The Effects of Chemotherapy on Your Body
After receiving a cancer diagnosis, your first reaction may be to ask your doctor to sign you up for chemotherapy. After all, chemotherapy is one of the most common and most powerful forms of cancer treatment. But chemotherapy does a lot more than get rid of cancer.
While these drugs are powerful enough to kill rapidly growing cancer cells, they also can harm healthy cells. This may cause a number of side effects. The severity of these side effects depends on your overall health, age, and type of chemotherapy.
While most side effects clear up shortly after treatment ends, some may continue well after chemotherapy has ended. And some may never go away. Be sure to discuss any side effects you’re experiencing with your doctor. In some cases, depending on the reactions your body is having, your doctor may need to adjust the type or dose of the chemotherapy. How the side effects of chemo manifest for each person may depend on other factors, such as age or existing health conditions. But no matter how severe, these effects are noticeable for each individual.
Chemotherapy drugs can affect any body system, but the following are most susceptible:
- digestive tract
- hair follicles
- bone marrow
- reproductive system
It’s worth understanding how these cancer drugs can affect your major body systems.
Circulatory and immune systems
Routine blood count monitoring is a crucial part of chemotherapy. That’s because the drugs can harm cells in the bone marrow, where red blood cells are produced. Without enough red blood cells to carry oxygen to tissues, you may experience anemia.
Symptoms of anemia may include:
- pale skin
- difficulty thinking
- feeling cold
- general weakness
Chemo can also lower your white blood cell count (neutropenia). White blood cells play an important role in the immune system. They help prevent illnesses and fight infections. Symptoms aren’t always obvious, but you might find yourself getting sick more often than you used to. Be sure to take precautions to avoid exposure to viruses, bacteria, and other germs if you’re taking chemo.
Cells called platelets help blood clot. A low platelet count (thrombocytopenia) means you’re likely to bruise and bleed easily. Symptoms include long periods of nosebleeds, blood in vomit or stools, and heavier-than-normal menstruation.
Finally, some chemo drugs can damage the heart by weakening your heart muscle (cardiomyopathy) or disturb your heart rhythm (arrhythmia). These conditions can affect your heart’s ability to pump blood effectively. Some chemo drugs may even increase your risk for heart attack. These problems are less likely to occur if your heart is strong and healthy when you start chemotherapy.
Nervous and muscular systems
The central nervous system controls emotions, thought patterns, and coordination. Chemotherapy drugs may cause problems with memory, or make it difficult to concentrate or think clearly. This symptom sometimes is called “chemo fog,” or “chemo brain.” This mild cognitive impairment may go away following treatment or may linger for years. Severe cases can even add to existing anxiety and stress.
Some chemo drugs can also cause:
- tingling in the hands and feet (peripheral neuropathy)
Your muscles may feel tired, achy, or shaky. And your reflexes and small motor skills may slow down. You may also experience problems with balance and coordination.
Some of the most common side effects of chemotherapy affect digestion. Dry mouth and mouth sores that form on the tongue, lips, gums, or in the throat can make it difficult to chew and swallow. Mouth sores also make you more susceptible to bleeding and infection.
You might even have a metallic taste in the mouth, or a yellow or white coating on your tongue. Food may taste unusual or unpleasant, leading to unintentional weight loss from not eating.
These powerful drugs can also harm cells along the gastrointestinal tract. Nausea is a common symptom and may result in vomiting. Talk to your doctor about anti-nausea medications to reduce vomiting during treatment.
Other digestive issues include loose or hard stools and diarrhea or constipation. You may also feel pressure, bloating, and gas around the abdomen. You can lessen these symptoms by avoiding dehydration by drinking plenty of water during the day.
Side effects involving the digestive system can contribute to loss of appetite and feeling full even though you haven’t eaten much. As a result, weight loss, general weakness, and a lack of energy are common. It’s important to continue eating healthy foods.
Integumentary system (skin, hair, and nails)
Hair loss is perhaps the most infamous side effect of chemo treatments. Many chemotherapy drugs affect hair follicles and can cause hair loss (alopecia) within a few weeks of the first treatment. Hair loss can occur anywhere on the body, from eyebrows and eyelashes to your legs. Hair loss is temporary. New hair growth usually begins several weeks after the final treatment.
Minor skin irritations like dryness, itchiness, and rash are also possible.
