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Chemotherapy

Chemotherapy is a treatment to destroy cancer cells with medicines. There are more than 100 chemotherapy medicines available. These can be used in a variety of ways according to the type of cancer you have, how advanced it is and your general health.

Your care may differ from what is described here as it will be designed to meet your individual needs. It’s important that you discuss your chemotherapy treatment with your doctor.

Chemotherapy is used to destroy many different types of cancer at various stages. Chemotherapy kills cancer cells that are dividing and reproducing. Your healthy cells can repair the damage caused by chemotherapy, but cancer cells can’t and die.

Chemotherapy treats solid tumours (cancerous lumps) that affect organs such as the breast or bowel, as well as blood cancers such as leukaemia.

You may have chemotherapy to:

  • shrink a cancer before surgery or radiotherapy
  • reduce the chance of a cancer coming back after surgery or radiotherapy
  • treat a cancer on its own (some cancers are very sensitive to chemotherapy)
  • treat cancer that has spread from where it first started

The type of chemotherapy medicine you have will depend on a number of factors including:

  • the type of cancer you have
  • where the cancer started
  • what the cancer cells look like under a microscope
  • whether the cancer has spread to other parts of your body
  • your general health

Chemotherapy can be used on its own or alongside other treatments, such as radiotherapy, surgery or hormonal, biological and immune therapies.

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Details

  • Preparation Preparing for chemotherapy

    In most hospitals, a number of different health professionals will be involved in your treatment. An oncologist (a doctor who specialises in cancer care) and a specialist nurse will usually oversee your chemotherapy. A dietitian, pharmacist, psychologist and physiotherapist may also be involved in your treatment.

    Your doctor will explain why you’re having chemotherapy and how to prepare for your treatment. The length of time you will need to have chemotherapy for will depend on a number of things. These include the type of cancer you have and how much it has spread through your body. It also depends on the types of medicine you have, how severe your side-effects are and how successful the chemotherapy treatment is.

    You may have a number of tests before, during and after your chemotherapy. These may include:

    • blood and urine tests – to check your blood count (the number of various blood cells in your blood) and how well your kidneys and liver are working
    • blood pressure checks
    • an ECG or echocardiogram – to see how well your heart is working
    • an X-ray, CT scan, or MRI scan

    A doctor or nurse may also check your height and weight to work out the right dose of chemotherapy for you.

    You can take chemotherapy tablets at home, whereas you will usually need to have injections or infusions in hospital. However, some people may be able to have certain chemotherapy injections and infusions at home if services are available.

    Your doctor will discuss with you what will happen before, during and after your chemotherapy. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to chemotherapy. This will help you to be informed, so you can give your consent for the treatment to go ahead. You may be asked to do this by signing a consent form.

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  • The procedure What happens during chemotherapy?

    You can have chemotherapy in different ways. Most commonly, you will have chemotherapy through a drip into your bloodstream (intravenous chemotherapy) or as tablets or capsules that you swallow.

    Other ways of having chemotherapy medicines include:

    • injections into the area around your spinal cord (intrathecal injection)
    • injections into an affected body cavity such as your bladder (intracavity chemotherapy)
    • creams for skin cancers

    If you’re having intravenous chemotherapy, the medicines can be given through:

    • a small tube in a vein in your arm or the back of your hand
    • a thin tube inserted through the skin of your chest into a main vein near your heart (central line) – this can be left in for many months so medicines can be injected through it
    • a thin tube placed into a vein in the crook of your arm and threaded through until it’s in a vein near your heart (a PICC – peripherally inserted central catheter line) – this can also stay in place for many months
    • a thin tube put into a vein ending in an opening (port) just under the skin on your arm or chest (called an implantable port or ‘portacath’) – medicines are passed via needles through the port
    • an infusion pump – this is a portable pump that attaches to a PICC line or a central line and feeds in the correct dose of chemotherapy over a period of time

    You will usually have several sessions of chemotherapy. Each session may take between 30 minutes and a few hours. You will then have a rest period, which could be anything from a few days to several weeks, to allow your body to recover. Treatment and rest periods make up a cycle. You may have a number of cycles depending on how well your cancer responds to chemotherapy. Your doctor will explain your treatment in more detail.

  • Recovery Recovering from chemotherapy

    Your doctor or nurse will advise you on what to expect after chemotherapy and any side-effects you may have. Some people manage to continue with their lives as usual during and after chemotherapy. A small number of people even feel better as the symptoms of their cancer decrease. However, for many people chemotherapy can have an impact on everyday life. In particular, tiredness often prevents people from working full-time or doing their usual levels of physical activity. Take things at your own pace and don’t overdo it, particularly after you have just had treatment (see our FAQs for more information)

  • Risks What are the risks?

