Chemotherapy reaches your body through several different routes, with intravenous (IV) infusion being the most common because it delivers the drug directly into your bloodstream with complete absorption. But IV is far from the only option. Depending on the type of cancer, its location, and the specific drugs in your treatment plan, you may receive chemotherapy by mouth, injection, topical cream, or directly into a body cavity.
Intravenous Chemotherapy
Most people picture an IV drip when they think of chemotherapy, and for good reason. IV delivery is the standard for the majority of chemotherapy drugs because 100% of the medication enters your bloodstream immediately. You’ll sit in a chair (sometimes called an infusion chair) while the drug flows through tubing into a vein. Sessions can last anywhere from 30 minutes to several hours depending on the drug and dosage.
If your treatment plan calls for just a few short infusions, a regular IV line placed in a vein on your hand or forearm may be enough. But most chemotherapy regimens run for multiple cycles over weeks or months, and repeated needle sticks in small veins cause irritation and damage over time. That’s where central venous access devices come in.
Ports
A port is a small, disc-shaped device surgically implanted under the skin of your chest. A thin tube connects it to a large vein near your heart. Because the entire device sits beneath the skin, there’s nothing visible between treatments. Ports require only monthly maintenance (typically a flush done at the end of each infusion session) and can stay in place for years. The tradeoff is that placing and removing one requires a minor surgical procedure.
PICC Lines
A PICC (peripherally inserted central catheter) is a long, thin tube threaded through a vein in your upper arm until the tip reaches a large vein near your heart. Unlike a port, the end of a PICC stays outside your body, which makes it easier for nurses to insert without surgery and keeps costs lower. The downside is that PICCs need weekly maintenance to prevent clotting and infection. Because part of the line sits outside the skin, there’s a higher risk of bacterial infection at the exit site compared to a fully implanted port. PICCs also sit in narrower veins, which can sometimes slow blood flow or irritate the vessel wall.
Your oncology team will recommend a device based on how long your treatment will last, how frequently you’ll receive infusions, and your personal medical history.
Oral Chemotherapy
Some chemotherapy drugs come as pills, capsules, or liquids you take at home. Oral chemo can feel more convenient and less clinical than sitting in an infusion center, but the drugs are just as potent and require careful handling.
Don’t crush, break, or chew tablets unless specifically instructed to. Use gloves when handling the medication, or tip pills directly from the container into a small disposable cup rather than touching them with bare hands. Store them away from food, water, direct sunlight, and anywhere children or pets could reach them. Anyone who is pregnant, breastfeeding, or a child should never handle the medication or any contaminated items.
During treatment and for four to seven days after stopping oral chemo, double-flush the toilet after every use. Wash your clothes and bed linens separately from the rest of the household’s laundry, and handle them with gloves. Never throw unused or expired medication in the trash or flush it down the toilet. Return it to your pharmacist or hospital for proper disposal.
Injections Under the Skin
Subcutaneous chemotherapy is delivered as a quick injection just beneath the skin, similar to an insulin shot. For some drugs, this route dramatically cuts the time you spend in the treatment chair. In one study comparing subcutaneous to IV delivery of targeted breast cancer therapies, chair time for maintenance doses dropped from about 124 minutes to just 18 minutes, a reduction of roughly 85%. Loading doses saw an even bigger difference, falling from nearly 300 minutes to around 12 minutes. Drug preparation time also shrank from about 16 minutes to just over 2 minutes.
Some patients feel brief discomfort at the injection site, which nurses can manage by slowing the injection speed. Even with that adjustment, the total visit is still far shorter than an IV infusion.
Regional Chemotherapy
When cancer is concentrated in a specific area of the body, delivering chemotherapy directly to that region can expose tumors to much higher drug concentrations while limiting side effects in the rest of the body.
