Chemotherapy

Overview

Chemotherapy — often called 'chemo' — is a cancer treatment that uses strong medicines to kill cancer cells or stop them from growing and spreading. Unlike surgery or radiotherapy, which treat one area of the body, chemotherapy travels through your whole body in the bloodstream. That is why doctors call it a 'whole-body' or 'systemic' treatment. It can be used to try to cure cancer, to shrink a tumour before surgery, to lower the chance of cancer coming back, or to slow cancer down and ease symptoms. Chemotherapy is a treatment, not an illness — so this article focuses on what it involves, the side effects it can cause, and how to look after yourself while having it.

Very common. Chemotherapy is one of the main treatments for cancer worldwide, and millions of people have it every year. Many people are treated with chemotherapy alongside surgery, radiotherapy, hormone therapy or newer targeted treatments.

Anyone can need chemotherapy — babies, children, adults and older adults — because cancer can affect people of any age. It is most often given to adults. Children are treated by specialist children's cancer teams. Older adults may need lower doses or extra checks if they have other health conditions, and doses are always adjusted to the person.

Symptoms

Common symptoms

• Tiredness that doesn't go away with rest — this is the most common side effect
• Feeling sick (nausea) or being sick, usually worst in the first few days after treatment
• Hair thinning or hair loss on the head, body, eyebrows or eyelashes, depending on the medicines used
• A sore mouth, mouth ulcers, or changes in how food tastes
• A higher chance of infections, because chemotherapy can lower the white cells that fight germs
• Bruising or bleeding more easily, because the cells that help blood clot can drop
• Low red blood cells (anaemia), which can make you feel short of breath, dizzy or washed out
• Loose stools (diarrhoea) or constipation
• Tingling, numbness or pins and needles in hands and feet
• Skin and nail changes, such as dry or darker skin, or ridges on nails
• Trouble concentrating or feeling 'fuzzy' — sometimes called chemo brain
• Changes to appetite, and weight loss or weight gain

Symptoms in children

• Children often have the same side effects as adults, but may show tiredness as being clingy, tearful or less playful
• They may eat and drink less, so keeping fluids up matters a lot
• Sore mouths and taste changes can make eating hard — soft, bland foods often help
• Missing school and time with friends can affect mood and confidence
• Some treatments can affect growth, hearing or fertility later on, so children's teams monitor these closely
• Ask your child's team about support for school, play specialists and counselling

Symptoms in older adults

• Tiredness can be more intense, especially if you already have other health conditions
• Dehydration from being sick or having diarrhoea can happen faster and cause confusion
• A higher risk of infection and of bruising or bleeding
• Extra care is needed with balance and falls if you feel weak or dizzy
• Some chemotherapy can affect the heart or kidneys, so your team may check these more often
• Bring a list of all your other medicines to every appointment

Causes

Main causes

• Chemotherapy is a treatment, not an illness, so it does not have a 'cause' in the usual sense
• It is given when cancer has been found and the care team judges that chemotherapy is likely to help — either to cure, to reduce the risk of cancer coming back, or to control it
• Common reasons include treating cancers of the breast, bowel, lung or blood, and many other types
• It may be given before surgery to shrink a tumour, after surgery to mop up leftover cells, alongside radiotherapy, or on its own

Risk factors

• The type, number and dose of chemotherapy medicines — stronger or combined treatments tend to cause more side effects
• Your age and general fitness
• Other health conditions, such as kidney, liver or heart problems
• Low blood counts before starting treatment
• Poor appetite or eating and drinking difficulties before treatment
• Previous radiotherapy to the same area
• Smoking and heavy alcohol use, which can make recovery harder

When to see a doctor

See a doctor urgently if:

• Any fever or feeling shivery during chemotherapy — do not wait to see if it passes; contact your care team straight away or go to your local emergency department
• Signs of infection such as a sore throat, cough, burning when you pass urine, or a red, hot area of skin
• Vomiting or diarrhoea that won't settle, or signs of dehydration such as a dry mouth and dark urine
• Bleeding that doesn't stop, nosebleeds that keep coming back, or new bruising
• A rash, swelling or reaction during or after a treatment session
• New shortness of breath, chest pain or a fast heartbeat

Book a routine appointment if:

• Side effects that are unpleasant but not urgent — your team can often adjust medicines or give extra support
• Trouble sleeping, low mood or constant worry
• Mouth sores or taste changes that affect eating
• Tingling or numbness in hands or feet
• Questions about your treatment plan, work, travel or fertility
• Any new symptom that worries you, even if it seems small

Diagnosis

Chemotherapy itself isn't 'diagnosed' — it is planned after cancer has been found. Your cancer team looks at your test results, the type and stage of the cancer, your general health and what matters to you, then recommends a treatment plan. They will explain the aim of treatment, the likely benefits, the possible side effects and any alternatives. You should be given time to think and ask questions before you agree, and you can change your mind or ask for a second opinion.

Tests that may be done

• A biopsy (a small sample of tissue) to confirm the type of cancer
• Blood tests to check your blood counts, kidney and liver function
• Scans such as CT, MRI, PET or ultrasound to see where the cancer is
• A heart test such as an echocardiogram, if your treatment can affect the heart
• A pregnancy test, if there is any chance you could be pregnant
• A dental check, because mouth problems can worsen during treatment
• A conversation about fertility and options to preserve it, if this applies to you

What to expect at your appointment

Your first visit is usually a planning appointment where you meet the team, go through the plan and sign a consent form. You may need a small device called a port or a thin tube called a line placed in a vein so treatments and blood tests are easier — this is done with local numbing. On treatment days you'll usually sit in a comfortable chair in a day unit for anything from half an hour to several hours, depending on the plan. Some people bring a book, headphones or a friend. Blood tests often come first, and treatment only goes ahead if your counts are safe.

