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Chemotherapy

9-minute read

Key facts

  • Chemotherapy uses medicines to destroy or slow the growth of cancer cells.
  • Chemotherapy can be used by itself to treat cancer, or together with other types of treatment, such as surgery, radiotherapy and immunotherapy.
  • Chemotherapy may also damage healthy cells, causing a range of side effects.
  • Side effects can often be managed with medicines and other strategies suggested by your medical team.
  • The type, dose and length of chemotherapy treatment will depend on the type and stage of cancer, your general health and your treatment goals.

What is chemotherapy?

Chemotherapy is the use of medicines to treat cancer. Chemotherapy medicines are used to destroy or slow the growth of cancer cells.

Chemotherapy is also known as 'chemo'.

How does chemotherapy work?

Your body is made up of billions of small building blocks called cells. The different tissues and organs of your body are made up of different types of cells.

Your body's cells divide to make new cells. When you are healthy, this process of division is tightly controlled and only takes place when needed, for example, to replace damaged or old cells. If your cells begin to grow and divide in an uncontrolled way, you may develop a cancer.

Chemotherapy is designed to target cancer cells that are dividing too quickly.

Chemotherapy may be used in cancer treatment for a few different reasons:

  • Curative chemotherapy is designed to directly treat the cancer and try to destroy it, usually without the use of other treatments.
  • Neoadjuvant chemotherapy can be used before surgery to shrink the cancer and make the surgery more effective.
  • Adjuvant chemotherapy is used after other cancer treatments such as surgery and radiotherapy to increase the chance of successfully destroying the cancer.
  • Palliative chemotherapy is not usually meant to cure cancer. It can be used to reduce cancer size, which can improve symptoms, or to limit the growth and spread of the cancer. This kind of chemotherapy may be used for months or years.

Chemotherapy can also be used together with cancer immunotherapy.

How is chemotherapy given?

Chemotherapy can be given in a few different ways, depending on the type of cancer and the chemotherapy medicines being used.

Chemotherapy is often given through a vein (intravenously, or IV). If this is the case, it will often be given at a day hospital or day-treatment centre. You can usually go home between sessions. Sessions may last for anywhere between 20 minutes and several hours. It depends on the kind of chemotherapy you are getting and how you feel during and after treatment.

If the medicine needs to be given for only a short time, it can be given through a small plastic tube (cannula) inserted into a vein, usually in your hand or arm.

If you need to receive IV treatment for longer, your doctor or oncologist may suggest using a device that can stay in place for weeks or months. This saves you from getting a new IV line every time you receive chemotherapy.

Chemotherapy can also be given in other ways, for example, as tablets or a cream. It can also be injected into a specific body area for certain types of cancer.

What are the side effects of chemotherapy?

Chemotherapy uses medicines which often have side effects. Everyone responds differently to chemotherapy. You may experience many or a few side effects and feel them strongly or only mildly.

Most commonly, people on chemotherapy feel fatigued (tired).

As chemotherapy affects fast-growing cells, it commonly causes side effects in your skin, hair, gut and immune system.

Side effects can include:

Some chemotherapy medicines can have a higher chance of damaging specific areas of your body, such as your heart, lungs or nervous system. These effects may last temporarily or permanently. Ask your doctor about the medicines recommended for you and any specific effects that they may have on your body.

There are many medicines and strategies which can help ease your side effects. For example:

  • your doctor can prescribe medicines to help with nausea
  • ice chips can help sooth a sore mouth
  • 'cold caps' may help reduce hair loss

Your medical team can give you more detailed advice about what is available to help you remain as comfortable as possible during your treatment.

How long will I need chemotherapy?

The specific type, dose and length of your chemotherapy will depend on:

  • the type and stage of your cancer
  • your general health
  • the purpose of the chemotherapy
  • how well your cancer is responding to treatment
  • any side effects

Chemotherapy is usually given in 'cycles'. For example, 2-weeks of treatment followed by a 2-week break. This gives your body a chance to recover.

You may need blood tests or scans between treatment cycles. This is to check on the cancer and to make sure your body has recovered enough to cope with the next cycle of chemotherapy.

Your medical team may make changes to your treatment based on how you feel and on your test results.

Will chemotherapy affect my fertility?

Chemotherapy can affect your fertility by damaging the cells of your reproductive organs, such as eggs or sperm. Sometimes these cells will recover months or years after chemotherapy, but sometimes the damage is permanent.

Chemotherapy may also affect your menstrual cycle (periods). Your periods can become irregular or stop completely while you are receiving treatment. Your cycle may return after you stop chemotherapy, but it can sometimes stop permanently, causing early menopause. This makes it impossible to conceive naturally.

Some people choose to take steps to preserve their fertility before starting cancer treatment. These steps can include freezing eggs, sperm or embryos, or more complex treatments.

Your options will depend on:

  • the cancer you have
  • the treatment suggested by your doctor

You may wish to discuss fertility preservation with your medical team before you start any cancer treatments.