    There are some risks associated with chemotherapy. We haven’t included the chance of these happening as they are specific to your treatment and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the treatment.

    Chemotherapy doesn’t only target cancer cells, but any cells that divide rapidly. This includes those in your bone marrow and skin, cells that produce hair and those that line your mouth and digestive system. Damage to these healthy cells may produce possible side-effects, including:

    • tiredness
    • feeling sick or vomiting
    • diarrhoea
    • thinning of your hair or hair loss
    • sore mouth, mouth ulcers or changes in your sense of taste
    • numbness or ‘pins and needles’ in your hands and feet
    • breathlessness
    • skin changes – your skin may become dry or discoloured
    • changes in hearing – some people get tinnitus (a ringing sound in your ears)

    Side-effects vary greatly between the different types of chemotherapy and from person to person. Many side-effects can be controlled using other medicines. For example, sickness can be reduced by taking antisickness medicines alongside your chemotherapy.

    The side-effects of chemotherapy, such as sickness and diarrhoea, can make the contraceptive pill less effective. If you’re a woman, don’t try to get pregnant while you’re having treatment because the chemotherapy medicines can damage a developing baby.

    Some chemotherapy medicines can affect your fertility and for some women, it brings on early menopause. It’s important that you discuss these risks with your doctor before you start the treatment. You may be offered the opportunity to store eggs, embryos, ovarian tissue or sperm for future fertility treatment (see our FAQs for more information).

    Treatment with certain chemotherapy medicines can slightly increase your risk of developing a type of blood cancer called acute myeloid leukaemia in later life. Your risk of developing leukaemia years later will vary depending on how much chemotherapy you have. Your doctor will give you more information about this.

    Different chemotherapy medicines cause different side-effects, so it’s important to discuss your specific treatment with your doctor.

  • FAQs FAQs

    Why is tiredness a common side-effect of chemotherapy?

    Answer

    Tiredness is a common side-effect because chemotherapy treatment doesn’t just kill cancer cells but also healthy cells that keep you well.

    Explanation

    Chemotherapy targets any cells that divide rapidly. This includes red blood cells that carry oxygen around your body. You can get very tired and breathless if the number of red blood cells that are carried around your body is low and you become anaemic.

    Chemotherapy also targets white blood cells that help you fight infections. You may be prone to getting ill and also feel tired if the number of white blood cells in your blood is low.

    Feeling tired all the time can be frustrating and difficult to cope with. It should get better once you finish chemotherapy but it can often last several weeks or months after you finish your treatment. You may feel less able to get out of bed or do your usual activities.

    There are many things that may help you cope with your tiredness.

    • Cut down on unnecessary activities and ask family or friends to help you.
    • Give yourself plenty of time to rest.
    • Give yourself plenty of time to do tasks and to get places.
    • Spread tasks out over the week and do a little bit each day.
    • Eat a healthy, balanced diet to help keep your energy levels up.

    Most people regain their usual energy levels a few months after chemotherapy ends, and for many people it’s sooner than this.

    Speak to your doctor or nurse if you feel tired as a result of your chemotherapy.

    How long does it take for hair to grow back after chemotherapy?

    Answer

    Hair loss is a common side-effect of some chemotherapy medicines. It usually starts to grow back once your treatment ends and by four to six months afterwards you’re likely to have a good head of hair.

    Explanation

    Some types of chemotherapy medicines can damage your hair and make it brittle, causing it to break off near your scalp. How much you lose depends on the type, dose and length of your treatment.

    You may get slight thinning, hair loss in patches or complete hair loss. Your head hair is usually affected first. Eyelashes, eyebrows, underarm, leg and sometimes pubic hair may also fall out. It may fall out within a few days of starting chemotherapy or several weeks later. It’s best not to colour your hair when it’s thin as it may not work well. Wait until your hair gets back to normal before you colour it.

    Once your treatment ends, your hair may grow back slightly differently, for example it may be a different colour or more curly than before.

    Before you start treatment, ask your doctor whether your chemotherapy medicines may cause hair loss. If it does, you may want to consider ways to cover your head using a wig, scarf or hat, or you may decide you don’t want to cover your head at all. It’s not uncommon for men and women to shave their heads.

    If you’re worried about hair loss as a result of your treatment, speak to your doctor or nurse for advice.

    Will chemotherapy affect my fertility?

    Answer

    Yes, some chemotherapy medicines may affect your fertility. It’s important to discuss the risk of infertility with your doctor before you start your treatment.