Your doctor can recommend topical ointments to soothe irritated skin. You may also develop sensitivity to the sun and be susceptible to burns. Be sure to take special precautions to avoid sunburn when outdoors, such as wearing sunscreen or long-sleeves.
As the drugs affect your integumentary system, your fingernails and toenails may turn brown or yellow. Nail growth may also slow down as nails become ridged or brittle and start to crack or break easily. In severe cases, they can actually separate from the nail bed. It’s important to take good care of your nails to avoid infection.
Sexual and reproductive system
Chemotherapy drugs are known to alter hormones in both men and women. In women, hormonal changes can bring on hot flashes, irregular periods, or sudden onset of menopause. You may experience dryness of vaginal tissues that can make intercourse uncomfortable or painful. The chance of developing vaginal infections also increases.
Many doctors do not advise getting pregnant during treatment. While some women may become temporarily or permanently infertile as a side effect, chemotherapy drugs given during pregnancy may also cause birth defects.
In men, some chemo drugs can harm sperm or lower sperm count. Like women, men can have temporary or permanent infertility from chemo.
While symptoms like fatigue, anxiety, and hormonal fluctuations may interfere with sex drive in both men and women, many people on chemotherapy are still able to have active sex lives.
Excretory system (kidneys and bladder)
The kidneys work to excrete the powerful chemotherapy drugs as they move through your body. In the process, some kidney and bladder cells can become irritated or damaged.
Symptoms of kidney damage include:
- decreased urination
- swelling of the hands
- swollen feet and ankles
You may also experience bladder irritation, which causes a feeling of burning when urinating and increased urinary frequency.
To help your system, your doctor will likely recommend you drink plenty of fluids to flush the medication out and keep your system functioning properly. Also, be aware that some medications cause urine to turn red or orange for a few days, but know this isn’t a cause for concern.
Most people lose some bone mass as they age, but with chemo, some drugs increase this loss by causing calcium levels to drop. Cancer-related osteoporosis tends to affect women more than men, especially post-menopausal women and those whose menopause was brought on suddenly due to chemotherapy.
According to the National Institutes of Health (NIH), women treated for breast cancer are at increased risk for osteoporosis and bone fracture. This is due to the combination of the drugs and a natural drop in estrogen levels. Osteoporosis increases the risk of bone fractures and breaks. The most common areas of the body to suffer breaks are the spine and pelvis, hips, and wrists. You can help keep your bones strong by getting enough calcium and regular exercise.
Psychological and emotional toll
Living with cancer and dealing with chemotherapy can take an emotional toll. You may feel fearful, stressed, or anxious about your appearance and health. Depression is a common feeling as well, as people juggle work, family, and financial responsibilities on top of cancer treatment.
Complementary therapies like massage and meditation can be a helpful solution for relaxation and relief. Talk with your doctor if you have trouble coping. They may be able to suggest a local cancer support group where you can speak with others undergoing cancer treatment. If feelings of depression persist, look for professional counseling or ask your doctors about medication. While emotional side effects are common, there are also ways to reduce them.
No matter what side effects chemo causes, it’s possible to take steps to increase your quality of life during treatment.
- Ask about protective drugs
Ask your doctor if you should take any protective drugs to help boost your immune system or prevent infection.
If you’re at high risk of infection, they might prescribe growth factors, also known as colony-stimulating factors (CSFs). CSF treatments can be administered as an injection or a skin patch. The treatments help promote the growth of blood cells and reduce your risk of infection. However, they can also cause serious side effects that are most often temporary.
If your immune system is very weak, your doctor might also recommend prophylactic antibiotics. These medications include anti-bacterial, anti-viral, and anti-fungal medications.
Talk to your doctor to learn more about the potential benefits and risks of taking these medications.
Hair loss, hair thinning and cancer drugs
Read about hair loss or hair thinning caused by cancer drugs and ways of dealing with it.
Hair loss is one of the most well known side effects of cancer treatment.
Cancer drugs can cause:
- mild thinning of your hair
- partial hair loss, or loss of patches of hair
- complete hair loss (alopecia)
Generally, chemotherapy is the type of cancer drug treatment most likely to cause hair loss.
Complete hair loss is very unlikely with any other type of treatment. But some other cancer drugs can cause hair thinning. We can’t tell beforehand who will be affected or how badly.
