Chemotherapy
Chemotherapy is one of the main treatments for cancer of unknown primary (CUP). Find out how you have it and the most common side effects.
What is chemotherapy?
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Cancer of unknown primary is an advanced cancer and unfortunately, most cases can't be cured. The aim of treatment is generally to relieve symptoms. It can also control the cancer and improve quality of life.
When you have it
You usually have chemotherapy every 3 weeks. Each treatment period is called a cycle.
You might have the chemotherapy drugs on the first day or first few days of each cycle, followed by a recovery period with no chemotherapy. Or you might have some chemotherapy drugs once a week for the first 2 weeks of each cycle.
You may have up to 6 cycles of treatment, but this will depend on:
- what chemotherapy drugs you are having
- how the cancer is responding to treatment
- the side effects you're having
Chemotherapy drugs
We can’t tell you for sure which chemotherapy drugs you will have for cancer of unknown primary. This is because the range of drugs and combinations that doctors might use is so large.
Your doctor chooses drugs that they think will suit you best. This depends on:
- the results of all your tests
- the side effects of the drugs
- your general health and fitness
You usually have a combination of 2 or 3 chemotherapy drugs. The most commonly used chemotherapy treatments include:
- carboplatin and paclitaxel
- epirubicin, cisplatin and capecitabine (ECX)
- epirubicin, cisplatin and fluorouracil (ECF)
- gemcitabine and carboplatin or cisplatin
- irinotecan and gemcitabine or oxaliplatin
You might have other types of chemotherapy if you have cancer spread in certain areas of the body, such as the lymph nodes of your armpit.
Your doctor may refer you to a breast cancer specialist if you have a type of cancer called adenocarcinoma in the lymph nodes of your armpit. This is because the cancer might have started in your breast.
You usually have a combination of chemotherapy drugs such as paclitaxel and doxorubicin.
Your doctor may refer you to a team that specialises in cancers of the female sex organs (gynae oncology team). You might have a platinum chemotherapy such as cisplatin or carboplatin, alongside paclitaxel or docetaxel.
This might suggest that the cancer has started in your head or neck. Your doctor will usually refer you to the head and neck specialist team for treatment.
You might have the chemotherapy drug cisplatin or carboplatin, alongside radiotherapy. This type of treatment is called chemoradiotherapy.
If you have cancer spread in the liver or lungs, doctors will use the results of all your tests to choose the best chemotherapy treatment for you. It might be:
- epirubicin, cisplatin and capecitabine or fluorouracil
- epirubicin, oxaliplatin and capecitabine
- carboplatin and paclitaxel
- gemcitabine
Cancer can sometimes develop in cells of the neuroendocrine system. If your doctor thinks you have this, they might refer you to a medical team that specialises in neuroendocrine tumours.
You might have treatment with carboplatin and etoposide.
Once you know which drugs you are going to have, you can learn more about them in our section about cancer drugs.
How you have it
You usually have chemotherapy through a drip into your bloodstream. Or you might take some chemotherapy drugs as tablets.
Into your bloodstream
You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Taking your tablets or capsules
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
COVID swab test
Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.
To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.
At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.
This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.
Check with your team about when you’ll have the test as there are some differences between hospitals.
Blood tests
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Side effects
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- a lower resistance to infections
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
When you go home
Chemotherapy can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
