Alopecia — Cancer-Related Hair Loss

Medically, alopecia describes the partial or complete loss of hair from areas of the body where it normally grows. In oncology, chemotherapy-induced alopecia is the most prevalent form, typically characterised by diffuse shedding across the scalp, eyebrows, eyelashes, and body. Radiotherapy can also cause localized alopecia restricted strictly to the treated anatomical field.

Antineoplastic agents do not differentiate between malignant cells and healthy, rapidly proliferating non-cancerous cells. Hair matrix keratinocytes possess one of the highest proliferative rates in the human body, rendering them acutely vulnerable to cytotoxic cellular disruption. Following cytotoxic insult, hair follicles abruptly arrest their growth cycle, leading to structural dystrophy of the hair shaft and subsequent shedding within days to weeks of treatment initiation.

Although alopecia does not directly threaten physical survival, its psychological impact can be profound. For many individuals, hair loss is an unwanted, visible marker of their illness, altering body image and self-esteem. Knowing in advance whether a proposed regimen causes alopecia empowers patients to make proactive decisions, such as cutting hair short, choosing head coverings, or exploring scalp-cooling systems to minimise shedding.

There is no laboratory biomarker to predict alopecia. Instead, clinical evaluation relies on visual assessment, tracking shedding severity using standard oncological grading systems such as the Common Terminology Criteria for Adverse Events. Clinicians examine scalp health, review family history of androgenetic hair loss, and monitor nutritional markers like serum ferritin or thyroid-stimulating hormone if regrowth seems unexpectedly delayed.

Alopecia is frequently discussed in cancers treated with systemic, high-dose chemotherapy regimens. It commonly arises during treatment for breast cancer, ovarian cancer, lung cancer, and testicular cancer. It is also very common in haematological malignancies, including acute leukemias and aggressive lymphomas. Patients receiving cranial radiotherapy for primary brain tumours or cerebral metastases also experience localized hair loss.

Alopecia influence treatment choices primarily around supportive care rather than altering curative protocols. The primary preventative intervention is scalp cooling, which constricts local blood vessels to reduce cytotoxic exposure to follicles. Dermatological therapies such as topical minoxidil may occasionally be recommended post-treatment to encourage regrowth, while gentle hair care regimens minimise mechanical trauma to fragile strands.