Chemotherapy is not a selective treatment -- it is more like the nuclear bomb of medicines. It works by killing cells that rapidly grow and divide throughout your body, which include healthy and cancerous cells. Unlike the cancer cells, the normal cells will regenerate. However, in the meantime, you may suffer unwanted side effects from the damage to these healthy cells.
There is not a "one size fits all" template when dealing with chemotherapy side effects. Some people will whiz through treatment without suffering one unwanted symptom, whereas another person may endure every possible side effect like clockwork. Although your doctor will help you anticipate and treat side effects, no one knows exactly how you will respond to treatment until you get started.
Damage to Healthy Gastrointestinal Cells
Your digestive tract, from your mouth to your anus, has a smooth lining composed of billions of cells that rapidly divide. When chemotherapy attacks, it damages many of these otherwise healthy cells along with the cancer, which can lead to:
- Mouth pain, sores and difficulty swallowing
- Loss of appetite, nausea and vomiting
- Diarrhea and constipation
Your doctor may try to mitigate loss of appetite, nausea, and vomiting with prescription medications called anti-emetics. These drugs can be taken around the clock while you undergo chemotherapy and can be paired with a low fat, low sugar diet. Eating smaller, bland meals may also help boost your appetite and decrease nausea.
Mouth pain, sores, difficulty swallowing and metallic after-taste can be helped by:
- Eating with plastic utensils
- Sucking on ice chips during chemotherapy (decreases blood supply to the mouth during treatment)
- Using prescription mouthwash containing antacids and numbing agents for sores already present
- Good oral hygiene including frequent brushing (soft-bristled brush) and flossing
Diarrhea and constipation may be relieved through dietary changes or medications, as directed by your doctor. If you are using opiate pain medications, such as morphine, your doctor may anticipate constipation problems and arrange for a prescription stool softener or laxative. Drink plenty of fresh water and oral re-hydration (sugar-free sports drinks) to keep yourself hydrated.
Damage to Healthy Blood Cells
Your blood has many vital functions that may become temporarily impaired following chemotherapy. The three blood components frequently damaged by chemotherapy include your red blood cells (oxygen transporters), white blood cells (infection fighters), and platelets (blood clotters). Damage to or a decrease (anemia) of these blood cells may lead to:
- Fatigue, weakness and shortness of breath
- Bleeding and bruising
- Fever and susceptibility to illness
According to the American Cancer Society, fatigue is one of the top complaints for patients undergoing chemotherapy. Barring a blood test that proves you have a low blood count, fatigue may be attributed to the emotional and physical work of fighting cancer. Learning how to conserve your energy, taking naps, and accepting help may help you combat this side effect.
When healthy platelets are affected, your ability to heal small cuts and scrapes may decrease. You may notice that you bruise for no apparent reason or bleed longer following a small cut, like from shaving. Contact your doctor if you notice these symptoms and he or she can complete a blood test to discern and treat the cause.
If chemotherapy attacks your white blood cells, you are more susceptible to getting sick. Your body is already preoccupied fighting cancer; it may not have the reserves left to fight off a simple infection or cold. Help your white blood cells and immune system by:
- Frequently washing your hands with soap or an alcohol-based rub
- Staying out of public spaces
- Staying away from people who are ill
- Monitoring your temperature and reporting a fever (100.4 degrees Fahrenheit or above) to your doctor immediately
- Avoiding raw or undercooked meats or seafood
- Avoiding cleaning litter boxes, sand boxes, fish tanks or bird cages
Damage to Healthy Epithelial Cells
Your skin, hair and nails are composed of a special type of cell: the epithelial cell. These cells are constantly dividing, making them a prime target for chemotherapy drugs. When healthy epithelial cells are damaged, you may develop:
- Skin rashes
- Nail fungus
- Hair loss
Skin rashes, nail problems and hair loss are not always anticipated side effects, although they may be the most disturbing to some people. Keep your skin clean and dry and wear loose-fitting clothing to help reduce friction and moisture. Many people prefer to keep their head covered following hair loss using a turban, hat or even a wig that resembles their hairstyle prior to loss. Just remember -- your epithelial cells rapidly divide, which means that your hair will grow back and your skin should return to normal following chemotherapy.
Damage to Healthy Nervous System Cells
Although they are more commonly anticipated with the plant-based chemotherapy drugs, any chemotherapy drug may cause damage to the cells in your nervous system that can cause:
- Pain and numbness in feet and hands
- Swelling in feet and hands
If the peripheral (think hands and feet) nerves become affected by chemotherapy, you may suffer a side effect called peripheral neuropathy. Usually reported as a "burning" or "numb" pain in the hands or feet (or both), peripheral neuropathy may impair your ability to detect hot surfaces and cuts, and may affect your balance. To protect yourself until your nerves recover:
- Always use handrails
- Pick up loose scatter rugs or electrical cords
- Wear hard-soled shoes, especially outdoors
- Check water temperature with your elbow, not your hands
Swelling in the hands and feet is called edema. Edema can be a side effect of chemotherapy drugs and can cause sudden weight gain. To reduce the effects of edema, try to:
- Keep well-hydrated
- Elevate your feet whenever you are seated
- Wear comfortable pants, socks and shoes -- avoid tight-fitting clothes
- Reduce your salt intake (also called sodium on some labels)
Memory changes (known as "chemo-brain") may occur during and following chemotherapy. Although the exact cause is unknown, the severity and duration of your forgetfulness may depend on certain factors, including your stress management, fatigue, and any underlying health problems. Try to take notes, set reminders, and accept help from friends and family to mitigate this side effect.
Talking to Your Doctor
Even though many of these side effects are anticipated or common, don't hesitate to contact your doctor when you are concerned, in discomfort, or experiencing a new symptom. Some people keep a log of symptoms during their chemotherapy cycles and bring the notes in to each doctor's appointment for discussion.
American Cancer Society. (2006). American Cancer Society's Complete Guide to Colorectal Cancer. Clifton Fields, NE: American Cancer Society.
Cancer Care. (n.d.). Understanding and Managing Chemotherapy Side Effects. Accessed April 16, 2012.
Lange, V. (2009). Be a Survivor. Colorectal Cancer Treatment Guide. Los Angeles: Lange Productions.
Medline Plus. (n.d.). When You Have Nausea and Vomiting. Accessed April 15, 2012.
National Cancer Institute. (n.d.). Memory Changes. Accessed April 16, 2012.
National Cancer Institute. (n.d.). Swelling (Fluid Retention). Accessed April 16, 2012.