Intrathecal Chemotherapy

What is it?

• Intrathecal (in-trah-THEE-kal) chemotherapy (kee-moh-THER-ah-pee) is one way to give chemotherapy. Intrathecal means that you are getting chemotherapy in your spinal canal. There are many ways to give chemotherapy. Depending on the medicine you need, intrathecal chemotherapy may be the best way to treat you. Intrathecal chemotherapy is given to treat certain types of cancer.
  
  
• Intrathecal chemotherapy may be given by an intralumbar (in-trah-LUM-bahr) injection (shot). This is when a needle that has chemotherapy in it is put into your spine. Your caregiver will then inject the chemotherapy, and the needle is removed. Intrathecal chemotherapy can also be given into a ventricle (VEN-tri-kl) in your brain. To do this, your caregiver will place an Ommaya (oh-MEYE-ah) reservoir. An Ommaya reservoir is a special device that is placed under the scalp. It allows chemotherapy to be given through the fluid around your spinal cord and brain.
  
  
• Giving intrathecal chemotherapy allows the chemotherapy to go where it can kill the cancer cells. This treatment is usually given over a short period of time. You may need to lie flat after the treatment. Lying flat allows the chemotherapy to go equally to all areas of your spinal cord and brain.

How do I get an Ommaya reservoir?

You will need to have surgery to have the reservoir put in. Your caregiver will place the Ommaya reservoir under your scalp (skin covering your head). Your caregiver will do this while you are asleep or very drowsy. The hair where the Ommaya reservoir is placed will be shaved. You may have a small raised area on your head where the Ommaya reservoir is located. When you need chemotherapy, a specially trained caregiver will give you the medicine. Your caregiver will place a small needle into the top of the Ommaya reservoir and give your chemotherapy. The needle will be removed after the chemotherapy has been given. Your caregiver will hold pressure over the area for a few minutes to stop any bleeding.

What is an intralumbar injection?

An intralumbar injection is when your caregiver gives your chemotherapy into your spine. It is also called a lumbar injection. Your caregiver will place a needle with the medicine into your spine. Once the chemotherapy is given, the needle is removed. An intralumbar injection may be painful. Your caregiver may use special medicine to make you lose feeling in the area or to make you drowsy before the medicine is given. Ask your caregiver for more information about intralumbar injections.

What is chemotherapy?

Chemotherapy is also called "chemo". It is a special medicine used to fight cancer. Chemo can cure many cancers. Chemo may also help you live longer if you have cancer. Chemo cannot cure all kinds of cancer. There are many different kinds of chemo. Some kinds of chemo can make you very sick. Most people get sick from chemo because chemo kills healthy cells. Your caregiver will decide what kind of chemo you will get and how you will get it. How often and how long you get chemo depends on the type of cancer you have. It also depends on the chemo medicines that are used and how your body handles the chemo.

How does chemotherapy work?

• In your body, you have healthy cells that divide and grow to make more healthy cells. Cancer cells do not divide and grow normally. Cancer cells multiply much more quickly than normal cells. This is how they take over normal cells. Your body cannot fight off these cancer cells because they grow so quickly.
  
  
• Chemotherapy prevents cancer cells from growing and dividing. Chemo may also help prevent the spread of cancer to other parts of your body. Chemo directly attacks these rapidly dividing cells. Chemo also kills healthy cells. Some healthy cells that may be killed by chemo are hair and reproductive (ree-proh-DUK-tiv) cells. Reproductive cells are cells in your ovaries (OH-var-ees) or testicles (TES-ti-kls). These cells will usually repair themselves when you are done with chemo.

How long will I need to have intrathecal chemotherapy?

Your caregiver will decide how long you need to receive intrathecal chemo. The kind of cancer you have will affect how long you get chemo. Different chemo medicines may be used together. For some people, combining chemo medicines may decrease the amount of time the medicine is needed. You may get chemo every day, week, or once or twice a month. You may need to get chemo treatments for several months or longer. Chemo is often given in cycles. This means that you will get chemo for a period of time, then you will have a break from it. This allows your body to grow new, healthy cells.

Where will I be treated?

You and your caregiver will decide where you will need to go to be treated with intrathecal chemo. Intrathecal chemo may be given in a hospital or a special clinic. A specially trained caregiver will give you the medicine. The very first time you get chemo, you may be in the hospital. Your caregivers can watch you closely to see how you feel during and after the treatment. Your caregivers can then decide if any changes in the chemo need to be made.