Treatment

Chemotherapy is given in cycles — a period of treatment followed by a rest period of a few weeks so your body can recover. It can be given as a drip into a vein, as a tablet or capsule, as an injection, or occasionally as a cream. How long you have it depends on the goal: some courses last a few months, others continue for longer to keep cancer under control. Your team will tell you the plan and review it regularly.

Self-care at home

• Rest when your body asks — short naps and pacing yourself work better than pushing through
• Drink plenty of fluids, and sip little and often if you feel sick
• Eat small meals more often rather than three large ones, and eat whatever appeals on difficult days
• Clean your teeth gently with a soft brush and rinse your mouth with plain water or salty water
• Wash your hands often and ask visitors to stay away if they are unwell
• Keep a simple diary of symptoms and temperatures so you can tell your team clearly
• Take anti-sickness and other supportive medicines exactly as your team advises, and ask before starting any new medicine, vitamin or herbal remedy
• Protect your skin from the sun with clothing and high-factor sunscreen
• Check with your team before travel, dental work or vaccinations

Medical treatments

Your cancer team decides which chemotherapy medicines to use, in what combination and on what schedule, based on the type of cancer, its stage, your health and your preferences. Alongside chemotherapy, they may prescribe supportive medicines: anti-sickness drugs, medicines to help white blood cells recover, antibiotics or antivirals to prevent or treat infection, treatments for diarrhoea or constipation, and pain relief. Some people also need blood transfusions or extra fluids. Radiotherapy, hormone therapy, targeted therapy or immunotherapy may be combined with chemotherapy. Never take a new medicine, supplement or herbal product without checking with your team first, as some can interfere with treatment.

When is surgery considered?

Surgery is a separate type of treatment, and whether you need it depends on the cancer. Chemotherapy is sometimes given before surgery to shrink a tumour (called neo-adjuvant treatment) and sometimes after surgery to reduce the chance of the cancer returning (adjuvant treatment). If surgery is part of your plan, your team will explain the order and why.

Living with this condition

Life during chemotherapy tends to follow a pattern: the first few days after treatment are often the hardest, then you gradually feel more like yourself before the next cycle. Plan demanding tasks for your better days, accept offers of help, and keep a bag ready with essentials for treatment days — water, snacks, something to do, a phone charger and a warm layer. It helps to tell family, friends and work what is happening and what kind of help you actually want.

Lifestyle tips

• Keep some gentle activity in your week — short walks and light tasks are better than long periods in bed
• Try to keep a regular sleep routine, with a short rest in the afternoon if needed
• Avoid crowded places and people with coughs, colds or stomach bugs when your immunity is low
• Stop smoking if you can, and keep alcohol low — ask your team for support
• Look after your mouth, skin, nails and feet, and tell your team about any changes
• Ask about free or low-cost support such as wig services, headscarves, counselling and financial advice

Diet and exercise

There is no special 'chemo diet' that suits everyone, but eating well helps you cope. Aim for a mix of protein (such as beans, eggs, fish, chicken, dairy or plant alternatives), starchy foods, fruit and vegetables, and plenty of fluids. If food tastes metallic, try cold or room-temperature foods, or use plastic cutlery. If you feel sick, cold bland foods and ginger may help. Gentle exercise — a short daily walk, stretching, or light housework — helps tiredness, mood and sleep. Ask your team before starting anything vigorous, and speak to a dietitian if eating is difficult or you are losing weight.

Mental health and emotional wellbeing

Fear, sadness, anger and worry are all normal during cancer treatment, and many people find the waiting and uncertainty the hardest part. Some days will feel too much, and that is not a sign of weakness. If low mood, anxiety or sleep problems last more than two weeks or stop you doing everyday things, tell your team — talking therapies, counselling and support groups help a lot. If you ever have thoughts of harming yourself or ending your life, contact your local emergency number or a crisis line in your country straight away, or go to your nearest emergency department. You deserve help immediately, and you are not alone.

Prevention

You cannot 'prevent' needing chemotherapy — it depends on whether you develop cancer. What you can do is lower your overall cancer risk by not smoking, keeping alcohol low, staying active, eating a balanced diet, protecting your skin from the sun and taking part in screening programmes when invited. During treatment, you can reduce some side effects by resting, drinking well, washing your hands, avoiding unwell people and reporting problems early.

Vaccines

Ask your cancer team which vaccinations you need before and during treatment. Some vaccines are recommended, such as flu and pneumonia vaccines, and others should be avoided during chemotherapy because they contain live germs. Your household members may also be advised to have certain vaccines. Always check with your team before booking any vaccination.

Screening programmes

Cancer screening programmes — such as those for breast, bowel and cervical cancer — help find cancer early, when treatment is often simpler. If you are due a screening test, ask your team whether it is safe to have it during chemotherapy. Screening does not prevent cancer, but it can catch it sooner.

Complications

If left untreated

• If the cancer being treated is not treated, it may grow or spread, which can make symptoms worse and reduce the chance of cure
• Stopping chemotherapy partway through can lower its chance of working — always talk to your team before making changes, as they can often adjust the plan instead
• Untreated side effects can become serious: an infection can become life-threatening within hours, and severe dehydration can cause kidney problems
• Long-term effects of some treatments can include heart, kidney, nerve or fertility problems, which is why your team monitors you

Long-term outlook

The outlook depends on the type and stage of cancer, the treatment used and your general health — your team can talk to you honestly about what to expect for your situation. Many people are cured with chemotherapy, and many more live well for years with cancer kept under control. Side effects are usually temporary and improve after treatment ends, although some can last longer and there is support for those too. Taking things one cycle at a time, and asking for help early, makes a real difference.

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