Chemotherapy is a cancer treatment in which drugs are used to stop the cancer from spreading, either by killing the cells or stopping them from dividing.  

Systemic chemotherapy is when the drugs are taken by mouth or injected into a vein or muscle.  This method takes the chemotherapy drugs through the bloodstream and allows them to reach cancer cells throughout the body. 

When chemotherapy drugs are placed directly into the cerebrospinal fluid, an organ, or body cavity such as the abdomen, the drugs will affect mainly the cancer cells in that area.  This is called "regional chemotherapy".

Drugs Approved for Testicular Cancer Treatment

The following is a list of chemotherapy drugs approved by the FDA for the treatment of testicular cancer.  This list includes generic and brand names. 

  • Blenoxane (Bleomycin)
  • Bleomycin
  • Cisplatin
  • Cosmegen (Dactinomycin) 
  • Cyfos (Ifosfamide) 
  • Dactinomycin
  • Etopophos (Etoposide Phosphate) 
  • Etoposide
  • Etoposide Phosphate
  • Ifex (Ifosfamide) 
  • Ifosfamide
  • Ifosfamidum (Ifosfamide) 
  • Platinol (Cisplatin) 
  • Platinol-AQ (Cisplatin) 
  • Toposar (Etoposide) 
  • Velban (Vinblastine Sulfate)
  • VePesid (Etoposide) 
  • Vinblastine Sulfide

The most commonly used drug combination is the treatment of testicular cancer is BEP (Bleomycin, Etoposide, Cisplatin). 

Side Effects of Chemotherapy

There are many side effects of chemotherapy.  They can be physical and mental and last for years after your treatment has ended.  Below you will find some common side effects. 

The risk of developing depression is already higher for patients with cancer. It is normal to feel distressed, anxious, sad and stressed - especially if you are concerned about what the future holds and whether treatment is going to be effective. 

It is important that you talk to a member of the medical team if you feel it is all getting to be too much, or if you no longer get pleasure out of the things that you used to like. Joining a support group and talking to people who are going through the same as you and understand how you feel has helped many people with cancer. You can visit our Facebook page for support from thousands of survivors and caregivers if you have any questions.

Nausea and vomiting
Over half of all patients receiving chemotherapy will experience nausea and vomiting. Doctors will usually prescribe anti-emetics for this. These need to be taken even when symptoms have gone as they will prevent them from coming back. If the anti-emetics do not work the patient should contact his/her doctor who may switch to another anti-emetic. 

Ginger - scientists at the Rochester University Medical Center found that taking ginger supplements with standard anti-vomiting drugs beforehand can reduce the nausea that often accompanies chemotherapy treatment by 40%.

Alopecia (Hair loss) 
Some chemotherapy medications cause hair loss while others don't. If hair does start to fall out this will usually happen a few weeks after treatment starts. On some occasions the hair will just become thinner and more brittle (without falling out). Hair loss can occur in any part of the body. 

Although hair loss has no physical health consequences, it may cause distress and embarrassment for some people. The psychological impact tends to be greater among women than men. If you experience hair loss and find it is causing distress and embarrassment, there are several steps you can take:

  • Tell your doctor, who may refer you to a counselor who can provide effective help and support.
  • Many people find that if they purchase a wig their quality of life improves significantly.
  • If there is a cancer support group in your area, go to their meetings. Meeting people who share similar experiences to yourself may help give you a boost, as well as providing you with some useful tips, and possibly an opportunity to make new friends.
  • Cold cap - this looks a bit like a bicycle helmet and keeps the scalp cool while the chemotherapy dose is being administered. If the scalp can be kept cool less chemotherapy medication reaches the scalp, thus preventing the occurrence or reducing the severity of hair loss. Some people cannot wear a cold cap -leukemia (blood cancer) patients need the medication to reach their scalp.

The hair loss is NOT permanent - it will grow back soon after treatment if finished. 

Most patients receiving chemotherapy will experience some degree of fatigue. This may be a general feeling which exists most of the day, or may only appear after certain activities. Doctors say patients need to make sure they get plenty of rest and not to perform tasks which are overtiring. 

