13 things to know about chemotherapy
January 10, 2025
Medically Reviewed | Last reviewed by Mariela Blum Murphy, M.D., on January 10, 2025
Starting chemotherapy for the first time? If you are new to this common cancer treatment, you're probably wondering how chemotherapy works, if you'll lose your hair or even if chemotherapy hurts.
To learn more, we spoke with Mariela Blum Murphy, M.D., a medical oncologist who specializes in gastrointestinal cancers. Here’s what she had to say.
What is chemotherapy?
Chemotherapy is a group of medications that can shrink or destroy cancer cells. It is used in a variety of ways. Chemotherapy may be given to rid the body of cancer, to shrink cancer so that surgery can be performed, or to control the disease and prolong someone’s life.
How does chemotherapy work?
There are multiple types of chemotherapy, and each one works a bit differently.
In general, chemotherapy works by attacking rapidly dividing cells, including cancer cells. Chemotherapy alters a cancer cell’s ability to grow or replicate itself. It can cause a cell to die by not functioning properly or stop it from multiplying by interfering with its ability to reproduce.
How are chemotherapy drugs usually given?
Most chemotherapy drugs are given through an IV, but some are injected into muscle, under the skin or directly into the spinal fluid. Other chemotherapy drugs can be swallowed in pill form.
Chemotherapy is often given in combination with other drugs or treatments, such as targeted therapy, radiation therapy or immunotherapy.
Will I have to be admitted to the hospital to get chemotherapy?
For most patients with solid tumors, such as pancreatic cancer or liver cancer, the answer is no. About 95% of those patients can receive chemotherapy as an outpatient.
But chemotherapy is often administered on an inpatient basis for people with blood-based cancers such as leukemia or lymphoma. That’s because their blood counts have to be monitored carefully.
What happens during chemotherapy?
Identity verification
If you’re a patient at MD Anderson, a staff member will double-check that the information on your wristband is correct and confirm the orders for your intended treatment.
Blood draw
You’ll have a blood sample drawn to make sure that its values are within normal limits and that you are healthy enough to receive chemotherapy.
Pre-medications
These are delivered by IV before the chemotherapy infusion starts to prevent nausea and allergic reactions.
Actual treatment
The chemotherapy drip begins.
From start to finish, the entire process takes between two and eight hours, depending on how many drugs are involved and if you’re also receiving immunotherapy. But on average, it takes about six hours to administer chemo, from the minute you check in until the minute you leave.
Does chemotherapy hurt?
IV chemotherapy should not cause any pain while it's being administered. If you do experience pain, contact a nurse immediately. There may be a leak in your IV line, causing the drug to get into surrounding tissues.
What are the most common side effects of chemotherapy?
Side effects depend on the type of chemotherapy you're receiving.
The most common ones are mouth sores, diarrhea, nausea, fatigue and those caused by bone marrow suppression, such as a decrease in white blood cell count (neutropenia).
Am I going to lose my hair?
Not necessarily. Some chemotherapy drugs do cause hair loss. Others may cause only hair thinning and some may not cause any hair loss at all.
The reason hair loss sometimes happens is that chemotherapy drugs affect rapidly dividing cells. This describes not only cancer cells, but also those found in the hair follicles, mouth and gastrointestinal tract. That is why some patients develop mouth sores, nausea, and diarrhea, too.
Talk to your doctor before starting treatment to find out if and when you are likely to lose your hair.
Am I going to feel sick all the time?
Not necessarily. We have very good medications now to control many chemotherapy side effects, such as nausea and vomiting. Our goal is not to make you sick with treatment but to make you feel better.
Which days are the hardest after chemotherapy?
That depends on which medications you’re receiving. Some chemotherapy drugs cause immediate side effects, while others cause delayed side effects.
But most patients report that the first week after an infusion is the most challenging. The first two days especially are the hardest in terms of managing nausea and appetite and feeling fatigued. But by the second week, most patients start to feel better.
Will I be able to have children?
Some chemotherapy drugs and other cancer treatments can affect fertility in both male and female patients. If you are of childbearing age, it’s important to talk to your doctor about options for preserving fertility before starting treatment.
Patients are often so focused on treating the cancer right away that they do not think about fertility. But consulting a fertility specialist before starting treatment allows you to explore your options more fully.
How long will I need chemotherapy?
That depends on the type of cancer you have, how advanced it is and your treatment goal. If the goal is to cure you, you will probably only receive chemotherapy for a limited time. If the goal is to keep you alive, it might be much longer.
Are there any special precautions I should take to protect others while I’m receiving chemotherapy?
It is strongly recommended that patients use a barrier form of birth control, such as condoms, to prevent conception during chemotherapy. You may need to continue doing this for some time after cancer treatment ends. Talk to your doctor to find out if this applies to you.
Request an appointment at MD Anderson online or call 1-877-632-6789.
Our goal is not to make you sick with treatment, but to make you feel better.
Mariela Blum Murphy, M.D.
Physician