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Chemotherapy

Chemotherapy means using medicines to kill cancer cells. If you have cancer, your doctor may recommend you have chemotherapy, either alone or alongside other treatments. People often shorten the word to ‘chemo’.

There are many different types of chemotherapy, used in many different ways. Here we give you just a general overview of what to expect if you’re having chemotherapy. Your doctor will give you more specific information about the type of chemotherapy you’re having. It will be the treatment they believe will work best for you, in your particular circumstances.

You may have heard a lot about side-effects of chemotherapy. We cover the main side-effects here, but remember that you probably won’t get all these effects. And for some people the effects are mild. Most side-effects go away after treatment, and there are a lot of ways your cancer team can help you cope with them.

Details

  • About About chemotherapy

    Chemotherapy medicines kill cells that are dividing and growing rapidly. This means that they’re good at killing cancer cells, which divide much more often than most normal cells. Chemotherapy medicine can work throughout your body so it can be a good treatment for cancer that has spread away from the original tumour. It may be used to cure or control your cancer, or to ease your symptoms.

    Not all cancers are treated with chemotherapy. Some cancers are sensitive to the chemotherapy medicines, but some aren’t. Your doctor will discuss with you whether chemotherapy is an option for you.

    Here are some examples of when your doctor might recommend chemotherapy.

    • Shrinking a tumour before surgery or radiotherapy
    • Reducing the chance of a cancer coming back after surgery or radiotherapy
    • Treating a cancer on its own (some cancers are very sensitive to chemotherapy)
    • Treatment for cancer that has spread from where it first started

    There are many different types of chemotherapy – too many for us to cover individually here. The type of chemotherapy medicine your doctor recommends will depend on a number of factors. These include what type of cancer you have, if it has spread to other parts of your body and your general health. Your doctor will also take into account any previous cancer treatments you’ve had.

    Your treatment may involve just one chemotherapy medicine or, more usually, a combination of medicines.

    You can have chemotherapy on its own or alongside other treatments, such as radiotherapy, surgery or hormonal, biological and immune therapies. If your doctor recommends these, they’ll explain what they are and how they work.

    If you have any questions about your chemotherapy medicines, ask your doctor or nurse. They can explain why the chemotherapy your doctor offers you is best for your own individual circumstances.

  • Preparation Preparing for chemotherapy

    Planning your chemotherapy

    In most hospitals, a number of different health professionals will be involved in planning and giving 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 may be given written information about the particular chemotherapy planned and the possible side-effects it may cause.

    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. For example, you may want to know more details about the risks, benefits and any alternatives to chemotherapy. It’s important that you feel fully informed so you feel happy 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
    • 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.

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  • What happens What happens during chemotherapy?

    How chemotherapy is given

    You can have chemotherapy in different ways. Most commonly, you’ll have chemotherapy through a drip into a vein (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
    • injections into an affected body cavity such as your bladder or abdominal (tummy) cavity
    • 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, flexible tube going through the skin of your chest into a main vein near your heart (central line). This can be left in place 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. This is called a PICC (peripherally inserted central catheter) line and it 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. This is 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. It feeds in the correct dose of chemotherapy slowly over a period of time

    Where you have chemotherapy

    If you’re given chemotherapy tablets or capsules to swallow, you can take these at home. If you need to have injections or wear a pump which gives you continuous infusions, 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. It may be possible to 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 number of cycles of treatment. A cycle is made up of a treatment period followed by a rest period to allow your body to recover. After each cycle your doctor and nurse will check how you are. Some people need a change to their treatment plan as they go through their chemotherapy course. Your doctor will explain your treatment at each stage, and the reason for any changes.

    For much more information about what is involved in having chemotherapy, visit the websites of the organisations given below in our section ‘other helpful websites’.

    Contraception during chemotherapy

    Your doctor will advise you to use condoms during your chemotherapy treatment and for a few weeks afterwards. This is because doctors don’t know for sure whether the chemotherapy medicines can pass to other people in body fluids. 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.