Despite this, it is important to realise that you may still be fertile while undergoing cancer treatment.

Chemotherapy may be dangerous for an unborn baby, who has many fast-growing cells, so you may also wish to discuss contraception with your doctor before starting treatment.

Safety advice for carers of people having chemotherapy

Chemotherapy medicines may remain in your body for about a week after each treatment session. During this time, very small amounts of chemotherapy drugs may be in your body fluids.

To protect people who you are in close contact with at home:

  • sit down when using the toilet and flush with the lid down
  • store any chemotherapy medicines safely
  • it's safest for people without cancer to avoid touching the medicines

During chemotherapy, it's also important to have safe sex (using condoms) and avoid pregnancy.

If you are caring for, or in close contact with, someone having chemotherapy, there are some precautions you can take, including:

  • wearing disposable waterproof gloves when you touch anything with body fluids on it
  • disposing of gloves and cleaning products in a sealed plastic bag

Usually, there is little risk to your visitors. This is because they aren't likely to have contact with any chemotherapy medicines or body fluids.

Resources and support

Dealing with cancer and cancer treatment can feel very overwhelming. There are many organisations that can help with information and support.

Cancer Council has information about cancer and cancer treatment, as well as support and services for people with cancer — call 13 11 20.

Children and teenagers

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: November 2023


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Early Menopause – Chemotherapy and Radiation Therapy | Fact Sheet | Australasian Menopause Society Hub

