Getting a cancer diagnosis has the potential to completely upend your world. Although starting treatment like chemotherapy can be reassuring, it can also be confusing and scary. Chemo is intended to destroy fast-growing cancer cells, but it can also have some harsh and unpleasant side effects.
“[Chemotherapy] can kill cancer cells, but it can’t distinguish between cancer cells and normal, healthy cells,” Marlon Saria, Ph.D., R.N., advanced practice nurse researcher at the John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, California, tells SELF. That means chemo can put your body through hell in the process of trying to save your life.
As they work, chemo drugs target fast-reproducing cells (like those of a tumor), so they’re most likely to harm the normal, healthy cells in your hair follicles, mouth, digestive tract, reproductive system, and blood-forming cells in your bone marrow, according to the American Cancer Society (ACS). They can also affect cells in other parts of your body, like your heart, kidneys, bladder, lungs, and nervous system.
All of that sounds terrifying, but there’s no guarantee you’ll get all of these side effects. You may have many, some, few, or none, and each of them can happen to differing degrees. Doctors generally try to give chemo at high enough levels to treat cancer while keeping side effects to a minimum, the ACS says. With that said, chances are someone going through chemo will experience some sort of physical or mental reaction. Knowing which side effects may be in store if you or a loved one is getting chemotherapy can help you feel more prepared. Here are some common chemotherapy side effects to keep in mind, plus what you can do to make the chemo experience a little less awful.
1. Nausea and vomiting
Certain types of chemo drugs are more likely to cause nausea and vomiting than others, which is why doctors classify them by their emetogenic potential, meaning how likely they are to provoke these symptoms, the ACS says. Other factors play in as well, like the dose you get and how it’s administered (your body absorbs IV drugs more quickly than ones you take orally, for example).
Although doctors are still determining exactly how chemo-induced nausea and vomiting happen, it seems as though chemotherapy can trigger the brain along with certain areas of the esophagus, stomach, small intestine, and large intestine in a way that prompts that sick-to-your-stomach feeling or actual throwing up.
If you’re very anxious or nervous, have ever had motion sickness or morning sickness, or you’re prone to vomiting when you’re sick, you might be more likely to have nausea and vomiting when you undergo chemo, the ACS says. Having had chemo in the past also raises your risk due to a phenomenon known as anticipatory nausea and vomiting, which is a conditioned response in which your brain pairs the sights, sounds, and smells of the treatment area with vomiting, so you expect that you’ll experience it again. The ACS estimates that about one in three people will have anticipatory nausea, while one in 10 will have anticipatory vomiting.
Discuss the potential of nausea and vomiting when talking about chemotherapy with your doctor. They can estimate how much of this side effect you might experience based on the drug they have in mind, and they may prescribe anti-nausea and anti-vomiting medications to prevent that sick feeling, Jack Jacoub, M.D., medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, California, tells SELF. Eating dry, salty foods like crackers and having small meals throughout the day can help as well, Janette Chirino, a nurse practitioner at the Moffitt Cancer Center, tells SELF. The Mayo Clinic also recommends drinking small amounts of fluids throughout the day and avoiding unpleasant smells, too.
2. Hair loss
You’ve probably heard a lot about this chemotherapy side effect, because it’s a common one. Chemo often harms cells that make up hair follicles because they’re fast-growing, much like cancer cells are. This can make your hair fall out on your head or other parts of your body, like your eyebrows, eyelashes, arms, legs, and genitals, according to the ACS. Different drugs can cause hair loss on different parts of your body, and it’s typically hard to anticipate if a person who’s never had chemo will deal with hair loss at all.
If you’re concerned about losing hair on your head, you may be able to try cold cap therapy, which reportedly works by cooling the scalp to constrict blood vessels, preventing the normal amount of blood (and medicine) from reaching hair follicles. Cold cap therapy is promising; research shows that at least half of women using cold cap therapy during chemo for early-stage breast cancer lost less than half their hair (this may be tied to factors like the chemo dosage and type of drugs, though). But it does come with side effects like headaches, scalp pain, neck and shoulder discomfort, and chills, and insurance often doesn’t cover the expensive treatment.
