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Side Effects of Chemotherapy
Approved by the Cancer.Net Editorial Board, 08/2017
A full-text transcript is available.
Chemotherapy treats many types of cancer effectively. But like other treatments, it often causes side effects. The side effects of chemotherapy are different for each person. They depend on the type of cancer, location, drugs and dose, and your general health.
Why does chemotherapy cause side effects?
Chemotherapy works on active cells. Active cells are cells that are growing and dividing into more of the same type of cell. Cancer cells are active, but so are some healthy cells. These include cells in your blood, mouth, digestive system, and hair follicles. Side effects happen when chemotherapy damages these healthy cells.
Can side effects be treated?
Yes. Your health care team can help you prevent or treat many side effects. Today, many more medications are available for side effects than in the past. Preventing and treating side effects, called palliative care or supportive care, is an important part of cancer treatment.
Doctors and scientists work constantly to develop drugs, drug combinations, and ways of giving treatment with fewer side effects. Many types of chemotherapy are easier to tolerate than they were a few years ago.
Common side effects of chemotherapy
Different drugs cause different side effects. Certain types of chemotherapy often have specific side effects. But, each person’s experience is different.
Tell your doctor about all the side effects you notice. For most types of chemotherapy, side effects do not show how well treatment is working. But they can for some types of drugs called targeted therapies.
Below is a list of common side effects of traditional chemotherapy.
Fatigue. Fatigue is feeling tired or exhausted almost all the time. It is the most common side effect of chemotherapy. Learn about how to cope with fatigue.
Pain. Chemotherapy sometimes causes pain. This can include:
Pain from nerve damage, such as burning, numbness, or shooting pains, usually in the fingers and toes
Most types of pain related to chemotherapy get better or go away between treatments. However, nerve damage often gets worse with each dose. Sometimes when this happens, the drug causing the nerve damage has to be stopped. It can take months or years for nerve damage from chemotherapy to improve or go away. In some people, it never completely goes away.
Treatment of pain often differs based on what is causing it. It is important to talk with your health care team about pain while you are taking chemotherapy. There can be other reasons for pain besides the chemotherapy, such as the cancer itself. If the pain is related to chemotherapy, doctors can treat it by:
Giving pain-relieving medications
Blocking pain signals from the nerves to the brain with spinal treatments or nerve blocks
Adjusting doses of chemotherapy
Learn more about cancer pain and how to manage it.
Mouth and throat sores. Chemotherapy can damage the cells inside the mouth and throat. This causes painful sores in these areas, a condition called mucositis.
Mouth sores usually happen 5 to 14 days after a treatment. The sores can get infected. Eating a healthy diet and keeping your mouth and teeth clean can lower your risk of mouth sores. Mouth sores usually go away completely when treatment ends. Learn more about managing mucositis and oral health during cancer treatment.
Diarrhea. Some chemotherapy causes loose or watery bowel movements. Preventing diarrhea or treating it early helps keep you from getting dehydrated (losing too much body fluid). It also helps prevent other health problems. Learn more about managing diarrhea.
Nausea and vomiting. Chemotherapy can cause nausea (feeling sick to your stomach) and vomiting (throwing up). Whether you have these side effects, and how much, depends on the specific drugs and dose. The right medications given before and after each dose of chemotherapy can usually prevent nausea and vomiting. Learn more about nausea and vomiting.
Constipation. Chemotherapy can cause constipation. This means not having a bowel movement often enough or having difficult bowel movements. Other medications, such as pain medication, can also cause constipation. Drinking enough fluids, eating balanced meals, and getting enough exercise can lower your risk of constipation. Learn more about managing constipation.
Blood disorders. Your bone marrow is the spongy tissue inside your bones. It makes new blood cells. Chemotherapy affects this process, so you might have side effects from having too few blood cells. Usually the number of blood cells return to normal after chemotherapy is complete. But during treatment, low numbers of blood cells can cause problems and must be monitored closely.
