What is biomarker testing for cancer treatment?

Biomarker testing is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer. Each person’s cancer has a unique pattern of biomarkers. Some biomarkers affect how certain cancer treatments work. Biomarker testing may help you and your doctor choose a cancer treatment for you.

There are also other kinds of biomarkers that can help doctors diagnose and monitor cancer during and after treatment. To learn more, visit the Tumor Markers fact sheet.

Biomarker testing is for people who have cancer. People with solid tumors and people with blood cancer can get biomarker testing.

Biomarker testing for cancer treatment may also be called:

• tumor testing 
• tumor genetic testing 
• genomic testing or genomic profiling
• molecular testing or molecular profiling 
• somatic testing 
• tumor subtyping 

A biomarker test may be called a companion diagnostic test if it is paired with a specific treatment.

Biomarker testing is different from genetic testing that is used to find out if someone has inherited mutations that make them more likely to get cancer. Inherited mutations are those you are born with. They are passed on to you by your parents.

How are biomarker tests used to select cancer treatment?

Biomarker tests can help you and your doctor select a cancer treatment for you. Some cancer treatments, including targeted therapies and immunotherapies, may only work for people whose cancers have certain biomarkers.

Patients Discuss Use of Genomic Data in Cancer Care

Workshop participants discussed data sharing, privacy, and other issues.

For example, people with cancer that has certain genetic changes in the EGFR gene can get treatments that target those changes, called EGFR inhibitors. In this case, biomarker testing can find out whether someone’s cancer has an EGFR gene change that can be treated with an EGFR inhibitor.

Biomarker testing could also help you find a study of a new cancer treatment (a clinical trial) that you may be able to join. Some studies enroll people based on the biomarkers in their cancer, instead of where in the body the cancer started growing. These are sometimes called basket trials. 

For some other clinical trials, biomarker testing is part of the study.  For example, studies like NCI-MATCH and NCI-COG Pediatric MATCH are using biomarker tests to match people to treatments based on the genetic changes in their cancers.

To find out if there are open trials for which you may be eligible, use the search tool at Find Clinical Trial. Or, contact the Cancer Information Service for help.

Is biomarker testing part of precision medicine?

Yes, biomarker testing is an important part of precision medicine, also called personalized medicine. Precision medicine is an approach to medical care in which disease prevention, diagnosis, and treatment are tailored to the genes, proteins, and other substances in your body.

For cancer treatment, precision medicine means using biomarker and other tests to select treatments that are most likely to help you, while at the same time sparing you from getting treatments that are not likely to help.

The idea of precision medicine isn’t new, but recent advances in science and technology have helped speed up the pace of this area of research. Scientists now understand that cancer cells can have many different changes in genes, proteins, and other substances that make the cells grow and spread. They have also learned that even two people with the same type of cancer may not have the same changes in their cancer. Some of these changes affect how certain cancer treatments work. 

Even though researchers are making progress every day, the precision medicine approach to cancer treatment is not yet part of routine care for most patients. But it’s important to note that even the “standard” approach to cancer treatment (selecting treatments based on the type of cancer you have, its size, and whether it has spread) is effective and is personalized to each patient. 

Should I get biomarker testing to select cancer treatment?

Talk with your health care provider to discuss whether biomarker testing for cancer treatment should be part of your care. Doctors usually suggest genomic biomarker testing (also called genomic profiling) for people with cancer that has spread or come back after treatment (what’s called advanced cancer). 

Biomarker testing is also done routinely to select treatment for people who are diagnosed with certain types of cancer—including non-small cell lung cancer, breast cancer, and colorectal cancer. 

It’s also a good idea to check with your health insurance provider to see if they will cover biomarker testing for your cancer. Biomarker testing is not available at every hospital. Check with your health care provider to see if biomarker testing is offered at the hospital or place where you get your cancer care.

How is biomarker testing done?

If you and your health care providers decide to make biomarker testing part of your care, they will take a sample of your cancer cells. If you have a solid tumor, they may take a sample during surgery. If you aren’t having surgery, you may need to have a biopsy of your tumor. 

