Chemotherapy

Expert review by:

Professor Andrew Protheroe, Consultant Oncologist

Content review by:

Victoria Goldman, Freelance Health Editor

Page last reviewed: February 2024
Next review date: February 2027

Chemotherapy is a treatment using medicines to kill cancer cells. If you have cancer, your doctor may recommend you have chemotherapy on its own or with other treatments.

About chemotherapy

Chemotherapy (or chemo) medicines kill cells that are dividing and growing quickly. Cancer cells divide much more often than most normal cells. So chemotherapy is good at killing cancer cells. Sometimes chemotherapy kills healthy cells as well as cancer cells. This can cause some side-effects.

People have chemotherapy for lots of reasons. You may have chemotherapy during any stage of your cancer treatment. Your doctor will explain why they think chemotherapy may help you. They may recommend chemotherapy to:

shrink a tumour before surgery or radiotherapy
reduce the chance of a cancer coming back after surgery or radiotherapy
treat your cancer (some cancers are very sensitive to chemotherapy)
treat cancer that’s spread from where it first started
ease your cancer symptoms
give you a longer life

You may have chemotherapy with other treatments such as:

radiotherapy
surgery
hormone therapy
immune therapy

Some types of cancer respond better than others to chemotherapy medicines. And some chemotherapy medicines work better for specific types of cancer.

Preparing for chemotherapy

Planning your chemotherapy

Lots of different healthcare professionals will usually help to plan and give your treatment. These may include an oncologist (a doctor who specialises in cancer care), a specialist nurse, and a pharmacist. Your doctor will discuss with you what will happen before, during, and after your chemotherapy. You should be given written information about your chemotherapy, treatment plan, and any possible side-effects.

If you’re unsure about anything, don’t be afraid to ask. No question is too small. It may help if you prepare some questions in advance. You may want to know more details about the pros and cons, and if there are any alternatives to chemotherapy. It’s important that you feel fully informed, so you feel comfortable and ready to give your consent for the treatment to go ahead. You may be asked to do this by signing a consent form.

Tests you may have

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

blood and urine tests – to check the numbers of the various blood cells in your blood and how well your kidneys and liver are working
lung function tests – to see how well your lungs are working
an electrocardiogram (ECG) or echocardiogram – to see how well your heart is working
scans such as an X-ray, CT scan, MRI scan or PET scan – to help your doctor decide which treatment you need

Your doctor or nurse may check your height and weight to work out the right dose of chemotherapy for you. Before you have chemotherapy, your nurse may check your blood pressure, pulse, temperature, and blood oxygen levels. If there are any concerns, you may not be able to have chemotherapy that day.

What happens during chemotherapy?

How chemotherapy is given

You can have chemotherapy in different ways. Usually, you’ll have it:

through a drip into a vein (intravenous chemotherapy)
by swallowing tablets or capsules (oral chemotherapy)

But you may also have chemotherapy:

injected into the area around your spinal cord
injected into a muscle
injected into an affected hollow part of your body, such as inside your bladder or tummy
in a cream for some types of skin cancers

If you’re having chemotherapy through a vein, you may be given the medicines through one of the following ways.

A cannula. This small tube is put into a vein in your arm or the back of your hand.
A central line. This thin flexible tube is put through the skin of your neck or chest into a main vein near your heart.
A PICC (peripherally inserted central catheter) line. This thin flexible tube may be put into your chest near your heart through a vein in your arm.
An implantable port or ‘portacath’. One end (called a port) sits under your skin and the other end sits in a vein just above your heart.
An infusion pump, which attaches to a PICC line or a central line. This portable pump gives you the right dose of chemotherapy slowly over a period of time.

A cannula is usually removed when the treatment has finished for that day. A central line, PICC line, portacath, and infusion pump can stay in place for several months – you can have different medicines through them.

Where you have chemotherapy

If you’re swallowing chemotherapy tablets or capsules or using a pump, you can have these at home. But if you need to have injections, you’ll usually have the treatment in a hospital. It may be given:

in a special outpatient area called a day treatment unit or chemotherapy area
in a day ward where you are seen as an inpatient

How long each treatment session takes will vary from 10 to 15 minutes up to several hours. Sometimes you may need an infusion of fluid to flush the chemotherapy out of your body. If you’re having several medicines and then fluid infusions, this can be a long day.

Sometimes, you may need to stay in hospital overnight. If you’re wearing a portable infusion pump, you’ll have this fitted in hospital. You’ll usually then go back to the hospital to have the pump changed or taken out. You may be able have certain chemotherapy injections and infusions at home if services are available in your area.

Cycles of chemotherapy

A whole course of chemotherapy usually takes between three and six months. During your course, you’ll have a few treatment cycles. Each cycle has:

a treatment period when you have the chemotherapy medicines
a rest period without chemotherapy medicines, so your body can recover

After each treatment cycle, your doctor and nurse will check how you are. But you should also contact your healthcare team if you feel unwell at any time – they’ll give you the telephone numbers you need.

Your treatment plan may need to be changed during your chemotherapy course. Your doctor will explain your treatment at each stage, and why they may need to change something.

Contraception during chemotherapy

You and your partner should use reliable contraception such as condoms while you’re having chemotherapy and for a few weeks to months afterwards. Doctors don’t know for sure whether or not chemotherapy medicines can pass to other people in your body fluids.

Don’t try to get pregnant while you or your partner are having treatment because chemotherapy medicines can harm your developing baby.