While light exercise has been shown to help, it is important to remember to keep the activities 'light'.

If the tiredness becomes severe it is important to tell the doctor, as this could be caused by a significant drop in red blood cells (anemia). 

Hearing impairment (deafness, ototoxicity) 
Scientists from Oregon Health & Science University reported that deafness as a side effect of chemotherapy has long been underreported by the medical community, because a well-known classification system doctors use for reporting toxicities in patients does not consider high-frequency hearing loss, allowing the magnitude of ototoxicity (hearing damage) in children treated with platinum agents to be miscalculated. 

Children with cancer who suffer hearing loss due to the toxic effects of chemotherapy might one day be able to get their hearing back through pharmacological and gene therapy, said researchers from St. Jude Children's Research Hospital after carrying out a study on mice. 

Neutropenia (low white blood cells) - Susceptibility to infections

When receiving chemotherapy the immune system will be weakened because the white blood cell count will go down. White blood cells form part of our immune system - they fight infection. Consequently, patients become more susceptible to infections. 

Some patients will be prescribed antibiotics which may reduce their risk of developing infections. The following precautions will help reduce the risk of infections:

  • Personal hygiene - the cleaner you are, the fewer bacteria there will be around which can infect you. Regularly wash your hands with warm water and soap, have a bath/shower at least once a day, change your clothes and bathroom towels and flannels daily. Change your bed linen regularly
  • Preparing food - make sure your food is free of food borne pathogens (organisms, such as bacteria that can make you ill). If you handle raw meat make sure you wash your hands before touching plates and cutlery or work surfaces. Thoroughly cook animal sourced proteins before eating them. Wash your dishes thoroughly and always use a clean plate and cutlery - keep the kitchen clean.
  • Infected people - stay away from people who are ill. This may include those who just have a temperature.
  • Skin wounds - bacteria find it hard to get in through your skin, unless there is a cut. If you graze or cut your skin, clean the area well with warm water, dry it, and cover it with a sterile dressing.

Patients receiving chemotherapy who develop an infection need immediate treatment. This may mean being hospitalized and receiving antibiotics via an intravenous drip. 

Thrombocytopenia (low blood platelet count) - Blood clotting problems
Chemotherapy may lower the patient's blood platelet count. A platelet is a type of blood cell that helps the blood to clot (coagulate). Coagulation is essential, otherwise bleeding does not stop. Lower blood platelet counts linked to chemotherapy is a risk, but less so than lower red or white blood cell counts. If you are affected you will bruise more easily, you will be more likely to have nosebleeds and bleeding gums, and if you cut yourself it may be harder to stop the bleeding. 

Patient's whose blood platelet counts fall too low will need a blood transfusion. 

Below are some steps you may wish to take to reduce your risk of bleeding:

  • Shave with an electric razor (or don't shave)
  • Avoid hard toothbrushes
  • Use kitchen utensils and gardening equipment carefully
  • If you are gardening, wear gloves

Anemia (low red blood-cell count) 
As well as lowering you white blood cell count, chemotherapy will also lower your red blood cell count. Tissues and organs inside your body get their oxygen from the red blood cells. If your red blood cell count goes down too many parts of your body will not get enough oxygen and you will develop anemia. 

People with anemia feel very tired. A patient on chemotherapy who has anemia will feel extra tired - much more tired than straightforward fatigue caused by the treatment. Dyspnea (shortness of breath) is also another symptom of anemia, as are palpitations (when the heart beat is irregular). 

Anemia linked to chemotherapy requires immediate treatment. A blood transfusion will bring the red blood cell count back up immediately. Erythropoietin (EPO) is a drug that makes the body produce more red blood cells. 

The following foods are rich in iron, which helps red blood cells carry more oxygen. Dark green leafy vegetables, beans, meat, nuts, prunes, raisins, and apricots. 