If you have blood cancer or are getting a biomarker test known as a liquid biopsy, you will need to have a blood draw. You might get a liquid biopsy test if you can’t safely get a tumor biopsy, for example, because your tumor is hard to reach with a needle. 

Your samples will be sent to a special lab where they will be tested for certain biomarkers. The lab will create a report that lists the biomarkers in your cancer cells and if there are any treatments that might work for you. Your health care team will discuss the results with you to decide on a treatment. 

For some biomarker tests that analyze genes, you will also need to give a sample of your healthy cells. This is usually done by collecting your blood, saliva, or a small piece of your skin. These tests compare your cancer cells with your healthy cells to find genetic changes (called somatic mutations) that arose during your lifetime. Somatic mutations cause most cancers and can’t be passed on to family members.

Are there different types of biomarker tests?

 Yes, there are many types of biomarker tests that can help select cancer treatment. Most biomarker tests used to select cancer treatment look for genetic markers. But some look for proteins or other kinds of markers.

Some tests check for a single biomarker. Others check for many biomarkers at the same time and may be called multigene tests or panel tests. One example is the Oncotype DX test, which looks at the activity of 21 different genes to predict whether chemotherapy is likely to work for someone with breast cancer. 

Some tests are for people with a certain type of cancer, like melanoma. Other tests look for biomarkers that are found in many cancer types, and such tests can be used by people with different kinds of cancer. 

FDA Approves Two Genomic Profiling Tests for Cancer

Tests can identify different cancer-associated genetic alterations.

Some tests, called whole-exome sequencing, look at all the genes in your cancer. Others, called whole-genome sequencing, look at all the DNA (both genes and outside of genes) in your cancer. 

Still other biomarker tests look at the number of genetic changes in your cancer (what’s known as tumor mutational burden). This information can help figure out if a type of immunotherapy known as immune checkpoint inhibitors may work for you.

Biomarker tests known as liquid biopsies look in blood or other fluids for biomarkers from cancer cells. There are two liquid biopsy tests approved by the Food and Drug Administration (FDA), called Guardant360 CDx and FoundationOne Liquid CDx. 

What do the results of a biomarker test mean?

The results of a biomarker test could show that your cancer has a certain biomarker that is targeted by a known therapy. That means that the therapy may work to treat your cancer. The matching therapy may be available as an FDA-approved treatment, an off-label treatment, or through participation in a clinical trial. 

The results could also show that your cancer has a biomarker that may prevent a certain therapy from working. This information could spare you from getting a treatment that won’t help you.

In many cases, biomarker testing may find changes in your cancer that won’t help your doctor make treatment decisions. For example, genetic changes that are thought to be harmless (benign) or whose effects are not known (variant of unknown significance) are not used to make treatment decisions. 

Based on your test results, your health care provider may recommend a treatment that is not FDA approved for your cancer type, but is approved for the treatment of a different type of cancer that has the same biomarker as your cancer. This means the treatment would be used off label, but it may work for you because your cancer has the biomarker that the treatment targets.

Some biomarker tests can find genetic changes that you may have been born with (inherited) that increase your risk of cancer or other diseases. These genetic changes are also called germline mutations. If such a change is found, you may need to get another genetic test to confirm whether you truly have an inherited mutation that increases cancer risk. 

Finding out that you have an inherited mutation that increases cancer risk may affect you and your family. For that reason, your health care provider may recommend that you speak with a genetic healthcare provider (such as a genetic counselor, clinical geneticist, or a certified genetic nurse) to help you understand what the test results mean for you and your family.

Will biomarker testing for cancer treatment help me?

Biomarker tests don’t help everyone who gets them. There are several different reasons why they may not help you. Biomarker testing may not help you if:

• you are unable to safely get a biopsy needed for testing.
• there is not enough tumor tissue in your biopsy sample to have biomarker testing done.
• the test doesn’t find any biomarkers in your cancer that match with available therapies.
• the test identifies a matching therapy that would be used off label, and your insurance doesn’t cover the cost.
• the test identifies a matching therapy that is being tested in a clinical trial, and you are not able to participate in the trial.

Even if your test finds a biomarker that matches an available treatment, the therapy may not work for you. Sometimes other features of your cancer or your body affect how well a treatment works, such as how the medicine is broken down in your body. 

