16859 Chemotherapy

Overview

Chemotherapy is a cancer treatment that uses strong medicines to destroy cancer cells. Cancer cells grow and divide quickly, and chemotherapy medicines are designed to attack cells that divide fast. Because some healthy cells in your body also divide quickly — like the cells in your hair, mouth, gut and blood — they can be affected too, which is why side effects happen. Chemotherapy can be given as a tablet, as a drip into a vein, as an injection, or sometimes as a cream. It is usually given in rounds called cycles, with a rest period in between so your body can recover.

Yes. Chemotherapy is one of the most common cancer treatments worldwide, and millions of people receive it every year. Your care team will have supported many people through it before.

Anyone who has been diagnosed with a cancer that responds to chemotherapy can be offered it, at any age. Children can have chemotherapy, though the medicines and schedules are often different from adults. Older adults can also have chemotherapy, and the team will consider other health conditions, kidney and heart function, and what matters most to you when planning treatment.

Symptoms

Common symptoms

• Tiredness that doesn't fully go away with rest — this is one of the most common effects.
• Feeling sick (nausea) or being sick (vomiting), usually worst in the first few days after treatment.
• Hair thinning or loss, often starting 2 to 3 weeks after the first treatment; hair usually grows back after treatment ends.
• A sore mouth, mouth ulcers or changes in taste.
• Lower levels of blood cells, which can cause infections, bruising, bleeding or anaemia (low red blood cells, causing breathlessness and tiredness).
• Changes in appetite, constipation or loose stools.
• Tingling, numbness or pins and needles in hands or feet.
• Dry, itchy or sensitive skin, and changes to nails.
• Trouble concentrating or remembering things — sometimes called 'chemo brain'.
• Changes in sleep, mood or sex drive.

Symptoms in children

• Children often get the same types of side effects as adults, including tiredness, sickness, mouth sores and hair loss.
• Sickness and mouth sores can affect eating and drinking, so children may need extra fluids or nutrition support.
• Children may be more likely to get infections, so parents and carers are taught what to watch for.
• Some treatments can affect growth, school attendance, learning or fertility later in life, and the children's team will discuss this with you.
• Children often cope better than expected, but they may need extra reassurance, play support and time off school.

Symptoms in older adults

• Tiredness can be more pronounced, and recovery between cycles may take longer.
• There may be a higher risk of infection and dehydration, especially if drinking is difficult.
• Confusion or a sudden change in alertness can be a warning sign and should be checked the same day.
• Other health conditions and medications may interact with treatment, so the team may adjust the plan.
• Falls risk can increase with numbness in the feet, dizziness or weakness; a home safety check can help.

Causes

Main causes

• Chemotherapy is given because a cancer has been found that responds to these medicines. It may be the main treatment, or it may be used alongside surgery or radiotherapy.
• It is often used before surgery to shrink a tumour, or after surgery to reduce the chance of cancer returning.
• For some cancers it can control the disease and ease symptoms over a longer period.
• The side effects happen because the medicines affect fast-dividing healthy cells as well as cancer cells.

Risk factors

• Higher doses or longer courses of treatment tend to cause more side effects.
• Having other health conditions, such as kidney, liver or heart problems, can affect how your body handles treatment.
• Being older or frail may increase the chance of tiredness, infection and dehydration.
• Poor appetite, low weight or already being low in vitamins can make side effects harder to manage.
• Certain combinations of medicines, including some over-the-counter remedies and herbal products, can interact with chemotherapy — always check with your team or pharmacist first.

When to see a doctor

See a doctor urgently if:

• A temperature of 38°C (100.4°F) or above, or shivering chills — call your emergency number or your 24-hour treatment line immediately, do not wait.
• Heavy or unexplained bleeding, or blood in vomit or stools.
• Chest pain, breathing difficulty, or a fast heartbeat.
• Severe vomiting or diarrhoea, or being unable to drink.
• Sudden confusion, fainting, or a seizure.
• A new severe rash, swelling of the face or throat, or wheezing.