Hair loss also depends on factors such as:
- the type of drug or combination of drugs you are taking
- the dose
- your individual sensitivity to the drug
- your drug treatment in the past
Drugs that cause hair loss or thinning
Most people think that chemotherapy drugs always cause hair loss. But some don’t cause any hair loss at all, or only slight thinning.
Other types of chemotherapy may cause complete hair loss, including your eyelashes, eyebrows, underarm, leg and sometimes pubic hair.
Hair loss is usually gradual rather than sudden. If your hair is going to fall out, it usually begins within 2 to 3 weeks after treatment starts.
The good news is that your hair will grow back once your chemotherapy treatment has finished. In very rare cases the hair does not grow back but usually this only happens with very high doses of particular drugs. You can ask your doctor or specialist nurse whether your drugs are likely to cause hair loss.
Other cancer therapies
Some hormone therapies or biological therapies can cause hair thinning. Usually this is quite mild and may not even be noticeable.
With hormone therapies, the thinning usually slows down or stops within the first year of starting treatment.
When your hair grows back
Unless you have had very high doses of particular chemotherapy drugs, your hair will grow back once the course of treatment is over.
After chemotherapy, this may take several months and your hair is likely to be softer. It might come back a different color and may be more curly than before. It will probably grow back at the same rate as it grew before chemotherapy.
Within 4 to 6 months after your treatment ends, you should have a good head of hair.
Other cancer therapies
When you have hair thinning from hormone therapy or biological therapy, it should start to thicken up again within a few weeks of finishing the treatment.
But it may take a couple of months before you really notice the difference.
Coping with hair loss
These tips can help if you are worried about hair loss or thinning from cancer treatment.
Tips for complete hair loss
- Ask about a wig before you start treatment, so you can match the colour and texture of your real hair
- If you are feeling adventurous, choose a wig for a whole new look – why not try the colour and style you’ve always wanted!
- Think about having your hair cut short before your treatment starts – this might help you get used to seeing yourself with less hair
- Some people shave their hair off completely to avoid the distress of seeing their hair fall out
- Wear a hair net at night so you won’t wake up with hair all over your pillow, which can be upsetting
- Keep your head warm in cooler weather – some people wear a soft hat in bed
- Remember to protect your scalp by covering your head in the sun – your scalp is particularly sensitive to the sun
General tips for hair loss or thinning
- Use gentle hair products such as baby shampoos
- Don’t use perms or hair colors on thinning hair – colors may not take well and perms can damage the hair
- Use a soft baby brush and comb thinning hair gently
- Avoid using hair dryers, curling tongs and curlers on thinning hair and pat your hair dry
- If your scalp flakes or itches this means it is dry – use oil or moisturizernot dandruff shampoo
- Protect your scalp by covering your head in the sun.
Covering your head
There are a lot of ways to cover your head if your hair falls out.
A wig is the most obvious choice. But not everyone wants to wear a wig. They can be a bit hot, especially in the summer. Younger people often prefer hats, scarves or baseball caps. Or you can just leave your head uncovered if you feel confident with your bald head.
Ask your nurse if you think you would like a wig. There will usually be someone who visits the hospital and gives advice about choosing the right type, color and style. If you want to match your own hair color and style (and not everyone does) it’s best to start the wig buying process as soon as you know you will be having cancer drugs that cause hair loss. Some people can get a wig on the NHS.
Reducing hair loss from chemotherapy
Your doctor will want to give you the treatment that’s most likely to work best in treating your cancer. But sometimes there is a choice of drugs you can have. If you find the thought of losing your hair very upsetting, your doctor might be able to suggest a treatment less likely to cause hair loss. It’s worth discussing.
Your doctor might also suggest you try something called a cold cap (also called scalp cooling). This can sometimes reduce the amount of hair loss.
You wear a cold cap to lower the temperature of your scalp. This reduces the blood flow in the scalp. And this lowers the amount of drug reaching the hair follicles on your head. With less of the cancer drugs getting to the hair follicles, the hair is less likely to die off and fall out.
Problems with cold caps
Scalp cooling only blocks certain chemotherapy drugs and doesn’t work for everyone. So you might still have hair thinning, or lose your hair completely. You can’t tell whether it will work for you until you try it.