Another reason the treatment might not work is that not all of your cancer cells have the same biomarkers. That means that a biomarker test may find a treatment that will kill some, but not all, of your cancer cells. Cancer cells that are not killed by the treatment could keep growing, preventing the treatment from working or causing the cancer to quickly come back.

One other reason biomarker tests might not help is because the biomarkers in your cancer can change over time. But a test only captures a “snapshot” of the changes at one point in time. So, the results of a biomarker test done in the past may not reflect the biomarkers in your cancer now. Your health care provider may want to test your cancer again, for example, if it comes back after treatment. 

How much does biomarker testing for cancer treatment cost?

The cost of biomarker testing varies widely depending on the type of test you get, the type of cancer you have, and your insurance plan. 

For people with advanced cancer, some biomarker tests are covered by Medicare and Medicaid. Private insurance providers often cover the cost of a biomarker test if there is enough proof that the test is required to guide treatment decisions. Tests without enough proof to support their value may be considered experimental and are likely not covered by insurance.

Many clinical trials involve biomarker testing. If you join one of these clinical trials, the cost of biomarker testing might be covered. The study coordinator can give you more information about related costs.

How radiation therapy works against cancer

At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.

Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.

Types of radiation therapy

There are two main types of radiation therapy, external beam and internal.

The type of radiation therapy that you may have depends on many factors, including:

• the type of cancer
• the size of the tumor
• the tumor’s location in the body
• how close the tumor is to normal tissues that are sensitive to radiation
• your general health and medical history
• whether you will have other types of cancer treatment
• other factors, such as your age and other medical conditions

External beam radiation therapy

External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions.

External beam radiation therapy is a local treatment, which means it treats a specific part of your body. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.

Learn more about external beam radiation therapy.

Internal radiation therapy

Internal radiation therapy is a treatment in which a source of radiation is put inside your body. The radiation source can be solid or liquid.

Internal radiation therapy with a solid source is called brachytherapy. In this type of treatment, seeds, ribbons, or capsules that contain a radiation source are placed in your body, in or near the tumor. Like external beam radiation therapy, brachytherapy is a local treatment and treats only a specific part of your body.

With brachytherapy, the radiation source in your body will give off radiation for a while.

Learn more about brachytherapy.

Internal radiation therapy with a liquid source is called systemic therapy. Systemic means that the treatment travels in the blood to tissues throughout your body, seeking out and killing cancer cells. You receive systemic radiation therapy by swallowing, through a vein via an IV line, or through an injection.

With systemic radiation, your body fluids, such as urine, sweat, and saliva, will give off radiation for a while.

Why people with cancer receive radiation therapy

Radiation therapy is used to treat cancer and ease cancer symptoms.

When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control.

Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

Types of cancer that are treated with radiation therapy

External beam radiation therapy is used to treat many types of cancer.

Brachytherapy is most often used to treat cancers of the head and neck, breast, cervix, prostate, and eye.

A systemic radiation therapy called radioactive iodine, or I-131, is most often used to treat certain types of thyroid cancer.

Another type of systemic radiation therapy, called targeted radionuclide therapy, is used to treat some patients who have advanced prostate cancer or gastroenteropancreatic neuroendocrine tumor (GEP-NET). This type of treatment may also be referred to as molecular radiotherapy.

How radiation is used with other cancer treatments

For some people, radiation may be the only treatment you need. But, most often, you will have radiation therapy with other cancer treatments, such as surgery, chemotherapy, and immunotherapy. Radiation therapy may be given before, during, or after these other treatments to improve the chances that treatment will work. The timing of when radiation therapy is given depends on the type of cancer being treated and whether the goal of radiation therapy is to treat the cancer or ease symptoms.

When radiation is combined with surgery, it can be given:

• Before surgery, to shrink the size of the cancer so it can be removed by surgery and be less likely to return.
• During surgery, so that it goes straight to the cancer without passing through the skin. Radiation therapy used this way is called intraoperative radiation. With this technique, doctors can more easily protect nearby normal tissues from radiation.
• After surgery to kill any cancer cells that remain.

