Breast cancer chemo side effects

Side effects are the unwanted effects of any treatment. Chemotherapy drugs kill cells that are dividing. Cancer cells divide more often than normal cells. But some normal body cells divide quickly and so are also affected by chemotherapy. These include cells in your skin, hair, nails, the lining of your digestive system, and your blood cells. Unlike cancer cells, normal body tissues can recover. So you usually have a couple of weeks break between treatments. The break allows your normal body tissues to get over the effects of the chemotherapy.

Chemotherapy affects different people in different ways. Your doctor or nurse can tell you what may happen, but they can't tell beforehand exactly what the treatment will be like for you. Some people have more side effects than others. Many people lead normal lives during their treatment and can carry on working. Other people find they are very tired and have to take things more slowly.

Remember that not all chemotherapy drugs cause the same side effects and some people have very few.

Chemotherapy has some general side effects. Your blood cells divide rapidly, so chemotherapy can lower the number of healthy white blood cells, red blood cells and platelets you have. This can mean you

• Are more likely to get infections
• May be more tired than usual
• Can be prone to nosebleeds and other bleeding problems

If you develop a temperature above 38°C or think you have an infection, it is very important to contact the hospital immediately. You may need urgent treatment with antibiotics. Your doctor or chemotherapy nurse will give you an emergency number to phone if you need to. There is detailed information about the effect of chemotherapy on your blood cells in the main chemotherapy section.

Tiredness (fatigue) is the most common side effect for people having chemotherapy. It may continue for some months after your treatment ends. How quickly you get back to normal will depend on your general health, on the amount of treatment you've had, and on other treatments you have had.

Other side effects of chemotherapy can include

• Feeling sick (nausea) and being sick 
• Hair loss or thinning
• A sore mouth
• Taste and appetite changes
• Diarrhoea
• Constipation
• Changes to your periods (menstrual cycle)
• Sore eyes – they may feel as if they have grit in them but eye drops can help

You can use the links above to go to pages in the cancer drugs side effects section that tell you about coping with these effects.

Side effects may seem hard to bear at the time. But most of the effects disappear when your treatment ends.

Always let your doctor know about any other medicines you are taking because some drugs can react with chemotherapy. Even some over the counter medicines, herbal medicines or complementary therapies may be harmful to take with chemotherapy.

Sometimes chemotherapy causes long term side effects. You will probably feel tired for some time after your treatment has finished. For some people, it can take up to a year to get their energy back.

If you had not had your menopause before you had breast cancer, you need to know that chemotherapy can affect your ability to get pregnant. If you are still having periods, they may stop when you have chemotherapy. This depends on how near you are to the age when you would naturally start your menopause. Your periods may start again from 6 months to a year after your treatment finishes. Or they may never start again and you may have an early menopause. If you do continue to have periods, they may not be as regular as they were.

If your periods stop, it is because the treatment has stopped your ovaries producing female hormones. You may also have menopausal symptoms such as

• Hot flushes and sweats
• Mood changes

There is information about early menopause and infertility in the living with breast cancer section. We have information about hot flushes and sweats caused by a lowering of the amount of sex hormones in your body in our hormone symptoms section.

There is detailed information about breast cancer chemotherapy drugs in the cancer drugs section. The drugs include

• Cyclophosphamide
• Epirubicin
• Fluorouracil
• Methotrexate
• Mitomycin
• Mitozantrone
• Doxorubicin
• Docetaxel (Taxotere)
• Gemcitabine (Gemzar)

We also have information about commonly used combination treatments such as 

• CMF
• FEC
• FEC-T
• E-CMF
• (Epi-CMF)
• AC
• EC
• MMM
• MM

But we've listed the most common side effects for each drug used for primary breast cancer below.

Cyclophosphamide

The most common side effects of this drug are

• Feeling and being sick
• Loss of appetite
• Low blood cell counts (causing an increased risk of infection)
• Hair loss or thinning

Fluorouracil

This commonly causes

• Diarrhoea
• Feeling or being sick
• Mouth ulcers
• Low blood cell counts (causing an increased risk of infection)
• Sensitivity of skin to sunlight

Methotrexate

This drug can cause

• A low blood count (causing an increased risk of infection)
• Taste changes
• A sore mouth
• Gritty eyes
• Diarrhoea
• Hair loss or thinning
• Sensitivity of the skin to sunlight

Epirubicin and doxorubicin

These drugs are similar. The most common side effects include

• Hair loss
• Feeling and being sick
• Low blood cell counts (causing an increased risk of infection)
• Mouth ulcers
• Skin changes
• Red urine for a few hours (this is not harmful)
• Skin darkening and sensitivity to the sun with doxorubicin – cover up or wear a sun block throughout your treatment and for a few months afterwards
• Irritation of the vein that you have the drug into
• Heart muscle changes

Mitoxantrone

This drug can cause

• Hair thinning
• Feeling or being sick
• Green urine for a day, which is not harmful

Mitomycin C

This drug can cause

• Low blood cell counts (causing an increased risk of infection)
• Feeling or being sick

Taxotere (docetaxel)

This drug can cause

• Low blood cell counts (causing an increased risk of infection)
• Complete hair loss (including all body hair)
• Swollen legs or hands
• Skin and nail changes
• An allergic reaction but this is rare – you have steroids to lower the chance of a reaction

The cancer drugs side effects section tells you about the side effects of individual drugs and combination chemotherapies. There is also information about how to cope with the side effects. 

You can get your doctor or nurse to write down the names of your chemotherapy drugs so you can look them up for yourself. See the questions for your doctor page in this section for suggestions of questions to ask about chemotherapy.

You can also ask your doctor or nurse if you can meet other patients who've had chemotherapy for breast cancer. Then you can chat about how they got on. Or you could contact a local support group to get in touch with other people with breast cancer. Some of the breast cancer organisations can put you in touch with your nearest support group. They can also give you more information about chemotherapy for breast cancer.

If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or go through MyWavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.