Having chemotherapy with radiotherapy (chemoradiotherapy) can cause more severe side effects. This is compared with having these treatments on their own.
Everyone is different, and the side effects vary from person to person. You might not have all of the effects mentioned. Side effects depend on the type of chemotherapy you have. They also depend on the radiotherapy treatment area.
The side effects gradually get worse during the treatment. They can continue to get worse after your treatment ends. Side effects will improve, but some might take a few weeks to months.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Possible side effects
You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks after the treatment has ended. But it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.
Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.
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.
You'll 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.
Feeling sick might be constant. It may be worse a few hours after chemotherapy treatment and you may be sick. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.
- Avoid eating or preparing food when you feel sick.
- Avoid hot fried foods, fatty foods or foods with a strong smell.
- Eat several small meals and snacks each day.
- Relaxation techniques help control sickness for some people.
- Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
- Try fizzy drinks.
- Sip high calorie drinks if you can’t eat.
You have blood tests before your treatments, to check how well your kidneys are working.
To help prevent damage, it is important to drink plenty of water. You also have fluids into your vein before and after your treatment for several hours.
Your nurse might ask you to keep a record of how much you drink. And you may need to measure the amount of urine that you pass and keep a record of that.
Tell your nurse or doctor if you're not able to drink as much as you should – for example, if you feel sick. And tell them if the amount of urine you pass goes down.
You might have some hearing loss, especially with high pitched sounds. Tell your doctor or nurse if you notice any changes.
Women might stop having periods (amenorrhoea) but this may be temporary.
You might not feel like eating and may lose weight. It is important to eat as much as you can.
- Eating several small meals and snacks throughout the day can be easier to manage.
- Ask your doctor to recommend high calorie drinks to sip between treatments if you are worried about losing weight.
- Eat whatever you feel like eating rather than what you think you should eat.
- 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.
Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.
- Keep your hands and feet warm.
- Wear well fitting, protective shoes.
- Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
- Use oven gloves when cooking and protective gloves when gardening.
- Moisturise your skin at least a couple of times a day.
- Take care when cutting your nails.
Loss of taste or metallic taste
Food may taste metallic.
- Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
- Season your food with spices or herbs, such as rosemary, basil and mint.
- Garnish cold meat or cheese with pickle or chutney.
- Try lemon or green tea if tea or coffee taste strange.
- Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
- Some people find that cold foods taste better than hot foods.
You might find that having a soft diet is easier to swallow until a few weeks after your treatment is over. Foods such as soups and stews are easier to swallow than more solid foods like meat or toast.
Your radiotherapy department can give you an information sheet to help advise you.
Tell your doctor or radiographers if you have problems swallowing. They can advise you on ways to reduce this.
Ask to see a dietitian if you have problems with eating and drinking.
Tips for eating and drinking
- Drink about 8 glasses of water a day while having treatment.
- Make sure that you eat slowly and avoid eating late in the day.
- Drink plenty during and after meals to soften your food.
- Eat small amounts often rather than big meals.
- Try different foods to find out which are easiest to swallow.
- You can have high calorie drinks to boost your calorie intake if you need them.
Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor, nurse or pharmacist if you are constipated for more than 3 days. They can prescribe a laxative.
Long term side effects
Most side effects gradually go away in the weeks or months after treatment. However some side effects can continue or might start some months or years later.
Rarely, your food pipe might become narrower and less stretchy over some months or years. This is called an oesophageal stricture. It can make it difficult for you to swallow.
If you develop a stricture, your doctor can stretch the food pipe slightly. They call this oesophageal dilatation. Stretching the food pipe opens it up again so that you can swallow food and drink more easily.
You have medicine to make you sleepy (sedation). Your doctor puts a tube called an endoscope down your throat. It has an area on it called a balloon. Your doctor expands the balloon to widen the food pipe. They repeat this a few times until the narrowing has gone.
You might need to have this repeated if the narrowing happens again.
A cough and breathlessness happen in about 1 out of 25 people (4%) who have radiotherapy to the chest area. This is due to changes in the lung tissue called chronic radiation pneumonitis. It might start many months or a few years after treatment.
Let your doctor know if you notice any changes in your breathing or if you cough up a lot of mucus.
You might have regular tests to check how well your lungs work. Treatment with steroids or other medicines can help you to breathe more easily.
Scarring of the lung in the treatment area could happen months to years after radiotherapy treatment.
Scarring is usually permanent and can cause a small portion of the lung to collapse. This might make you more short of breath, and you may need to use oxygen.
This page doesn't list all the very rare side effects of this treatment that are very unlikely to affect you.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it.