Chemotherapy Side Effects

Although technically chemotherapy is the ingestion of any drug as treatment of any condition, the term chemotherapy is generally used to discuss the treatment of cancer with medications.  Most chemotherapy works on the premise that cancer cells are undergoing cell division more rapidly than most of the non-cancer cells in the body, and chemotherapy drugs usually target some aspect of cell replication and division.  The theory is that by damaging cells which are in the process of replication more cancer cells will be damaged and killed than normal cells.  Many chemotherapy side effects are predictable in that they are manifest mostly in the normal body cells that also have a rapid turnover rate.  Examples of these types of cells re the bone marrow blood cell precursors and the gastrointestinal tract lining cells.  Other chemotherapy side effects are more specific to the various chemotherapy drugs and drug classes.   This article will be limited to the more common chemotherapy side effects that are common to several classes of chemo agents.

Chemotherapy Side Effects Common to Many Chemotherapy Agents:

Anemia:  Anemia is a reduction in the number of red blood cells in the bloodstream.  The normal lifespan of a red blood cell is only about 90 days, meaning about 1% of the bodies red blood cells are produced daily.  The bone marrow contains cells that are constantly dividing to produce new red blood cells, and they are fairly sensitive to damage by most chemotherapy agents.  This leads to anemia being among the more common of the chemotherapy side effects. Neutropenia:  Neutrophils are the type of white blood cell that is important in defending against bacterial infections.  The bond marrow precursors to neutrophils are also very sensitive to many of the chemotherapy agents.  Low neutrophil counts make patients vulnerable to bacterial infections and hospitalizations with fever, infection and neutropenia are common in chemotherapy patients.  Sometimes specific injections of a drug called granulocyte stimulating factor (Neupogen or Neulasta) are used to treat or prevent neutropenia.

Low Platelet Counts:  Thrombocytopenia, or low platelet count is another of the bone marrow suppression related chemotherapy side effects. Platelets are needed to stop bleeding, and serious bleeding complications are seen in these cases.

Nausea:  Many of the chemotherapy agents are notorious for causing severe nausea.  Modern oncology has become much better at the prophylactic therapy of nausea and in most patients today nausea is much less of a problem than it had been years ago.  Still nausea is among the notorious chemotherapy side effects.

Hair Loss:  The hair follicles are constantly growing hair, and so are among the rapidly dividing cells most susceptible to chemotherapy.   Total body hair loss is among the more distressing of the common chemotherapy side effects. Not all agents cause this alopecia, but for many agents this is almost a universal side effect.

Peripheral neuropathy:  Many of the chemotherapy agents have neurotoxicity as one of the common side effects. Many chemotherapy agents cause damage to the longest of the nerve cells to the tips of the toes and fingers.  A tingling, burning pain or discomfort is noted along with an odd numbness.  This is similar to the condition seen in diabetes and B12 deficieny.

Chemo brain:  Although not well understood or studies many chemotherapy patients complain of mild to moderate difficulty with memory, organization of thoughts, and generally feeling cognitively sharp.

Cardiotoxicity:  Most of the chemotherapy drugs do not specifically cause cardiac toxicity, but doxorubicin and the related agents daunomycin and idarubicin are notorious for dose related cardiotoxicity.  Other agents possibly associated with cardiotoxicity may include mitoxanthrone, 5-fluorouracil, and cyclophosphamide.

Chemotherapy associated Pulmonary Toxicity:  Like cardiotoxicity this is among the chemotherapy side effects limited to certain agents. Bleomycin and mitomycin are the most common chemo agents to cause lung toxicity.  Methotrexate has been reported to cause lung damage also.  Radiation to the chest area is a common cause of lung toxicity also, though not technically a chemotherapy treatment it deserves mention in this category.

Fatigue:  Many if not most chemotherapy patients experience some degree of fatigue while on therapy.  This can range from mild to quite debilitating, and is not simply related to anemia.  Rest, nutrition, and having realistic expectations for how active you can be while on chemo may be helpful.

Sexual and Fertility Chemotherapy Side Effects: Some types of chemotherapy may lead to permanent infertility.  Others may lead to anovulation while on chemo.  Many patients develop vaginal dryness that can be quite bothersome while on chemotherapy.  Loss of libido while on chemo can be a part of the overall fatigue, or may be more pronounced than the general lack of energy.

Anorexia:  Loss of appetite during chemotherapy can be very debilitating.  Control of nausea is key, but the loss of appetite can persist even if the nausea is controlled and is among the most common of chemotherapy side effects.

To see the specific side effects of any specific chemotherapy agents you are taking or considering taking ask your oncologist for detailed information.