Systemic chemotherapy (chemo) is the use of anti-cancer drugs that are injected into a vein or are taken by mouth. These drugs enter the bloodstream and reach throughout the body, making this treatment very useful for cancers that may be in more than one part of the body. Chemo can be useful for treating intraocular lymphoma, but it is used less often for intraocular melanoma.
Chemotherapy for lymphoma of the eye
Depending on the type and the stage of the lymphoma, chemo may be used alone or in combination with radiation therapy. There are several routes by which chemo may be given:
Intraocular: Some chemo drugs may be injected directly into the eye. This concentrates the chemotherapy at the site of the cancer, allowing higher doses to be given without causing severe side effects in other parts of the body.
Intrathecal: If the lymphoma may have spread to the brain or spinal cord, chemo may be given directly into the cerebrospinal fluid (the fluid surrounding the brain and spinal cord). Often, the chemo is given into this fluid during a lumbar puncture (spinal tap). Another option is to place a special type of catheter (an Ommaya reservoir) into the fluid through a small hole in the skull. The end of the catheter, which has a dome-shaped reservoir, stays just under the scalp. Doctors and nurses can use a thin needle to give chemo drugs through the reservoir
Systemic: Chemo drugs may be injected into a vein (usually in the arm) or taken as pills, after which they will reach all areas of the body. This route is especially useful if the cancer might have spread to parts of the body beyond where it started.
Many drugs are useful in treating patients with intraocular lymphoma. Methotrexate is a chemo drug often used to treat lymphoma of the eye. It can be given directly into the eye, intrathecally, and systemically. It is often given in combination with other drugs to treat lymphoma.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks. Most chemo treatments are given on an outpatient basis (in the doctor's office or hospital outpatient department), but some require hospital admission. Sometimes a patient may take one chemotherapy combination for several cycles and later switch to a different one if the first combination does not seem to be working well.
High-dose chemo followed by stem cell transplant: Doctors are limited in the doses of chemotherapy they can give because of the side effects these drugs can cause. High doses of chemo can especially damage the bone marrow (where new blood cells are made), which can be life-threatening.
In certain cases, such as where standard doses of chemo are no longer working, doctors sometimes give high doses of chemo that they know will likely destroy the bone marrow. To do this, they take blood stem cells from the patient's body before the treatment, and then infuse them back into the body after the chemotherapy. These cells settle in the bone marrow, where they make new blood cells.
This technique can be useful in some situations, but it can be hard for the patient to go through and can cause serious side effects. For more detailed information on stem cell transplants, see our documents, Non-Hodgkin Lymphoma and Bone Marrow and Peripheral Blood Stem Cell Transplant.
Chemotherapy for melanoma of the eye
Melanoma usually does not respond well to chemotherapy. Chemo is used only when the cancer has become widespread. The treatment is the same as for melanoma of the skin. For more information on treatment of widespread melanoma, refer to our document, Melanoma Skin Cancer.
Possible side effects of chemo
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Diarrhea
- Increased chance of infections (due to low white blood cell counts)
- Easy bruising or bleeding (due to low blood platelet counts)
- Fatigue (due to low red blood cell counts)
These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs to help prevent or reduce nausea and vomiting. Some drugs may also have specific side effects not listed above. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.
For more information on chemotherapy, see our document, Understanding Chemotherapy: A Guide for Patients and Families.
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