Lifetime dose limits

There is a limit to the amount of radiation an area of your body can safely receive over the course of your lifetime. Depending on how much radiation an area has already been treated with, you may not be able to have radiation therapy to that area a second time. But, if one area of the body has already received the safe lifetime dose of radiation, another area might still be treated if the distance between the two areas is large enough.

Radiation therapy can cause side effects

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

Learn more about the side effects of radiation therapy.

How much radiation therapy costs

Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Special diet needs while on radiation therapy

Radiation can cause side effects that make it hard to eat, such as nausea, mouth sores, and throat problems called esophagitis. Since your body uses a lot of energy to heal during radiation therapy, it is important that you eat enough calories and protein to maintain your weight during treatment.

If you are having trouble eating and maintaining your weight, talk to your doctor or nurse. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or read more about side effects.

Working during radiation therapy

Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.

You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel better—or it could take months.

You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.

How surgery is performed

Surgeons often use small, thin knives, called scalpels, and other sharp tools to cut your body during surgery. Surgery often requires cuts through skin, muscles, and sometimes bone. After surgery, these cuts can be painful and take some time to heal.

Anesthesia keeps you from feeling pain during surgery. Anesthesia refers to drugs or other substances that cause you to lose feeling or awareness. There are three types of anesthesia.

• Local anesthesia causes loss of feeling in one small area of the body.
• Regional anesthesia causes loss of feeling in a part of the body, such as an arm or leg.
• General anesthesia causes loss of feeling and a complete loss of awareness that seems like a very deep sleep.

There are other ways of performing surgery that do not involve cuts with scalpels. Some of these include:

• Cryosurgery
  Cryosurgery is a type of treatment in which extreme cold produced by liquid nitrogen or argon gas is used to destroy abnormal tissue. Cryosurgery may be used to treat early-stage skin cancer, retinoblastoma, and precancerous growths on the skin and cervix. Cryosurgery is also called cryotherapy.

  For more information, see Cryosurgery to Treat Cancer.

• Lasers
  This is a type of treatment in which powerful beams of light are used to cut through tissue. Lasers can focus very accurately on tiny areas, so they can be used for precise surgeries. Lasers can also be used to shrink or destroy tumors or growths that might turn into cancer.

  Lasers are most often used to treat tumors on the surface of the body or on the inside lining of internal organs. Examples include basal cell carcinoma, cervical changes that might turn into cancer, and cervical, vaginal, esophageal, and non-small cell lung cancer.

  For more information, see Lasers to Treat Cancer.

• Hyperthermia
  Hyperthermia is a type of treatment in which small areas of body tissue are exposed to high temperatures. The high heat can damage and kill cancer cells or make them more sensitive to radiation and certain chemotherapy drugs. Radiofrequency ablation is one type of hyperthermia that uses high-energy radio waves to generate heat. Hyperthermia is not widely available and is being studied in clinical trials.

  For more information, see Hyperthermia to Treat Cancer.

• Photodynamic Therapy
  Photodynamic therapy is a type of treatment that uses drugs which react to a certain type of light. When the tumor is exposed to this light, these drugs become active and kill nearby cancer cells. Photodynamic therapy is used most often to treat or relieve symptoms caused by skin cancer, mycosis fungoides, and non-small cell lung cancer.

  For more information, see Photodynamic Therapy for Cancer.

Types of surgery

There are many types of surgery. The types differ based on the purpose of the surgery, the part of the body that requires surgery, the amount of tissue to be removed, and, in some cases, what the patient prefers.

Surgery may be open or minimally invasive.

• In open surgery, the surgeon makes one large cut to remove the tumor, some healthy tissue, and maybe some nearby lymph nodes.
• In minimally invasive surgery, the surgeon makes a few small cuts instead of one large one. They insert a long, thin tube with a tiny camera into one of the small cuts. This tube is called a laparoscope. The camera projects images from the inside of the body onto a monitor, which allows the surgeon to see what they are doing. They use special surgery tools that are inserted through the other small cuts to remove the tumor and some healthy tissue.

Because minimally invasive surgery requires smaller cuts, it takes less time to recover from than open surgery.  

