Dr Bolaji Lateef Salako, a consultant clinical radiation oncologist at the Federal Medical Centre, Abeokuta, explains how chemotherapy works, why it does not spread cancer, the truth about side effects, why patients should complete treatment, and how misinformation is costing lives in this interview with SADE OGUNTOLA. Excerpts:
What exactly is chemotherapy, and how does it work to fight cancer in the body?
Chemotherapy refers to the use of cytotoxic drugs that destroy cancer cells. These drugs mainly target rapidly dividing cells, one of the characteristics of cancer cells. Different types work in different ways depending on the cancer being treated. Chemotherapy may be given as tablets, creams, injections or intravenous infusions.
Is chemotherapy the same for all cancers, or does it vary by type and stage?
Chemotherapy is not the same for every cancer. The specific cancer must first be confirmed through histological examination, with additional tests where necessary. These findings guide the choice of treatment. For example, chemotherapy for breast cancer differs from that used for lung cancer.
Chemotherapy may also be given at different stages of treatment. Neoadjuvant chemotherapy is given before surgery to shrink a tumour and make it easier to remove. Adjuvant chemotherapy is given after surgery to destroy cancer cells that may remain and reduce the risk of recurrence. It can also be combined with surgery, radiotherapy, hormonal therapy or targeted therapies, depending on the patient’s needs.
How do you decide whether a patient needs chemotherapy, surgery, radiotherapy, or a combination?
The decision depends on the type and stage of cancer, the patient’s overall health and fitness, previous treatments and medical history, and the pathology and biological characteristics of the tumour. If cancer is detected early, surgery alone is sufficient. Chemotherapy may not be necessary. If there is a risk that cancer cells have spread beyond the primary site, chemotherapy may be recommended. We also consider the treatment goal: whether we are aiming for a cure or trying to control the disease, relieve symptoms and improve quality of life.
What are the most common side effects of chemotherapy?
Side effects depend on the drugs used. Common ones include nausea, vomiting, fatigue, weakness, hair loss, skin darkening, body aches and changes in appetite. Many side effects can be prevented or reduced with supportive medication. Some patients may experience temporary disruption of their menstrual cycle, which often returns to normal after treatment.
Most side effects are temporary and improve when treatment ends. It is important to distinguish side effects from complications. Side effects are expected reactions that can usually be managed, while complications are more serious problems that may occur if chemotherapy is not properly administered. That is why chemotherapy should be prescribed and supervised by qualified oncology specialists.
Many people fear that chemotherapy kills faster than cancer. How do you respond?
This is one of the biggest misconceptions we encounter. Chemotherapy does not kill patients; its purpose is to destroy cancer cells. It may also affect some normal, rapidly dividing cells, causing effects such as hair loss, skin darkening and nail changes, but these are generally temporary.
Once chemotherapy is completed, most side effects gradually resolve. Unfortunately, misinformation has increased fear of treatment. Some people discourage patients from receiving chemotherapy or promote unproven alternatives. I remember a breast cancer patient who declined chemotherapy after receiving such advice. Months later, she returned with metastatic disease, making treatment much more difficult.
Patients should seek information from qualified oncology specialists rather than relying on rumours, social media or unverified sources. Chemotherapy is powerful because it is designed to destroy abnormal cells. It must therefore always be prescribed and administered by trained professionals.
Does chemotherapy spread cancer?
No. Chemotherapy does not spread cancer. It is used to control cancer, destroy cancer cells and prevent further spread. One major challenge we face is that many patients present very late. In my experience, about 90 per cent of our patients arrive with advanced disease. Advanced cancer may be locally advanced or metastatic, meaning it has already spread to other parts of the body. The goal of chemotherapy in such cases is to destroy cancer cells, reduce tumour burden and control the disease. It does not cause cancer to spread.
Once patients start chemotherapy, do they have to continue for life?
No. Chemotherapy is given according to a treatment plan, or protocol. The schedule depends on the cancer, the drugs used and the treatment objective. Some regimens are given weekly, others every two or three weeks. Treatment usually has a defined number of cycles, which may be six, eight, ten or twelve. Once the planned treatment is completed, chemotherapy is usually stopped.
What exactly is a chemotherapy cycle?
A chemotherapy cycle is one treatment session followed by a recovery period before the next treatment. For example, a patient may receive chemotherapy today and return three weeks later. Before each cycle, we examine the patient and conduct necessary tests to ensure they are fit to continue. For some patients, particularly those with locally advanced breast cancer, several cycles may be given before surgery to shrink the tumour. Additional cycles may follow surgery to complete treatment.
So chemotherapy is not like drugs for hypertension or diabetes that patients take for life?
Exactly. Most chemotherapy drugs are not taken for life. However, in some advanced or metastatic cancers, patients may receive low-dose oral chemotherapy for an extended period while it remains effective and well tolerated. Some cancers also require hormonal therapy for several years. That is different from chemotherapy and depends on the cancer being treated.
Some people believe that once a patient starts chemotherapy, they will die within a few months. What do survival statistics show?
Chemotherapy itself does not determine whether a patient survives or dies. One of the greatest factors affecting survival is the stage of the cancer at diagnosis. Patients with Stage I, II, III or IV disease may all receive chemotherapy, but their outcomes differ because the extent of disease differs. Two patients with breast cancer may receive the same chemotherapy while having very different prognoses because one has early-stage disease and the other has advanced metastatic cancer.
Does completing treatment as scheduled affect outcomes?
Yes, very much. Treatment compliance is extremely important. Sometimes patients begin chemotherapy but fail to return for subsequent cycles, coming back months later instead of at the scheduled time. When this happens, we may need to reassess or restart treatment. Irregular treatment can allow cancer cells to develop resistance, making future treatment less effective. Patients should therefore complete their treatment according to schedule. Regular treatment gives the best chance of achieving a good outcome.