How will I feel after I get my intrathecal chemotherapy?

You may feel pain after you get your intrathecal chemo. You may be tired for a few days or longer after you get your chemo. You may be too tired to go to work or do any other activities. You may also feel nauseated (sick to your stomach) or you may vomit (throw up). Follow your caregivers instructions about rest and activity during and after your treatments.

What are the side effects of intrathecal chemotherapy?

Chemo can have many side effects. A possible bad side effect from intrathecal chemo is that it may accidentally leak into an area it should not. This can cause other medical problems, and take longer for the chemo to reach the cancer. It can also cause a buildup of chemo in your spinal fluid. This can be very dangerous. Other possible side effects from intrathecal chemo include:

• Fatigue. You may feel fatigued (very tired) after you get chemo. This may happen suddenly or over time. It is often not relieved with rest or naps. Fatigue can last for days, weeks, or months.
  
  
• Infection. Chemo kills healthy cells. This puts you at risk for infection (in-FEK-shun). Ask your caregiver about protecting yourself from infection.
  
  
• Mouth, gum, or throat problems. You may develop sores in your mouth or throat. You may also have white patches in your throat. Ask your caregiver about ways to prevent these problems.
  
  
• Nerve and muscle problems. Intrathecal chemo can sometimes cause dizziness or blurred vision. It may also cause you to lose your balance. These side effects usually go away in a few hours. It may help to lie flat for a few hours after receiving intrathecal chemotherapy.
  
  
• Pain. Intrathecal chemo can cause headache pain. Let your caregiver know if you have pain that does not go away, or gets worse.
  
  
• Poor appetite. You may not feel like eating. Ask your caregiver about what you can do to have a balanced and healthy diet.
  
  
• Problems with memory or mood. Chemo may make you feel depressed (very sad) or confused. Talk to family, friends and your caregiver about your feelings. Caregivers may suggest ways to help you cope with your treatment, and feel better.
  
  
• Sexual problems. Chemo can affect your sexual organs. Women's menstrual (MEN-stroo-al) cycle (monthly periods) may change or stop. There may be vaginal (VAJ-i-nal) dryness, and having sexual intercourse (sex) may hurt. You may also feel hot flashes. A hot flash is a sudden feeling of heat that spreads throughout your body. Men may not be able to have or keep an erection (ee-REK-shun). Men and women may be unable to have children, or it may be dangerous for a woman to become pregnant. Ask your caregiver for more information about sexual function while using chemo.
  
  
• Skin problems. The place where the intrathecal needle went in may feel sore or have a bruise.

What tests may I need while I get intrathecal chemotherapy?

Your caregiver may order several different tests to be done. This will help your caregiver see how the chemo is working. It will also allow your caregiver to see how your body is handling the chemo. Your caregiver may order the following tests:

• Blood culture: Your blood may be tested to see if there is infection in it. You may need to have your blood tested more than one time.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• CT scan: This is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of your cancer. Your caregivers look at these pictures. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps cancer areas show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

What are the risks with getting intrathecal chemotherapy?

• There are risks with getting intrathecal chemotherapy. You could have a bad reaction to the chemo. You may develop a bad infection in your spinal canal or other parts of your body. Chemo can permanently damage many organs in your body. The chemo may not work well for you, and the cancer could spread to other places in your body. If the chemo is not given into the right area, it could take a long time for the chemo to kill the cancer cells. This could mean that you might need chemo longer. A new area of cancer could grow.
  
  
• The chemo could be toxic (very dangerous) to you. It may cause a severe (very bad) headache, fever, nausea and vomiting. It may also cause your eyes to be sensitive to light. It could also cause death. If you have an Ommaya reservoir, the part that delivers the chemo to your spinal canal may become twisted or blocked. This could mean that you will need surgery to correct this. You may also get neck stiffness or an infection. Ask your caregiver if you have any questions or concerns.

Support:

You and your family may feel scared, confused, and anxious after being told you have cancer. Getting chemo is very frightening. These feelings are common. Talk about them with your caregiver or with someone close to you. For more information, you may call or write:

• American Cancer Society
  250 Williams Street
  Atlanta , GA 30303
  Phone: 1- 800 - 227-2345
  Web Address: http://www.cancer.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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