Download: Early Menopause – Chemotherapy and Radiation Therapy  | Fact Sheet MAIN POINTSChemotherapy and radiation therapy for cancer and other conditions can cause temporary or permanent loss of your menstrual periods and menopause.Before the age of 40, this is known as premature ovarian insufficiency (POI).Between the ages of 40 and 45, this is known as early menopause.Early menopause and POI can cause infertility and have short- and long-term health consequences such as heart disease, osteoporosis and memory problems.Some women who have chemotherapy remain fertile, so it is important to use contraception if you do not want to become pregnant or if your doctor advises you that it is not safe to become pregnant.Speak with your doctor about treatments and other options to manage any infertility and long-term health consequences.Chemotherapy and radiation therapy for cancer and other conditions can cause temporary or permanent loss of your menstrual periods, which can lead to menopause and infertility.If this occurs before the age of 40, it is known as premature ovarian insufficiency (POI) and between the ages of 40 and 45, it is known as early menopause. POI and early menopause can also happen for other reasons (see AMS fact sheet – Menopause before 40 and premature ovarian insufficiency).Chemotherapy and radiation therapy can be toxic to the ovariesChemotherapy or radiation therapy can cause early menopause because these treatments are toxic to the ovaries, especially when used at high doses to treat cancer. Whole-body radiation therapy and radiation in the pelvic area are more likely to affect your ovaries. At birth, ovaries contain one million immature eggs (primordial follicles). The number of eggs naturally decreases until, at menopause, less than 1000 eggs remain. When chemotherapy or radiation therapy damages the ovaries, women can have fewer remaining immature eggs and/or the immature eggs are unable to mature. Loss of your period after chemotherapy or radiation therapy can either be temporary or permanent. If your period returns, that does not necessarily mean that your fertility returns.Risk factors for entering early menopauseThe likelihood of entering POI or early menopause after chemotherapy or radiation therapy increases:with increasing agewhen there are fewer eggs in the ovaries before treatment startswith higher doses of chemotherapy or radiationwith radiation therapy of the whole body or pelvic areawith some types of chemotherapywhen doses of chemotherapy and radiation are given together.Symptoms and health consequences of POI and early menopauseThe signs, symptoms and health consequences of POI and early menopause after chemotherapy and radiation therapy include: missing your period or having infrequent periods – an early symptom of POI or early menopausemenopausal symptoms (either with or without your period) includinghot flushesmood changesproblems sleepingaching jointsdry vagina or poor lubrication during sexual arousal.psychological distress and increased risk of anxiety and depression because of:a diagnosis of cancer or severe medical illnesstreatment with chemotherapy/radiotherapy and the related longterm consequencesinfertility – women often feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies.short and long-term health risks – infertility, osteoporosis and heart disease.Diagnosis of POI and early menopausePOI and early menopause are difficult to diagnose and the process can take many months. This can be a very stressful time and women should speak with their healthcare team for support and management options. Criteria for a diagnosis of POI or early menopause include:more than four months without a periodfollicle stimulating hormone (FSH) levels in the menopausal range on two occasions at least 4–6 weeks apart.Managing fertility issuesChemotherapy and radiation therapy might affect your fertility. Thinking about whether you will be able to have children and preserving your fertility can be overwhelming, especially when added to the stress of a diagnosis of cancer or other serious illness. Speak with your healthcare team and get the support you need. If losing fertility is a possibility, your doctor might be able to suggest options to try to preserve your ability to have children. Monthly injections with a gonadotrophin releasing hormone analogue during chemotherapy may help to preserve ovarian function. The most effective option is to have your eggs or embryos frozen before you begin treatment. Some women who have chemotherapy remain fertile, so it is important to use contraception if you do not want to become pregnant or if your doctor advises it is not safe to become pregnant. Some types of contraception are not safe for women with certain cancers or illnesses so talk to your doctor about what is best for you. For those who have developed POI or early menopause, some women choose to live a childfree life, while others adopt or foster children.Treatment of POI and early menopauseWomen with POI/early menopause should discuss with their doctor the possibility of using hormone therapy. In women more than 50 years of age, hormone therapy is called menopausal hormone therapy (MHT). In women who are aged less than 50, the same hormone therapy can be called hormone replacement therapy (HRT) because the treatment is replacing the hormones that the ovaries would be producing if you hadn’t had chemotherapy or radiation therapy.If you choose to use HRT, your doctor might advise you to continue this treatment until the typical age of menopause (51 years).HRT options include:oestrogen tablets, patches, gels and topical vaginal treatments – if you have had a hysterectomy (see AMS fact sheet – What is MHT and is it safe?)oestrogen plus progesterone – if you have not had a hysterectomycombined oral contraceptive pill as a replacement hormone – if you have no significant risk factors (such as risk of blood clotting, past blood clots or if you are a current smoker).Oestrogen therapy is not suited to everyone and is best avoided if you have breast or endometrial cancer. Your doctor can suggest non-hormonal options to help manage hot flushes and other symptoms. If contraception is required, hormonal options include the oral contraceptive pill or an intrauterine device plus oestrogen (usually as a patch or gel). If your doctor does not recommend hormones for your situation, discuss non-hormonal contraceptive options.Managing health risks associated with POI and early menopauseAdopting healthy lifestyle changes (see AMS fact sheets – Lifestyle and behaviour changes for menopausal symptoms and Weight management and healthy ageing) can reduce the risk of some of the health impacts associated with POI and early menopause. These health impacts include:osteoporosis or bone losscardiovascular/heart diseaselearning and memory disturbancesemotional issues.It is widely known that regular physical activity, a healthy diet and healthy sleep patterns can improve these problems, no matter what the cause. In addition, regular check-ups (including blood tests and bone scans) with your doctor can help you to manage your health.OsteoporosisOsteoporosis in women with POI and early menopause can be caused by:low levels of oestrogenlow levels of calcium in the dietsmokinglow levels of physical and weight-bearing activitysome types of chemotherapy and medications.In addition to lifestyle changes (quitting smoking, engaging in regular weight-bearing activities, and ensuring adequate dietary intake of calcium and vitamin D) women should have regular bone density scans every one or two years. Use of HRT can also help to maintain bone density.Cardiovascular or heart diseasePOI and early menopause can result in an earlier increase in the risk of heart disease in women.Taking HRT early and continuing treatment until the age of a natural menopause (50–55 years) can reduce the risk of heart disease. A healthy lifestyle and regular check-ups for high blood pressure, diabetes and fats in the blood will help you manage your heart health.Learning and memory problemsThere is evidence that chemotherapy can cause memory problems, but there is limited evidence that low levels of oestrogen affect memory.Taking HRT early and continuing treatment until the age of a natural menopause (51 years) might reduce the risk of learning and memory problems.Emotional issuesIn addition to a diagnosis of cancer (or severe medical illness) requiring chemotherapy/radiation therapy, women also have to cope with possible infertility and other long-term health impacts.It is only natural to feel distressed and some women might have anxiety and depression. Women often feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies. Psychological counselling can ease this distress. Support from the woman’s partner, family and friends is also important.Support groupsIn addition to the support of family, friends and a healthcare team, some women find it useful to talk to other women in the same situation. Available support groups include:ACCESS Australia (Australia’s National Infertility Network) – www.access.org.auCancer Australia – www.cancer.org.auThe Daisy Network Premature Menopause Support Group – www.daisynetwork.orgNew Zealand Early Menopause support group - www.earlymenopause.org.nzWhere can you find more information?If your symptoms are bothering you or you feel you need more support, your doctor can help. Your doctor can tell you about the changes in your body and offer options to manage your symptoms. Other fact sheets about treatment options include:Menopause before 40 and premature ovarian insufficiencyWhat is Menopausal Hormone Therapy (MHT) and is it safe?9 myths and misunderstandings about Menopausal Hormone Therapy (MHT)Non-hormonal treatment options for menopausal symptomsComplementary medicine options for menopausal symptomsLifestyle and behaviour changes for menopausal symptomsWeight management and healthy ageingPOI/ Early menopause and osteoporosisThe Healthtalk Australia Early Menopause online resource contains women’s stories, information, question prompt list and links to services: https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Member service on the AMS website.

Read more on Australasian Menopause Society website

Chemotherapy - Counterpart

Find out about chemotherapy as a breast cancer treatment to kill cancer cells that may have spread outside the breast or armpit area.

Read more on Counterpart website

Understanding Chemotherapy: Overview and Treatment Guide - Cancer Council Victoria

Read more on Cancer Council Victoria website

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