Some patients believe natural alternatives can cure cancer better than chemotherapy. How do you address this?
Counselling is an essential part of cancer care. Before chemotherapy, we explain why treatment is necessary, how it works and why it should be completed as prescribed. There is no evidence from my clinical experience that natural alternatives can replace chemotherapy. However, good nutrition is very important because it supports the body and helps patients cope with treatment.
Misinformation sometimes leads patients to avoid foods such as rice, bread, eggs, chicken or fruits without scientific basis. We tell patients they can eat a balanced diet consisting of foods they normally enjoy. We advise them to avoid smoking and alcohol. Some patients are hardly eating because they have been told certain foods will “feed” the cancer. These claims are false and misleading. Patients should not deny themselves food because of misinformation.
Can a cancer patient eat normally while receiving chemotherapy?
Yes. Some chemotherapy drugs may reduce appetite, and medication can be prescribed when necessary. Patients should eat as well as they can throughout treatment. We encourage balanced meals, plenty of water, fruits and vegetables. Good nutrition supports the body during treatment.
Can patients continue to live normally while receiving chemotherapy?
Yes. Most patients can continue many normal activities. They can eat normally, attend social events, drive, work if they feel well enough, and maintain their usual routine. Married couples may continue sexual intercourse, but barrier contraception such as condoms is advised because pregnancy should be avoided during chemotherapy. Women who are breastfeeding should stop during chemotherapy.
After the first chemotherapy session, we usually observe patients to see how they tolerate treatment. If possible, someone else should drive them home after the first session. Many patients experience no significant problems and can return to their usual activities. Chemotherapy does not automatically prevent someone from working or carrying out normal responsibilities. Patients should listen to their bodies, follow medical advice and attend scheduled appointments.
How can patients ensure they are receiving safe, quality chemotherapy?
Whenever possible, patients should obtain chemotherapy medicines from recognised hospital pharmacies or reputable sources. At our centre, prescribed chemotherapy is obtained through the hospital pharmacy. If a drug is unavailable and must be sourced elsewhere, we carefully inspect it before administration. If we are unfamiliar with a brand, we advise patients to obtain one we recognise and trust. Government agencies and regulatory authorities should also continue strengthening medicine regulation to ensure safe, quality cancer treatment.
Are there cancers that chemotherapy can cure completely?
Yes. However, the outcome depends not only on the type of cancer but also on the stage at diagnosis. When cancer is detected early and treatment begins promptly, chemotherapy can be very effective and, in some cases, curative.
Lymphoma, for example, can respond very well to chemotherapy. If detected early and confined to a limited area, treatment may eliminate the disease completely. If lymphoma has spread extensively to organs such as the lungs, liver or kidneys, treatment becomes more challenging. Chemotherapy may still control the disease and improve survival, but the chances of complete cure are lower. The stage of the disease remains one of the most important factors influencing outcome.
When you talk about the stage of cancer, do you mean how far it has spread?
Exactly. Stage refers to the extent to which cancer has spread through the body. If it remains confined to its original site, treatment is generally more successful. When the disease has spread widely to multiple organs, chemotherapy cannot perform miracles. It can, however, slow progression, improve quality of life, relieve symptoms and increase survival.
For patients afraid of chemotherapy, what is the one thing you wish every Nigerian knew before refusing treatment?
The most important message is that chemotherapy does not kill people—ignorance does. Delaying treatment, refusing recommended therapy or relying on misinformation can have serious consequences. Chemotherapy can destroy cancer cells and, in many cases, cure cancer. In other situations, it slows progression, relieves symptoms, improves quality of life and prolongs survival.
Everyone should seek information from qualified healthcare professionals rather than relying on rumours or unverified sources. Cancer treatment should be guided by trained oncology specialists, just as you would trust an engineer to assess a building or a mechanic to repair a vehicle.
Should people receiving chemotherapy stay away from family members because the treatment is dangerous to others?
No. Chemotherapy is prepared in specialised units because the drugs require careful handling. Healthcare workers follow strict safety procedures when preparing them. Once chemotherapy has been administered, the patient does not become dangerous to others. Patients can sit with family members, interact with friends and maintain normal relationships.
So chemotherapy does not stop patients from relating with their families?
Exactly. Patients can interact with spouses, children, relatives and friends. Cancer itself is also not contagious. You cannot get cancer simply by being close to someone who has it. Patients should not be isolated because of their diagnosis or because they are receiving chemotherapy.
What is the difference between chemotherapy and radiotherapy?
Chemotherapy and radiotherapy are different forms of cancer treatment. Chemotherapy is a systemic treatment, meaning the medicines travel throughout the body to destroy cancer cells wherever they may be. Radiotherapy is a local treatment. It uses radiation from specialised machines and directs it precisely at the tumour. Chemotherapy is usually given in cycles, while radiotherapy is delivered in fractions, often over several weeks.
There are also specialised radioactive treatments for certain cancers, such as thyroid and some prostate cancers. These differ from external beam radiotherapy and may require temporary precautions while radioactive materials remain active.
Is it safe for someone receiving chemotherapy to be around children, pregnant women or pets?
Yes. A patient receiving chemotherapy can safely be around children, pregnant women, family members and pets. The main safety precautions apply to healthcare professionals while chemotherapy is being prepared, not after it has been administered. Patients can continue normal family interactions. Similarly, patients receiving standard external radiotherapy do not become radioactive after treatment and can safely be around others.
Some specialised forms of radiation treatment, such as certain implanted radioactive therapies, may require temporary precautions. In those situations, the medical team provides specific instructions until normal contact is safe.
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