Chemotherapy ("chemo") is when medicines are used to treat cancer. These medicines work by helping stop the growth of cancer cells. Teens usually get chemo medicines through a central line (a long, thin tube placed in a vein for long-term medicines), an IV (a needle in a vein), or as a medicine to take by mouth. They often get more than one type of chemo medicine at a time.

Teens on chemo are more likely to have infections and bleeding. Staying away from some activities can help prevent problems. This is especially true when blood cell counts are low.

Chemo medicines may be in a teen's body fluids (blood, sweat, spit, tears, vaginal fluids, semen, pee, vomit, or poop) for about 72 hours after they are given. Other people should not touch these fluids because they could get sick from the medicines in them.

Sexual Health:

• Teens on chemo who are sexually active need to take extra precautions. This is because they may get infections or bleed more easily. 
• Check with your care team about times that you should not have sex (vaginal, anal, or oral) or put anything in the vagina or anus. These times may include:
  • during the 72 hours after getting a dose of chemotherapy
  • when your platelet count is below 50,000
  • when your absolute neutrophil count (ANC) is below 1,000
• If you are sexually active at times when the care team says it is safe, use a condom or dental dam every time you have sex (vaginal, anal, or oral).
• Teens who are sexually active should use birth control to prevent pregnancy. Birth defects can happen if there is a pregnancy.

General Health:

• Tell a parent or other caregiver right away if you don't feel well.
• Stay away from people who are sick, and wash your hands well and often to help prevent infections.
• Make sure you understand which activities to avoid and why. This list may change during times that your neutrophil count or platelet count are low. If you have concerns, talk to your parent or adult caregiver.
• Follow your care team's instructions about foods to avoid when your blood counts are low.
• Girls should use pads during their periods, not tampons, if their neutrophil count is low.
• Don't drink alcohol, smoke, take recreational drugs, or use chewing tobacco during chemo. These can make chemo side effects (like nausea and vomiting) worse, and can make the chemo not work as it should.
  • If you smoke or chew tobacco, call 1-800-QUIT-NOW for advice on quitting.
• Use a soft toothbrush that is gentle on your gums.
• Have another family member clean up pet waste, like cat litter or fish tank water.

Skin Care:

• Skin problems like breakouts are common. But don't pick at skin or squeeze pimples as this can cause infection. 
• Use an electric shaver instead of a razor. 
• Keep cuts clean and covered with a bandage.
• To prevent scalp irritation, use a mild shampoo and conditioner.
• If you want to get a tattoo, ear piercing, or body piercing, wait until your cancer treatment is complete and the care team says it's OK.
• Protect skin from the sun by wearing a hat and sunblock. 

Emotions:

• Ask your care team about support groups for teens with cancer.
• Going through chemo and having side effects might make you feel sad, stressed, or scared. Talk to your family, friends, and care team about how you're feeling.

You:

• have signs of infection; these may include a fever of 100.4°F (38°C) or higher, shaking chills, cough, pain, skin redness, diarrhea, discharge, burning when you pee, sores, or a rash
• have trouble peeing or pooping
• can't keep fluids down
• have blood in your spit, poop, or pee
• think you are pregnant
• develop any other new problems
• have questions about your treatment, or concerns about how you are feeling

You:

• have vomit that is bloody or black, or that looks like coffee grounds
• have a very bad headache or trouble with your vision
• may be dehydrated; signs include dizziness, drowsiness, a dry or sticky mouth, or peeing less often
• have trouble breathing

What if chemo makes me feel tired? Lots of teens feel exhausted and perhaps even a little "foggy-headed" during treatment — and possibly for a while afterward. This is normal. Scale back on activities and rest as much as possible. When treatment is over, your energy should return.

What about my hair? Treatment can make your hair fall out, but it will grow back. Until then, you can wear a wig, hat, scarf, or nothing at all — whatever you are most comfortable with.