Fatigue related to cancer is different than everyday fatigue: Rest doesn’t fully make it go away, and even doing little things can be exhausting, Dr. Saria says. When you do a chemo cycle, the fatigue usually gets worse in the first few days and then gets better until the next treatment, the ACS says.
There are plenty of reasons why people on chemo feel tired, but stress, lack of sleep, and other side effects like nausea and vomiting can all factor in, Chirino says. Chemo also may kill blood-forming cells in bone marrow, which can lead to anemia, another cause of fatigue, Dr. Saria says.
You might feel tempted to rest as much as possible in response to the fatigue, but marathon naps can actually compound the problem by lowering your energy levels and making it harder to sleep at night, the ACS says. Instead, the organization recommends taking naps of 30 or fewer minutes throughout the day.
And, though it seems counterintuitive (or just feels plain impossible), doctors recommend that you try to stay as active as you can when you’re going through chemotherapy. “Less activity begets more fatigue,” Dr. Jacoub says. “It’s a vicious cycle.” The ACS specifically recommends aerobic and strength-building exercises (with your doctor’s OK, of course), as they can improve the way your body functions, help you sleep, and just help you feel better all around. Before adding new activity into your routine, talk to your doctor to make sure it’s safe. They may have other specific recommendations to combat fatigue, too.
Pain medication, changes in your eating habits, and being less active than usual during chemo can all make your bowels move less often and cause your stool to be harder than you’re used to, the ACS says.
Dr. Jacoub recommends a preventive strategy of eating high-fiber foods, staying hydrated, and trying to be physically active. If you do end up constipated, talk to your doctor about your other options for relief, which may include things like stool softeners so you don’t have to strain as much when you go (which can lead to hemorrhoids).
If you’re dealing with diarrhea while you’re on chemo, the ACS has an entire list of things you may want to consider eating more or less often to get your poop closer to normal. It’s also important to try to stay hydrated during this time, Chirino says—diarrhea makes it easier to get dehydrated since you’re losing liquid so quickly.
6. Mouth sores
Healthy cells in your mouth can grow quickly, similarly to cancer cells, the Mayo Clinic says. This means chemotherapy might accidentally target and harm them.
When the cells in your mouth are damaged, it’s tough for your mouth to heal itself and fight off germs—and that can lead to mouth sores. These sores usually develop a few days after treatment starts and go away within two or three weeks after you stop chemo, the Mayo Clinic says.
To try to combat this, your doctor may recommend you suck on ice chips or popsicles during your chemo treatment. It’s not totally clear why this can help, Dr. Saria says, but it may have something to do with narrowing the blood vessels in your mouth, potentially limiting how much of the drug can make it there (much like with the cold caps for hair loss).
If you do develop mouth sores, some of the pain-alleviating treatments are pretty similar to the ones you might turn to for canker sores. Your doctor might suggest using medications called coating agents that create a film protecting the sores, the Mayo Clinic says. This might help ward off pain you’d normally feel when eating or drinking. Your doctor can also point you toward topical painkillers you can put on your sores to reduce the aching. Avoiding acidic and spicy foods and using a mouthwash of ¼ teaspoon salt with one cup of water can also help ease your symptoms, Chirino says.
7. Appetite changes and weight loss
Chemotherapy can make food taste bitter or metallic, which won’t exactly make you want to sit down to a hearty meal. Plus, side effects like nausea, vomiting, and mouth sores might put you off food even more. This lowered appetite can result in unintended weight loss, which can eventually make you feel weak and like daily activities are a struggle.
Your medical team can help you figure out the best way to deal with a lowered appetite or unintended weight loss. Their suggestions may include things like eating small, frequent meals instead of trying to have larger ones, focusing on high-calorie foods that are simple to eat like yogurt or milkshakes, and trying liquid meal supplements under their guidance. The goal is to help you maintain the healthiest weight possible without forcing yourself to eat in a way that’s really uncomfortable, so keep that in mind as you discuss your options.
8. Excessive bruising and bleeding
Chemotherapy can increase your risk of bruising and bleeding, and there’s a very specific reason why: The drugs involved can lower your number of platelets, which are cells that help your blood clot, the National Cancer Institute (NCI) says. When your platelet count is low, you might bruise or bleed far too easily, which can be a really inconvenient or even scary side effect. You may even develop thrombocytopenia, which is a condition that causes tiny purple or red spots to form on your skin, the NCI says.
