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Chemotherapy is systemic treatment that acts on rapidly dividing cells throughout the body. It is given intravenously or as tablets in successive cycles, with intervals between them that allow healthy tissue to recover. Treatment is not chosen by the name of the disease alone but by the tumour type, its grade and stage, the pathology result and molecular markers, and by the patient's age and kidney, liver and heart function. One rule has no exception: **a biopsy is the basis of every treatment decision.** Chemotherapy is not started without a confirmed tissue diagnosis identifying the cell type precisely, because tumours that look similar on imaging can be treated in entirely different ways. Molecular markers or receptor testing are often requested with the biopsy, since the result may shift the plan from chemotherapy to targeted or immune therapy, or to a combination. The aim of treatment is stated openly and you should ask about it. It may be treatment intended to cure in certain tumours, adjuvant treatment after surgery to reduce the chance of recurrence, treatment before surgery to shrink the tumour and improve the chance of complete removal, or treatment to control disease, relieve symptoms and protect quality of life where removal is not possible. Neither this page nor any responsible doctor will give you **a numerical success rate or a promise of complete cure**; outcomes differ from person to person according to many factors, and honesty about that is part of the care. Three matters must be raised before the first dose, not after. First, **a second opinion is your right.** It does not offend the treating team and is not a breach of trust; take your pathology report, imaging and letters and ask for an opinion at another centre, since review of the histology slide and the plan is routine practice in oncology. Second, **ask about the effect of treatment on fertility and about options for preserving it before you begin**, because some drugs affect the ovary or testis, and options such as freezing eggs or sperm narrow or disappear once treatment has started. This question is essential for young patients, the newly married and anyone planning children, and you should not wait for the doctor to raise it. Third, **psychological and social support belongs to the treatment plan and is not a luxury**: anxiety, depression, insomnia, fear of recurrence and the burden on the family are treated and followed just like nausea or anaemia. In practice you are assessed before every cycle with a blood count and kidney and liver function, a dental review is advised before starting, and a central venous access device may be placed to protect your veins and simplify treatment. Preventive anti-sickness medication is given, and other effects such as fatigue, mouth ulcers, changes in appetite and numbness of the hands and feet are managed as they arise. Hair loss occurs with some drugs and not with others, is usually temporary, and **is not a measure of how well treatment is working**. The common claim that chemotherapy is worse than the disease is inaccurate: the side effects are real, but most are anticipated and managed with medicines and a plan, and refusing treatment without discussing it is a decision with its own cost.
A biopsy is taken and examined histologically and immunologically, with molecular markers added where they may change the plan. Stage is defined with appropriate imaging and kidney, liver and heart function are assessed. Chemotherapy does not begin without a confirmed tissue diagnosis.
The doctor explains the type of treatment, its aim, the number of cycles and the expected effects. Ask openly about the aim, request a second opinion if you wish since it is your right, and ask **before the first dose** about fertility and preservation options, because timing is decisive.
Blood count and kidney and liver function are checked, a dental review is advised before starting, and a central venous access device may be placed to protect the veins. Preventive anti-sickness medication is prescribed and every drug, herb and supplement you take is reviewed.
The dose is given in an equipped unit under nursing supervision with monitoring for any reaction, after which you go home with written instructions and contact numbers. Symptoms are managed with prescribed medicines, and you keep a note of what you feel to discuss at the next cycle.
After a number of cycles imaging and blood tests are repeated to assess response, and doses may be adjusted, the protocol changed, or surgery or radiotherapy added. Psychological, nutritional and social support is built into follow-up, and the period after treatment is planned.
Bring your pathology report, all previous imaging and letters, and a complete list of your medicines including herbs, supplements and immune-boosting products, because some interact with treatment and must be stopped. Tell the team about chronic illnesses, heart, kidney or liver disease, hepatitis if present, and any previous drug allergy. See a dentist before treatment begins so that infection or decay is dealt with, which reduces mouth complications later. Before the first dose, ask about the effect of treatment on fertility and the options for preserving it, ask about contraception during treatment, and request a second opinion if you want one. Arrange for someone to accompany you and drive on the first day, and bring light food, water, something to occupy the time and comfortable clothing that leaves the arm accessible. At home, prepare a thermometer, keep the team's phone number somewhere visible, and plan who will care for children on tired days.
Take your temperature daily during treatment days and record it, and carry a card stating that you are receiving chemotherapy to show at any emergency department. Drink water regularly, eat small frequent meals, and take preventive anti-sickness medicines on schedule rather than after vomiting starts. Care for your mouth with a soft brush and alcohol-free rinse, wash your hands often, and avoid crowded places, contact with anyone infectious and undercooked food. Do not take any medicine, painkiller, herb or supplement without asking your team, and tell every other doctor treating you that you are on chemotherapy. Expect fatigue that varies between cycles and organise your rest around it, and ask for psychological support if you are struggling: that is part of treatment, not weakness. **Go to the emergency department immediately for** **a temperature of 38C or above — fever during chemotherapy is an emergency because of low immunity, go straight to the emergency department, do not wait for a clinic appointment, and do not let a fever-reducing tablet delay your assessment**; **unexplained bleeding or bruising, or nose or gum bleeding that will not stop**; **vomiting or diarrhoea that stops you drinking water**; shivering and sweating, breathlessness or chest pain, mouth ulcers that prevent eating, pain, redness or discharge around the venous access device, rash or facial swelling, severe numbness or sudden weakness, or a clear fall in urine output.
A single session usually takes from one hour to several hours depending on the protocol, cycles repeat every one to three weeks, and the full programme may run for several months or longer according to tumour type, treatment aim and response.
Dr Taher Abu Hejleh is a consultant hematologist and medical oncologist with Jordanian and American board qualifications in hematology and oncology and American…
Dr Ra’id Marji is a consultant hematologist and oncologist whose experience includes work in the hematology and oncology department at Al Hussein Medical City, …
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