To learn about the type of surgery that may be used to treat your type of cancer, see the cancer treatment summaries for adult and childhood cancers.

Types of cancer treated with surgery

Many types of cancer are treated with surgery. Surgery works best for solid tumors that are contained in one area. It is a local treatment, meaning that it treats only the part of your body with the cancer. It is not used for leukemia (a type of blood cancer) or for cancers that have spread.

Sometimes surgery will be the only treatment you need. But most often, you will also have other cancer treatments.

How surgery works against cancer

Depending on your type of cancer and how advanced it is, surgery can be used to:

• Remove the entire tumor
  Surgery removes cancer that is contained in one area.
• Debulk a tumor
  Surgery removes some, but not all, of a cancer tumor. Debulking is used when removing an entire tumor might damage an organ or the body. Removing part of a tumor can help other treatments work better.
• Ease cancer symptoms
  Surgery is used to remove tumors that are causing pain or pressure.

Risks of surgery

Surgeons are highly trained and will do everything they can to prevent problems during surgery. Even so, sometimes problems do occur. Common problems are:

• Pain
  After surgery, most people will have pain in the part of the body that was operated on. How much pain you feel will depend on the extent of the surgery, the part of your body where you had surgery, and how you feel pain.

  Your doctor or nurse can help you manage pain after surgery. Talk with your doctor or nurse before surgery about ways to control pain. After surgery, tell them if your pain is not controlled.

  For more information, see Pain and Cancer Treatment.

• Infection
  Infection is another problem that can happen after surgery. To help prevent infection, follow your nurse’s instructions about caring for the area where you had surgery. If you do develop an infection, your doctor can prescribe a medicine (called an antibiotic) to treat it.

  Other risks of surgery include bleeding, damage to nearby tissues, and reactions to the anesthesia. Talk to your doctor about possible risks for the type of surgery you will have.

How much surgery costs

The cost of surgery depends on many factors, including:

• the type of surgery you have
• how many specialists are involved in your surgery
• if you need local, regional, or general anesthesia
• where you have surgery—at an outpatient clinic, a doctor’s office, or the hospital
• if you need to stay in the hospital, and for how long
• the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for surgery to treat cancer. To learn more, talk with the business office of the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the NCI database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

Where you have surgery

Where you have surgery depends on:

• the type of surgery
• how extensive it is
• where the surgeon practices
• the type of facility your insurance will cover

You can have outpatient surgery in a doctor’s office, surgery center, or hospital. Outpatient means that you do not spend the night. Or, you may have surgery in the hospital and stay the night. How many nights you stay will depend on the type of surgery you have and how quickly you recover.

What to expect before, during, and after surgery

Before surgery

Before surgery, a nurse may call you to tell you how to prepare. They may tell you about tests and exams you need to have before the surgery. Common tests that you may need, if you have not had them lately, are:

• blood tests
• chest x-ray
• electrocardiogram (ECG)

You may not be able to eat or drink for a certain period of time before the surgery. It is important to follow the instructions about eating and drinking. If you don’t, your surgery may need to be rescheduled.

You may also be asked to have supplies on hand for taking care of your wounds after surgery. Supplies might include antiseptic ointment and bandages.

During surgery

Once you are under anesthesia, the surgeon removes the cancer, usually along with some healthy tissue around it. Removing this healthy tissue helps improve the chances that all the cancer has been removed.

Sometimes, the surgeon might also remove lymph nodes or other tissues near the tumor. These tissues will be checked under a microscope to see if the cancer has spread. Knowing if the nearby tissue contains cancer will help your doctors suggest the best treatment plan for you after surgery.

After surgery

Once you are ready to go home after surgery, the nurse will tell you how to take care of yourself. They will explain:

• how to control pain
• activities you should and should not do
• how to take care of your wound
• how to spot signs of infection and steps to take if you do
• when you can return to work

You will have at least one more visit with the surgeon a week or two after you go home. For more complex surgeries, you may need to see the surgeon more often. You may have stitches removed, and the surgeon will check to make sure you are healing as you should.

Special diet needs before and after surgery

Surgery increases your need for good nutrition. If you are weak or underweight, you may need to eat a high-protein, high-calorie diet before surgery.