While some bleeding and bruising may be unavoidable, you can take a few steps to lower the odds that it will happen often. The NCI specifically recommends avoiding over-the-counter medications that contain aspirin or ibuprofen (these can increase your risk of bleeding), brushing your teeth gently with a soft toothbrush to avoid bloody gums, always wearing shoes so you don’t accidentally cut yourself, using an electric shaver instead of a razor, and being extra careful when you use sharp objects, among other strategies.
If you do start to bleed for some reason, the NCI recommends pressing firmly on the area with a clean cloth and applying pressure until the bleeding stops. (Here’s more information on exactly how to stop a cut from bleeding.) As for bruising, you can try applying ice or a cold compress to the area as soon as you’ve injured it, since the cold might help damaged blood vessels constrict so you don’t release as much blood under your skin (yup, that’s what causes a bruise).
9. Pain, tingling, and other nerve problems
Some chemo drugs can cause something known as peripheral neuropathy. These symptoms happen when there’s damage to the nerves that control sensations and movements of your arms and legs, the ACS says. Signs of chemo-induced peripheral neuropathy include pain (this can be ever-present or a shooting or stabbing sensation that comes and goes), burning, tingling, numbness, balance problems, and being more sensitive to touch. These feelings may start in your toes, but move on to your ankles and legs, or go from your fingers to your hands and arms.
There’s no sure way for you to prevent chemo-induced peripheral neuropathy. (Your doctor may be able to do a few things to lower your risk, like giving smaller doses of chemo instead of one big dose, or administering your dose over a longer period of time. Some people put bags of ice on their hands and feet while getting certain chemo drugs.) If you do develop it, your doctor may recommend steroids, numbing creams, anti-seizure medication, or, in severe cases, opioids or narcotics, the ACS says.
10. Skin issues like dryness and itching
Chemo can damage your skin cells in a way that makes them dry, the NCI notes. Also, dehydration from issues like vomiting, diarrhea, and not drinking enough fluids can cause dryness, Dr. Saria says, as can poor nutrition that can come with appetite changes. Dry skin can, in turn, cause itching and make it more likely for your skin to crack, which is an issue if you’re dealing with easy bleeding and lowered white blood cells to fight off infection.
To try to lower the chances of this happening to you, try to get enough fluids and healthy foods every day, and talk to your doctor if you’re struggling with that or with diarrhea and vomiting. If your skin does start feeling parched, the NCI recommends using gentle soaps and creams, washing with warm (not hot) water, applying moisturizer after you shower, and generally protecting your skin from the elements. You should absolutely discuss which other measures you can take with your doctor, along with if they have any recommendations for skin-care products to use during chemo.
11. Mood and thinking changes
Cancer sucks, and it makes complete sense that going through chemo might result in some mood changes, including anxiety and depression. “This is common, and it’s often due to the diagnosis,” Dr. Jacoub says, explaining that cancer can of course make it feel like you’ve lost control over your life, which is understandably upsetting. Also, side effects like fatigue can also be a major factor here. But sometimes the actual cancer or its treatment can have a direct effect on your cognition, too. This is often called “chemo brain,” and although experts don’t know exactly what causes this mental cloudiness, it’s a very real thing that happens to some people.
If you’re dealing with issues like anxiety or depression, it’s important to speak about your feelings rather than bottling them up, even if that’s your natural instinct, Dr. Jacoub says. He recommends looking for therapy groups at your cancer center for support or seeking out a mental health professional for individual therapy. And if chemo brain is more your issue, again, work to feel comfortable explaining that to people—it’s a completely legitimate problem. You can also try adopting tactics like getting more organized than you ever thought possible, avoiding multitasking, and keeping track of your memory or cognition issues so you can ask your doctor for help with those specific scenarios.
Chemotherapy is far from easy. But knowing the side effects may make it easier to handle them, or even prevent them in the first place.
It’s essential to have regular, honest conversations with your doctor and medical team about your symptoms. Their goal is to get you through this in the most comfortable, healthiest way possible, and they can only help if they know what exactly you’re going through.