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 CANCERBACKUP FACTSHEET 2006

Chemotherapy
This factsheet has been written to help you understand more about chemotherapy. It should ideally be
read with Cancerbackup’s booklet Understanding chemotherapy, which gives more information. If you
require any further information please telephone our Cancer Support Service and speak to one of our
experienced cancer nurses.

What is cancer?

The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease
of these cells. Although cells in each part of the body may look and work differently, most repair and
reproduce themselves in the same way. Normally this takes place in an orderly and controlled way, but
if this process gets out of control the cells will continue to divide much more rapidly than normal cells.
This is important to remember, because as you will see from the following information chemotherapy
works on dividing cells.

What is chemotherapy?

Chemotherapy means treatment with drugs. These may be given by mouth (orally), or more commonly
into a vein (intravenously). Occasionally chemotherapy may also be given by injection under the skin
(subcutaneous) or into the muscle (intramuscular).

A single drug or a combination of several drugs may be given during a course of treatment. There are
about 40 chemotherapy drugs available, so there are therefore many different combinations of drugs
which may be used.

Chemotherapy is usually given as several courses of treatment. Depending on the drugs that are given
each course can last from a few hours to a few days. This is then followed by a rest period of a few
weeks which allows the body to recover from any side effects of treatment. The number of courses
given depends on the type of cancer a person has, and how well it is responding to the drugs.

When is chemotherapy used?

Chemotherapy is one type of cancer treatment. Other forms of treatment include surgery, radiotherapy
or hormone treatment. Chemotherapy is given to control or destroy existing cancer, and to try and
prevent a recurrence. It may be necessary to have more than one type of treatment, for instance
surgery followed by chemotherapy, to eradicate cancer cells which cannot be removed surgically.
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How chemotherapy works

The drugs work by interfering with the ability of the cancer cell to divide and reproduce itself.
The affected cells become damaged and eventually die. Different chemotherapy drugs damage
the cancer cells in different ways. This is one of the reasons why it is necessary to have more
than one chemotherapy drug, sometimes over several days. In some situations, a course of
tablets may be sufficient to treat the cancer.

Where is the treatment given?

Some chemotherapy drugs can be given as an outpatient, but with others, a short stay in
hospital may be necessary.

Length of treatment

The length of treatment depends on the type of cancer and the person’s response to
chemotherapy. Treatments also differ from patient to patient as each person responds
differently. Usually, after about three courses, treatment will be reviewed and the specialist
may be able to give more of an idea as to how much more treatment is needed.

For the patient going on holiday it is important to let the doctors know as soon as possible
so that treatment can be arranged accordingly. Because chemotherapy affects the immune
system, it is not possible to receive ‘live’ vaccines such as polio, measles, rubella (German
measles), BCG (TB), smallpox and yellow fever.

Possible side effects

It is important to remember that not everyone having chemotherapy will have side effects.
Different drugs have different side effects and each person will react in a different way.

The main areas of the body that are particularly affected by chemotherapy are those where
the normal cells grow and divide quickly. These are the mouth, digestive system, skin, hair and
bone marrow (where the new blood cells are made).

Some side effects which are quite common are:

Nausea and sickness. Some people feel sick after treatment but they do not always vomit.
It is important to inform your doctor if there is a problem as they will be able to prescribe an
appropriate anti-sickness drug.

Loss of appetite. This could be due to nausea or to the changes in taste sometimes caused by
chemotherapy treatment. Normal taste will return once chemotherapy is over. Cancerbackup’s
booklet Diet and cancer has plenty of tips on how to eat well when feeling unwell.
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Sore mouth and unpleasant taste. Teeth or dentures should be cleaned with a soft toothbrush
morning and evening and after meals to prevent infection. A bicarbonate of soda mouthwash can
be used (one teaspoon of bicarbonate of soda dissolved in a mug of warm water). It may be more
comfortable to leave dentures out if possible.

The lining of the digestive system may be affected by some chemotherapy drugs, which can lead to
diarrhoea or constipation. Again, tell your doctor if you experience these symptoms.

Chemotherapy can make some people feel very tired, whilst others carry on working. The important
thing to remember is to carry on with normal activities as much as possible and try not to become
over-tired.

Hair. Not all chemotherapy drugs cause hair loss but this should be clarified before treatment. Wigs
are available on the NHS. Hair always grows back at the end of treatment. You may find it helpful
to read Cancerbackup’s booklet Coping with hair loss.

Fertility. Although it is possible to have a normal sex life during treatment some people may find
that their interest has decreased. Women find that their periods may become irregular and may
stop altogether. The implications of this should be discussed with their doctors. In men the sperm
count may be reduced. The opportunity to bank (store) sperm will be offered if this effect is likely
to be permanent. However, effective contraception should be maintained, as pregnancy during, and
for about two years following treatment is not advisable. These points should be discussed with
your specialist.