Scalp cooling can’t be used for all types of cancer. You can’t really have scalp cooling if there is too high a risk that there might be cancer cells in your scalp blood vessels. This is because the cells in these blood vessels might survive the treatment.
So scalp cooling isn’t usually available for people:
- with cancers such as leukemia and lymphoma
- with cancers that have spread to the scalp
- who are due to have radiotherapy to their scalp
You also wouldn’t have scalp cooling with continuous chemotherapy through a pump or with chemotherapy tablets. This is because you would need to wear the cold cap for 24 hours a day.
You have to spend longer at the hospital having your treatment if you have scalp cooling. You need to wear the cold cap for a while before you have your drugs. It will make you feel cold all over – so wear a jumper or ask for a blanket. Hot drinks will help you feel warmer. You might find that the cold cap gives you a headache.
If you’re interested in trying a cold cap with your chemotherapy, ask your specialist nurse if it’s suitable for you. You can discuss the possible risks with your specialist if you’re worried.
Patient stories on hair loss and thinning
Everyone’s experience is different – read about how these patients coped.
PV first had his hair cut very short, then shaved it all off
“My hair started to fall out 2 weeks after my first chemotherapy session. As soon as I noticed a few strands coming out, I had my hair cut very short. A few days later it all started to come out and I shaved the rest off.
As a man it doesn’t really bother me and my wife quite likes my bald head. Still I’m looking forward to it growing back.”
PF lost lots of hair and got a wig
“My doctor said my hair would gradually thin, so I was expecting it. However, I was a bit frightened when it started to come out in handfuls when I washed my hair. So I had my hair cut in a short style to suit thin hair.
When I was in hospital the nurses organized for the wig lady to visit. She was very friendly and helped me choose a wig similar to my own color and style. I was nervous when my daughter came to see me but she said she could hardly tell the difference. I thought it was a lot greyer than my real color but my daughter thought it was a perfect match!
I don’t wear it all the time. I usually wear a scarf round my head but I like wearing my wig when I go out and I feel very comfortable in it.”
EW’s hair grew back curly, then straightened
“My hair took about 6 to 7 months to grow back. At first, it was quite curly, but as it grew, it became heavier and the curls dropped out.”
Anti-cancer drugs and treatments do have certain side effects. One of the most obvious and visible side effects is hair loss. A patient’s hair usually begins to fall out after 2-4 weeks of chemotherapy treatment. Loss of hair may be gradual or very rapid and drastic (chunks of hair falling out at once).
You see, these drugs and medications are made to be very powerful, as they are supposed to tackle tumors and malignant growths at the cellular level. In other words, these drugs attack cells that grow at a rapid pace. Unfortunately, these drugs can also attack other healthy, non-malignant cells that also grow rapidly once the treatment is administered to the patient.
Hair follicles, a tiny skin organ responsible for producing hair in humans by packing old cells together, is also one of the fastest-growing cells in the body.
o, while working against malignant cells that divide rapidly, anti-cancer drugs also attack these hair follicles, therefore impeding hair growth and causing hair loss. Some medications cause patients to lose hair only on their heads, while others result in loss of hair on the legs, arms, eyebrows, eyelashes and pubic areas.
Factors affecting the extent of hair loss
Chemotherapy does cause hair loss, but the extent varies according to the type and duration of the drugs being administered. Drugs like Adriamycin, when used during the first few weeks, usually results in loss of hair on the head (some women also lose eyebrows and eyelashes), whereas taxol (another anti-cancer drug) generally causes complete hair loss all over the body.
Hair loss is very common during chemotherapy for breast cancer as well as other cancers, though some drugs and methods of administration are more likely than others to disrupt hair follicles.
Why it Happens
Chemotherapy drugs work systemically (throughout the body) by interfering with the division and growth of rapidly growing cells. While these drugs can be effective in eliminating cancer cells, they also damage normal cells in our bodies which divide rapidly. This includes hair follicles (leading to hair loss), cells in the digestive tract (leading to nausea and vomiting), and cells in your bone marrow (leading to fewer red blood cells, white blood cells, and platelets).
