How chemotherapy is given

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

• into a vein (intravenously) by drip or injection in the hand or arm
• by mouth (orally) as a tablet or capsule.

Intravenous chemotherapy

A small plastic tube called a cannula is put into a vein (usually in the arm or hand) and the diluted drug is injected over several minutes. If a large volume of fluid is needed it's given as an infusion (drip) through the cannula over several hours.

If it is difficult to find a vein, sometimes a central venous access device is used, such as a skin-tunnelled catheter. This stays in place throughout the course of the treatment.

Different types of central venous access device are described below.

Skin-tunnelled catheter

A skin-tunnelled catheter (commonly called a Hickman or Groshong line) is a fine silicone tube that is put into a large vein through a small cut in your chest wall. It can stay in place for several months, which means that you don’t need to have a cannula put into the vein each time you have treatment. Blood samples can also be taken from the catheter.

The catheter can be put in under a local or general anaesthetic. A small cut is made near the collar bone though which the catheter is put into a large vein that leads to the heart. Along the outside of the catheter is a small cuff that lies just under the skin where it exits the body. After the treatment has finished the catheter will be removed under a local anaesthetic.

Peripherally inserted central catheter (PICC)

A PICC is a catheter put into a vein in your arm, at or above the bend in your elbow. It extends into the large vein leading to your heart. It is usually put in under local anaesthetic. Like a skin-tunnelled catheter it stays in place throughout the course of your treatment. It is held in place with a dressing, which has to be changed once a week.

Implanted port

An implanted port (sometimes called a portacath) is a small chamber put under the skin, usually on the chest. A catheter attached to the port is put into a vein. Chemotherapy drugs can be given directly into the port by puncturing it each time with a special type of needle.

Unlike a skin-tunnelled catheter or PICC, the port is hidden and it has to be put in under general anaesthetic. When it is removed via a small cut, the wound will be stitched and covered with a dressing.

Ambulatory chemotherapy

Some chemotherapy drugs are given through a central venous access device that is attached to a battery-operated portable pump. The pumps come in different sizes but are usually small and light enough to carry around in your bag or on your belt. The pump is programmed to give you a controlled amount of the drug continuously over a given period. This means that you can have your treatment at home and will need to visit the hospital only when the drug has finished.

Oral chemotherapy

Oral chemotherapy is usually taken at home as all or part of your treatment. Your chemotherapy nurse will tell you when to take your tablets/capsules and you will be given other written instructions such as whether or not to take them with food.