Different ways chemotherapy can be given

1. How is chemotherapy given
2. Intravenous chemotherapy
3. Oral chemotherapy
4. Electrochemotherapy
5. Further support

1. How is chemotherapy given?

Chemotherapy can be given in several ways. For breast cancer the drugs are most commonly given:

• Into a vein (intravenously)
• By mouth as tablets or capsules (orally)
• Electrochemotherapy

2. Intravenous chemotherapy

Intravenous chemotherapy can be given in different ways depending on factors such as how easy it is for your chemotherapy team to find suitable veins, and your preferences.

Cannula

The most common way of giving chemotherapy involves inserting a small needle and plastic tube called a cannula into a vein, either in the back of the hand or lower arm. The needle is removed and the cannula left in place. The cannula will be removed before you go home.

The diluted drugs are then slowly injected into the vein. If a large volume of fluid is used it can be given as an infusion (drip) through the cannula over a fixed period of time.

Image of a cannula in the hand.

Risk of lymphoedema

Lymphoedema is swelling of the arm, hand or breast area caused by a build-up of lymph fluid. Some people develop lymphoedema after surgery or radiotherapy to treat breast cancer.

Current guidance suggests there is no evidence that giving intravenous medicines on the side of your operation increases your risk of developing lymphoedema. While many treatment teams will give chemotherapy into a vein in the arm on the opposite side, practice can vary from hospital to hospital. Some teams may give chemotherapy in the arm on the same side as your surgery, or alternate the arms used each cycle. This is also usually the case if you have had surgery on both sides. 

If you have lymphoedema

If you have lymphoedema, the cannula will be placed in the arm on the opposite side to where you had surgery. If you have lymphoedema on both sides, your treatment team will discuss with you how your chemotherapy will be given.

Other ways of giving intravenous chemotherapy

Although a cannula is the most common way of giving chemotherapy, a central venous access device is sometimes used instead. This stays in place throughout the course of the treatment and the chemotherapy is given through it.

Various types of central venous access device are described below.

Skin-tunnelled catheter (Hickman line)

A skin-tunnelled catheter is a fine silicone tube that’s inserted into a vein through a small cut in the chest. This is called a Hickman line. The catheter is usually put in under a local anaesthetic but occasionally a general anaesthetic may be used.

It can stay in place for several months. Blood samples can also be taken from it.

Your chemotherapy nurse will explain how to take care of your catheter. After you have completed your treatment the catheter will be removed. This is usually done using a local anaesthetic.

Image of a skin-tunelled catheter (Hickman line). 

Peripherally inserted central catheter (PICC)

A PICC is inserted into a vein in your arm, at or above the bend in your elbow, and extends into the large vein leading to your heart. It’s usually put in under a local anaesthetic.

It can stay in place until your whole course of treatment is finished. Blood samples can also be taken from it.

The PICC line will be covered by a clear dressing and you’ll be given instructions on how to care for it and change the dressing. After you have completed your treatment the PICC will be removed by a nurse or doctor.

Image of a peripherally inserted central catheter (PICC).

Implanted port

An implanted port is a small device connected to a thin tube (catheter). It’s put under the skin, usually in the chest or arm. The other end of the tube goes into a large vein just above the heart. The port is hidden but can be felt under the skin. It is usually put in using a local anaesthetic. You may be given some medication to help you relax.

Chemotherapy drugs are given directly into the port. The area over the port may be numbed with an anaesthetic cream and a special needle is pushed into the port.

It can stay in place until your whole course of treatment is finished. Blood samples can also be taken from it.

When it needs to be removed a small cut is made over the site of the port using local anaesthetic. Sometimes a general anaesthetic may be used. The port is then removed and the catheter is taken out of the vein. The wound is stitched and covered with a dressing.

You’ll be given instructions on caring for your dressing and what to do if you feel sore or bruised after having the port removed.

Image of an implanted port in the chest.

Blood clots

If you have a Hickman, PICC line or port, it’s possible for a blood clot to form in your vein at the end of the line.

If you experience any of the following symptoms contact your local A&E department, GP or treatment team straight away:

• Pain, redness/discolouration, heat and swelling of the arm or leg

• Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck

• Shortness of breath
• Pain or tightness in the chest

If a blood clot forms, you’ll be given medication to dissolve it. Your line may need to be removed.

Find out more about blood clots.

3. Oral chemotherapy

Oral chemotherapy is taken by mouth, either as tablets or capsules. It is usually taken at home.

The hospital pharmacist or your chemotherapy nurse will give you instructions on how to handle and store the chemotherapy. They’ll also tell you when to take it, and you’ll be given other written instructions such as whether to take it with food.

The drugs you’re given by the hospital make up a complete course of treatment, and it’s important to take them exactly as they’ve been prescribed. Always read the labels on the boxes before you leave the hospital. If the instructions are unclear, ask your nurse or doctor before taking any of the drugs.

If you can’t take your medicines for any reason or if you are sick after taking your tablets, do not take an extra dose. Contact your treatment team immediately for advice.

Oral chemotherapy can cause side effects similar to treatment given intravenously. You will still need regular blood tests.

Image showing oral chemotherapy.

4. Electrochemotherapy

Electrochemotherapy, sometimes called ECT, is a treatment for breast cancer that has spread to the skin (skin metastases). It combines a low dose of a chemotherapy drug with electrical impulses given directly to the areas being treated using an electrode. This allows the chemotherapy to work in the treated areas only, with little or no effect in other areas.

If this is a suitable treatment option for you, your treatment team can refer you to the nearest available hospital for treatment.

Find out more about skin metastases.

5. Further support

Your chemotherapy team and breast care nurse can help with any questions you have. You can also call us free on 0808 800 6000 for information and support.

On our online Forum, you can find people going through treatment at the same time as you on the chemotherapy monthly threads.

You can also speak to someone who has had chemotherapy through our Someone Like Me service.