Some types of surgery may change how your body uses food. Surgery can also affect eating if you have surgery of the mouth, stomach, intestines, or throat. If you have trouble eating after surgery, you may be given nutrients through a feeding tube or IV (through a needle directly into a vein).

Talk with a dietitian for help with eating problems caused by surgery. For more information about coping with eating problems see Nutrition During Cancer Treatment.

Working after surgery

You will need to take time off from work to have and recover from surgery. You may need only 1 day or many weeks. How long you need to recover depends on many factors, such as:

• The type of anesthesia you have. If you have local or regional anesthesia, you will probably return to work more quickly than if you have general anesthesia.
• The type of surgery you have, and how extensive it is
• The type of work you do. If you have an active job, you may need to take off more time than if you sit at a desk. If your job allows, you may want to see if you can work at home, or start back part time, to help you ease back into a full day.

Ask your doctor how long you will need to recover from your surgery. If you expect a longer recovery time, talk with your employer to find out if you can take medical leave. Check to make sure your health insurance will cover costs if you are on medical leave and not working for a time.

How chemotherapy works against cancer

Chemotherapy works by killing or stopping the growth of cancer and other fast-growing cells. Chemotherapy is used for two reasons:

• Treat cancer: Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.
• Ease cancer symptoms: Chemotherapy can be used to shrink tumors that are causing pain and other problems.

Which types of cancer does chemotherapy treat

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy with other cancer treatments. The types of treatment that you need depend on the type of cancer you have, if it has spread and where, and if you have other health problems. To learn more about treatment for your cancer, see the PDQ® cancer treatment summaries for adult and childhood cancers.

How chemotherapy is used with other cancer treatments

When used with other treatments, chemotherapy can

• make a tumor smaller before surgery or radiation therapy (called neoadjuvant chemotherapy)
• destroy cancer cells that may remain after surgery or radiation therapy (called adjuvant chemotherapy)
• help other treatments work better
• kill cancer cells that have returned or spread to other parts of your body

Chemotherapy can cause side effects

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by

• asking someone to drive you to and from chemotherapy
• planning time to rest on the day of and day after chemotherapy
• asking for help with meals and childcare on the day of and at least one day after chemotherapy

There are many ways you can help manage chemotherapy side effects. For more information, see the section on side effects.

How much chemotherapy costs

The cost of chemotherapy depends on

• the types and doses of chemotherapy used
• how long and how often chemotherapy is given
• whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
• the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.

If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

What to expect when receiving chemotherapy

How chemotherapy is given

Chemotherapy may be given in many ways. Some common ways include

• oral: comes in pills, capsules, or liquids that you swallow
• intravenous (IV): goes directly into a vein
• injection: given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly
• intrathecal: injected into the space between the layers of tissue that cover the brain and spinal cord
• intraperitoneal (IP): goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver
• intra-arterial (IA): injected directly into the artery that leads to the cancer
• topical: comes in a cream that you rub onto your skin

Of all the methods mentioned above, chemotherapy is most often given with an IV, through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.

• Catheter: A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter. See the section about infection for more information.
• Port: A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port. See the section about infection for more information.
• Pump: Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

How your doctor decides which chemotherapy drugs to give you

There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on

• the type of cancer you have and how advanced it is
• whether you have had chemotherapy before
• whether you have other health problems, such as diabetes or heart disease

Where you go for chemotherapy

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. For more information on side effects and how to manage them, see the section on side effects.

How often you receive chemotherapy

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on

• your type of cancer and how advanced it is
• whether chemotherapy is used to
  • cure your cancer
  • control cancer’s growth
  • ease symptoms
• the type of chemotherapy you are getting
• how your body responds to the chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

Missing a chemotherapy treatment

It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

How chemotherapy may affect you

Chemotherapy affects people in different ways. How you feel depends on

• the type of chemotherapy you are getting
• the dose of chemotherapy you are getting
• your type of cancer
• how advanced your cancer is
• how healthy you are before treatment

Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

How will I know if chemotherapy is working?

You will see your doctor often. During these visits, they will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Special diet needs while on chemotherapy

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or the section on side effects.  

Working during chemotherapy

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.