Any kind of disease treatment can bring unintended and potentially unpleasant side effects, and chemotherapy is no different. This common form of cancer treatment is infamous for causing nausea, fatigue and hair loss, but not every patient has the same experience with side effects from chemo when being treated for breast cancer.

“It’s a spectrum. There’s quite a bit of variation with how the patients respond,” says Dr. Maryam Lustberg, breast medical oncologist and director of the survivorship clinic at the Stefanie Spielman Comprehensive Breast Center at Ohio State University. Some patients will have severe side effects, while others experience very few complications. “It’s not always horrible because a lot of advance has been happening in the last decade. But we’re investigating why one person may struggle so much more than another,” Lustberg says, and the evidence seems to be pointing toward genetic variations among patients.

Although your individual experience may vary, the side effects listed here are ones you may face when having chemotherapy for breast cancer.

[See: 10 Things You Didn’t Know About Breast Cancer.]

Hair and Nail Loss

Many patients undergoing chemotherapy will lose their hair, a condition called alopecia. The Susan G. Komen organization reports that, although “it’s most visible on your head, hair loss may occur all over your body (including eyebrows and pubic hair).”

Chemotherapy drugs target cancer cells that grow quickly. Hair follicles also rapidly divide, and they succumb to chemotherapy drugs more than other types of cells in the body. Although losing your hair can be a terribly upsetting experience, once treatment concludes, it nearly always grows back.

Some patients also report a weakening or loss of fingernails and toenails, and it’s the same principle of fast-growing cells being targeted. Keeping your nails trimmed short during treatment may make them easier to manage.

Nausea

Along similar lines, the cells that line your digestive tract also divide rapidly and are constantly being replaced under normal circumstances. This means chemotherapy can disrupt their typical growth, resulting in nausea, vomiting and loss of appetite. Some patients may develop sores in the mouth and throat, called mucositis or stomatitis. As with hair and nail loss, this feeling of nausea will go away after treatment has concluded.

Meanwhile, there are several drugs that your oncologist may prescribe to help manage nausea. Lustberg says acupuncture has been shown to help, too: “There’s good data that acupuncture might be a good option for some patients with chemo-induced nausea.”

Neuropathy

A potentially longer-lasting side effect that some patients experience is called neuropathy, which Lustberg describes as “sensation changes in the fingertips and feet.” According to The Memorial Sloan Kettering Cancer Center‘s On Cancer blog, “chemotherapy is often used as a strategy to kill cancer cells, but it can also affect the nerves that connect the spinal cord to muscles, skin and internal organs. This condition is known as peripheral neuropathy.”

Breastcancer.org reports that “chemotherapy-associated neuropathy can start any time after treatment begins, and it may worsen as treatment continues.” The condition typically starts in the toes, but it can also affect the legs, arms and hands. Symptoms include pain, tingling, weakness or burning in the extremities and reductions in sensation and dexterity. Some patients may also experience balance problems, blood pressure changes, reduced reflexes, sensitivity to temperature changes and other symptoms. “We’re doing ongoing studies trying to determine how to prevent and manage this,” Lustberg says.

Your doctor may prescribe drugs to alleviate some of the symptoms of neuropathy, and acupuncture may help, too. “The data is emerging on this alternative modality,” Lustberg says, “but it may help.”

Neutropenia

Chemotherapy treatment can also cause neutropenia, sometimes called leukopenia, which is an abnormally low white blood cell count. This drop in white blood cells means your body’s ability to fight secondary infections like a cold or the flu is reduced. A 2014 study published in Breast Care reported that “this side effect is associated with life-threatening infections and may alter the chemotherapy schedule, thus impacting on early and long-term outcomes.” Patients experiencing neutropenic fevers may be hospitalized and administered intravenous antibiotics. Your doctor will monitor your blood count during treatment.

[See: 11 Changes Women Go Through in Menopause.]

Hormonal Shifts and Early Menopause

Chemotherapy can also cause a woman to enter early menopause. “For a younger woman who has not reached menopause, a lot of times [chemotherapy] will push her into accelerated menopause,” Lustberg says. “Hormonal changes from menopause can also cause sleep disturbances, bone loss and achiness. It can also increase depression, mood disturbance and anxiety.” Your doctor may prescribe other medications to alleviate some of these symptoms.

Chemo Brain

Many patients report cognitive changes — called “brain fog” or “chemo brain.” Lustberg says this condition includes “concentration changes, memory changes and recall or word-finding difficulties. It may take them longer to do tasks that were simpler before, and they may have to focus more or take their time” when performing cognitively demanding tasks or multitasking. “These symptoms are most noticeable to the patient him or herself, and other people may not notice, as it doesn’t always affect work function or ability to interact or communicate. But it’s very unsettling,” Lustberg says.

Lustberg says there are multiple ongoing studies into the causes of chemo brain, but it may be related to chemotheraphy drugs disrupting how the brain uses energy. “Pain, depressive symptoms and poor sleep can also affect cognition,” she says. These problems can last for up to two years after treatment concludes.

Fatigue

Lastly, Lustberg says many chemo patients experience extreme fatigue that’s worse than just being tired. “Fatigue during chemo is different. Patients feel it in every part of their being,” and it can get worse over the course of treatment. Rest and exercise are both helpful in combating fatigue, but be sure to speak with your doctor about your energy level. Feelings of fatigue generally improve after chemotherapy concludes.

Why You Should Speak Up

It’s a lengthy and scary list of potential side effects you’ll be facing when you begin chemotherapy treatment for breast cancer, but Lustberg says you shouldn’t suffer in silence. “Sometimes patients are afraid of complaining because they’re afraid it’ll affect treatment,” but your doctor may have other drugs or ways of helping alleviate some of those side effects.

There are also dietary changes that can lessen some of the symptoms. Although some patients lose weight while on chemotherapy, that doesn’t mean you have license to eat everything in sight. What’s more, many women actually gain weight while on chemotherapy, in part because of all the hormonal changes their bodies are going through. Either way, Lustberg says the focus should be on “good, clean nutrition. Ask to speak to a dietitian and control your portions.” Eating right can also improve your energy levels.

Similarly, Lustberg says if you were exercising before your diagnosis, “continue to exercise. [You] may need to do less, but the data is very strong that people who exercise during treatment have fewer complications from cognitive changes and less neuropathy.”

[See: 7 Innovations in Cancer Therapy.]

Lastly, Lustberg says not to neglect the emotional side effects you may experience. “Many patients need short-term counseling to cope with the diagnosis and things going on in treatment.” She also encourages patients to be specific with friends and family members in asking for help. “People love to help when they know what to do,” she says.

Staying as positive as possible throughout your cancer journey also helps. “There’s actually good data that patients who feel more hopeful and have better social support actually do better with treatment,” Lustberg says. “They tolerate it better, and so in our breast center we really try to focus on the whole patient’s experience. It’s not just about giving a drug and getting through.”

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What Are the Typical Side Effects of Chemotherapy for Breast Cancer? originally appeared on usnews.com