Chemotherapy For Dummies: What does BEP do?

Since Mike’s testicular cancer diagnosis, I’ve learnt all sorts of new words – words like seminoma, bleomycin, etopiside, cisplatin, and nadir.

Nadir. Every time I hear that I picture somewhere similar to Mordor – a land of gloom and shadows, peopled by savage beasts and dark-robed warlords mounted on black stallions.

Clearly, learning the words and actually understanding what they mean are two separate things.

Before all of this, I only had a rudimentary understanding of what chemotherapy actually did. I figure there are probably lots of you out there in the same boat, so here’s a “chemo for dummies” post.

What’s cancer?

Cancerous tumors form when cells in the body start to multiply abnormally fast. These cells clump together, and then damage and invade nearby tissues. The cancerous cells can also break away and spread (often through the lymphatic system) to other areas of the body, where they plant themselves and start making new tumors.

What does chemotherapy do?

Chemo drugs kill fast-dividing cells. They are designed to interfere with the cell’s growth cycle. Different chemo drugs interfere with different stage of the growth cycle, which is why cancer patients are often given different chemo drugs in combination.

Sounds good so far, right? Yeah, well, except for the fact that the chemo drugs can’t tell the difference between rapidly dividing cancer cells and other “rapid-divider” cells in the body (like bone marrow, skin cells, hair cells, and the lining of our mouths and gastro-intestinal tract). Chemo drugs are good at attacking cancer cells, but they’re also good at killing rapidly-dividing healthy cells. That’s why chemo patients experience undesirable treatment side effects.

You can lose your hair because the drugs “zap” your hair cells. You can experience mouth sores and G.I. distress because all those lining cells are depleted. You get fatigued because your bone marrow temporarily stops producing blood cells and your blood counts plummet. And nausea? Well, not only are your stomach and intestines struggling, but your body doesn’t know the chemo drugs are busy saving your life – all it knows is that they’re dangerous poisons, and it tries to get ride of them however it can. 

What the heck is nadir?

Nadir refers to the lowest point that an individual’s blood count will reach during a chemotherapy cycle. With the BEP chemotherapy cycle usually used to treat testicular cancer and non-hodgkins lymphoma, that’s about day 10-14 of the 21 day course.  

What drugs are used to treat testicular cancer?

Mike’s on a chemo regime called BEP. Here’s a bit about the three drugs in his cocktail.

Bleomycin (B): Bleomycin is actually an antibiotic that’s only used to treat cancer. It works by binding to a cell’s DNA and causing it to “break” so that the cell cannot grow or divide.

Etopiside (E): This works by blocking the action of an enzyme that cells need to keep their DNA in proper shape while they are dividing. Because cancer cells divide more quickly than normal cells, they are more likely than normal cells to be affected by etoposide and to die before successfully dividing.

Cisplatin (P): Cisplatin is a platinum-based drug that works to stop cancer cells from multiplying by binding the DNA strands together. Normal cells can recognize and repair this kink in their DNA. Some types of cancer cells cannot recognize and repair this DNA damage, and therefore die without dividing.

You’ve mentioned a “cycle”. What does a cycle of BEP look like?

Different chemotherapies are administered on very different cycles. BEP is a pretty intense regime. One cycle of 5-day BEP takes 21 days. Here’s what the treatment schedule looks like:

• Day 1: B, E, and P
• Day 2: E, P
• Day 3: E, P
• Day 4: E, P
• Day 5: E, P
• Day 8: B
• Day 15: B

On day 21, if you’ve been prescribed more than 1 cycle of chemo, that cycle starts all over again. Mike will receive at least three cycles.

What are some of the side-effects of BEP?

Mike and I are both more concerned about possible long-term side effects than the short-term ones that I mentioned earlier. Here’s a look at a couple of the possible long-term side effects of BEP.

Long-term, bleomycin can cause lung problems. It makes receiving general anesthetics more risky, and scuba diving is not recommended after treatment with bleo.

Etopiside raises your risk of developing leukemia and can cause peripheral nerve damage.

Cisplatin also raises your risk of developing leukemia, and it can cause peripheral nerve damage and high frequency hearing loss.

Those are some pretty scary possible side effects. Did you think about taking a “wait and see” approach rather than doing chemotherapy?

Not really. For testicular cancer, this drug regime “cures” more than 95% of Stage 1 or 2 cases. Mike’s diagnosis was early stage 3, and his odds of reaching five years cancer-free are still above 80% if he goes through chemo. Those are pretty good cure odds – definitely worth risking some yucky side effects. 

We did question our oncologist what might happen if we chose not to proceed with chemotherapy.

“If Mike eats right, drank 10kg of kale juice a week, and meditates for five hours a day while standing on his head facing the sunrise,” we asked, “is it possible that his body could deal with the cancer on its own?”

(OK, so we didn’t ask that, exactly, but you get the point.)

“Well,” our oncologist said slowly, “I doubt it. After all, you eat pretty well and you’re young and healthy, yet your immune system couldn’t shut down the original tumor the first time round or prevent the breakaway cancer cells from settling into your lymph nodes.”

Game, set, and match to the oncologist. And hello, BEP, our trio of new best friends. Bring your best cancer-fighting DNA-wrecking ninja moves to the party.

Want to find out more about cancer and chemo? Here are some links to explore:

1. Mike found his cancer because he performed a self-exam. If you were were a man and standing in this room right now, he’s probably ask you at some point when you did you last self-exam (no joke, he would). Here’s a link about testicular self-exams for you men.
2. Here’s the American Cancer Institute’s site on testicular cancer. Most comprehensive site we’ve found. 
3. A checklist of questions to ask your doctor or nurse after you’ve been diagnosed with cancer.
4. A cool YouTube video of chemo attacking growing cancer cells.
5. Another cool YouTube video about testicular cancer. 
6. A  relaxation/visualization script for people going through chemo.
7. And… what on earth are we doing in our wedding clothes in the oncology ward? Read this post.