Chemotherapy – A Guide

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Chemotherapy is a drug treatment for cancer. It uses medication to kill cancerous cells.

How chemotherapy works
How chemotherapy is performed
Side effects



The term cancer refers to a number of conditions where the body’s cells grow and reproduce uncontrollably. The rapid growth of cancerous cells is known as a malignant tumour These cells can invade and destroy healthy tissue and organs.

Cytotoxic medication

In the past, any medication that killed cancerous cells wa called chemotherapy In recent years, new cancer medications have been introduced that work differentl fro traditional chemotherapy.

Today, when health professionals talk about chemotherapy medication, they are specifically talking about cytotoxic medication. Cytotoxic refers to medication that prevents cancer cells from dividing and growing.

The aims of chemotherapy

Chemotherapy is used for a number of different reasons, including:

  • To achieve a complete cure. In some cases, it may be possible to kill all the cancer cells using chemotherapy alone.
  • To help make other treatments more successful. For example, chemotherapy is often combined with radiotherapy.
  • To reduce the risk of cancer returning For example, some people are given a course of chemotherapy after surgery to remove a cancerous tumour.
  • To relieve symptoms. If a cancer has reached an advanced state, a cure may not be possible, but chemotherapy could still relieve symptoms and slow dow the cancer’s spread.

Side effects

Chemotherapy is very effective in treating cancer and has helped save millions of lives. However, it does cause side effects.

Side effects occur because the medicatio used in chemotherapy cannot distinguish between fast-growing cancer cells and other types of fast-growing cell, such as blood cells, the cells on the skin and scalp and the cells inside the stomach.

Some people who are about to begin chemotherapy are concerned that any harmful affects of chemotherapy can be passed on to other people, particularly those who are vulnerable such as children or pregnant women. However, there is no risk in coming into close contact with someone having chemotherapy.

Living with and adapting to the side effects of chemotherap can b challenging, but it is important to realise that most, if not all, side effects will disappear once treatment is complete.

See the Side effects section, above for more information and advice about how to cope with the side effects of chemotherapy.


How chemotherapy works

The principle behind chemotherapy was discovered by accident during World War Two, when a number of sailors were accidentally exposed to mustard gas.

When they were treated in hospital, doctors noticed that all the sailors had an unusually low number of white blood cells. White blood cells are similar to cancer cells in that they divide and grow rapidly.

Doctors reasoned that if the chemicals in mustard gas reduced the number of white blood cells by stopping them growing, they could have the same effect on cancer cells. Testing soon showed they were right.

Over time, the chemicals used in chemotherapy were improved and more efficient medications were created.

There are now over 50 different types of chemotherapy medication to treat hundreds of different cancers.

Depending on the type of cancer, you may be given:

  • monotherapy, where only one chemotherapy medication is used, or
  • combination therapy, where a combination of different medication is used

When should chemotherapy be given?

Depending on the type and severity of your cancer, chemotherapy is given at different stages of treatment.

You may receive chemotherapy:

  • before undergoing surgery or radiotherapy to shrink the tumour before other treatments begin (neo-adjuvant therapy)
  • in combination with radiotherapy (chemoradiation), or
  • after surgery or a course of radiotherapy (adjuvant therapy)

Chemotherapy protocols

You will need regular chemotherapy over a set period of time for it to be effective. Your chemotherapy care team will draw up a protocol that outlines when you will receive treatment and for how long.

Chemotherapy protocols vary depending on the type of cancer that you have and how advanced it is. It is common to have chemotherapy for one day before treatment is suspended for one to three weeks to allow your body to recover from the effects of the treatment.

An example of a chemotherapy protocol is:

  • one day of treatment
  • seven days of rest
  • one day of treatment, and
  • 21 days of rest

This cycle will be repeated six times over the course of 18 weeks.

How chemotherapy is performed

Your care team

Many primary care trusts (PCTs) have multidisciplinary teams (MDTs) wh treat cancer. An MDT is made up of a number of different specialists, including:

  • A clinical oncologist: a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy.
  • A pathologist: a specialist in diseased tissue.
  • A haematologist: a blood specialist.
  • A psychologist, who can provide support and advice about the psychological and emotional impact of chemotherapy.
  • A cancer nurse, who will usuall be your first point of contac with the MDT.

You may see some or all of these people as part of your cancer treatment.

Blood tests

Before chemotherapy begins, you will need a number of blood tests to assess your health and to make sure you will be able to cope with any side effects.