Book a routine appointment if:

• Side effects that are bothering you but aren't emergencies — your team can often adjust medicines or give extra support.
• Mouth sores, taste changes, or appetite problems that are making eating difficult.
• Tiredness that is affecting your daily life, sleep, or mood.
• Numbness or tingling in hands or feet.
• Low mood, worry, or feeling overwhelmed — support is available and it's worth asking.
• Questions about your treatment plan, work, travel, or fertility.

Diagnosis

Chemotherapy isn't a test result — it is a treatment your cancer team recommends after your cancer has been diagnosed and assessed. Your doctors look at the type of cancer, its size and whether it has spread, your general health, your preferences and the likely benefits and side effects. You will usually meet a cancer specialist (an oncologist or haematologist) and a specialist nurse to talk through the plan together.

Tests that may be done

• A biopsy (a small tissue sample) to confirm the type of cancer.
• Scans such as CT, MRI, PET or ultrasound to see the size and position of the cancer.
• Blood tests to check your blood counts, liver and kidney function.
• A heart test (such as an ECG or echocardiogram) if your treatment could affect the heart.
• A pregnancy test when relevant, and a discussion about fertility and contraception.
• Regular blood tests throughout treatment to check your blood counts before each cycle.

What to expect at your appointment

You will usually have a planning appointment where the team explains the aims of treatment, how many cycles are planned, how it will be given, and the side effects to watch for. You may be given a phone number for a 24-hour advice line — keep it somewhere visible. On treatment days, you may sit in a day unit for anything from half an hour to several hours, and you may be given anti-sickness medicines beforehand. You'll have blood tests before most cycles, and a review with your team to check how you're doing.

Treatment

Chemotherapy is given in planned cycles, usually over several weeks or months. It may be given through a drip into a vein, as tablets, as injections, or occasionally as a cream. Some people have a small device called a port or a line placed under the skin to make repeated treatments easier. Between cycles you have a rest period so your body, especially your blood counts, can recover. Your team will adjust the plan if side effects are hard to manage.

Self-care at home

• Take anti-sickness medicines exactly as your team advises — they work best when started early, before sickness builds up.
• Drink fluids regularly through the day; small, frequent sips are easier than large amounts at once.
• Eat small meals and snacks more often if your appetite is low, and choose foods that appeal to you.
• Rest when you need to, but gentle activity like a short walk can help with tiredness and mood.
• Wash your hands often, avoid people with colds or infections, and stay away from crowded places when your blood counts are low.
• Use a soft toothbrush and check your mouth daily for sores; tell your team early if your mouth is sore.
• Protect your skin from the sun, use gentle unperfumed products, and tell your team about any rash.
• Keep a simple diary of side effects and temperatures to share at your appointments.
• Ask before taking any new medicine, supplement or herbal remedy, as some can interact with treatment.
• Use reliable contraception if there is any chance of pregnancy — discuss this with your team first.

Medical treatments

Chemotherapy itself is the medical treatment, and there are many different types chosen for different cancers. Alongside it, your team can offer medicines to prevent or ease specific side effects, such as anti-sickness medicines, treatments to help blood counts recover, medicines for diarrhoea or constipation, mouthwashes for sore mouths, and creams for skin changes. Some people also have radiotherapy, surgery, hormone treatment or targeted treatments as part of their overall plan. Your team may also recommend vaccines, dental checks, or dietitian and physiotherapy support. Always ask your team or pharmacist before taking anything new, including over-the-counter remedies, vitamins and herbal products.

When is surgery considered?

Surgery is sometimes part of the wider plan — for example, an operation to remove a cancer, or a small procedure to place a port or line so chemotherapy can be given more easily. Your team will explain if surgery is relevant for you and how it fits with your chemotherapy schedule.

