Chemotherapy works by killing off cells in your body, such as cancer cells, that divide rapidly.  In addition to the cancer cells, you have normal cells that also divide rapidly as part of their function.  Chemo drugs kill off these normal cells, too. This explains some of the most common side effects of chemotherapy.  When these normal cells stop dividing, you may experience:
  • A decreased production of blood cells, causing you to be tired.
  • A decreased replacement of the cells lining your intestines resulting in an inflammation of the lining of the digestive tract causing nausea and vomiting.
  • A decreased production by hair follicles causing you to lose your hair.
Other common side effects include:
  • Weight loss.
  • Changes in taste.
  • Mouth sores.
Side effects are different for each chemotherapy drug, and they also differ based on the dose, how the drug is administered, and how the drug affects you individually.  While the side effects of chemotherapy can be hard to endure, this suffering must be weighed against the impact the treatment is having on the cancer.
If you are becoming discouraged, talk to your doctor or the staff.  They may be able to suggest ways to reduce or make the side effects less unpleasant.  Riverside offers support groups that may be helpful to your during this difficult time.
Below are some of the most common side effects of chemotherapy.
Low Blood Counts
As chemotherapy kills the cancer cells, it also kills the rapidly dividing new cells within the bone marrow. This reduces the production of new blood cells.
  • At first, your blood counts will not be low. Chemotherapy doesn't kill the mature cells in your existing blood. But as these cells mature and die, they are not replaced as quickly as they normally would be.
  • Your three types of blood cells are produced on different time schedules; from six hours for some white blood cells to as many as 120 days for red blood cells.
  • The type and dose of the chemotherapy will influence how low the blood cell counts will drop and how long it will take for the drop to occur.
Here are the three blood cell types and the impact chemotherapy might have on them and the side effects you may experience:
Low white blood cell counts
Your white blood cells help you fight off infections. Neutropenia, an abnormally low number of an infection fighting type of white blood cell, is the most common side effect that puts people at risk for infection. Having a low white blood count doesn't mean you will get an infection, but you need to watch for signs and call your doctor right away if you have:
  • Fever
  • Sore throat
  • New cough or shortness of breath
  • Nasal congestion (stuffy nose)
  • Burning during urination
  • Shaking chills
  • Redness, swelling, pain, and warmth at the site of an injury or at an implanted catheter site
You may be given antibiotics as a precaution when your white blood count is low. If your white blood counts are very low, your oncologist may delay your chemotherapy treatments. Or, your doctor may prescribe injections of growth factors that will boost production of white blood cells.
Low red blood cell counts
Your red blood cells carry oxygen throughout the body.  Not having enough red blood cells is called anemia. With anemia, you may have the following symptoms:
  • Extreme tiredness (called fatigue )
  • Pallor or paleness of the skin and mucous membranes
  • Dizziness
  • Headaches
  • Irritability
  • Shortness of breath, especially with exertion (walking, going up steps, etc.)
  • Low blood pressure
  • A rise in heart rate or breathing rate (or both)
Anemia caused by chemotherapy is usually temporary.  If the symptoms are severe or if you have other conditions such as lung and heart disease, blood transfusions can temporarily correct the red blood count levels until the bone marrow is healthy.
Low platelet counts
Platelets help stop bleeding The medical term for a low platelet count is thrombocytopenia. If your platelet count is low, you may:
  • Bruise easily
  • Bleed longer than usual after minor cuts or scrapes
  • Have bleeding gums or nose bleeds
  • Develop small reddish-purple spots on your skin
  • Have headaches
  • Have visible blood in stool or urine
  • Have serious internal bleeding if the platelet count is very low
Although low platelet counts resulting from chemotherapy are temporary, they can cause serious blood loss. This, in turn, can lead to damage in internal organs. If platelet counts are very low, platelet transfusions may be given as well as some drugs.
Nausea and Vomiting
Perhaps the most dreaded side effect of chemotherapy is the nausea and vomiting. There are new medicines that can treat this side effect and help keep it under control.