Blood tests are a useful way of assessing the health of your liver. This is important because the chemotherapy medications will pass through your liver, where they will be broken down. The medication can harm the liver so if you have liver damage, it may not be suitable for you until your liver ha recovered.

Another important role of blood testing is to assess your blood count. This is a measurement of how many blood cells you have.

There are three types of blood cell:

  • red blood cells, which carry oxygen around your body
  • white blood cells, which help fight infection, and
  • platelets, which help the blood to clot (solidify)

Chemotherapy reduces the number of all three types of blood cell

If you have a low blood count, treatment may be delayed until your blood count has returned to normal.

Alternatively, there is medication that can raise your blood count.

You will have regular blood tests during your chemotherapy so that your liver and blood count can be carefully monitored.

You may also need other tests to check how well the cancer is responding to treatment. The tests you require will depend on the type of cancer you have.

How is chemotherapy given?

Chemotherapy is usually given in one of two ways:

  • in tablet form (oral chemotherapy), or
  • directly into one your veins using an injection or a drip (intravenous chemotherapy)

The type of chemotherapy you have depends on the type of cancer.

Oral chemotherapy

If you are in a good state of health, you may be able to take your tablets at home You will still have to make regular hospital visits for check-ups.

It is very important that you only take your tablets on the days that are specified in your chemotherapy protocol. If you forget to take a tablet, contact your care team for advice. Also contact your care team if you are sick shortly after taking a tablet.

Intravenous chemotherapy

There are a number of different devices that can deliver chemotherapy medications into a vein.


A cannula is a small tube that is placed int a vein on the back of your hand or lower arm. Chemotherapy medication is slowly injected through the tube into your vein. Once the dose of medication has been delivered, the tube can be removed.

Skin-tunnelled catheter

A skin-tunnelled catheter is a fine tube that is inserted into your chest and connected to one of the veins near your heart. The catheter can be left in place for several weeks or months, so you do not have to have repeated injections. The catheter can also be used to carry out blood tests.

Peripherally inserted central catheter

A peripherally inserted central catheter (PICC) is similar to a skin-tunnelled catheter except the tube is connected to your arm rather than your chest.

Implanted port

An implanted port is a chamber that can be inserted under your skin and connected to a nearby vein. A special needle is placed into the chamber and connected to a drip or used for blood tests.

The type of device used often depends on the type of cancer you have and your general state of health. You may be able to choos the device, althoug this is not always possible.

Intravenous chemotherapy is not like receiving a vaccine, where you are simply given one quick injection. Instead, the chemotherapy medication are slowly released into a vein over the course of many hours.

The time it takes to administer one dose can range from several hours to several days.

Occasionally, some peopl need a continuous low dose of chemotherapy medication over the course of several weeks or months. If this is the case, you may be given a small portable pump that you can take home with you.

Other medication

If you are having chemotherapy, check with your care team before taking any other type of medication, including over-the-counter (OTC) medication and herbal remedies. Other medication could react unpredictably with your chemotherapy medication.


If you are a sexually active woman, avoid becoming pregnan while having chemotherapy. Man medications used in chemotherapy can cause birth defects.

You will need to use a barrier method of contraception, such as condoms, while having chemotherap and for a year after your treatment has finished.

Contact your care team straight away if you think you may have become pregnan during chemotherapy.

Side effects

It is difficult to predict exactly what side effects you will experience while having chemotherapy because different people react to treatment in different ways. A small number of people experience very few or even no side effects.

The common side effects of chemotherapy are listed below It is unlikely that you will experience all the side effects listed.

Your care team is there to help you cope with the physical and psychological side effects.

When to seek urgent medical advice

While they are distressing, most side effects of chemotherapy are not a serious threat to your health Occasionally, some side effects can be very serious. For example, if you experience a rapid fall in white blood cells, you may be vulnerable to serious infections.

Symptoms that may suggest you have a serious side effect include:

  • a high temperature (fever) of 38°C (100.4°F) or above
  • shivering
  • breathing difficulties
  • flu-like symptoms, such as muscle aches and pain
  • bleeding gums or nose
  • bleeding from other parts of the body that does not stop after applying pressur for 10 minutes
  • mouth ulcers that stop you eating or drinking
  • vomiting that continues despite taking anti-sickness medication
  • four or more bowel movements a day or diarrhoea

If you experience any of these symptoms, contact your care team or GP immediately.


Fatigue is a common side effect of chemotherapy. Almost everyone who has chemotherapy will experience fatigue. You may fee generally tired, or you may tire very easily after carrying ou everyday tasks.