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Recovering from chemotherapy

Everyone reacts differently to chemotherapy. Don’t expect too much of yourself too soon – it takes time to recover and get back to normal. Take things at your own pace, especially after you’ve just had treatment.

After your chemotherapy, you’ll probably carry on having regular check-ups with your doctor or nurse. You may even have more scans or X-rays. If you have any problems or worries, discuss these with your doctor or nurse when you see them. You may be able to carry on with your life as usual during chemotherapy. You may even feel better as you get fewer cancer symptoms. But you may feel very tired or find that your memory and concentration aren’t so good.

Some people keep working while they’re having chemotherapy, but others decide to stop working or work part-time. You may feel too tired to work or be as active as usual. You may need to take time off to have treatment or because you’re unwell and are in hospital. You may find it harder to concentrate or make decisions at work. It’s best to tell your employer about your treatment, so they can support you.

It’s natural to have mixed emotions after you’ve been through cancer treatment. You may be happy that your treatment is over, but also worry about the future. You may have lost some or all of your hair, which can affect your self-esteem.

Chemotherapy can affect your mental health, and some people get depression. It may help if you talk to a friend or family member about how you’re feeling. You could also join an online forum or local support group. If your low mood is getting worse and you start to feel depressed, contact your cancer team or your GP.

After chemotherapy, you may decide to make healthy changes to your lifestyle. This may mean:

This may make you feel better and help your body to recover. And you’ll be lowering your risk of getting other illnesses, including cancer, in the future.

Side-effects of chemotherapy

Chemotherapy may cause side-effects. The side-effects might be very mild and not last for very long.Some side-effects can be eased with medicines (such as anti-sickness medicines).

Most side-effects go away after treatment. But sometimes they can affect your body for longer. Or they may start to affect you several days or even weeks or months after your chemotherapy has finished.Always tell your healthcare team if you notice any side-effects or changes during or after your treatment. If you do get side-effects, there are many ways to make you feel better.

General side-effects

Chemotherapy doesn’t just target cancer cells. It targets any cells that divide quickly. This includes cells in your bone marrow, cells that make your hair, and cells that line your mouth and digestive system. If these healthy cells are damaged, you may:

feel tired
feel sick or be sick
have diarrhoea and/or constipation
have thinner hair or lose some of your hair
have a sore mouth, mouth ulcers, or changes in how things taste
get numbness or ‘pins and needles’ in your hands and feet
feel out of breath
not feel hungry
notice changes such as dryness or sensitivity to your skin
find it harder to hear or get tinnitus (a ringing sound in your ears)

You may be able to control many of these side-effects with other medicines, treatments, or self-help measures. If you’re feeling sick, you’ll be prescribed anti-sickness medicines to take with your chemotherapy. Ginger, acupressure bands, tonic water, acupuncture, and eating small meals regularly may also help to stop you feeling sick.

To reduce hair loss, you may be offered a ‘cold cap’ during your chemotherapy treatment. This cools down your scalp so less chemotherapy medicine reaches your hair follicles. But it doesn’t work for all cancers or all chemotherapy medicines, and it isn’t suitable for everyone.

If you’re feeling very tired, make sure you get some rest every day but also get some gentle exercise. Chemotherapy medicines can reduce your number of red blood cells. This can cause anaemia, which may make you feel tired. You’ll usually have regular blood tests to check your red blood cell level.

Infections

Chemotherapy can reduce the white blood cells that help your body fight infections. If you have a raised temperature (fever) during or shortly after chemotherapy, you may have an infection. Your doctor or nurse will usually give you advice about what to do if your temperature goes up. They may tell you to contact your chemotherapy unit urgently because you’ll probably need antibiotics. It’s important to follow any advice you’re given.

Fertility

Some chemotherapy medicines can affect fertility in men and women. Others may bring on an early menopause. It’s important to discuss these risks with your doctor before you start your chemotherapy. You may be able to store eggs, embryos, ovarian tissue, or sperm for future fertility treatment.

You can have chemotherapy in lots of different ways. You’ll usually have it through a drip into a vein in your arm, hand or chest. Or you may swallow tablets or capsules have injections or use a cream on your skin.

For more information, see our section on what happens during chemotherapy.

Chemotherapy can cause several side-effects. These include feeling tired, feeling or being sick, losing some of your hair, and not feeling very hungry. Some side-effects may be mild. They may not last for very long.

For more information, visit our section on side-effects of chemotherapy.

Chemotherapy shouldn’t be painful. If you notice any pain or burning when the medicine is being injected into your skin, tell your nurse straightaway. Some chemotherapy medicines can affect your nerves. You may get some pain or tingling sensations in your hands and feet.

For more information, see our section on side-effects of chemotherapy.

Each chemotherapy session may vary from 10 to 15 minutes to several hours. You’ll usually have chemotherapy for three to six months. You’ll have a number of different treatment cycles. In each cycle, you’ll have the chemotherapy medicines for a few weeks and then a break.

For more information, see our section on what happens during chemotherapy.

Everyone reacts differently to chemotherapy. Some people hardly have any side-effects and feel better straightaway. Others take longer to recover. It’s important to take things slowly at first and go at your own pace.

For more information, see our section on recovering from chemotherapy.

Some types of cancer respond better than others to chemotherapy. You may need several medicines at once so the chemotherapy works well. Your doctor will choose the right cancer treatment for you.

For more information, see our section: About chemotherapy.

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Personal communication. Professor Andrew Protheroe, Consultant Medical Oncologist, February 2024

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