Cancer is a disease that requires a thorough and well-planned treatment approach. One of the most widely known treatment modalities — and the one that tends to raise the most questions among patients and their families — is chemotherapy. What exactly is chemotherapy? How are the drugs administered? And are the side effects always as overwhelming as people imagine?
dr. Nia Noviantri Siregar, Sp.PD, Subsp.H Onk. M(K), an internal medicine specialist with a subspecialty in hematology and medical oncology at Mandaya Royal Hospital Puri, addresses all of these questions in full.
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What Is Chemotherapy?
According to dr. Nia, cancer treatment approaches can broadly be divided into two major categories. The first is local therapy — such as surgery and radiotherapy — which targets the tumor at its site of origin. The second is systemic therapy, a form of treatment that works not only on the primary cancer cells, but can also reach throughout the entire body, along with the potential for side effects on other organs.
Chemotherapy is one form of systemic therapy that falls under the category of cytotoxic agents, meaning it works by killing cancer cells. Its mechanism is closely tied to the cell cycle. Every cell in the body has a life cycle consisting of several phases, and chemotherapy drugs work by disrupting specific phases within that cycle — preventing cancer cells from multiplying and ultimately causing them to die.
How Is Chemotherapy Administered?
Many people associate chemotherapy with an IV needle and a slowly dripping bag of medication. According to dr. Nia, intravenous (IV) administration remains the most commonly used method to this day. IV delivery itself can be carried out through several types of access, including:
- Peripheral line — standard venous access via a vein in the arm; the most frequently used due to its relative ease and practicality
- Chemoport — a special port implanted under the skin, typically used for patients undergoing long-term chemotherapy
- CVC (Central Venous Catheter) — a catheter inserted through a large blood vessel, usually used in specific clinical situations
However, dr. Nia explains that as medical science has advanced, chemotherapy is no longer limited to IV delivery. Several other administration routes are also available, depending on the type of cancer and the drug selected, including:
- Oral (taken by mouth) — certain chemotherapy drugs are available in tablet or capsule form
- Topical (applied to the skin) — used for certain types of skin cancer
- Intrathecal — injected into the cerebrospinal fluid surrounding the spinal cord
- Intravesical — delivered directly into the bladder
- Intra-arterial — administered through an artery leading to the tumor site
Do All Chemotherapy Patients Experience the Same Side Effects?
This is one of the most frequently asked questions among patients. According to dr. Nia, the answer is not always. Chemotherapy side effects can essentially be divided into two groups: general side effects and organ-specific side effects.
General side effects are the most widely recognized and can occur with nearly all types of chemotherapy drugs, including:
- Nausea and vomiting — among the most commonly reported complaints from patients
- Mouth sores (mucositis) — caused by the impact on the mucosal lining cells of the mouth
- Hair loss — occurs because hair follicles contain actively dividing cells that are also affected
- Malaise or fatigue — a general sense of exhaustion throughout the body
On the other hand, dr. Nia also explains that certain chemotherapy drugs carry more specific side effects that target particular organs, for example:
- Cisplatin — can place a significant burden on kidney function, requiring patients to receive adequate fluid intake during administration
- Anthracyclines such as doxorubicin — known to affect the heart, making it mandatory for patients to undergo an echocardiography (Echo) examination before starting chemotherapy
- Bleomycin — may have an impact on lung function
That said, dr. Nia emphasizes that not every patient will necessarily experience these side effects. Each drug carries a different likelihood of causing side effects, and supportive medications have advanced considerably in recent years. Anti-nausea and anti-vomiting drugs are now far more effective, and treatments for other common complications — such as drops in white blood cell or hemoglobin levels — are also widely available. With proper management, the side effects of chemotherapy can be minimized significantly.
How Does a Doctor Determine and Formulate a Chemotherapy Regimen?
According to dr. Nia, the selection of chemotherapy drugs is never arbitrary. For common cancer types — such as lung cancer, colorectal cancer, or breast cancer — established treatment guidelines are already available, both from international and national medical bodies, recommending chemotherapy regimens based on the type and characteristics of the cancer.
However, dr. Nia emphasizes that these guidelines serve only as a starting point. Before determining the most appropriate regimen, the doctor must take several important factors into consideration, including:
- Cancer type and cell characteristics — since even the same type of cancer can present with different cellular profiles
- Cancer stage — which determines how aggressive the treatment approach needs to be
- The patient’s physical condition and performance status — whether the patient is still able to carry out daily activities independently
- Vital organ function — particularly the heart, kidneys, and liver, which can influence the choice and dosage of drugs
dr. Nia gives an example: if the guidelines recommend a three-drug combination, but the patient’s condition does not allow for it — whether due to advanced age, a weakened physical state, or reduced heart function — the doctor will adjust the regimen accordingly, either by reducing the number of drugs or modifying the dosage.
This is precisely why the assessment prior to the first chemotherapy session tends to be more thorough and time-consuming. The doctor needs to ensure that the patient is genuinely fit to undergo chemotherapy, and to determine the approach best suited to their condition — all in pursuit of optimal treatment outcomes with manageable risks.
Consult with dr. Nia About Chemotherapy
dr. Nia Noviantri Siregar, Sp.PD, Subsp.H Onk. M(K) is an internal medicine specialist with a subspecialty in hematology and medical oncology at Mandaya Royal Hospital Puri, with expertise in managing various types of cancer through systemic therapies, including chemotherapy.
Having completed her internal medicine specialist training at Universitas Indonesia, dr. Nia is also an active member of the Indonesian Medical Association (IDI) and the Indonesian Society of Internal Medicine Specialists (PAPDI).
If you are looking to consult about cancer treatment options such as chemotherapy, do not hesitate to schedule an appointment with dr. Nia at Mandaya Royal Hospital Puri.
dr. Nia Noviantri Siregar, Sp.PD, Subsp.H Onk. M(K) is available for consultations at Mandaya Royal Hospital Puri on:
- Tuesday: 5:00 PM – 8:00 PM
- Friday: 5:00 PM – 8:00 PM
To make your visit to Mandaya Royal Hospital Puri as convenient as possible, you can use the WhatsApp Chat feature, Book an Appointment online, or download the Care Dokter app on Google Play or the App Store to easily manage your queue number and access complete information.
The information provided on this page is compiled for educational and general informational purposes and does not reflect the full range of medical services that each doctor may perform. For treatment tailored to your specific health condition, it is advised to consult directly with the relevant doctor.
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