  • Recovery Recovering from chemotherapy

    Different people react to chemotherapy in different ways. Don’t expect too much of yourself too soon – it takes time to recover from chemotherapy.

    After your chemotherapy you’ll probably continue to have regular check-ups with your doctor or nurse. You may even have further 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 continue with your life as usual during and after your treatment. You may even feel better as the symptoms of your cancer decrease. Some people find that it takes them a while to get back to normal though. Take things at your own pace and don’t overdo it, particularly after you’ve just had treatment. See our FAQ on tiredness and chemotherapy below for more information.

    Getting back to work after your treatment may help you to feel more normal. Be aware that you may feel too tired to work full-time or to keep as active as usual. And sometimes side-effects can carry on for weeks after your chemotherapy treatment has finished. It’s best to tell your employer about your treatment, so that they can support you in getting back to work. See our health blog on returning to work after cancer.

    It’s natural to have mixed emotions after you’ve been through cancer treatment. Chemotherapy can make you feel a bit down, or even depressed. It may help to talk to someone about how you’re feeling – a friend or family member perhaps. There are online forums, and maybe local support groups you can join. You can also get help and support from the organisations listed below (other helpful websites). If you feel that you may be becoming depressed, contact your cancer team or your GP.

    As you adjust to life after chemotherapy you may decide it’s a good time to think about making healthy changes to your lifestyle. If it’s relevant to you, perhaps you’ll decide to be more physically active, eat more healthily, lose excess weight or give up smoking. As well as helping to make you feel better, these may help your body to recover. And you’ll be lowering your risk of getting other illnesses, including cancer, in the future.

  • Side-effects Side-effects of chemotherapy

    As you’re probably aware, chemotherapy may bring unwanted side-effects. The good news is that these are mostly temporary.

    Before you start your chemotherapy, your doctor or nurse will talk to you about the possible side-effects of your specific treatment. Tell them of any particular concerns you have. There are many ways to lessen or manage side-effects if you get them. Tell your healthcare team about any side-effects or changes you notice as you go through your treatment.

    As well as reading the information we cover here, you may like to see our health blog on coping with the side-effects of cancer.

    General side-effects

    Chemotherapy doesn’t specifically target cancer cells; it targets any cells which divide rapidly. This includes cells in your bone marrow, cells that produce hair, and cells that line your mouth and digestive system. If these healthy cells are damaged, you may:

    • feel tired
    • feel sick or vomit
    • have diarrhoea and/or constipation
    • have thinning of your hair or hair loss. See our FAQ below on hair loss
    • 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
    • lose your appetite
    • notice changes to your skin – your skin may become dry or more sensitive
    • have changes to your 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. You can control many of these side-effects with other medicines. For example, you can reduce any sickness by taking anti-sickness medicines alongside your chemotherapy.

    Infections

    Chemotherapy can destroy the white blood cells which help your body fight infections. If you develop a fever (raised temperature) during or soon after chemotherapy, this is a sign that 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 that you discuss these risks with your doctor before you start your chemotherapy. Your doctor may offer you the opportunity to store eggs, embryos, ovarian tissue or sperm for future fertility treatment. See our FAQ on chemotherapy and fertility below for more information.

  • FAQ: Tiredness Why am I so tired? What can I do about it?

    Tiredness is a very common side-effect of chemotherapy, affecting around seven out of 10 people.

    Tiredness may be due to the direct effect of your chemotherapy medicines on your body. Or the chemotherapy may have the effect of reducing the number of red blood cells you have, so making you anaemic. This can make you feel tired and breathless.

    Your tiredness may be made worse if you’re feeling anxious, or depressed, or are sleeping badly. If you think you might be getting depressed speak to your doctor or nurse.

