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Side effects of EC

Find out about the side effects of the chemotherapy drug combination EC. 

EC is made up of the drugs epirubicin and cyclophosphamide.

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection, including a temperature above 37.5C.

The side effects may be different if you are having EC with other cancer treatments.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your advice line or doctor straight away if you have any of these signs, or your temperature goes above 37.5C or below 36C. Severe infections can be life threatening.

Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

Feeling or being sick can be severe. It can start a few hours after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You may need to try different anti sickness medicines to find one that works.

Contact your doctor or nurse straight away if you’ve been sick more than once in a day.

Tips

  • Avoid eating or preparing food when you feel sick.
  • Avoid fried foods, fatty foods or foods with a strong smell.
  • Drink plenty of liquid to stop you from getting dehydrated.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Fizzy drinks help some people when they are feeling sick.

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

If you have had radiotherapy in the past, the skin in the radiotherapy treatment area might become dry and flaky. You may also have some pain and burning similar to sunburn.

It is very important to keep those areas out of the sun.

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Women might stop having periods (amenorrhoea) but this may be temporary.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

Your mouth might become sore a few days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.        

Your nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently, use a soft bristled toothbrush.
  • Avoid mouthwashes that contain alcohol.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Eating fresh or tinned pineapple can keep your mouth fresh and moist.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

Tell your nurse straight away if you notice any signs of redness, swelling or leaking at your drip site.

A small number of people have an allergic reaction, usually during the first or second treatment.

Symptoms include a skin rash, itching, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.

Tell your nurse or doctor immediately if you have any of these symptoms.

Your nurse will keep a close eye on you and give you treatment straight away if this happens. They might slow your drip down.

You might feel that you have to pass urine more often than usual. And you may have a burning feeling when you do. Or you might feel that you can't wait when you need to go. This is called cystitis. 

It helps to drink plenty of fluids. Some people think that cranberry juice can help but others feel it makes the soreness worse. Research studies haven't found that it helps. 

You might find that some drinks increase the soreness, such as tea and coffee. You can experiment for yourself and see what works for you.

Don't take any over the counter medicines for cystitis as they could be harmful.

Tell your doctor or nurse if you have soreness. They can prescribe medicines to help.

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

There is a small risk that you may get a second cancer some years after this treatment.

You might develop changes in your lung tissue that can cause a cough or breathlessness. 

Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

Changes to the heart muscle may happen in some people. This is usually temporary but for a small number of people might be permanent. Your doctor will check your heart before and after your treatment.

About EC

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help