Frequently Asked Questions: Cancer and Oncology

Chemotherapy is a treatment with drugs that target rapidly dividing cancer cells.

The drugs are mostly given as an infusion into a vein; some are taken by mouth as tablets and some are applied under the skin. Treatment is usually planned in periods called “cycles”: drug days are followed by rest intervals that allow the body to recover. The number and duration of cycles vary according to the type and stage of the cancer, the aim of treatment and the response to the drugs. Chemotherapy can be used alone or together with surgery, radiotherapy, immunotherapy or targeted drugs. Administrations are often done in day-treatment units, and before each cycle the blood values and general condition are checked.

Not every chemotherapy causes hair loss; if hair falls out, it usually grows back after treatment ends.

Hair loss depends on the drug and the dose; some drugs cause marked hair loss, while others cause only thinning or do not affect the hair at all. According to the US National Cancer Institute, hair mostly starts to grow back 2–3 months after chemotherapy ends; at first the new hair may be finer or have a different texture or colour. In some centres, scalp-cooling methods can be used with certain treatments to reduce hair loss. Asking before treatment about the possible effect of your drugs on hair makes it easier to plan in advance for a wig or headscarf.

A temperature of 38 °C or higher during chemotherapy is an emergency that you must report to your treatment team without waiting.

Chemotherapy can temporarily reduce the white blood cells that fight infection; in this period fever may be the only sign of an infection, and the picture can worsen quickly. The US Centers for Disease Control and Prevention (CDC) recommends calling the doctor immediately for a fever of 38 °C and above, even at night. It is important to keep a working thermometer at home and to measure your temperature when you feel chills, shivering or weakness. If you go to an emergency department, be sure to say that you are receiving chemotherapy. Taking fever-lowering drugs or antibiotics without consulting your doctor can mask the symptoms.

Because chemotherapy also affects the rapidly dividing blood-forming cells in the bone marrow, blood counts can fall temporarily.

A fall in white blood cells can increase the risk of infection, a fall in red blood cells (anaemia) can increase weakness and shortness of breath, and a fall in platelets can increase the tendency to bruising and bleeding. According to the CDC, white blood cells usually reach their lowest level 7–12 days after the end of a chemotherapy dose. For this reason a blood count is done before cycles; if the values have not recovered enough, treatment can be postponed, the dose adjusted, or drugs that support blood production used. The values generally rise again between cycles.

Yes; nausea and vomiting caused by chemotherapy can be prevented or markedly reduced with suitable drugs in most patients.

Each chemotherapy drug has a different likelihood of causing nausea. The ASCO and MASCC/ESMO guidelines define which anti-nausea drugs are given before and after treatment according to this likelihood. It is important to take the drugs at the recommended times, before nausea starts. Eating small, frequent meals, avoiding fatty and strong-smelling foods and drinking fluids in sips can also help. If vomiting continues despite the drugs, if you cannot keep fluids down or if your urine output has decreased, tell your treatment team; the drug plan can be rearranged.

Many people can continue their work and daily life during chemotherapy, with some adjustments if needed.

The main factors that decide this are the intensity of treatment, the frequency of cycles, side effects, the physical load of the job and whether it carries a risk of infection. Fatigue often increases in the days after a cycle; a work plan that keeps these periods light, flexible hours or options to work from home can be helpful. In crowded places care with hand hygiene is needed, and on days when blood counts are low, extra precautions should be taken. Making time for rest and light physical activity is recommended. Talking about your working conditions with your treatment team helps you find the balance that suits you.

Immunotherapy is a treatment approach that helps the immune system recognise cancer cells and act against them.

The type most often used in oncology is the immune checkpoint inhibitors, which block the “brake” signals on immune cells. They are used in different tumours, such as lung, melanoma, kidney, bladder, head and neck and some digestive-system cancers, at particular stages and under particular conditions. It is not suitable for every patient; the type and stage of the cancer and, at times, biomarkers such as the PD-L1 level or microsatellite instability (MSI) are assessed for the decision. Immunotherapy can be given alone or together with other treatments such as chemotherapy.