Scientists from The Medical University of Vienna, Austria found that patients with breast cancer who developed anemia during chemotherapy had nearly three times the risk of local recurrence as those who did not.

Mucositis (inflammation of the mucous membrane) 
Chemotherapy attacks rapidly dividing cells, such as blood cells, bone marrow cells, and cells of the mucous membranes that line the digestive system - this includes the mouth, esophagus, stomach, intestines, and the rectum to the anus. Chemotherapy may damage and even destroy some of those mucous membrane cells.

Oral Mucositis (in the mouth) - patients more commonly experience symptoms in their mouth. 

If symptoms do appear, they will usually do so about 7 to 10 days after treatment starts. The inside of the mouth may feel like sunburn; some people say it feels as if the area had been scalded. Ulcers often appear on the lining of the mouth, the tongue, and sometimes around the lips. The severity of symptoms is closely linked to the strength of the chemotherapy dose. 

Some may find it painful when they eat, drink, or even talk. If the ulcers bleed there is a risk of infection. 

Caphosol is often prescribed for mucositis.

A clinical trial showed that out of 100 cancer patients that were treated with DAVANAT® and chemotherapy that included 5-FU, none developed mucositis

As better drugs are appearing, mucositis is becoming less common. Symptoms clear up a few weeks after treatment is completed. 

Loss of appetite
Loss of appetite is a common side effect of chemotherapy. It is possible that the chemotherapy, or the cancer itself, affects the body's metabolism. If the loss of appetite is just due to the chemotherapy it will come back when the treatment is finished - although this may sometimes take a few weeks. 

The severity of appetite and consequent weight loss depends on the type of cancer and chemotherapy treatment.

Although this is sometimes easier said than done, it is important to keep trying to eat well and take in plenty of fluids. Many patients find that smaller and more frequent meals are easier to get down than the typical three meal-a-day regime. Also, drinking liquids through a straw may result in a better fluid intake. 

Patients who become seriously affected by lack of food and liquid intake may need to be hospitalized and fed through a nasogastric tube. The tube goes into the patient's nose and down to his/her stomach.

Nails and skin
Chemotherapy can sometimes cause dry and sore skin. Nails may also become flaky and brittle. The skin may become more sensitive to sunlight. It is important to protect yourself from too much sunlight exposure. This includes staying out of the sun during peak times of the day, using sun blocks, and wearing clothes that provide maximum protection. Surprisingly, scientists at Michigan University, USA, reported that the chemotherapy drug fluorouracil appeared to reduce the appearance of sun-damaged and aging skin as well as the number of potentially pre-cancerous skin patches. 

Cognitive problems
About one fifth of patients undergoing chemotherapy report some kind of cognitive problem, including attention, thinking and memory. This can sometimes have an impact on daily tasks. Patients who do experience these symptoms should talk to their doctor, and social worker.

Symptoms may include:

  • Shorter attention span; concentration, focus and attention problems
  • Memory problems; especially the short-term memory
  • Comprehension and understand problems
  • Judgment and reasoning problems
  • Organizational skills may be affected
  • Multitasking problems (performing/thinking about several things at the same time)
  • Mood swings

Experts are unsure how much is due to the chemotherapy, and how much is due to fatigue, stress and anxiety that comes with having cancer.

Libido (sex drive) and fertility
For a significant proportion of patients, chemotherapy may result in a lower sex drive (less interest in sex). This is temporary and usually returns after treatment is completed. 

Depending on the type of medication administered, chemotherapy may also damage men's sperm. Some women may become infertile. In most cases - though not all - fertility returns after treatment is over.

Men who wish to father children and women who plan to become pregnant one day should discuss possible options with their doctors before starting treatment. It is possible to freeze sperm and embryos. 

Bowel movement problems (diarrhea or constipation) 
Sometimes when damaged cells in the intestinal tract are rapidly expelled from the body there is a risk of diarrheaConstipation is also a possible risk for chemotherapy patients. You should talk to your doctor if you experience any unpleasant change in your bowel movements. Symptoms, if they do occur, will do so a few days after chemotherapy begins.