Your health care team uses the following tests to check for blood disorders:
Complete blood count (CBC) – A CBC test shows the levels of red blood cells and white blood cells in your blood.Platelet count – This test measures the number of platelets in your blood. Platelets are cells that stop bleeding. They do this by plugging damaged blood vessels and helping blood form clots.
Not enough red blood cells causes a condition called anemia. Symptoms include fatigue, dizziness, and shortness of breath.
Not enough white blood cells causes a condition called leukopenia. This raises your risk of getting infections. Getting one when your white blood cells are low can be serious. If you get an infection, you need antibiotics as soon as possible.
Platelet count – This test measures the number of platelets in your blood. Platelets are cells that stop bleeding. They do this by plugging damaged blood vessels and helping blood form clots.
Not having enough platelets causes a condition called thrombocytopenia. You can bleed and bruise more easily than normal.
The doses of chemotherapy can often be adjusted to minimize low blood counts. Drugs are also available to treat these blood disorders. The drugs help your bone marrow make more blood cells. They can help prevent leukopenia in people with a high risk. Learn more about managing anemia, infection, and thrombocytopenia.
Nervous system effects. Some drugs cause nerve damage. This can cause the following nerve or muscle symptoms:
Weakness or numbness in the hands, feet, or both
Weak, sore, tired, or achy muscles
Loss of balance
Shaking or trembling
You might also have a stiff neck, headache, or problems seeing, hearing, or walking normally. You might feel clumsy. These symptoms usually get better with a lower chemotherapy dose or after treatment. But damage is sometimes permanent. Learn more about managing nervous system side effects.
Changes in thinking and memory. Some people have trouble thinking clearly and concentrating after chemotherapy. Cancer survivors often call this chemobrain. Your doctor might call it cognitive changes or cognitive dysfunction.
Sexual and reproductive issues. Chemotherapy can affect your fertility. For women, this is the ability to get pregnant and carry a pregnancy. For men, fertility is the ability to make a woman pregnant. Being tired or feeling sick from cancer or treatment can also affect your ability to enjoy sex. Talk with your doctor about these possible side effects before treatment starts. Learn more about managing sexual and reproductive side effects.
Women might need a test called a Pap test before starting chemotherapy. This is because chemotherapy can cause misleading results on the test.
Chemotherapy can also harm an unborn baby, called a fetus. This is especially true in the first 3 months of pregnancy, when the organs are still developing. If you could get pregnant during treatment, use effective birth control. If you do get pregnant, tell your doctor right away. Learn more about pregnancy and cancer.
Appetite loss. You might eat less than usual, not feel hungry at all, or feel full after eating a small amount. If this lasts through treatment, you may lose weight and not get the nutrition you need. You may also lose muscle mass and strength. All these things lower your ability to recover from chemotherapy. Learn more about managing appetite loss.
Hair loss. Some types of chemotherapy cause hair loss from all over your body. It may come out a little at a time or in large clumps. Hair loss usually starts after the first several weeks of chemotherapy. It tends to increase 1 to 2 months into treatment. Your doctor can predict the risk of hair loss based on the drugs and doses you are receiving. Learn more about managing hair loss.
Heart health: Some types of chemotherapy can affect your heart. It can help to check your heart before treatment. This way, doctors can tell if treatment causes problems later. One common test is an echocardiogram (echo). This test uses ultrasound waves to create a moving picture of the heart. Learn more about heart problems from cancer treatment.
Long-term side effects. Most side effects go away after treatment. But some continue, come back, or develop later. For example, some types of chemotherapy may cause permanent damage to the heart, lung, liver, kidneys, or reproductive system. And some people have trouble with thinking, concentrating, and memory for months or years after treatment.
Nervous system changes can develop after treatment. Children who had chemotherapy may develop side effects that happen months or years after treatment. These are called late effects. Cancer survivors also have a higher risk of second cancers later in life.
