Chemotherapy

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

• the type of cancer
• 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

An oncologist and a specialist nurse will usually oversee your chemotherapy. A pharmacist, physiotherapist, psychologist and dietitian 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 your chemotherapy depends on the type of cancer you have, how much it has spread through your body, types of medicine used, severity of side-effects and how successful the 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
• lung function tests – to see how well your lungs are working
• an X-ray, CT scan, or MRI scan

Your height and weight may also be checked to work out the right dose of chemotherapy for you.

You can take chemotherapy tablets or apply creams at home, whereas injections or infusions are usually given in hospital. However, some people may be able to have chemotherapy at home.

Your doctor will discuss with you what will happen before, during and after your chemotherapy. This is your opportunity to understand what will happen, and 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, which you may be asked to do so by signing a consent form.

Chemotherapy medicines can be given to you in different ways. Most commonly chemotherapy is given 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 a muscle – usually your thigh or buttocks (intramuscular injection)
• injection under your skin (subcutaneous injection)
• injections into an affected body cavity such as your bladder (intracavity chemotherapy)
• creams for skin cancers

If you're having intravenous chemotherapy, medicines are given to you through a drip into your bloodstream and 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 'port-a-cath') – 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

Chemotherapy will usually be given as several sessions. These may take between 30 minutes and a few hours at a time. 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 is responding to chemotherapy.

Your doctor will explain the treatment to you.

Your doctor or nurse will advise you on what to expect after chemotherapy and the 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 most 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 common questions for more information).

There are some risks associated with chemotherapy. We have not included the chance of these happening as they are specific to you 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 of a successful 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 lining your mouth and digestive system. Damage to these healthy cells may produce possible side-effects, including:

• tiredness
• feeling sick or vomiting
• diarrhoea
• thinning of 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. Your doctor will discuss the possible side-effects of your specific treatment with you.

Many side-effects can be controlled using other medicines. For example, sickness can be reduced by taking anti sickness medicines alongside your chemotherapy.

The side-effects of chemotherapy, such as sickness and diarrhoea, can make the contraceptive pill less effective. Women shouldn't try to become pregnant during treatment because the chemotherapy medicines may damage a developing baby.

Some chemotherapy medicines can affect your fertility. 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 common questions 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 be able to 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.

Question: 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.

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. Your tiredness should ease once your chemotherapy has ended but it can often last several weeks or months after 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 between six months and a year 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.

Question: 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, loss of hair 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.

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.

Question: 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

For men, chemotherapy may temporarily or permanently reduce the number of sperm produced 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.

For some women, chemotherapy may temporarily stop your ovaries from working. 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. 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.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only.  It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. Last updated August 2017.