Chemotherapy is not without side effects. Different chemotherapeutic drugs cause different chemotherapy side effects and different patients present with different side effects. Since chemotherapy aims at destroying the fast growing cancer cells, it can also damage the normal fast growing cells in the body.
Effects of Chemotherapy
The side effects of chemotherapy are due to the damage caused by chemotherapy to the normal fast growing cells or the fast dividing cells in the body. The fast growing cells in the body are:
- Blood cells which are being produced in the bone marrow.
- Cells of the G.I. tract lining the mouth, esophagus, stomach and the intestines.
- Cells of the hair follicles.
- Cells of the reproductive system.
Vital organs such as the heart, brain, lungs and kidneys can also suffer damage due to chemotherapy. It is necessary for the patient to maintain a proper record of the chemo side effects which he experiences, and present the record to the doctor during his chemo visits, in order that the doctor monitor his chemotherapy treatment and dosage.
The onset of this fatigue is sudden. The patient feels very tired and weak. This fatigue due to chemotherapy is different from the normal fatigue we feel. This fatigue does not go away even after taking rest. Fatigue due to chemo can last for a few days or a few months. It goes away after the cancer starts responding to chemotherapy.
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. Hair loss is experienced all over the body and not just the scalp. 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 a slight change of hair color may be seen.
3) G.I. system side effects due to chemotherapy
Due to damage by chemotherapy on the fast growing cells of the lining of the gastrointestinal system, the following side effects may be seen:
- Dryness of the throat, stomatitis, sore throat or ulcers in the mouth.
- Nausea and vomiting are common.
- Diarrhea or constipation.
- Loss of appetite.
- Malnutrition and dehydration due to loss of appetite, vomiting and diarrhea.
To treat these side effects,
- maintain oral hygiene,
- anti emetics are given for vomiting,
- diarrhea and constipation are treated with respective medicines,
- small frequent meals are advised to stay nourished and
- iron and vitamin tonics are advised.
4) Side Effects on bone marrow
Bone marrow depression is due to damage to the fast growing cells in the bone marrow by chemotherapy. This leads to fall in count of the white blood cells, red blood cells and platelets. There is suppression of the immune system due to chemotherapy.
- 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. Colony stimulating factors (CSF) are given by way of treatment to increase the WBC count to counter this side effect. At times, chemotherapy may sometimes be postponed. 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 breadth. Iron tonics are prescribed to increase hemoglobin levels in the blood. If required, blood transfusion is given when 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 clotting of blood. Fall in platelet count makes you bleed more heavily. You may experience bleeding from 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. This side effect is treated with platelet transfusion , CSF and hematinics(iron tonics).
- 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 given.
5) Infertility due to chemotherapy
Infertility due to decreased sperm count is caused by certain gonadotoxic cancer drugs. There may erectile dysfunction, loss of libido and vaginal dryness. This side effect usually goes away after treatment is stopped.
6) Effect of Chemotherapy on Skin and Nails
Skin becomes darker. There may be skin rashes, 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 change in the color or shape of the nails.
7) Secondary Cancer due to chemotherapy
This is a rare side effect but has been seen. Successful treatment with certain cancer drugs(alkylating agents) has caused a 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.
8) Ototoxicity due to chemotherapy
Chemotherapy may cause damage to the ears and the symptoms include tinnitus (ringing in the ears), loss of hearing and loss of balance and vertigo. This damage may be transient or permanent.
Photo showing chemotherapy side effects
Side Effects of Chemotherapy on Major Organs
This is the side effect of chemotherapy on the heart which causes heart muscle damage and decreased heart function. Circulation of blood is hampered.
10) Renal Toxicity
Damage to the kidneys may be seen due to certain cancer drugs, leading to decreased renal function. Patients are therefore given I.V fluids before treatment and renal function tests are periodically done for any signs of kidney damage.
11) Liver toxicity
Patients on chemo have to be periodically assessed for liver function tests to check for any signs of liver damage such as hepatitis.
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 where symptoms such as giddiness, headache, anxiety and loss of cognitive function are seen. At times, the damage, if minimal will be reversed after stopping of treatment. If the damage to the brain and nerves is more, these side effects are irreversible even after stopping the treatment.
13) Retention of fluids due to chemotherapy
Some cancer drugs cause water retention which means an abnormal collection of body fluids in the circulatory system, in the body tissues or in the body cavities. This may result in swelling of the face or hands or legs or the abdomen. This is explained as due to hormonal changes due to chemotherapy or due to the cancer itself.
The aim of Chemotherapy is to cure the cancer. The side effects of chemotherapy are many. To control these chemo side effects, it is necessary that you maintain a proper written record of the various unwanted symptoms you experience. Produce this record every time you visit your doctor for chemo treatment. He will know what to do.