Care after cancer treatment is important
Getting care after treatment ends is important. Your health care team can help you treat long-term side effects and watch for late effects. This care is called follow-up care. Your follow-up care might include regular physical examinations, medical tests, or both.
ASCO has cancer treatment summary forms to help you keep track of the cancer treatment you received and develop a survivorship plan after treatment.
What to Expect When Having Chemotherapy
Fear of Treatment-Related Side Effects
CancerCare: Understanding and Managing Chemotherapy Side Effects
National Cancer Institute: Chemotherapy and You
Approved by the Cancer.Net Editorial Board, 03/2017
Almost everyone gets a headache from time to time. There are 2 main types of headaches:
Primary headaches. Primary headaches include migraines, cluster headaches, and tension headaches. Tension headaches are also called muscle contraction headaches.
Secondary headaches. Secondary headaches are caused by other medical conditions or underlying factors. These factors may include a brain tumor, head injury, infection, or medicines.
Primary headaches and secondary headaches are common in people with cancer.
Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care.
Headaches may have different symptoms. These factors help describe them:
Timing. This is the time of day when you develop a headache. Sometimes, the timing of a headache provides a clue to its cause. For example, headaches later in the day are often tension headaches.
Frequency. This is how often you have a headache. For example, occasionally, weekly, or daily.
Triggers. These are the factors that start a headache. Triggers can include exposure to cold, blinking lights, loud noises, or specific foods.
Duration. This is how long the headache lasts. It may range from minutes to hours to days. Some headaches start and end very suddenly. Others come and go over several hours or days.
Location. This is the place where the pain occurs. For example, pain may develop in these places:
Over the eyes
In the forehead or temples
At the back of the neck
On one side of the head
Severity. This is the degree of pain. It may range from mild to severe and incapacitating. Incapacitating means that you have difficulty moving or speaking during the headache. Some headaches start with mild pain that gradually becomes severe. Other times, they start with severe pain and remain that way.
Quality. This is the type of pain. You may describe it with some of these words:
Stabbing or piercing
A feeling of pressure
A dull ache
In addition to the headache itself, you may experience symptoms related to the headache:
Nausea and vomiting
Sensitivity to light or noise
Difficulty moving or speaking
Pain that increases with activity
Consider keeping a headache diary to track these symptoms. This will help your doctor diagnose and treat your headaches.
Causes of headaches
The following factors can cause a headache:
Cancer. Certain cancers may cause a headache, particularly these types:
Cancers of the brain and spinal cord
Pituitary gland tumors
Cancer of the upper throat, called nasopharyngeal cancer
Some forms of lymphoma
Cancer that has spread to the brain
Infections. Sinusitis and meningitis can cause headaches. Sinusitis is an infection of the sinuses. These are hollow passages in the bones around the nose. With meningitis, the protective membranes covering the brain and spinal cord swell.
Cancer treatment. The following cancer treatments can cause headaches:
Some types of chemotherapy, such as fluorouracil (5-FU, Adrucil) and procarbazine (Matulane)
Radiation therapy to the brain
Immunotherapy, a treatment that boosts the body's natural defenses to fight cancer
Other medicine. Medicine for cancer-related symptoms or other conditions can cause headaches:
Antibiotics, used to treat infections
Antiemetics, used to prevent or treat vomiting
Cancer-related side effects or other conditions. Symptoms or side effects related to cancer or cancer treatment can also cause headaches:
Anemia, a low red blood count
Hypercalcemia, a high level of calcium
Thrombocytopenia, a low platelet count
Dehydration, a loss of too much water from the body. This may result from severe vomiting or diarrhea.
Other factors. Stress, fatigue, anxiety, and sleeping problems may also cause headaches.
Your doctor will assess your symptoms and medical history. He or she will also conduct a physical exam. This information will help determine the headache type and cause.
Tell your doctor if you have headaches with these features:
They are frequent or severe.
They wake you at night.
They have new patterns or a change in frequency.
They are new or exhibit new symptoms.
