Chemotherapy is an aggressive and very powerful form of cancer treatment. It is not without side effects, some of which can be very serious. These side effects of chemotherapy disturb your quality of life adding to the already mental trauma of having being diagnosed with cancer.

There are ways to prevent or minimize these effects and your doctor always monitors them and uses means to get rid of them or reduce their severity.

Different chemotherapeutic drugs cause different side effects and different patients present these effects differently. Since chemotherapy aims at destroying the fast-growing cancer cells, it can also damage the normal and healthy growing cells in the body.

Some facts:

  • Not all persons experience every side effect.
  • Some people may experience no side effects at all.
  • The intensity of the side effects varies from person to person.
  • Your doctor may give you prophylactic medicines to prevent certain side effects from happening.
  • Some people may experience long-term side effects, such as damage to the heart or nerve and even fertility problems.

Why does chemotherapy cause side effects?

The side effects of chemotherapy are due to the damage caused by chemotherapy on the normal and healthy growing cells in the body, which are constantly dividing.

Because some tissues in the body have constantly dividing cells, chemotherapy can cause damage to these tissue cells. However, normal cells that are damaged are replaced or they repair themselves. The damage to healthy cells, therefore, does not usually last and most side effects go away once your chemo treatment is over. To better understand, you should know the differences between the normal cell and the cancer cell.

Which are the normal cells most affected by chemotherapy?

The cells that are constantly growing in the body and most likely to be damaged by chemotherapy are:

  • Blood cells, which are produced in the bone marrow
  • Cells of the gastrointestinal tract lining the mouth, esophagus, stomach, and the intestines
  • Cells of the hair follicles (hair is constantly growing)
  • Cells of the reproductive system
  • Skin cells

Vital organs such as the heart, brain, lungs, and kidneys can also suffer damage due to chemotherapy. The patient must maintain a proper record of the chemo side effects, which he experiences, and present the record to the doctor during his chemo visits so that the doctor monitors his chemotherapy treatment and dosage.

Doctors plan chemotherapy protocol and give drug doses at levels high enough to treat cancer and keep the side effects to a minimum. When combination therapy is indicated, doctors try to avoid using the combination drugs that have similar side effects.

How long do side effects of chemotherapy last?

Most chemotherapy side effects disappear quickly, but some might stay for months or even years. These are the long-term or late side effects.

Some side effects can last a lifetime, such as those that cause damage to the heart, lungs, kidneys, or reproductive organs.

Certain types of chemo drugs can cause second cancer that can appear after many years. A second cancer is new cancer unrelated to cancer you have survived.

Common side effects of chemotherapy

When the doctors advise you to undergo chemotherapy, you are anxious about the side effects you may face. The severity of these side effects depends on certain factors such as your general health, age, and type of chemotherapy.

Here are the side effects that you commonly face. However, please note that, as mentioned above, not all people on chemo experience side effects.

1) Fatigue

The onset of fatigue due to chemotherapy is sudden. The patient feels very tired and weak. This fatigue due to chemotherapy is different from the normal fatigue we feel.

The chemo fatigue does not go away even after taking a rest. It is accompanied by muscle aches and pains. You are unable to concentrate and you find it difficult to perform your daily activities.

This type of fatigue can last for a few days or a few months. It goes away after cancer starts responding to chemotherapy.

How do you cope with chemo fatigue? Exercise, yoga, massage, and dietary counseling are all effective to help you cope with fatigue and weakness. Proper sleep is essential and if you’re having problems with your sleep, you should go in for sleep therapy.

2) Hair Loss

Hair loss or alopecia due to chemotherapy occurs after a few doses have been administered. It does not start immediately after treatment has been started. This hair loss is due to damage to the fast-growing cells of the hair follicles.

You experience loss of hair all over the body and not just the scalp. Your eyelashes, eyebrows, armpits, pubic and other body hair may fall. Some drugs cause total hair loss while some cause only partial hair loss.

Hair loss is usually reversed over a period after chemotherapy has been stopped. The hair that grows back may be brittle and you may see a slight change of hair color.

How do you prevent hair loss due to chemo?

You should wear a scalp-cooling cap during your chemotherapy sessions. It slows down the blood circulation to your scalp and reduces the concentration of chemo drugs. This reduces the toxicity of the drug on the hair follicles.

3) G.I. system side effects due to chemotherapy

Due to damage caused by chemotherapy on the fast-growing cells of the lining of the gastrointestinal system, you may experience the following side effects:

  • Dryness of the throat, stomatitis, sore throat, or ulcers in the mouth
  • Nausea and vomiting
  • Diarrhea or constipation
  • Loss of appetite
  • Malnutrition and dehydration due to loss of appetite, vomiting, and diarrhea.

How you can minimize G.I. tract effects?

  • Maintain oral hygiene,
  • Your doctor may prescribe antiemetics for vomiting,
  • Similarly, medicines for diarrhea and constipation may be prescribed
  • Eat small frequent meals to stay nourished and
  • Take iron and vitamin supplements

4) Side effects on bone marrow

Chemotherapy causes damage to the fast-growing cells of the bone marrow, which leads to bone marrow depression. This leads to a fall in the count of white blood cells, red blood cells, and platelets leading to suppression of the immune system.

