What is chemotherapy?

Chemotherapy is a type of cancer treatment given to destroy cancer cells.

How does chemotherapy work?

Cancer cells grow and divide more rapidly than normal cells. Chemotherapy attacks these rapidly growing cells throughout the body.

How can chemotherapy be given?

Chemotherapy drugs can be given in the following ways:

  • Injection: The chemotherapy is given as a shot either into a muscle or under the skin.
  • Intravesicular: The chemotherapy is given into the bladder.
  • Intravenous: The chemotherapy is given through a vein.
  • Intra-arterial: The chemotherapy is given through an artery.
  • Intraperitoneal: The chemotherapy is given into the peritoneal cavity. The peritoneal cavity is a cavity in the abdomen that contains the liver, spleen, stomach and intestines.
  • Intrathecal: The chemotherapy is given into the fluid surrounding the brain and spinal cord. It can be given through a needle placed directly into the spine or through a port placed under the skin of the scalp called an Ommaya reservoir.
  • Oral: The chemotherapy is given by mouth in the form of a pill, capsule or liquid.
  • Topical: The chemotherapy is given as an ointment or cream that is rubbed onto the skin.

CHEMOTHERAPY SIDE EFFECTS AND MANAGEMENT

Chemotherapy works by attacking all rapidly growing cells in the body. This means it can affect healthy fast-growing cells too. These cells are found in the digestive system, bone marrow, skin and hair. Because chemotherapy affects these cells, there are some common side effects for chemotherapy.

See the below side effects for more information on the cause and management of each side effect. Because every patient is unique, not everyone will have the same side effects. Talk to your doctor about possible side effects related to your chemotherapy treatment.

Decreased Blood Cell Counts

Chemotherapy can affect your body’s bone marrow. Bone marrow is where your body makes red blood cells, white blood cells and platelets. Because chemotherapy is designed to attack fast-growing cells, it can cause a decrease in the amount of red blood cells, white blood cells and platelets in your body.

Red Blood Cells

Red blood cells are responsible for carrying oxygen throughout the body. They contain a protein called hemoglobin which helps them carry the oxygen away from the lungs to the rest of the body. When there are not enough red blood cells in the body to carry the oxygen, you can feel tired, weak, dizzy or short of breath. This is called anemia.

If you become anemic, there are some ways to help manage the symptoms of anemia.

  • Make sure you are getting enough rest. If you are having trouble sleeping eight hours a night, try taking short naps throughout the day.
  • Stand up slowly when getting up from sitting or lying down. Getting up too quickly may cause you to feel dizzy.
  • Take rest breaks during your activities.

White Blood Cells

White blood cells help defend your body against infection. During chemotherapy, you could be at an increased risk for developing an infection if your white blood cell count becomes too low.

There are many different types of white blood cells. One type of white blood cell is called a neutrophil. When your neutrophil count becomes low, it is called neutropenia.

If you develop neutropenia, it is important to take steps to prevent an infection.

  • Practice good hand hygiene. Wash your hands with soap and water after using the restroom, after sneezing or coughing, after petting an animal and before/after cooking and eating. If soap and water is not available, you can use hand sanitizer. When using hand sanitizer, make sure to rub the product onto your hands until they are dry.
  • Avoid contact with people who are sick.
  • Avoid large crowds.
  • Avoid picking up your pet’s waste or cleaning litter boxes, bird cages or fish tanks.
  • Practice good skin care, mouth care and body hygiene.
  • Avoid eating undercooked or raw meat, seafood or egg products.
  • Refrigerate leftovers as soon as you are finished eating.
  • Thoroughly wash fresh fruits and vegetables before eating them.

Diarrhea

Diarrhea is when your bowel movements become loose or watery. Your bowels may also move more frequently with diarrhea. Certain drugs, like chemotherapy or drugs used to treat constipation, can cause diarrhea. Infections can also cause diarrhea.

Here are some ways to help manage your diarrhea:

  • Drink plenty of fluids. Try to drink eight cups of water or other fluids each day.
  • Avoid alcoholic or caffeinated beverages.
  • Try eating five to six small meals throughout the day instead of three large meals. Refer to our nutrition summary for ideas to include in this regimen.
  • Avoid eating foods high in fiber.
  • Eat foods that are low in fiber. Skinless chicken or turkey, cream of wheat, noodles, white bread, white rice, baked or mashed potatoes without the skin, applesauce, gelatin and yogurt are examples of low-fiber foods.

