Long term effects of chemotherapy may or may not happen depending on the type of cancer, drug used and the quantity. However, even if they happen they can be treated and the benefits of chemotherapy outweigh the side effects. Most of the common side effects that happen during or after chemotherapy are short term and disappear within 2-3 months of treatment.

Some of the long term effects that could possibly occur are-

Dryness

Mucous membranes, salivary glands and tear glands are sensitive to some chemotherapy drugs. These can cause dry mouth or mouth ulcers. This could be long term and can affect the quality of life of that patient as it leads to bad breath and difficulty while speaking at a stretch or swallowing.

Hair Loss

Hair follicles contain rapidly growing and dividing cells and hence they are susceptible to chemotherapy drugs. This effect is generally temporary. However, in some cases depending on the amount of drug used the damage can be extensive enough to cause permanent hair loss.

Secondary Tumors

A secondary tumor is the formation of a new cancer in some other part due to the chemotherapy for existing cancer. This arises several months to years later after the previous treatment. Chemotherapy is known to be carcinogenic; hence, it can cause cancer. The risk of secondary is however very low and definitely outweighs the benefits. Hence, the patient should have follow up tests every few months to rule out the possibility of a secondary cancer after the initial treatment.

Hearing Loss

Certain chemotherapy drugs like cisplatin cause tinnitus i.e. a ringing sensation in the ears. There is no particular treatment and hence can lead to hearing loss.

Infertility

Certain chemotherapy drugs cause permanent damage to the testes as well as the quality and quantity of the sperms, which leads to infertility in men.

Chemotherapy also causes permanent damage to the ovaries, which leads to early menopause or irregular menstruation. There is no ovulation, which leads to infertility in women. It also causes hormonal imbalance and at times weight gain.

Some of the drugs used in chemotherapy, the organs affected, possible disorders, diagnosis and treatment-

Organ: Ears

Drugs: cisplatin, ifosfamide, aminoglycosides

Side Effects: tinnitus, hearing loss; failure to follow instructions, poor school or work performance, damage to the outer hair cells of the cochlea due to cisplatin. Middle and high-frequency range hearing thresholds are affected in children.

Physical Findings: fluid or pus behind tympanic membrane

Organ: Heart

Drugs: anthracyclines like adriamycin or daunomycin, cyclophosphamide

Side Effects: pericarditis, myocarditis, left ventricular failure, arrhythmias

Physical Findings: heart failure, exercise intolerance, palpitations, breathlessness, peripheral edema, cardiomyopathy, congestive heart failure, adriamycin cardiotoxicity

Organ: Lungs

Drugs: alkylating agents, nitrosoureas, antimetabolites, antibiotics like Bleomycin

Side Effects: restrictive lung disease and pulmonary fibrosis

Physical Findings: shortness of breath, cyanosis, tachypnea and wheezing

Organ: Liver

Drugs: methotrexate

Side Effects: hepatotoxicity, liver cirrhosis, fibrosis, chronic liver disease

Organ: Gastrointestinal Tract

Drugs: antimetabolites like methotrexate or cytosine arabinoside.

Side Effects: damage to the mucosal lining of cells, delayed absorption and secretion of nutrients

Organ: Urinogenital System

Drugs: cisplatin, mitomycin, nitrosoureas, ifosfamide

Side Effects: decreased creatinine clearance, hypomagnesaemia and renal tubular acidosis

Organ: Bladder

Drugs: cyclophosphamide, ifosfamide, cisplatin, nitrosoureas

Side Effects: hematuria, pyuria, dysuria, increased frequency of urination

Organ: Gonads

Drugs: cyclophosphamide, procarbazine, nitrogen mustard, ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine cause transient germ cell toxicity.

Side Effects in Women: menstrual irregularities, premature menopause, infertility, hormonal imbalance

Side Effects in Men: infertility, decreased testosterone production, decreased sperm production, decreased sperm viability

Long term effects of chemotherapy should be discussed with the doctor before beginning the treatment. This applies especially in case of youngsters who want to have children and where the quality of life is affected. Research trials are still going on to develop better treatment options and drugs that would minimize these side effects.