The different ways chemotherapy can be given

Most chemotherapy is given in one of two ways: through a drip into a vein, called intravenous chemotherapy, or as tablets and capsules taken by mouth, called oral chemotherapy. Both deliver medicine into the bloodstream so it can reach cancer cells throughout the body. Intravenous treatment may be given through a small tube in the arm, or through a central line, port or PICC line that stays in place for the course of treatment. Some chemotherapy and related medicines are also given as injections under the skin or into a muscle.

For certain cancers, chemotherapy is delivered directly to the area where the cancer is, to concentrate treatment and reduce effects elsewhere. It can be given into the fluid around the brain and spinal cord through a lumbar puncture, called intrathecal chemotherapy, used for some leukaemias and lymphomas. It can be placed into the bladder through a thin tube, called intravesical treatment, for some early bladder cancers. It can be washed through the abdomen, called intraperitoneal chemotherapy, sometimes heated during surgery, known as HIPEC. It can be injected into an artery that feeds a tumour, called intra-arterial chemotherapy, for example to the liver. It can be applied to the skin as a cream for some superficial skin lesions, or placed as a dissolving wafer during brain surgery. The route chosen depends on the type and location of cancer, the medicines used, how well they reach the cancer, and your overall health. Your team will explain which routes apply to you and why.

The route affects your routine

Drips mean day care visits; tablets mean managing doses at home; local routes often involve a procedure.

The route affects side effects

Local treatments can reduce whole-body side effects, though they rarely remove them completely.

Different routes can be combined

Some treatment plans use more than one route, such as drips plus tablets or intrathecal doses.

It cannot tell you which route is right for your cancer. That depends on the cancer type, stage, location, medicines and your health, and is decided by your oncology team, sometimes with surgeons and radiologists.

It also cannot tell you whether a particular local treatment is available at your centre or suitable for you. Some routes, such as HIPEC or wafers, are used only in specific situations and at specialised centres.

Safety checks for spinal treatment

Hospitals use strict checks to ensure that medicines never meant for the spine are never given there.

Lines and ports

Central lines and ports make repeated drips easier but need care to prevent infection and clots.

Tablets are not weaker

Oral chemotherapy is real chemotherapy with real side effects.

Local routes still have systemic effects

Some medicine reaches the bloodstream even with local treatment.

Evidence varies

Some regional treatments have strong evidence for particular cancers and weak evidence for others. Ask what the evidence shows for yours.

Costs differ

Procedures and specialised routes may cost more. Ask for estimates.

Children and routes

Children often have ports and intrathecal treatment. Teams explain procedures in child-friendly ways.

Second opinions

For complex procedures such as HIPEC, a second opinion from an experienced team can help.

How teams choose a route

Choosing how to give chemotherapy involves several questions. Can the medicine be absorbed reliably from the gut, or does it need to go straight into the blood? Is the cancer confined to one area that can be reached directly, such as the bladder lining or the spinal fluid? Would a local route allow a higher concentration of medicine where it is needed, while reducing effects elsewhere? Is there good evidence that the route improves results for this particular cancer? And what are the risks, costs and practical demands for the patient and family? Oncologists weigh these together, often with surgeons, radiologists and pharmacists, and the answer can differ even for people with similar-sounding cancers.

Your role in the decision

You can ask why a particular route has been chosen, whether alternatives exist, what each option would mean for your time in hospital, travel and daily life, and what the evidence shows. Understanding the reasons helps you prepare, follow aftercare instructions and recognise warning signs.

Lines, ports and your daily life

If your treatment is given through a port or central line, you will be shown how to care for it, what to avoid, and which signs of infection or blockage need urgent attention. Many people find ports make repeated treatment much easier, because they avoid repeated needles in the arm.

Keeping a record of routes

Note in your treatment diary which medicines were given by which route and when.

What to do next

Ask your team how each medicine will be given and why, what preparation and aftercare each route needs, which warning signs to watch for, and whether any local treatment offered has good evidence for your cancer.