Fatigue

Fatigue is often a side effect from a cancer treatment. You may feel physically and emotionally tired. Fatigue can be caused by chemotherapy and radiation therapy. It can also be caused by medication, anemia, changes in your appetite or diet, pain, lack of sleep and stress.

Here are some ways to manage your fatigue:

  • Get plenty of rest. Try to sleep at least eight hours each night.
  • Plan your activities. Do the tasks most important to you first.
  • Don’t be afraid to ask for help.
  • Take rest breaks.
  • Eat a well-balanced diet and drink plenty of fluids.
  • Stay active. Exercise can help decrease fatigue and improve your sleep during the night.
  • Take some time to relax and enjoy your favorite activities.

Hair Loss

Chemotherapy can cause hair loss, also known at alopecia. It affects all of the hair on your body, including the hair on your head, face, arms, under arms, legs and pubic area.

Hair loss can be different for each patient. Some patients may have thinning while others may lose all of their hair completely. Hair loss usually starts two weeks after your first treatment, and your scalp may be tender during this time.

Hair usually starts growing back two to three months after you have completed chemotherapy treatment. It may come back a different texture or color. For example, in some cases it comes back curly instead of straight or a lighter color versus an earlier darker color.  

Hair loss can be the most difficult part of treatment for some patients. There are some ways to manage your hair loss throughout the chemotherapy process.

  • Consider cutting your hair short or shaving your head before you start treatment.
  • If you decide to wear a wig, choose your wig before you start treatment so you can match it to your hair color and style.
  • Some insurance companies will cover the cost of a wig for chemotherapy patients. If not, there are local resources available to help. For additional information, visit our online resources; we have an assortment of free wigs for our patients.
  • Gently wash your hair with a mild shampoo and pat dry with a soft towel.
  • Avoid using heated tools like a blow dryer, curling iron or hair straightener.
  • Protect your scalp after hair loss. You can do this by wearing a scarf, turban or hat and by applying sunscreen or sunblock to your scalp.

Mouth Sores

Chemotherapy can affect the cells in the lining of your mouth and around your throat because, like cancer, they are the fastest growing cells. Some possible side effects include mouth sores, pain in your mouth or gums, dry mouth, infections and taste changes.

If you develop any of these side effects during your treatment, there are some ways to help manage the symptoms.

Dental Care

  • Visit your dentist before starting chemotherapy for a check-up and have any dental work completed before chemotherapy starts.
  • Look at your mouth and tongue daily to check for any changes, such as redness, sores or white patches inside your mouth or on your tongue.
  • Brush your teeth using a soft bristled toothbrush after eating and at bedtime.
  • If your mouth is too sore to use a toothbrush, try brushing with a spongy oral swab. These are available at most drug stores or in the pharmacy section of department stores.
  • Rinse your mouth after you eat and at bedtime with a baking soda solution. ¼ teaspoon of basking soda and 1/8 teaspoon of salt mixed with warm water. If your mouth becomes sore, increase your rinses to every two hours while awake.
  • Do not use any mouthwash that has alcohol in it, because the alcohol can be irritating to your mouth.
  • Keep your mouth and lips moist by drinking plenty of water throughout the day and by applying lip balm or moisturizer to your lips. Ice chips, popsicles and sugar free gum or hard candy may be helpful too.
  • If you develop a metal like taste in your mouth, try eating with plastic utensils instead of metal utensils.

Eating & Drinking

  • Avoid eating foods that could irritate or hurt your mouth. This includes spicy foods, hot foods, crunchy foods, sugary foods and citrus foods and juices.
  • Avoiding drinking alcohol or smoking tobacco products.
  • Pick foods that are soft and easy to chew and swallow. Pureed or chopped meats, eggs, cottage cheese, oatmeal, mashed potatoes, cooked vegetables, yogurt, pudding and ice cream are all examples of recommended foods to eat if you have a sore mouth.
  • Bottled or canned nutritional supplements are also a good source of nutrition. Good nutrition is important because your body uses nutrients and proteins to promote healing in your mouth.