The side effects of immunotherapy arise because the stimulated immune system also affects healthy tissues, and they can be seen in almost any organ of the body.

Common ones include fatigue, itching and rash, diarrhoea and thyroid gland dysfunction; less often, inflammation can develop in the lung, liver, kidney, bowel or hormone glands. These effects may occur in the first weeks of treatment, but also months later, even after treatment has ended. When noticed early, they can usually be brought under control with drugs such as corticosteroids. It is important to report changes such as new cough, shortness of breath, diarrhoea, marked fatigue or jaundice to your treatment team without delay.

Targeted therapies, known as “smart drugs”, are drugs that target specific gene changes or proteins that drive the growth of cancer cells.

For example, there are drugs that target EGFR or ALK changes in some lung cancers and the HER2 protein in some breast cancers. These drugs can be given as tablets by mouth or through a vein. For them to be effective, the relevant target must be present in the tumour; this is why pathology and molecular tests are done before treatment. The side effects of targeted therapies can differ from chemotherapy; they include rash, diarrhoea, changes in liver tests and raised blood pressure. The word “smart” does not mean free of side effects; regular follow-up is needed.

Before these treatments, biomarker (molecular) tests are usually done on tumour tissue or blood.

In pathology, proteins such as HER2 or PD-L1 can be assessed by immunohistochemistry; with methods such as next-generation sequencing (NGS), gene changes such as EGFR, ALK, KRAS and BRAF can be examined together. If tumour tissue is insufficient, a “liquid biopsy”, which looks at tumour DNA circulating in the blood, can be used. Which test is needed is determined by the cancer type, its stage and current guidelines; the same panel is not requested in every patient. These tests can sometimes also point to an inherited predisposition; in that case genetic counselling is additionally recommended.

No; there is no scientific evidence that the sugar you eat makes cancer grow, or that cutting out sugar shrinks cancer.

It is true that cancer cells use more glucose than normal cells; however, even if you do not eat sugar, the body obtains blood sugar from other nutrients and from its own stores. The US National Cancer Institute also states that this common belief is not correct. That said, a diet high in sugar can lead to weight gain, and excess weight is a factor that raises the risk of many types of cancer. During treatment, instead of banning sugar completely, the priority is a balanced diet and, especially in patients with loss of appetite, preventing weight loss. If you have diabetes, your nutrition plan is arranged separately.

The basic aim during treatment is to prevent loss of weight and muscle by taking in enough energy and protein.

The guideline of the European Society for Clinical Nutrition and Metabolism (ESPEN) recommends that daily protein intake in cancer patients be above 1 gram per kilogram of body weight and, if possible, up to 1.5 grams. Meat, fish, eggs, dairy products and legumes are good protein sources. In loss of appetite, small, frequent meals and energy-rich snacks can help. In periods when immunity is low, attention should be paid to food safety; raw or undercooked meat and eggs and unpasteurised dairy products should be avoided. If there is unintentional weight loss, support from a dietitian is considered.

It is recommended that you do not use herbal products, vitamins or supplements without consulting your treatment team.

No herbal product has been shown scientifically to cure cancer; some can interact with chemotherapy, targeted drugs or radiotherapy and reduce the effect of treatment or increase side effects. For example, St John’s wort is known to lower the blood level of some cancer drugs, and grapefruit to raise the level of some drugs. High-dose antioxidants and mixtures promoted as “natural” may also not be harmless. A safe approach is to show your doctor all the products you use or are thinking of using, together with their packaging.

Yes; regular physical activity suited to your condition is generally recommended during and after treatment.

Research shows that exercise can reduce cancer-related fatigue and support muscle strength, physical function and mood. The World Health Organization recommends 150–300 minutes of moderate-intensity activity a week for adults; in people receiving treatment this target is approached gradually and according to the person’s condition. Walking, light resistance exercises and stretching can be a good start. In periods when blood counts are very low, fever is present, there is spread to the bones or marked weakness is experienced, the exercise plan should be arranged together with your doctor.

