Drugs used in chemotherapy regimens can be given in many ways:

• oral (PO) -- taken by mouth (usually as pills)
• topical -- applied to the skin as a cream or lotion
• intravenous (IV) -- infused through a vein
• intramuscular (IM) -- injected into a muscle
• subcutaneous (SQ) -- injected under the skin
• intra-arterial -- injected into an artery
• intrathecal -- infused into the central nervous system via the cerebrospinal fluid
• intrapleural -- infused into the chest cavity
• intraperitoneal -- infused into the abdominal cavity
• intravesical -- infused into the bladder
• intralesional/intratumoral -- injected directly into the tumor

Some chemotherapy drugs are never taken by mouth because the digestive system can't absorb them or because they are very irritating to the digestive system. Even when a drug is available in an oral form (such as a pill or liquid), this method may not be the best choice. For example, some people with certain symptoms (severe nausea, vomiting, or diarrhea) can't swallow liquids or pills, and some people may have trouble remembering when or how many pills to take. Still, chemotherapy drugs are powerful treatments, regardless of the form in which they are administered.

The term parenteral is used to describe drugs given intravenously, intramuscularly, or subcutaneously. The IV route is the most common. Intramuscular and subcutaneous injections are less often used because many drugs can irritate or even damage the skin and muscle tissue.

The IV route gets the drug quickly throughout the body. IV therapy may be given through a catheter placed in a vein in the arm or hand or through a catheter placed into a larger vein in the chest, neck, or arm which is known as a central venous catheter (CVC).

Central venous catheters (CVCs) or vascular access devices may be needed

Central venous catheters are also known as vascular access devices. They are used for these reasons:

• to give several drugs at one time
• for long-term therapy (to reduce the number of needle sticks)
• for frequent treatments (using a CVC won't cause as much wear and tear to the veins, potential scarring, and discomfort as numerous IVs)
• for continuous infusion chemotherapy
• to give drugs that can cause serious damage to skin and muscle tissue if they leak outside of a vein (these drugs are known as vesicants). Delivering these through a CVC provides more stable access to a vein than a regular IV, reducing the risk that the drug will leak outside the vein and damage tissues.

There are many different types of CVCs that can be used to allow an easier route for IV medicines. These CVCs have different types of catheters and ports. The type of CVC used is based on how long you will be getting treatment, how long it takes to infuse each dose of chemotherapy, your preferences, your doctor's preferences, the care required to maintain the CVC, and its cost. Before you consent to a vascular access device, find out more from the doctor about the type that he or she recommends and why. Devices are placed in different parts of the body and require different levels of care. Some can restrict certain activities that you normally do, and safety can be a concern as well. Ask about other options to be sure that you get the type that will work best for you while still meeting your treatment needs. Also find out if your health insurance will cover the costs of the CVC.

Types of central venous catheters (CVCs) or vascular access devices

Most of the time, these catheters or ports are put in while you are awake. The port or catheter insertion may be done in the treatment center, clinic, or hospital. You can check with your doctor or nurse about whether you need to limit your food and fluid intake before the procedure, and if medicine will be used to keep you comfortable. Inserting some of the vascular access devices is more involved than others, and may require medicine that lessens pain and makes you sleepy. Plan to have a friend or relative drive you home after the procedure.

Chemotherapy for specific areas of the body (regional chemotherapy)

When there is a need to give high doses of chemotherapy to a specific area of the body, it may be given by a regional method. Regional chemotherapy involves directing the anti-cancer drugs into the tumor-bearing part of the body. The purpose is to get more of the drug to the cancer, while minimizing side effects on the whole body. Examples of regional chemotherapy include drugs given into the body through these routes:

• intra-arterial (into an artery that goes to a certain area of the body)
• intravesical (into the bladder)
• intrapleural (into the chest)
• intraperitoneal (into the abdomen)
• intrathecal (into the central nervous system via spinal fluid)

Intra-arterial chemotherapy

Intra-arterial infusions gained some popularity during the 1980s. An intra-arterial infusion allows a chemotherapy drug to be given directly to the tumor through a catheter placed in the artery that supplies blood to the tumor. This method is used to treat disease in an organ such as the liver (isolated hepatic perfusion), or to treat an extremity such as the leg (isolated limb perfusion). The goal is to concentrate the drug in the areas of the tumor and decrease systemic effects. The catheter is attached to an implanted or portable pump. Although this approach sounds like a good idea for better effectiveness and fewer side effects, most studies have not found it to be as useful as was expected. This approach is still being studied in clinical trials. Except for these studies, it is rarely available outside of specialized cancer centers.

Intracavitary chemotherapy

Intracavitary is a broad term used to describe chemotherapy given directly into a body cavity such as intravesical (bladder), intraperitoneal (abdominal cavity), intrapleural (chest cavity between the lungs and chest wall), or intrathecal (fluid surrounding the brain and spinal cord) chemotherapy. The drug is given through a catheter placed directly into one of these areas.

Intravesical chemotherapy is often used for early stage bladder cancer. The chemotherapy is usually given weekly for 4 to 12 weeks. For each treatment a urinary catheter is placed into the bladder to give the drug. The drug is kept in the bladder for about 2 hours and then drained. The urinary catheter is removed after each treatment.

Intraperitoneal chemotherapy has become one of the standard treatments for certain stages of ovarian cancer. It may also be used to treat some recurrent colon cancers, as well as cancers of the appendix that have spread extensively within the abdomen. Intraperitoneal chemotherapy is given through a Tenckhoff catheter (a catheter specially designed for removing or adding large amounts of fluid from or into the abdominal cavity) or through an implanted port attached to a catheter. Chemotherapy injected into the port travels through the catheter into the abdominal cavity where it is absorbed into the bloodstream. This approach can work very well, but it can also have more severe side effects than regular IV chemotherapy.

Intrapleural chemotherapy is not used very often but may be helpful for some people with mesothelioma (cancer that develops in the lining of the lung), and those with lung or breast cancers that have spread to the pleura (the membrane around the lungs and lining the chest cavity). Intrapleural chemotherapy is given through large or small chest catheters that may be connected to an implantable port. These catheters can be used to give drugs and to drain fluid that can build up in the pleural space when cancer has spread to that area.

Intrathecal chemotherapy is given directly into the fluid surrounding the brain and spinal cord (cerebrospinal fluid or CSF) to reach cancer cells in the fluid and the central nervous system (brain and spinal cord). Most chemotherapy drugs that are given into veins are unable to cross the barrier between the bloodstream and the central nervous system, called the blood-brain barrier.

Intrathecal chemotherapy is given by one of two methods:

• The chemotherapy can be given by a lumbar puncture (spinal tap) done daily or weekly into the space around the spinal cord.

A special device called an Ommaya reservoir can be used. It is a small, drum-like port which is placed under the skin of the skull. An attached catheter goes through the skull into a ventricle (a space inside the brain filled with cerebrospinal fluid). The port is accessed with a needle that goes through the skin into the drum.

Chemotherapy is given this way when it is needed to treat cancer cells that have entered the central nervous system (this is called leptomeningeal spread). It is seen most commonly in leukemias, but also may happen with some lymphomas and advanced solid tumors like breast and lung cancers. Intrathecal chemotherapy does not help when tumors have already started growing in the brain or spinal cord.

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Last Medical Review: 06/17/2009
Last Revised: 06/17/2009