Chemotherapy drugs can irritate the linings of the stomach and the first part of the small intestine or cause inflammation or delayed gastric emptying. These and other side effects can trigger the parts of your brain that cause you to experience nausea and to vomit and retch. 
Vomiting can start immediately after treatment or be delayed for a day.  There are instances where it can last for days.  Anticipatory vomiting can occur in response to sights, sounds or odors.
The best way to handle the vomiting side effect is prevention.  Some chemotherapy drugs make you more prone to vomiting and nausea and some people are more prone to vomiting and nausea. In both of these situations, medicines for nausea and vomiting are started before the therapy is given.
Talk to your oncologist about this unpleasant side effect before your treatment begins.  Let him or her know if you have a history of nausea and vomiting when anxious or are prone to motion sickness or if you are concerned about this side effect.  Ask if the drug you are using is on the list that tends to cause vomiting.  Used alone or in combination, many drugs can prevent or decrease the vomiting. 
Losing your hair
Chemotherapy may cause the loss of your hair. Your hair may break off at of the scalp, or it may fall out completely.
Hair follicles are rapidly growing cells.  As we mentioned earlier, chemo drugs work by killing off rapidly growing cells whether or not they are cancer cells or normal hair follicle cells.  During treatment, the chemotherapy drugs may damage your follicles causing your hair to break or fall out.
Basic facts about hair loss:
  • Whether or not hair loss occurs depends on the drugs given, the doses, and the length of treatment.
  • Hair loss can vary with each person. Some people may have complete loss of hair while others may see just a thinning of their hair.
  • Loss of eyebrows, eyelashes, pubic hair, and body hair can occur but is usually less severe than scalp hair loss
  • Your hair may start falling or breaking 2 to 3 weeks after treatment begins.
  • Hair loss is almost always temporary.
  • When your hair grows back, its color or texture may be different. Sometimes the color change is permanent.
  • Hair may start to grow again near the end of your treatment or after the treatment is finished.
Hair loss doesn't impact your health, but it can take an emotional toll.  Hair loss may cause depression, loss of self-confidence, and grief reactions. Here are some tips that may help:
  • Some people find it helps them from an emotional standpoint to take charge and to shave their head before treatment rather than waiting for the hair to fall out.  
  • Women who are bothered by lost eyelashes may want to try eyeliner.  False eyelashes won't work because there are not lashes to glue them onto.
  • Wigs made especially for chemotherapy patients are now widely available.
  • Do not dye, perm or straighten your hair until after your hair becomes normal again. This may be as long as six months. You may have unexpected results or irritate your scalp.
One of the most common side effects of cancer and chemotherapy is fatigue.  If you have fatigue, you'll experience an extreme tiredness that is not relieved with rest.  The fatigue a person with cancer feels is different from the fatigue of everyday life.  Here are some of the symptoms:
  • Weariness
  • Weakness
  • Lack of energy
  • Decreased ability for physical and mental work
  • Trouble thinking and concentrating
  • Forgetfulness
Talk to your health care team about your fatigue. They may help to manage it by correcting any physical causes.  Riverside offers cancer support groups to help with coping strategies for cancer fatigue.
Taste changes
Cancer patients can experience taste changes. With taste changes caused by chemotherapy, you may notice:
  • Either a dislike for or an increased desire for sweet foods
  • Dislike of foods with bitter tastes
  • Dislike for tomatoes and tomato products
  • Dislike for beef or pork
  • Constant metallic or medicinal taste in your mouth
These changes occur because chemotherapy drugs can change the taste receptor cells in your mouth that tell you what flavor you are tasting.  Several weeks after chemotherapy has ended, taste and smell sensations usually return to normal.
Other side effects
Depending on what drugs you are given, the dosages and the length of treatment there are many other side effects you might experience.  Some are temporary lasting only during the course of treatment and others, more serious, may not develop for years. 
Ask your doctor questions about the drugs being used and the side effects of your treatment now and in the future. Do your own reading and research. Together you and your medical team can make the best decision for your health.