While having chemotherapy, it is importan to ge plenty of rest and no t do any activities that you do not feel up to.

Light exercise, such as walking or yoga, can help boost your energy levels, but be careful not to push your body too hard.

If you are working you may nee to ask your employer if you ca work part-time until your chemotherapy has finished.

If you suddenly find yourself significantly more tired than usual, contact your care team. Extreme fatigue can be a sign of anaemia, which is caused by having a low number of red blood cells (see below for more details).

Nausea and vomiting

Nausea and vomiting are common side effects of chemotherapy. An estimated 60% of people who have chemotherapy will feel sick and 50% will experience vomiting.

If yo have nausea and vomiting, you will be given medication to control your symptoms. This is known as an anti-emetic.

You should continue to take your anti-emetics even if you do not feel sick because they will help prevent your symptom from returning.

Contact your care team if you continue to experience nausea and vomiting despite taking anti-emetics. Different types of anti-emetic are available and different people fin some more effective than others.

Hair loss

Hair loss is a common side effect of chemotherapy. Not all chemotherapy medications cause hair loss and sometimes the hair becomes thin and brittle rather than falling out.

If hair loss does occur, it usually begins within a few weeks of starting treatment. Hair loss can happen anywhere on the body including:

  • head
  • arms
  • legs
  • face
  • armpits
  • pubic region

People who have never experienced chemotherapy-related hair loss can underestimate how traumatic it is, particularly for women.

If you find your hair loss particularly hard to cope with talk to your care team. They understand how distressing it can be and will be able to give you support and counselling.

You may decide that you want to wear a wig. For some people, such as inpatients (who need to stay in hospital overnight) or those who are under 16 years of age, synthetic wigs are available free on the NHS. Find out more

It is important to remember that hair loss is always temporary and your hair will begin to grow back soon after your treatment has finished.

Cold cap

It may be possible to prevent chemotherapy-associated hair loss by using a cold cap.

A cold cap looks similar to a bicycle helmet and is designed to cool your scalp while you receive a dose of chemotherapy. In cooling the scalp, the cold cap reduces the amount of bloodflow to the scalp, which reduces the amount of chemotherapy medication that reaches it.

Whether or not yo can use a cold cap during treatment will depend on the type of cancer you have. For example, if you have leukaemia, there may be cancer cells near your scalp so a cold cap cannot be used.

Cold caps work better with certain chemotherapy medications than others and they may not always prevent hair loss.

Vulnerability to infection

Chemotherapy lowers the amount of white blood cells. The main function of white blood cells is to fight infection If the number of white blood cells is reduced, your immune system will be weakened and you will be more vulnerable to infection.

You may be given a course of antibiotics to reduce your risk of developing an infection. You will also need to take extra precautions to protect yourself against infection.

  • Practise good personal hygiene. Take daily baths or showers and make sure that clothes, towels and bed linen are washed regularly.
  • Avoid contact with people with serious infections, such as chicken pox or flu.
  • Wash your hands regularly with soap and hot water, particularly after going to the toilet and before preparing food and eating meals.
  • Take extra care not to cut or graze your skin. If you do, clean the area thoroughly with warm water, the dry i and cover it with a sterile dressing.

If you develop an infection, you may need to be admitted to hospital and treated with intravenous antibiotics (antibiotics that are injected directly into a vein).


Chemotherapy will lower your amount of red blood cells. Red blood cells carry oxygen around the body. If your red blood cell count drops too low, your body will be deprived of oxygen and you will develop anaemia.

Symptoms of anaemia include:

  • tiredness (you will feel much more tired than the general level of fatigue associated with chemotherapy)
  • lac of energy
  • shortness of breath (dyspnoea)
  • irregular heartbeat

If you experience any of these symptoms, contact your care team as soon as possible.

You may need a blood transfusion to help increase the number of red blood cells. Alternatively, a medication called erythropoietin (EPO can stimulate the production of red blood cells.

It is importan to eat a diet that is hig in iron because iron helps red blood cells carry more oxygen. Foods that are high in iron include:

  • dark green leafy vegetables (such as spinach)
  • iron-fortified bread
  • beans
  • nuts
  • meat
  • apricots
  • prunes
  • raisins

Bruising and bleeding

Chemotherapy can lower the amount of platelets in your body.

Platelets are blood cells that help blood to clot to prevent excessive bleeding or bruising.