For most cancer patients, inactivated (killed) vaccines such as the flu vaccine are recommended, whereas live vaccines are generally not given during treatment.

Because chemotherapy weakens the immune system, infections can take a more severe course; inactivated vaccines can help reduce this risk. Timing is important; to improve the response to the vaccine, a period between cycles when blood values are suitable is often preferred. Live vaccines such as measles-mumps-rubella and chickenpox, on the other hand, can pose a risk in people with suppressed immunity. Keeping the vaccinations of household members up to date is also a way of protecting the patient. Which vaccine is given when should be planned together with your oncologist.

In the Ministry of Health’s national breast cancer screening programme, a mammogram every two years is recommended for women aged 40–69.

The programme also includes a clinical breast examination once a year and informing women about monthly breast self-examination. Screening is carried out through Cancer Early Diagnosis, Screening and Education Centres (KETEM) and family physicians. In women with breast or ovarian cancer at a young age in the family, who carry an inherited change such as BRCA, or who have previously had radiotherapy to the chest area, screening may need to start earlier or MRI may need to be added. If you notice a lump, discharge or a change in the skin of the breast, you should see a doctor without waiting for the screening date.

In the national programme, cervical cancer screening with an HPV test every five years is done for women aged 30–65.

HPV (human papillomavirus) is a virus responsible for the great majority of cervical cancers. The test aims to catch risky infections and cell changes in the period before cancer develops; where needed, a smear (cervical cytology) examination accompanies the HPV test. Women with a positive result are referred for further assessment such as colposcopy. Screening is done at KETEMs and family medicine units. The World Health Organization recommends that the HPV vaccine be given primarily to girls aged 9–14; vaccinated women also need to take part in screening.

In the national programme, a faecal occult blood test every two years and a colonoscopy every ten years are recommended for women and men aged 50–70.

The faecal occult blood test detects bleeding that cannot be seen by eye and helps identify people who need further examination. Colonoscopy allows direct examination of the large bowel, and polyps that could turn into cancer can often be removed in the same procedure. In people who have a first-degree relative with colorectal cancer, inflammatory bowel disease or an inherited syndrome, screening may need to start earlier and be done more often. If there is blood in the stool, a lasting change in bowel habit, unexplained anaemia or weight loss, assessment should be made without waiting for the age.

Lung cancer screening is not among the national screening programmes in Türkiye; however, some international guidelines recommend screening with low-dose tomography in high-risk people.

In our country the national programmes cover breast, cervical and colorectal cancers. The US Preventive Services Task Force (USPSTF) recommends annual low-dose computed tomography in people aged 50–80 with at least a 20 pack-year smoking history who currently smoke or have quit within the last 15 years. The benefits of screening should be assessed together with the person against possible harms such as false-positive results, additional tests and radiation. The basic way to prevent lung cancer is to quit smoking. If there is a cough that does not go away, blood-stained sputum or shortness of breath, a doctor should be consulted.

No; the PSA test is not a screening routinely recommended to everyone; an individual decision is made after discussing its benefits and possible harms.

PSA is a blood value that can rise in prostate cancer; however, it can also increase with prostate enlargement, inflammation and after some procedures. Screening can catch prostate cancer early in some men, but it can also lead to the detection of tumours that would never cause problems and to unnecessary treatments. For this reason the US Preventive Services Task Force (USPSTF) recommends that in men aged 55–69 the decision be made individually, taking the person’s values into account. Earlier assessment may be needed for those with early-onset prostate cancer in the family or those carrying a change such as BRCA2.

Yes; age alone is not a reason for not giving chemotherapy.