Living with this condition

Life during chemotherapy usually settles into a rhythm: treatment days, a few days when side effects are strongest, then a gradual return to feeling more like yourself before the next cycle. Many people find it helps to plan around this pattern — keeping the days right after treatment lighter, and saving errands and social plans for when you feel better. Accept help with shopping, cooking, childcare and lifts. Keep important numbers, including your 24-hour advice line, somewhere you can find them quickly, and keep a thermometer at home.

Lifestyle tips

• Keep a simple routine with regular sleep and wake times where possible.
• Ask your team about work — many people reduce hours or take time off, and some can keep working with adjustments.
• Avoid contact with anyone who has a cold, flu, chickenpox, shingles or a stomach bug, and ask visitors to stay away if unwell.
• Be careful with gardening, pet litter and raw foods when your immune system is low.
• Avoid alcohol in large amounts, and check with your team about any limits.
• Continue gentle hobbies and social contact — they are good for wellbeing, even if you need to pace yourself.
• Ask about travel insurance and fit-to-fly advice well before booking any trips.

Diet and exercise

There is no single 'chemo diet', but eating well helps you cope. Try to include protein at each meal — eggs, beans, lentils, fish, chicken, dairy or plant alternatives — and aim for variety with fruit and vegetables. If food tastes metallic or bland, cold or strongly flavoured foods sometimes help. If your appetite is poor, small frequent snacks and nourishing drinks can be easier than large meals. Ask to see a dietitian if eating is difficult. Gentle movement, such as short walks, stretching or light housework, can reduce tiredness and lift mood. Build up slowly and rest when you need to — the aim is movement, not a workout. Your team can advise if there are movements or activities to avoid.

Mental health and emotional wellbeing

Being told you need chemotherapy, and living through it, can bring worry, sadness, anger, and a sense of losing control. It is normal to have good days and hard days. Some people find it hard to sleep or concentrate, or feel low for weeks. These feelings are common and treatable — you don't have to just put up with them. Talking to a specialist nurse, a counsellor or a psychologist can help, and your team can refer you. If you ever have thoughts of harming yourself or feel you cannot go on, please reach out for crisis support straight away — call your local emergency number or a local crisis line, or tell someone you trust and ask them to stay with you. Support is available, and you deserve it.

Prevention

You cannot prevent the need for chemotherapy — it is a treatment, not a disease. What you can do is prepare well and lower your risk of complications: keep up with vaccinations your team advises, look after your teeth and gums before starting, stop smoking if you can, eat as well as possible, and tell your team about all medicines and supplements you use. Many cancers are more treatable when found early, so keep up with any cancer screening you are invited to.

Vaccines

Ask your team which vaccinations you need before or during chemotherapy. Some vaccines are helpful, while live vaccines are usually avoided during treatment. Your household members may also be advised to have certain vaccines to protect you. Always check with your team before booking any vaccination, including flu and travel vaccines.

Screening programmes

Keep up with the cancer screening programmes you are invited to — for example screening for bowel, breast and cervical cancer where relevant to you. If you are starting chemotherapy, your team may also arrange checks such as heart, kidney and dental assessments to keep you safe during treatment.

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 options available.
• Unmanaged side effects can lead to dehydration, weight loss, serious infection, or treatment delays.
• Low mood, isolation and money worries can build up if support isn't asked for — these are treatable problems, not something you have to accept.
• Some long-term effects, such as numbness in hands and feet or changes in fertility, may be reduced by talking to your team early.

Long-term outlook

Chemotherapy is a well-established treatment that helps many people live longer, live better, or be cured. Most side effects are temporary and ease after treatment ends, and hair usually grows back. Everyone's situation is different, so no one can promise a particular outcome — but your team will be honest with you about what to expect and will adjust the plan to balance benefit and comfort. Many people go on to return to work, family life and the things they enjoy. Take it one cycle at a time, and lean on the support around you.

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