Factors That Affect Whether Hair Loss Will Occur
Whether or not you develop hair loss and the degree of your hair loss depends on a number of factors including:
- Dose of chemotherapy
- How often the chemotherapy is given
- The route of administration
- The drugs or combination of drugs you receive
- Your individual makeup: Some people are more likely to lose hair than others, even with the same doses of the same drugs
Timing of Hair Loss
Hair loss often begins around the time of your second chemotherapy infusion, though this varies widely. It may start slowly, but increases rapidly around 1 month to 2 months after starting treatment. Some people do not lose all of their hair until they have nearly completed chemotherapy. Hair re-growth typically begins within 3 months of concluding chemotherapy. When your hair does grow back, many people find they have what’s been coined chemo curls. If your hair was straight prior to chemotherapy it will likely become straight again, but this process can take up to several years.
Permanent vs Temporary Hair Loss
The good news is that chemotherapy-induced hair loss is almost always temporary and reversible, though there have been a few rare exceptions.
Some women with breast cancer have developed permanent hair loss following a combination of taxanes (such as Taxol or Taxotere) and hormonal therapy, though this is rare. There have also been a few reported cases of permanent and severe hair loss in women with breast cancer who have received a combination of FEC (fluorouracil/epirubicin/cyclophosphamide) with docetaxel.
Some techniques have been tried to prevent or reduce hair loss (see below).
Which Chemotherapy Drugs Cause Hair Loss?
There are a number of chemotherapy agents used in breast cancer—many of them used in combination. Common regimens for adjuvant treatment such as Cytoxan and Adriamycin followed by Taxol are usually associated with hair loss.
Here is a list of chemotherapy drugs—not exclusive to breast cancer—that are most and least likely to cause hair loss.
Chemotherapy Drugs Most Likely to Cause Hair Loss
Chemotherapy medications which cause hair loss, or at least significant hair thinning in the majority of people include:
- Adriamycin (doxorubicin)
- Cytoxan or Neosar (cyclophosphamide)
- Taxol (paclitaxel)
- Taxotere (docetaxel)
- Cerubine (daunorubicin)
- Ellence (epirubicin)
- VePesid (etoposide)
- Hexalen (altretamine)
- Idamycin (idarubicin)
- Ifex (ifosfamide)
- Ixempra (exabepilone)
- Camptosar (irinotecan)
- Hycamtin (topotecan)
- Navelbine (vinorelbine)
- Ixempra (Ixabepilone)
- Vincristine (vinorelbine)
Chemotherapy Drugs That Sometimes Cause Hair Loss
Chemotherapy medications which cause hair loss for some but not all people include:
- Blenoxane (bleomycin)
- Myleran or Busulfex (busulphan)
- Cytosar-U (cytarabine)
- 5-FU, Fluorouracil, Adrucil (5-fluorouracil)
- Gemzar (gemcitabine)
- Gleostine (lomustine)
- Alkeran (melphalan)
- Thioplex (thiootepa)
- Velban (vinblastine)
- Oncovin (vincristine)
Chemotherapy Drugs That Rarely Cause Hair Loss
Some chemotherapy drugs result in only minimal hair loss, though these are often combined with drugs that cause more hair loss. These include:
- Paraplatin (carboplatin)
- Xeloda (capecitabine)
- Gliadel (carmustine)
- Platinol (cisplatin)
- Fludara or Oforta (vludarabine)
- Trexall, Otrexup, Rasuvo (methotrexate)
- Mutamicin (mitomycin C)
- Novantrone (mitroxantrone)
- Procarbazine (sold by generic name in US)
- Purinethol (6-mercaptopurine)
- Zanosar (streptozotocin)
Targeted Therapies and Hair Loss
The newer targeted therapies for cancer don’t usually cause total hair loss like chemotherapy drugs, but can result in changes such as thinning of the hair and dryness, as well as changes in texture similar to the chemo curls noted above. Some targeted therapies may also affect the pigmentation of hair, often causing the hair to become darker.