Bone marrow. This is where the blood cells are manufactured. The red blood cells carry oxygen
around the body. The white blood cells are essential for fighting infections, and platelets help the
blood to clot to prevent bleeding.

Regular blood tests are done to make sure there are enough of these types of blood cells to keep
well. If there are not enough, treatment may be temporarily delayed to give the bone marrow time
to recover. The doctor should be informed immediately if there is any sign of bruising, bleeding or
infection or if you have a temperature over 38˚C (100.5˚F).

For more information call Cancerbackup’s Cancer Support Service on Freephone 0808 800
1234 to speak to a cancer specialist nurse. Lines are open Monday-Friday, 9am-8pm.

This information has been compiled by Cancerbackup’s Support Service.

We thank the patients and specialist advisers who have helped with the production of the
factsheet.

Copyright © Cancerbackup 2006, Chemotherapy. All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission in writing from Cancerbackup,
3 Bath Place, Rivington Street, London EC2A 3JR. Charity Registration No. 1019719.
A company limited by guarantee. Registered in England and Wales. Company No.
2803321. Registered office as above.
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 Chemotherapy

Some useful information in South Asian languages

• Length of the treatment

As discussed in the main factsheet, after about three courses, the effect of the treatment will
be assessed and your specialist may be able to give you an idea of how your treatment is
going and how much more treatment you may need.

If you are planning to go on holiday, you must let the doctor know how long you will be
away for and the country you are visiting. As discussed in the main factsheet, it may not be
possible to give certain vaccinations during chemotherapy and also a few months after the
treatment has finished. You may also have some difficulties in arranging travel insurance
during your treatment.

As we discussed in the main factsheet, one of the ways of giving chemotherapy drugs
is intravenously (in the vein). If you have any religious or cultural issues around the
administration of chemotherapy or blood transfusions you must discuss these with your
doctor during the planning of your treatment.

• Possible side effects

Loss of appetite: Sometimes due to chemotherapy, or other treatments, stress or anxiety,

you might feel you have lost your appetite. If this happens, try to eat small but frequent
meals. Do not skip meals.

Sore mouth/ulcers: Some of the following tips might help. Avoid spicy foods such as garlic,
onions, and chillies. Citrus fruit juices should also be avoided as they may irritate the lining
of the mouth. There are mouthwashes available which can help. If you are used to tongue
cleaners, apply gently, or you may use a soft cloth to clean your tongue.

Diarrhoea/constipation: If you have either of these side effects and they are disrupting
your religious activities, inform the doctor so that he can prescribe some medicines.

Tiredness: Cancer treatments can sometimes cause tiredness. Other causes of tiredness
include anaemia, pain, eating too little, stress and anxiety. Try not to overdo things or exert
yourself. You can carry on with your daily activities, but try to rest as much as possible.
Going out for short walks can be helpful.

Hair. Hair loss depends on the length of your treatment and what chemotherapy drugs
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are being given. Discuss with your doctor or specialist nurse if you have religious or cultural
issues around hair loss. Hair loss may be accepted when it is not a deliberate action. In some
hospitals, for particular types of chemotherapy, cold caps can be applied to protect against
hair loss.
Use more conditioner and brush your hair gently. If using a comb, don’t pull your hair.
Consider having your hair short, it is less traumatic and not harsh on the scalp.
Avoid wet shaving as this carries a higher risk of cuts.

Temperature: Use a thermometer if you feel that you have a high temperature. A
temperature over 38˚C should be reported to your doctor.

Fertility: As discussed in the main factsheet, chemotherapy can affect fertility in men and
women. If you, your partner or your family members are concerned about it please discuss
this with your doctor or specialist nurse. They can inform you of the choices available for
sperm banking and fertilised egg storage.
Many religions may not use any form of contraception. It is recommended that you avoid
pregnancy for at least two years after the treatment has finished. It is important that you
discuss this with your doctor as well.

Diet tips: As discussed in the main factsheet, chemotherapy may affect the lining of the
digestive system, so it’s very important to eat a sensible and balanced diet. Sometimes there
is a change in one’s taste. Discuss your diet with the Dietitian as well.
If your treatment falls during any religious festivals and you need to fast, or you need to
bring your treatment forward or delay it, it is important to discuss this with the doctor before
the treatment starts.
If you need any further information on diet, Cancerbackup produce a booklet, Diet and
cancer, which they can send you.

This information has been compiled by Madhu Agarwal (Greenwich Primary Care Trust) and
Harinder Sandhu (Bexley Primary Care Trust), South East London.
We thank all the specialist advisers locally and nationally who have helped us with the
production of this factsheet.