    It can be frustrating if you feel tired all the time and struggle to cope with your usual daily activities. You may feel as if you have no energy, and aren’t able to get out of bed or do your usual activities. This should start to get better once you finish chemotherapy. But be aware that tiredness can often last for several weeks or months after you finish your treatment.

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

    • Try to get some gentle exercise each day.
    • Cut down on unnecessary activities and ask your family or friends for help.
    • Give yourself plenty of time to rest.
    • Give yourself plenty of time to do tasks and to get to 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.

    Give yourself time – gradually your tiredness should ease and your normal energy levels return.

  • FAQ: Hair loss When will my hair grow back after chemotherapy?

    Hair loss is a side-effect of some chemotherapy medicines. If you lose your hair, it will usually start to grow back any time between three and six months after your treatment has ended. It’s natural to feel upset at the thought of losing your hair. Speak to your doctor or nurse about your concerns and how they can help.

    Some types of chemotherapy medicine can cause hair loss. You may notice slight thinning, hair loss in patches or you may lose all your hair. If you’re going to lose some hair, this will probably begin within two to three weeks of your chemotherapy starting. The loss will be gradual, but you may find clumps come out when you brush or shampoo your hair.

    Your hair usually starts to grow back after your treatment, although this may take several months. It will probably be finer than it was before, at least at first. Once your chemotherapy ends, your hair may grow back slightly differently; for example, it may be a different colour or more curly than before.

    With some types of chemotherapy, you may be offered a ‘cold cap’ during your treatment. This cools down your scalp so less of the chemotherapy medicine reaches your hair follicles. The aim is to lessen the amount of hair loss. Cold cap therapy isn’t suitable for all types of cancer though, and it doesn’t work for everybody. With some kinds of cancer, doctors think there’s a chance that the cap may stop some of the cancer cells being killed. This might mean the cancer comes back. You can discuss this more with your doctor if you’re considering cold cap therapy.

    If you’re worried about hair loss as a result of your treatment, speak to your doctor or nurse. They’ll have lots of advice and tips to help you cope. You can also get help and support from the organisations listed below under other helpful websites.

  • FAQ: Chemotherapy and fertility Will chemotherapy affect my fertility?

    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.

    Many people go on to have children after chemotherapy. But some chemotherapy medicines may temporarily or permanently affect your fertility. If you’re hoping to have children in the future, ask your doctor before your treatment whether this may be an issue for you.

    In men, chemotherapy may temporarily or permanently reduce the number of sperm produced and their ability to fertilise an egg. Your doctor may offer you the chance to bank your sperm so it can be frozen and stored for future fertility treatment.

    In women, chemotherapy may temporarily stop your ovaries from working. Your periods may become irregular or stop. It usually takes about six months to a year for your periods to return to normal after chemotherapy.

    Sometimes, chemotherapy stops your ovaries working permanently. This is more likely if you’re coming up to the age when the menopause would be expected. Depending on the type of cancer you have, and whether it’s safe to delay treatment, you may have three options for future fertility treatment. These are:

    • freezing embryos (eggs that have been fertilised with your partner’s sperm)
    • freezing your eggs
    • a new treatment to remove and freeze ovarian tissue and then put it back after chemotherapy so it produces eggs again

    Your doctor can explain these methods, and whether they would be an option for you in your circumstances.

  • FAQ: Chemotherapy and sex Can chemotherapy affect your sex life?

    Yes, chemotherapy may affect your sex life. But it doesn’t affect everyone the same, so you may not notice any changes at all.

    If you’re feeling tired, sick or generally unwell, you may not feel like having sex. Feeling anxious about your condition and how your treatment is going can also affect your desire to have sex. Losing hair may make you feel less confident.

    There usually isn’t any medical reason why you can’t have sex. The chemotherapy medicines don’t have any permanent effect on your performance or enjoyment of sex. However, some men find that chemotherapy makes it difficult to get an erection. This is usually only temporary and gets better after your treatment.