Some of the targeted therapies that have been linked with hair changes include:
- Erbitux (cetuximab)
- Erivedge (vismodegib)
- Gilotrif (afatinib)
- Gleevec (imatinib)
- Ibrance (palbociclib)
- Imbruvica (ibrutinib)
- Kisqali (ribociclib)
- Mekinist (trametinib)
- Nexavar (sorafenib)
- Sprycel (dasatinib)
- Tafinlar (dabrafenib)
- Tarceva (erlotinib)
- Tasigna (nilotinib)
- Zelboraf (vemurafenib)
Hormonal Therapies and Hair Loss
Some of the hormonal therapies commonly used for breast cancer have been associated with thinning of the hair for some people. Unlike chemotherapy, people may be using the drug for many months or even years before they notice the changes in their hair. Hormonal therapies more often linked to hair loss include:
- Aromatase inhibitors: Hair loss appears to be more common with Arimidex (anastrozole), and Femara (letrozole) than with Aromasin (exemestane)
- Faslodex (fulvestrant)
- Octreotide (sandostatin)
Other Drugs and Conditions That Cause Hair Loss
Immunotherapy drugs for cancer, at least checkpoint inhibitors, do not usually cause hair loss, though often times these drugs are used along with chemotherapy. In fact, researchers are currently looking at ways of harnessing the gene involved in autoimmune alopecia (hair loss such as with alopecia areata) to look for ways of improving the effectiveness of chemotherapy.
There are a number of non-cancer related medications that are associated with hair loss, that might accentuate the effects of chemotherapy drugs if used in combination. Some of these include retinoids (such as Accutane), anti-thyroid medications, L-Dopa (levodopa), amphetamines, non-steroidal anti-inflammatory medications, and several antidepressants such as tricyclic antidepressants and Wellbutrin (bupropion).
In addition to medications, illness, surgery, or dietary changes (low protein diets or very low calorie diets) may lead to hair loss. Thyroid disease (either hypothyroidism or hyperthyroidism) may cause hair loss, and may occur with cancer treatment (such as chemotherapy-induced hyperthyroidism or hypothyroidism which is very common with immunotherapy).
Preventing Chemotherapy-Induced Hair Loss
For those who are interested, it may sometimes be possible to prevent hair loss from chemotherapy.
Scalp cooling units can reduce roughly 50 percent of hair loss, but comes with a price. Many infusion centers do not have these units and therefore you may have to rent a cooling device, and depending on the device, this can be fairly pricey.
Scalp cooling (referred to as scalp cryotherapy) works by narrowing the blood vessels in the scalp so that chemotherapy drugs are less able to reach hair follicles. With some cancers, especially blood-related cancers like leukemia and lymphomas, there has been concern that cooling could reduce the effectiveness of chemotherapy. While it’s not likely to be a problem with breast cancer, scalp cooling can be very uncomfortable, similar to the symptoms of brain freeze you may remember while eating ice cream in the past.
Medications such as Rogaine (minoxidil) have also been tried, but are not very effective in reducing hair loss.
Care to Reduce Hair Loss
When hair loss is not complete or when it begins to regrow, taking good care of your hair can reduce further loss. Measures that can make a difference include:
- Avoiding hair dryers: If you need to blow dry your hair, choose a cool setting even though it takes longer to dry.
- Avoid chemical coloring or straightening products
- Avoid hair curlers: For those who like a little curl, heated rollers might give the same result but with much less damage.
- Choose a soft pillowcase that provides little friction that could rub off tender hair
- Use a gentle shampoo and try to skip days between hair washes
- Avoid brushing your hair when wet or vigorously drying your hair with a towel. Some brushes such as a “wet brush” may help remove snarls if you need to brush wet, but with less hair loss. Using a good conditioner may help as well.
Handling Hair Loss From Chemotherapy
It can be very emotional coping with the hair loss you experience during chemotherapy. Even though this complication is more of a nuisance, it remains one of the most feared side effects. Many oncologists recommend that you purchase a wig, hats, or scarves before beginning chemotherapy. All or a portion of the cost of a wig may be covered by your insurance. To have it covered, however, you will need to have your oncologist write a prescription for a “hair prosthesis.”
It’s important to keep in mind that hair loss may occur all over your body. This includes eyelashes, eyebrows, pubic hair, and more. While women may appreciate a reprieve from shaving their legs (and men, their faces), our eyelashes perform a protective function you may not realize until you open an oven door or are outside on a dusty day. Check out these 6 ways to prepare for hair loss from chemotherapy.
Many chemotherapy drugs result in hair loss, including those used for breast cancer. Some people choose scalp cooling as a way to reduce hair loss whereas others prefer the comfort of a warm head and planning ahead with a scarf or wig. The preference is very personal and it’s important that you do what is best for you alone. Fortunately, most hair loss is temporary and many women find that their hair grows back even healthier than before.