Into the Abdominal Cavity
Intraperitoneal chemotherapy delivers drugs directly into the abdominal cavity. This approach is most often used for cancers that have spread to the lining of the abdomen, such as ovarian, colorectal, or gastric cancers. These types of metastases respond poorly to standard IV chemotherapy because not enough drug reaches the peritoneal surface through the bloodstream. By placing the medication directly into the cavity, drug concentrations at the tumor site are many times higher than what IV delivery could achieve. The lining of the abdomen acts as a natural barrier, slowing the drug’s absorption into the bloodstream and keeping it in contact with cancer cells longer.
Into the Spinal Fluid
Intrathecal chemotherapy is injected into the cerebrospinal fluid, the liquid surrounding the brain and spinal cord. This is necessary when cancer cells are found in or threaten to spread to the central nervous system. Most chemotherapy drugs given by IV cannot cross the blood-brain barrier effectively, so direct injection is the only way to reach adequate drug levels in that space.
Into the Bladder
Intravesical chemotherapy is instilled directly into the bladder through a catheter. This is a standard treatment for certain types of bladder cancer, allowing high concentrations of the drug to bathe the bladder lining while minimizing exposure to the rest of the body.
Topical Chemotherapy
For certain skin cancers and precancerous skin conditions, chemotherapy comes as a cream or gel applied directly to the affected area. You apply it at home following a prescribed schedule. Because the drug acts locally, systemic side effects are minimal compared to other routes.
Where Treatment Happens
Most IV chemotherapy takes place in a hospital outpatient unit or a dedicated infusion center. You arrive, get settled in a chair, and leave after the infusion is complete. But some treatment plans, especially those using portable infusion pumps, allow you to continue receiving chemo at home.
To qualify for home-based infusion, you generally need to meet five criteria. First, your overall health must be stable enough for safe discharge. Second, the specific drug must be suitable for ambulatory delivery (not all are). Third, you need a reliable way to communicate with your care team, such as a mobile phone. Fourth, you need a clean home environment and at least one family member or caregiver willing to be present during treatment and trained to help manage any side effects. Fifth, you should live within 30 to 60 minutes of a hospital. If you live farther away, your team may suggest staying at a nearby hotel during treatment.
What Happens if Chemotherapy Leaks From the Vein
Extravasation occurs when an IV chemotherapy drug leaks out of the vein and into surrounding tissue. Some chemotherapy agents, called vesicants, can cause serious damage to skin and tissue if this happens. The first sign is usually pain, burning, or swelling at the IV site.
If you feel any unusual pain or notice swelling during an infusion, tell your nurse immediately. The infusion will be stopped right away, and the medical team will attempt to withdraw as much of the leaked drug as possible through the existing IV line before removing it. Your arm will be elevated to help the body reabsorb the fluid, and cold or warm compresses will be applied (the choice depends on which drug leaked) for about 20 minutes at a time, four times a day, over the next one to two days. Depending on the drug involved, specific antidotes may be given to neutralize the agent and limit tissue damage.
Extravasation is uncommon, and trained infusion nurses monitor you throughout each session specifically to catch it early. Ports and PICC lines reduce the risk compared to standard peripheral IVs because they deliver drugs into larger, more resilient veins.
Safety Precautions During Administration
Chemotherapy drugs are hazardous not just to cancer cells but to anyone who comes into contact with them. The safety protocols surrounding administration are extensive. Nurses and pharmacists preparing and delivering these drugs wear two pairs of specially tested gloves (changed every 30 to 60 minutes), protective gowns made of coated material with tight-fitting cuffs, goggles or face shields, and respirators rated to filter airborne particles. A standard surgical mask alone does not provide adequate protection.
The drugs themselves are mixed in specialized ventilated enclosures that maintain negative air pressure, preventing any aerosolized particles from escaping into the room. These systems are equipped with high-efficiency air filters and are recertified every six months. Closed-system transfer devices are used during both preparation and administration to prevent any drug from escaping into the environment. These precautions explain why chemotherapy is prepared and given by specially trained professionals, even when the drug itself is something as simple as a liquid pushed through tubing.