    You may prefer to wait for a rest period in your chemotherapy treatment cycle to have sex again. If you don’t feel ready, you may rather wait until you finish chemotherapy treatment completely. Most people regain their usual energy levels between a few months to a year after chemotherapy ends. 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. So using a condom will protect your partner. If you’re a woman, don’t try to become pregnant while you’re having treatment because chemotherapy medicines can harm a developing baby.

    It’s important to remember that if your feelings about having sex do change during your chemotherapy treatment, this won’t last forever. Any side-effects will usually wear off gradually when your treatment is finished and your feelings may well change.

    If you can, talk to your partner about your feelings so that they can understand what you’re going through. If you have concerns about sex, you may find it helpful to talk to your doctor or nurse for advice and support.

  • FAQ: Changes to skin and nails How might chemotherapy affect my skin and nails?

    Chemotherapy affects cells in your body which grow fast. This includes the cells of your skin and nails. So it’s not surprising that you may notice some changes in your skin and nails when you have chemotherapy.

    With chemotherapy your skin may become:

    • dry
    • red
    • itchy
    • a different colour (darker) in places
    • more sensitive to the sun

    You may also develop a rash.

    If chemotherapy affects your nails they might:

    • become brittle or flaky
    • develop ridges or lines
    • get darker or yellower

    The skin around your nails may become red and sore.

    Let your doctor or nurse know if you notice these, or any other skin and nail changes. They’ll be able to give you advice on how to care for your skin and nails during chemotherapy.

    If you notice sudden severe itching, a rash or hives during chemotherapy, tell your doctor at once. This might be a sign of an allergy to your medicine.

    Chemotherapy doesn’t always cause skin and nail problems. This may depend on your chemotherapy and how you react to it. Ask your doctor and nurse about how your particular chemotherapy may affect your skin and nails, and how long these changes might last.

    You can get lots of good tips on caring for your skin and nails from the organisations listed under other helpful websites below.

  • Resources Resources

    Further information

    Sources

    • General aspects of chemotherapy. PatientPlus. patient.info/patientplus, last checked 13 June 2014
    • Modalities of cancer therapy. The MSD Manuals. www.msdmanuals.com, last full review/revision July 2013
    • Management of adverse effects of cancer therapy. The MSD Manuals. www.msdmanuals.com, last full review/revision July 2013
    • Cytotoxic drugs. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 7 November 2017
    • Principles of chemotherapy. Oxford handbook of oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, published September 2015
    • Late effects of chemotherapy and radiotherapy. Oxford handbook of oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, published September 2015
    • Therapy-related issues: malignant diseases and immunosuppression. Oxford handbook of clinical pharmacy (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2017
    • Chemotherapy. Cancer Research UK. www.cancerresearchuk.org, last reviewed 13 January 2015
    • Cancer drugs. Cancer Research UK. www.cancerresearchuk.org, last reviewed 7 September 2017
    • Chemotherapy. Macmillan. www.macmillan.org.uk, reviewed 1 May 2016
    • Work and cancer. Macmillan. www.macmillan.org.uk, reviewed 30 November 2016
    • Chemotherapy. American Cancer Society. www.cancer.org, last revised 16 February 2016
    • Hair loss. American Cancer Society. www.cancer.org, last revised 12 May 2017
    • Chemotherapy. NIH National Cancer Institute. www.cancer.gov, posted 29 April 2015
    • Shin H, Jo SJ, Kim, D H, et al. Efficacy of interventions for prevention of chemotherapy-induced alopecia: A systematic review and meta-analysis. Int J Cancer 2015; 136:E442–E454. doi:10.1002/ijc.29115
    • Caring for skin and nails. Macmillan. www.macmillan.org.uk, reviewed 30 September 2014
    • Skin and nail changes during cancer treatment. NIH National Cancer Institute. www.cancer.gov, posted 29 April 2015
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    Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, November 2017
    Expert reviewer, Mr Robin Crawford, Consultant Gynaecological Oncologist
    Next review due November 2020

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