    Explanation

    It can be difficult to find out that your treatment may affect your fertility. Some chemotherapy medicines won’t affect your fertility, whereas others may temporarily or permanently affect your fertility. The impact of chemotherapy on your fertility is influenced by:

    • your age
    • the type of chemotherapy medicine
    • dose and duration of chemotherapy
    • your general health
    • the type of cancer

    In men, chemotherapy may temporarily or permanently reduce the number of sperm you produce and their ability to fertilise an egg. You may be offered the opportunity to bank your sperm so it can be frozen and stored for future fertility treatment.

    In some women, chemotherapy may temporarily stop your ovaries from working. Your doctor will offer advice on this before you start treatment. Sometimes, you can have hormonal treatment during chemotherapy to try and protect your ovaries. Your periods may become irregular or stop and you may develop symptoms of the menopause. It usually takes about six months to a year for your periods to return to normal after chemotherapy.

    Some chemotherapy medicines stop your ovaries working permanently. Treatment for this can be complex and is still being improved, but depending on the type of cancer you have, you may have three options for future fertility treatment, including:

    • freezing embryos (fertilised eggs)
    • freezing eggs
    • a new treatment to remove and freeze ovarian tissue and then put it back after chemotherapy so it produces eggs again – this isn’t widely available but may become more widespread if research continues to show it to be successful
       

    Can chemotherapy affect your sex life?

    Answer

    Yes, chemotherapy may affect your sex life but it doesn’t affect everybody. It can also affect different people in different ways.

    Explanation

    Chemotherapy doesn’t affect everyone and you may not notice any changes at all. However, some of the side-effects of chemotherapy such as tiredness and feeling sick can affect your sex life as you may not feel like having sex if you don’t feel well. Some people feel anxious about their condition and how their treatment is going, which can also affect your desire to have sex. Others feel less confident about their appearance if they have lost their hair after having chemotherapy, for example, and this can affect their sex life too.

    However, there is usually no medical reason why you cannot have sex and the chemotherapy medicines won’t have any effect on your performance or enjoyment of sex. The only exception to this is if you have a low white blood cell count, as your doctor may advise you not to have penetrative sex until this improves.

    You might find it best to wait for a rest period in your chemotherapy treatment cycle to have sex again, or if you don’t feel ready, wait until you finish chemotherapy treatment. Most people regain their usual energy levels between a few months to a year after chemotherapy ends, and for many people it’s sooner than this.

    It’s best to use condoms for a few days after chemotherapy because it isn’t known if chemotherapy medicines pass into semen or vaginal fluids. This will protect your partner. And if you’re a woman, don’t try to become pregnant while you’re having treatment because chemotherapy medicines can damage a developing baby.

    It’s important to remember that if your feelings about having sex do change during your chemotherapy treatment, it won’t last forever. The side effects of the treatment will usually gradually wear off when your treatment is finished and your feelings may well change. If you have concerns about sex, you might find it helpful to talk to your partner, doctor or nurse for advice and support.

  • Resources Resources

    Further information

    Sources

    • About chemotherapy. Cancer Research UK. www.cancerresearchuk.org, published 7 March 2013
    • Chemotherapy principles. American Cancer Society. www.cancer.org, published 7 February 2013
    • Living with and beyond cancer: taking action to improve outcomes. Department of Health. www.gov.uk, published March 2013
    • Understanding chemotherapy: a guide for patients and families. American Cancer Society. www.cancer.org, published 7 March 2013
    • Planning chemotherapy. Cancer Research UK. www.cancerresearchuk.org, published 17 August 2011
    • Chemotherapy. Macmillan Cancer Support. www.macmillan.org.uk, published 1 October 2012
    • Having chemotherapy. Cancer Research UK. www.cancerresearchuk.org, published 17 August 2011
    • Living with chemotherapy. Cancer Research UK. www.cancerresearchuk.org, published 6 September 2011
    • Chemotherapy side effects. Cancer Research UK. www.cancerresearchuk.org, published 17 August 2011
    • Acute myeloid leukaemia risks and causes. Cancer Research UK. www.cancerresearchuk.org, published 20 June 2012
    • Treating cancer fatigue. Cancer Research UK. www.cancerresearchuk.org, published 16 August 2012
    • Fatigue in people with cancer. American Cancer Society. www.cancer.org, published 10 December 2012
    • Hair loss, hair thinning and cancer drugs. Cancer Research UK. www.cancerresearchuk.org, published 31 January 2013
    • Fertility and chemotherapy. Cancer Research UK. www.cancerresearchuk.org, published 18 August 2011
    • Sex and chemotherapy. Cancer Research UK. www.cancerresearchuk.org, published 18 August 2011
  • Related information Related information

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    Produced by Rachael Mayfield-Blake, Bupa Health Information Team, June 2013.

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