Nausea and Vomiting

Chemotherapy may cause nausea and vomiting. Nausea is when you feel sick to your stomach or your stomach feels uneasy. Vomiting is when you throw up the contents of your stomach through your mouth. Nausea and vomiting can happen during or after your chemotherapy treatment. You may also experience nausea before your treatment. This is called anticipatory nausea.

There are medications available to help prevent and treat nausea and vomiting. These medications are called anti-emetics or anti-nausea drugs. You will receive these medications before your treatment. Your doctor may also have you take them for a certain number of days after your treatment or as needed. Your doctor may also prescribe more than one type of anti-nausea medication for you to take.

Here are some ways to help prevent and treat nausea and vomiting:

  • Choose foods that are bland and easy for your stomach to break down, like clear broth, baked or broiled chicken without the skin, oatmeal, potatoes without the skin, saltine crackers, pretzels, white rice or toast, canned fruit, gelatin and yogurt.
  • Avoid greasy, fried or overly fatty foods.
  • Try to have a light meal or snack before your chemotherapy treatment.
  • Avoid foods and drinks that have a strong smell or odor.
  • Sucking on ice chips, popsicles or sugar-free hard candy or mints may be helpful.
  • Try eating five to six small meals throughout the day instead of three large meals.
  • Drinking liquids before or after meals instead of with your meals may help decrease nausea or queasiness.
  • Avoid laying down right after you eat.
  • Avoid eating your favorite foods when you are sick to your stomach or nauseated.

Not all types of chemotherapy cause nausea or vomiting. It can vary depending on the type of drug, how much of the drug you are getting and how you will be receiving it. Ask your doctor if nausea is a common side effect from the chemotherapy drug you will be receiving, and be sure to tell your doctor or nurse if your anti-nausea medication is not working.

Nervous System Side Effects

Some types of chemotherapy can affect your nervous system. The nervous system controls most of your body’s organs and tissues including the brain and spinal cord. It also controls your sensory organs responsible for sight, hearing, taste, smell and touch.

Some possible nervous system side effects include numbness, burning or tingling in the hands or feet, muscle weakness, muscle aches, dizziness, clumsiness or loss of balance, difficulties picking up objects, vision changes and hearing changes.

If you develop any nervous system changes, there are some ways to help manage your symptoms.

  • If you develop numbness or tingling in your hands, be careful when handling hot or sharp objects. If you develop numbness or tingling in your feet, always wear well-fitting shoes with rubber soles to protect your feet.
  • If you are experiencing dizziness, stand up slowly when getting up from sitting or lying down.
  • Check your home for potential trip hazards, such as cords and area rugs.

Nervous system side effects usually get better over time, but some side effects may be permanent. Be sure to tell your doctor or nurse right away if you develop any symptoms of nervous system changes or problems.

Effects on Thinking and Emotions

It’s possible that chemotherapy can affect the way your brain functions during and after treatment. Some of the functions the treatment can affect are memory and concentration. It can also affect the way you think. Sometimes you will hear these changes referred to as “chemo-brain.”

Talk with your doctor if you experience any confusion, memory changes or problems with concentration. Being diagnosed with cancer and undergoing treatment can cause big changes in your life. It’s normal for patients and their loved ones to experience a wide range of emotions including anger, sadness and anxiety.

Here are some ways to help cope with the emotional side effects from treatment:

  • Talk with your doctor or nurse if you are feeling depressed or anxious.
    • Talking with a counselor or other mental health care professional can help you better understand the emotions you are feeling and help you find ways to cope.
  • Consider joining a local support group.
  • Eat a well-balanced diet. Good nutrition is important because your body uses nutrients and proteins to promote healing and gain strength.
  • Consider alternate treatments, such as yoga, meditation or massage.

Skin and Nail Side Effects

Chemotherapy may damage the fast-growing cells in your skin and nails. It can cause changes like dryness, itching, acne, sensitivity to light and cracked or brittle nails. Sometimes your nails may become darker, develop ridges or start to loosen from the nail bed. Most of the time these nail changes are not permanent, but it does take some time for the nails to grow back out.