In the treatment decision, more than calendar age, the person’s general health, independence in daily life, accompanying diseases, nutrition and own expectations are decisive. Of two people of the same age, one may tolerate intensive treatment well, while a lighter treatment plan may be suitable for the other. In older patients, drug doses can be adjusted according to kidney and liver function and side effects are monitored more often. In some cases targeted therapy, hormone therapy or supportive treatments may come to the fore instead of chemotherapy. The aim is to preserve quality of life as well as length of life.

A geriatric assessment is the systematic examination of the physical, mental and social state of an older cancer patient before a treatment decision.

Areas such as activities of daily living, history of falls, accompanying diseases, medicines used, nutritional status, memory and mood are assessed with short scales. The American Society of Clinical Oncology (ASCO) recommends a geriatric assessment in patients aged 65 and over for whom chemotherapy is planned. This assessment helps to predict the risk of treatment side effects, to notice problems that could be overlooked (for example inadequate nutrition or risk of falls) and to plan extra measures such as physiotherapy, a dietitian or social support. The results make shared decision-making with the patient and relatives easier.

In older patients who use more than one medicine, the whole medicine list needs to be reviewed for possible interactions with cancer treatment and for side effects.

At an advanced age, blood pressure, diabetes, heart and blood-thinning drugs are often used; some of these can interact with chemotherapy, targeted drugs or supportive treatments. Bringing over-the-counter painkillers, vitamins and herbal products, together with their packaging, in addition to prescription drugs to the examination makes the assessment easier. Reducing medicines that have become unnecessary under a doctor’s supervision can lower the risk of falls and side effects. Weekly pill boxes, a written plan or the support of a relative help with taking medicines regularly. The ASCO geriatric guideline also recommends medication review as part of the assessment.

Yes, it is; getting a second opinion is a patient’s natural right and a widely accepted practice in oncology.

Particularly in situations such as a rare diagnosis, multiple treatment options, a major surgical decision or progression despite treatment, another specialist’s assessment can help clarify the options and let you make your decision with more confidence. Most doctors receive this request with understanding and support the preparation of documents. A second opinion does not mean that you have to leave your current treatment; it most often results in confirmation of the current plan or in the suggestion of some adjustments. What matters is to proceed without delaying the process and while keeping in touch with your treatment team.

For a second opinion, current documents showing your diagnosis, the stage of the disease and your treatments to date are needed.

First among these is the pathology report (the biopsy and, if there is one, the surgical report); if you have molecular or genetic test results, add them too. Reports of imaging such as CT, MRI and PET-CT are important; if needed, the images themselves may also be requested. The discharge summary, the operation note, the names, dates and doses of the treatments you have received and recent blood tests make the assessment easier. Also state the list of medicines you use and your accompanying diseases. Arranging the documents in date order helps the assessment to be done faster and more completely.

You can submit your second-opinion request, together with your existing reports and imaging results, by sending it to the WhatsApp number 0530 250 54 85.

The “Second Opinion” button on the page takes you to the Second Opinion page; the “Second Opinion via WhatsApp” button there starts a conversation with a ready-made message, after which you can attach your pathology, imaging and discharge reports. Your documents are used to plan your outpatient appointment and prepare your file. The assessment is made face to face at the Mersin University Oncology Hospital outpatient clinic. No diagnosis is made and no treatment recommendation is given over WhatsApp. If you have an urgent health problem, you should go to the nearest emergency department without waiting. When sharing your documents, it is recommended to send only those needed for the assessment and not to share your identity details unnecessarily. For details you can see the Second Opinion and Privacy Notice pages.

For an appointment, you can write via WhatsApp or call the number 0530 250 54 85.

The “WhatsApp Appointment” button on the page starts a conversation with a ready-made message, and the “Call now” button lets you make a direct call. Stating your name, briefly the reason for your request and your diagnosis, if any, in your message makes it easier to plan a suitable day and time. Address: Mersin University Faculty of Medicine Oncology Hospital, Çiftlikköy Campus, Yenişehir/Mersin. Bringing with you documents of previous tests and treatments helps the first meeting to be productive.