Chemotherapy

Your health expert: Professor Andrew Protheroe, Consultant Medical Oncologist
Content editor review by Victoria Goldman, August 2021
Next review due August 2024

Chemotherapy, or chemo, means 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 medicines kill cells that are dividing and growing quickly. This means that they’re good at killing cancer cells, which divide much more often than most normal cells.

There are different reasons for having chemotherapy and it’s important that you know what the aims of your treatment are. Your doctor will explain this to you. Chemotherapy may be able to cure or control your cancer or it may be used to ease your symptoms. Chemotherapy travels throughout the body and works wherever the cancer is. This means it can treat cancer that’s spread away from the original tumour.

Your doctor may recommend chemotherapy to:

shrink a tumour 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’s spread from where it first started
improve the symptoms of cancer and prolong life

Some types of cancer respond better than others to chemotherapy medicines. And some chemotherapy medicines work better for specific types of cancer. But chemotherapy medicines can cause side-effects. So, your doctor will discuss with you whether or not chemotherapy is right for you and will tell you about all the side-effects.

There are lots of different chemotherapy medicines. You may have just one or, more usually, a combination of medicines. The right chemotherapy medicine or medicines for you may depend on:

the type of cancer you have
if your cancer has spread to other parts of your body
your general health
any cancer treatments you’ve already had

You can have chemotherapy with other treatments such as radiotherapy, surgery or hormonal, biological and immune therapies. Your doctor will explain about the different treatments and how they work.

If you have any questions about your chemotherapy medicines, ask your doctor or nurse.

Preparing for chemotherapy

Planning your chemotherapy

Several 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 may include:

blood and urine tests – to check the number of 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, or MRI 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 your chemotherapy, your nurse may take your temperature. If you have a high temperature or an infection, this needs to be treated before you can have chemotherapy.

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) or by swallowing tablets or capsules (oral chemotherapy).

But you may also have chemotherapy:

injected into the area around your spinal cord
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 in any of the following ways.

A small tube (cannula) may be placed in a vein in your arm or the back of your hand through which the medicine is given.
A thin, flexible tube may be passed through the skin of your neck or chest into a main vein near your heart. This is called a central line. It can be left in place for many months so medicines can be injected through it.
A thin flexible tube may be put into a vein in your arm (usually your forearm). The tube is then threaded through your vein until it is near your heart. This is called a PICC (peripherally inserted central catheter) line and can stay in place for many months. Medicines can be injected through it.
A thin flexible tube can be tunnelled just under the skin on your arm or chest. This is arranged so that one end (called a port) is under your skin and the other is in a vein just above your heart. This is called an implantable port or ‘portacath’. Medicines are passed through needles into the port.
An infusion pump is a portable pump that attaches to a PICC line or a central line. It gives you the right dose of chemotherapy slowly over a period of time

Where you have chemotherapy

If you’re swallowing chemotherapy tablets or capsules, you can take these at home. But if you need to have injections, you’ll usually have the treatment in a hospital. This may be in a chemotherapy day clinic or a day ward. Sometimes, you may need to stay in hospital overnight.

If you’re wearing a pump giving you continuous infusions, 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 cycles of treatment. Each cycle has:

a treatment period, which is 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. However, contact your healthcare team if you feel unwell at all at any time. They will give you the telephone numbers you need so you can contact them.

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

Your doctor will advise you and/or your partner to use reliable contraception such as condoms while you’re having chemotherapy, and for a few weeks to months afterwards. This is because 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 to chemotherapy differently. Don’t expect too much of yourself too soon – it takes time to recover afterwards.

After your chemotherapy, you’ll probably continue to have regular check-ups with your doctor or nurse. You may even have more scans or X-rays. Seeing your doctor or nurse again gives you the chance to discuss any problems or worries you may have.

You may be able to carry on with your life as usual during and after your treatment. You may even feel better as you get fewer cancer symptoms. But some people find that it takes them a while to get back to normal after they’ve had chemotherapy. You may feel very tired or find that your memory and concentration aren’t so good. Some side-effects last for a long time, even once you’ve stopped having chemotherapy. Take things at your own pace and don’t overdo it, especially after you’ve just had treatment.

Some people keep working while they’re having chemotherapy, but others decide to stop working or work part-time. Getting back to work after your treatment may help you to feel more normal. But you may feel too tired to work full-time or to be as active as usual. It’s best to tell your employer about your treatment, so that they can support you in getting back to work.

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 someone about how you’re feeling – for example, a friend or family member. You could 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 it’s a good time to think about making healthy changes to your lifestyle. This may mean being more physically active, eating healthier foods, losing excess weight or giving up smoking. This may make you feel better and help your body to recover too. 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 and it’s important that you know what these are. This is so you understand how you are feeling and what the treatment is doing. The good news is that side-effects don’t usually last for very long. And some medicines (such as anti-sickness medication) can help with side-effects. Not everyone gets side-effects and they can be very mild.

Most side-effects go away after treatment. However, for some people, side-effects can cause longer-term changes in the body.

Before you start your chemotherapy, your doctor or nurse will talk to you about the possible side-effects of your specific treatment. If you’re worried about anything, it’s important to tell them. Also tell your healthcare team about any side-effects or changes you notice as you go through 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 your sense of taste
get numbness or ‘pins and needles’ in your hands and feet
feel out of breath
not feel very hungry
notice changes to your skin – for example, your skin may get dry or more sensitive
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. You’ll usually have regular blood tests to check your red blood cell levels.

Infections

Chemotherapy can reduce the white blood cells that help your body fight infections. If you get a fever (raised temperature) during or soon 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 very important to follow any advice you’re given.

Fertility

Some chemotherapy medicines can affect your fertility. 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. Usually, you’ll have it through a drip into a vein in your arm, hand or chest. You may swallow tablets or capsules. Sometimes, you’ll have injections or use a cream on your skin instead.

For more information see our section, How chemotherapy is given.

Some chemotherapy medicines can affect your nerves. This may cause pain or tingling sensations in your hands and feet. You may feel burning where the medicine has been injected into your skin. It’s important to tell your healthcare team if you have any pain.

For more information, see our section: Side-effects of chemotherapy.

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. Then you’ll have some time without the medicines so your body can recover.

For more information, see our section: Cycles of chemotherapy.

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

For more information, see our section: Recovering from chemotherapy.

How well chemotherapy works will depend on the type of cancer you have. Some cancers respond better than others to chemotherapy. You may need a combination of several medicines, 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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