Here are some ways to help manage your skin and nail changes:

  • When bathing, use lukewarm water instead of hot water.
  • Use a mild soap.
  • Apply moisturizing creams or lotion to your skin after you get out of the tub or shower.
  • Avoid using perfumes, colognes or aftershave lotion that contain alcohol. These products may cause further irritation to your skin.
  • Avoid direct sunlight and use a sunscreen or sunblock with an SPF of at least 15 or higher.
  • Protect your skin from the sun by wearing long-sleeve shirts, pants and hats.

Sexual Side Effects and Infertility

Chemotherapy may affect a person’s sexual organs and the way they function. It can affect the ability to impregnate or become pregnant. This is called infertility. Chemotherapy can decrease the number of eggs in your ovaries, or it can decrease your sperm count. These decreases in eggs and sperm can cause infertility.

Chemotherapy can cause a decrease in the amount of hormones your ovaries produce. This can lead to early menopause and cause symptoms of menopause including hot flashes, vaginal dryness, irritability, irregular menstrual periods or stoppage of menstrual periods.

Chemotherapy can also cause a decrease in other hormones, specifically testosterone. This can lead to a decrease in sexual desire and can affect the ability to achieve and maintain an erection.

For everyone, the emotional and physical stress from cancer and its treatment can affect a persons interest in sex and sexual activity.

Here are some ways to help manage sexual changes from cancer and its treatment:

For women

  • Before you start chemotherapy, talk with your doctor about possible infertility issues from your treatment and if you want to have children in the future. Your doctor may discuss options such as referral to a fertility specialist or ways to preserve your eggs to use in the future.
  • For women who have not gone through menopause, birth control is very important. Chemotherapy drugs can cause birth defects during the first trimester of pregnancy. Talk with your doctor about birth control options that are right for you.
  • If you experience vaginal dryness, use a water-based lubricant when having sex. Avoid oil-based lubricants such as petroleum jelly or baby oil. These products can lead to infection or may cause a condom to tear. If your dryness does not improve or if vaginal sex is still painful, talk to your doctor about medications to help restore moisture within your vagina.
  • To help prevent infection, wear cotton underwear and panty hose with a cotton lining. Also, avoid wearing tight fitting pants or shorts.

For men

  • Before you start chemotherapy, talk with your doctor about possible infertility issues from your treatment and if you want to have children in the future. Your doctor may discuss options such as a referral to a fertility specialist or banking your sperm before you start treatment in the future.
  • Again, birth control is very important. Chemotherapy can damage your sperm and cause birth defects, so it is important that your partner does not get pregnant during treatment.

For everyone

  • Talk with your doctor to make sure it is ok for you to have sex during your treatment.
  • Avoid having sex if your platelet level falls below 50,000 to prevent injury.
  • Chemotherapy is excreted through your bodily fluids for 48 hours following chemotherapy. It is important that you or your partner use protection if you have sex during this time period and throughout treatment.
  • Talk with your partner about your feelings or concerns.
  • Talk with your doctor or nurse about any sexual side effects you experience during your treatment.

Remember, not all patients will experience sexual changes during their treatment. You may experience different side effects based on the type of treatment you are receiving, your age or other side effects you may be experiencing. Talk with your doctor about possible sexual changes related to your treatment.

When to Call Your Doctor

During your cancer treatment, your primary care physician will continue to remain an integral part of your health care team and will work together with our providers to provide you with the best care possible.

For conditions overseen by your primary care physician and other specialists, such as diabetes or hypertension, please contact their offices so their teams can continue to manage your care.

For our patients receiving chemotherapy, please call our office if you develop any of the following symptoms:

  • A fever of 100.5oF or higher or shaking chills
  • Dizziness or feeling faint
  • Headaches or vision changes
  • Unexplained bruising or bleeding
  • Persistent vomiting over 24 hours
  • Diarrhea with more than three stools a day or lasting over 24 hours
  • Severe mouth sores or a sore throat
  • Painful urination
  • Blood in your urine or bowel movements
  • Labored breathing, wheezing or a new cough
  • Pain, redness or swelling at your IV site

Go to the closest emergency department if you develop any of the following symptoms:

  • Chest pain
  • Severe difficulty breathing
  • Bleeding that does not stop
  • Seizures