Most chemotherapy medications do not seriously affect the number o platelets, although small number o people experience a significant drop in their platelet count.

Symptoms of a low platelet count include:

  • easily bruised skin
  • nose bleeds
  • bleeding gums

Report any of the above symptoms to your care team as you may need a blood transfusion to raise your platelet count.

You may need to take extra precautions to avoid damaging your skin and gums, including:

  • using an electric razor to shave
  • using a soft toothbrush
  • taking extra care when using knives or other sharp instruments
  • wearing a thick pair of gloves when gardening

Oral mucositis

In some cases, chemotherapy can cause pain and inflammation of the surface of the inside of your mouth. This is known as oral mucositis.

The severity of your symptoms usually depends on the strength of your medication.

Peopl havin high-dose chemotherapy usually experience more severe symptoms.

Symptoms of oral mucositis usually begin between seven and 10 days after you start your chemotherapy treatment.

If you develop oral mucositis, the tissue inside your mouth will begin to feel sore, as if you have burnt it by eating very hot food. You will probably develop ulcers on the lining of your mouth and, in some cases, on your tongue and on or around your lips.

The ulcers can be very painful and make it difficult for you to eat, drink and talk. They may also bleed and become infected.

The symptoms of oral mucositis should clear up a few weeks after you chemotherapy has finished.

A number of different medications are available to relieve the symptoms of oral mucositis. See Useful links for more information.

Loss of appetite

Some people who have chemotherapy lose their appetite and do not feel like eatin or drinking. If you lose your appetite, it is still important to make an effort to ea healthily and drink plenty of liquids.

You may find that eating smaller, more frequent meals is better than eating three large meals a day. Try sipping drinks slowly through a straw rather than drinking them straight from a glass or cup.

If you experience serious problems eating and drinking due to symptoms such as mouth ulcers, you may need to be admitted to hospital and attached to a feeding tube.

You will probably be given a nasogastric tube, which is a tube that passes down your nose and into your stomach. The tube can be removed once you are able to eat and drink normally.


Some chemotherapy medications can cause your skin to become dry and sore, particularly on your hands or feet. You may notice that your nails become brittle and flakier than usual and that white lines develop across the nails.

During chemotherapy, and for some time after your treatment has finished, your skin may become more sensitive to sunlight. It is important to take extra precautions to protect your skin from the sun.

  • Avoid the sun when it is at its hottest, usually between 10am and 2pm (although the sun can also be damaging to skin before and after these times).
  • Use a sunscreen that blocks both ultraviolet A (UVA) and B (UVB) radiation and has a sun protection factor (SPF) of at least 15.
  • Dress in a way that protects your skin from the sun For example, wear a wide-brimmed hat to protect your face and scalp and sunglasses to protect your eyes.

Memory and concentration

Some people on chemotherapy have problems with their short-term memory, concentration and attention span. You may find tha doing routine tasks takes a lot longer than usual.

Exactly why these symptoms appear is uncertain. They may be due to a combination of factors such as fatigue and anxiety

The symptoms usually improve once your treatment has finished.

Sexuality and fertility

Many people find that their libido (interest in sex) diminishes during chemotherapy. Loss of libido is usually temporary and your interest in sex should gradually return once your treatment has finished.

Some chemotherapy medications can stop women being able to conceive and can prevent men from producing healthy sperm. Loss of fertility is usually temporary, although in some cases a person can become permanently infertile.

If there is a risk that you could become permanently infertile, your care team will discuss the possibility with you before treatment begins

number of options are available. Women can have their embryos froze to be used later in IVF (in-vitro fertilisation).

Men can have a sample of their sperm froze to be used at a later date for artificial insemination.

See Useful links for more information about IVF and artificial insemination.

Diarrhoea and constipation

You may experience diarrhoea or constipation a few days after you begin chemotherapy.

Your care team can recommend suitable medication to help control the symptoms.


Living with the effects of chemotherapy can be frustrating, stressful and traumatic. It is natural to feel ongoing anxiety and concern about whether your treatment will be successful.

Stress and anxiety can increase your risk of getting depression. You may be depressed if you have been feeling particularly down for two weeks or more and you no longer take pleasure in the things you used to enjoy.

If you are experiencing psychological and emotional difficulties, contact your care team They can recommend treatments to help improve the symptoms of stress, anxiety and depression.

Joining a support group for people who are having chemotherapy may also help Talking to other people in a similar situation can often reduce feelings of isolation and stress.

See Useful links for more information about what support groups are available.