Your doctor may also order tests to help diagnose the cause of your headaches:
A computerized tomography (CT) scan. This makes a 3-dimensional picture of the inside of the body.
Magnetic resonance imaging (MRI) of the brain. This uses magnetic fields to produce detailed images of the body.
Other tests, based on the headache pattern and symptoms
Treating and managing headaches
When possible, doctors treat the condition that causes the headache.
These medications may prevent and treat headaches or reduce the pain:
Over-the-counter pain relievers, like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)
Prescription narcotic pain relievers, like codeine
Triptan medications, like sumatriptan (Alsuma, Imitrex, Zecuity)
Steroid medications, especially for headaches caused by cancer that spreads to the brain
Antibiotics, if an infection is causing the headache
Tell your doctor about any over-the-counter pain medication you take.
The following may help reduce the number and severity of headaches:
Get enough sleep.
Additionally, complementary medicine may help relieve and prevent headaches. Complementary medicine techniques include:
Acupuncture, the use of fine needles placed in specific points of the body
Talk with your health care team about controlling your headaches with complementary medicine.
Coping with Cancer
Evaluating Complementary and Alternative Therapies
What Is A Headache?
Headache, pain in the head, can have many causes. The most common causes of headache are tension and sinusitis. Other headache causes include; migraines, cluster headaches and eye problems. Some chemotherapy or biologic therapies may also cause a headache. For example: headache can be part of the flu-like syndrome associated with various biologic therapies. It also can occur because of the irritation to the lining of the brain and spinal column when chemotherapies are given intrathecally (directly into the spinal fluid).
Because a headache can also be caused from more serious complications such as bleeding, meningitis, or high blood pressure other disorders may need to be ruled out when it is unclear why a headache is present.
A tension headache is usually described as a band-like pain around the head, which may be more severe at front or back of head, with no other symptoms. A tension headache usually lasts no more than 3-4 hours, although may have some discomfort for days.
A sinus headache is usually described as a pain in forehead or cheeks, made worse by coughing or bending down. Often a sinus headache includes nasal discharge and blockage. The sense of smell and taste may be reduced. Commonly occurs 3-10 days after a cold. A sinus headache usually clears within 3 weeks, even without antibiotics.
How To Manage Headache Symptoms:
Rest in a quiet, dimly lit room. Perhaps, relaxing music would help soothe your headache.
Cool cloth on the forehead.
A sinus headache may be helped by warmth and steam.
A headache originating in the back of the head or neck may be related to muscle tension - heat and/or massage may help.
Complementary therapies that have shown some benefit to those suffering from chronic headaches are; massage, acupressure and reflexology (massage limited to the feet or hands). Discuss this with your health care professional as to whether this may be appropriate for your headache.
Drugs That May Be Recommended By Your Doctor:
Analgesics such as acetaminophen. Do not take more than the recommended amount of acetaminophen in a 24 hour time frame. No more than 4 grams (gm) of acetaminophen should be taken for headache treatment. Higher doses may lead to toxicity to the liver. Check the bottle for the milligram dose (mg) of each pill, 1000mg = 1gram. If you are taking medications that have acetaminophen as one of the ingredients, this needs to be taken into account of the total dose for the day. For example: Percocet® and Darvocet® each contain 325mg of acetaminophen per pill. It is important to review all of the medications you are taking with your health care professional.
If you have a bleeding disorder, you should avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood platelets, and prolong bleeding. Use of such drugs to treat headache should be discussed first with your healthcare professional.
Over-the-counter decongestants: Usually containing pseudoephedrine. If the headache is due to sinus irritation.
When to Contact Your Doctor or Health Care Provider:
Headache follows a head injury.
Severe headache, especially if it starts suddenly.
Other headache symptoms such as vomiting, visual disturbance, neck stiffness, drowsiness, confusion, made worse by coughing or lowering head, rash, weakness in an arm or leg, or numbness.
Headache not going away after three days.
Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website about sinus headache, tension headache and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.