV) or taken orally in a pill/capsule. Sometimes, the chemotherapy treatment plan may involve a combination of drugs to improve the success rate of the treatment. Read about caring for a loved one going through Chemotherapy here.

4. Hormone Therapy

Aimed at slowing the growth and development of some types of uterine cancer, this is usually given by an oral pill containing a sex hormone called progesterone, which helps to balance out the hormone levels in the body.

This article is part of our Gynaecological Cancers series. To know more about other Gynaecological Cancers, continue reading about Ovarian Cancer and Cervical Cancer.

References:

1. Singapore Cancer Society (2016). Uterine Cancer. Retrieved from https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/uterine-cancer.html
2. Singhealth Group. (2019). Uterine Cancer. Retrieved from https://www.singhealth.com.sg/patient-care/conditions-treatments/uterine-cancer
3. The Straits Times (2016, March 29). High survival rate for uterine cancer if detected early.  Retrieved from https://www.straitstimes.com/singapore/health/high-survival-rate-for-uterine-cancer-if-detected-early
4. Cancer Research UK (2017, September 3). Womb Cancer – Risks and Causes. Retrieved from https://www.cancerresearchuk.org/about-cancer/womb-cancer/risks-causes

At Jaga-Me, we believe that healthcare should be a social good – it is a basic human need, and should be available to as many people as possible. We aim to deliver the highest quality care through innovation and a commitment to building meaningful relationships.

Save travelling and long wait times at the hospitals. Get specialised medical treatments:
– Urinary Catheterisation
– Complex Wound Care
– Nasogastric (NG) Feeding Tube
– IV Infusion Therapy

Jaga-Me: Your Trusted Medical Home Care Professional