  • Fall in the WBCs due to chemotherapy leads to a weak immune system, which can make the patient prone to infections. Though proper hygiene is maintained, the naturally occurring organisms present in the intestinal flora and the skin, which are kept sub-clinical by the immune system, start growing and can cause systemic infections such as sepsis and skin infections such as herpes zoster. To cope with this side effect, your doctor will prescribe colony-stimulating factors (CSF) by way of treatment to increase the WBC count to counter this side effect. At times, your doctor may postpone chemotherapy if the counts fall dangerously low. A blood count is, therefore, periodically done during chemo treatment
  • Fall in RBC count due to chemotherapy leads to anemia. Anemia can again cause weakness, dizziness, and shortness of breath. To fight this effect, iron supplements are prescribed to increase hemoglobin levels in the blood. If required, blood transfusion is given when the RBC blood counts fall very low.
  • Fall in platelet count due to chemotherapy leads to bleeding disorders. Platelets, also called thrombocytes play an important role in the clotting of blood. Fall in platelet count makes you bleed more heavily. You may experience bleeding from the nose and gums. There may be blood in stools (black stools) and urine (pinkish tinge to the urine). Vaginal bleeding may be more than normal. This excessive bleeding can cause anemia. Your doctor may order platelet transfusion and hematinics (iron tonics) to minimize this side effect. Your doctor may lower the chemotherapy dose or increase the interval between treatment cycles.
  • In severe cases of bone marrow depression or myelosuppression, all the stem cells in the bone marrow (cells that produce blood cells in the bone marrow) may be destroyed. This happens in chemotherapy given for leukemia. Immediate hospitalization is advised and specialized treatment is given.

5) Infertility due to chemotherapy

Certain gonadotoxic cancer drugs cause infertility due to decreased sperm count. Other side effects may include erectile dysfunction, loss of libido, and vaginal dryness. All these problems caused by chemo usually go away after treatment is stopped.

6) Effect of chemotherapy on skin and nails

Chemotherapy causes the skin to become darker. Your skin may develop rashes, there may be dryness of skin, itching, and a reddish discoloration. The skin may become extra sensitive to sunlight. The nails may turn yellowish, become brittle and show cracks. Later, there may be a change in the color or shape of the nails.

How do you tackle side effects on skin and nails? Your oncologist may prescribe hydrating nail solutions to reduce the risk of nail loss associated with chemotherapy. You may be advised moisturizers and dry skin soap for your skin to minimize the damage due to the chemo drug.

7) Secondary cancer due to chemotherapy

This is a rare side effect but it does present. Successful treatment with certain cancer drugs (alkylating agents) has caused the second occurrence of cancer, which is usually acute myeloid leukemia. This is seen after successful treatment of cancer in children and can occur many years after the first treatment.

To reduce the risk of secondary cancer, you can do certain things to stay healthy and strengthen your immune system.

  • Eat healthy
  • Take vitamin and supplements
  • Engage in physical activity
  • Have adequate sleep

The American cancer society describes this strategy in detail.

8) Ototoxicity due to chemotherapy

Chemotherapy may cause damage to the ears and the symptoms include tinnitus (ringing in the ears), loss of hearing, loss of balance, and vertigo. This damage may be transient or permanent.

Hearing loss caused by chemotherapy is often permanent. Your doctor may monitor your hearing, adjust the chemotherapy dose to possibly prevent damage to your ear. However, hearing rehabilitation with hearing aids remains the only possible option once the sense of hearing is lost.

Side effects of chemotherapy on major organs

Many people may not experience any serious long-term problems with chemotherapy. But in some cases, it can cause permanent damage to the body organs such as the heart, lungs, nerves, kidneys, and reproductive or other organs.

9) Cardiotoxicity

Chemotherapy can cause heart muscle damage (cardiomyopathy) and decrease heart function. This hampers blood circulation.

Chemotherapy can cause cardiotoxicity during the cancer treatment or it can develop within days, months, or years after treatment or even after the patient becomes cancer-free.

Heart damage can reduce the patient’s quality of life and increase the risk of death from cardiac-related causes.

Once cardiac toxicity develops, aggressive medical treatment remains the only choice because this toxicity does not reverse when chemo is stopped.

10) Renal Toxicity

Certain cancer drugs can cause kidney damage, which can lead to decreased renal function. You may be given I.V fluids before treatment and renal function tests are periodically done for any signs of kidney damage.

11) Liver toxicity

Liver toxicity due to chemo can present as inflammatory hepatitis, cholestasis, and steatosis.

Patients on chemo are periodically assessed for liver function tests to check for any signs of liver damage such as hepatitis. On any sign of liver inflammation, doctors often lower doses or stop administering the chemo drugs completely

12) Nervous system toxicity

Certain cancer drugs can cause pain, weakness, tingling, and numbness in the arms and legs due to peripheral neuritis.

Some cancer drugs can cause damage to the brain and you may develop symptoms such as giddiness, headache, anxiety, and loss of cognitive function. At times, the damage, if minimal, can reverse after stopping treatment.

If the brain and nerves damage is more, these side effects are irreversible even after stopping the treatment.

13) Retention of fluids

Some cancer drugs cause water retention, which is an abnormal collection of body fluids in the circulatory system, in the body tissues, or the body cavities. This may result in swelling of the face or hands or legs or abdomen. This is due to hormonal changes due to chemotherapy or due to cancer itself.

Ending note:

Chemotherapy aims to cure cancer. The side effects of chemotherapy are many. To control these, you must maintain a proper written record of the various undesirable symptoms you experience. Produce this record every time you visit your doctor for chemo treatment. This will help him to plan a proper treatment protocol to control the side effects.


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