Medical Oncologist
Before you start
Tests needed before chemotherapy starts
Four groups of tests: blood counts, organ function, a heart test if the plan includes drugs that can affect it, and an infection screen. Some people also need a dental check and a fertility referral before cycle one. Together they take roughly a fortnight of separate appointments, which is the part nobody warns families about.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- Which tests are done before chemotherapy starts?
- What each test is actually looking at
- The appointments that are not tests at all
- How long each part realistically takes
- What an out-of-range result usually means
- Four things families get wrong about this fortnight
- Common questions about the tests before chemotherapy
The short answer
Which tests are done before chemotherapy starts?
Four groups: blood counts, organ function, a heart test if the plan includes drugs that can affect it, and an infection screen. Some people also need a dental check and a fertility referral before cycle one, and those two are the ones most often forgotten.
Together they take roughly a fortnight of separate appointments, which is the part nobody warns you about. Families arrive expecting treatment to begin that week and instead spend it moving between a laboratory, a scan room and two outpatient departments.
They are not there to decide whether you get treatment
That decision has usually already been made from the biopsy and the scans. These tests decide the dose, the drugs and the order — which is why an abnormal result almost never means chemotherapy is cancelled, and usually means it is adjusted.
Ask for the whole list on one sheet
Written down in one place, with which are fasting, which need an appointment and which can be walked into. Collecting it piecemeal over a fortnight is how people end up making the same trip three times.
Ask which tests will be repeated before every cycle. Knowing that early saves a great deal of confusion later.The usual list
What each test is actually looking at
- Full blood count
- The white cells that fight infection, the haemoglobin that carries oxygen and the platelets that stop bleeding. This becomes your baseline, and it is the test repeated before every single cycle afterwards.
- Kidney function
- A blood test, sometimes with a urine collection. Several drugs leave the body through the kidneys, so how well they are working sets how much can safely be given.
- Liver function
- Also a blood test. Other drugs are broken down by the liver, and a liver working slowly holds on to them for longer. The result changes the dose rather than the decision.
- Heart test
- Usually an echo, sometimes a MUGA scan, plus an ECG. Needed when the plan includes a class of drugs that can weaken the pumping action, so the team knows where you started from.
- Infection screen
- Hepatitis B and C, HIV, and sometimes a test for past tuberculosis. Chemotherapy lowers immunity, and an infection sitting quietly can wake up once it does. Found early, this is manageable.
- Height, weight and a pregnancy test
- Dose is calculated from body size, so the weighing is not a formality. A pregnancy test is routine for anyone it could apply to, and is not a comment on your circumstances.
Not sure whether this applies to you?
Ask an oncologistEasy to miss
The appointments that are not tests at all
These two are time-critical, rarely offered unprompted in India, and cannot be done once treatment has begun.
A dental check
An infected tooth or an inflamed gum is a quiet infection source, and it becomes a loud one during the days when your counts are at their lowest. Anything needing extraction is far better dealt with before treatment starts than during it.
Ask for
- An appointment in the coming days, not the coming weeks
- A note saying you are about to start chemotherapy
A fertility discussion
For anyone who may want children later, this has to happen before cycle one. It cannot be revisited afterwards, and it is the single largest source of regret in the whole pathway. Raise it yourself if nobody raises it with you.
Ask for
- A referral now, even if you are unsure
- How much time the options would need
A medicines review
Bring every box you take, including the ones prescribed by another doctor for blood pressure, sugar, thyroid, heart or tuberculosis. Also bring anything bought without a prescription. The list matters more than anyone expects it to.
A line or port decision
If the plan runs for many cycles, or the drugs are hard on veins, this gets discussed now. Deciding early avoids a course of difficult cannulas and a device fitted halfway through in a hurry.
Timing
How long each part realistically takes
Step
What to expect
Blood tests
One morning visit; results often the same day or next
Echo or MUGA
A separate appointment, often the longest wait of the lot
Infection screen
Drawn with the other bloods; results take a little longer
Dental check
One visit, plus time to heal if a tooth is removed
Fertility referral
Needs its own conversation; ask how much time it requires
Planning appointment
Once results are in; the date for cycle one is set here
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
If something comes back abnormal
What an out-of-range result usually means
Most often it means an adjustment, not a cancellation. The whole point of testing first is to find these things while they can still be worked around, and that is exactly what the team does with them.
A dose changed to match the organ
If the kidneys or liver are working below par, the amount given is reduced, or a different drug is chosen. This is a normal part of planning and is not a sign that your treatment has been downgraded.
A treatment given first
A low haemoglobin may be corrected, an infection treated, sugar or blood pressure brought under control, a tooth removed. These add days, occasionally a week or two, and make the course that follows safer.
A different plan altogether
Sometimes a heart result means one drug class is set aside and another used instead. Ask directly what changed and why. You are entitled to that explanation in words you understand, and to ask again if it was rushed.
Ask what the delay actually costs
Families panic about a fortnight lost. Ask whether the wait carries a real risk in your situation, because for most plans the answer is that starting safely matters more than starting immediately.
Keep every report, in date order, in one file. You will be asked for the baseline results repeatedly over the course.Commonly believed
Four things families get wrong about this fortnight
"All these tests mean they have found something else."
They are a standard list done for everybody, in the same order, regardless of what the scans showed. None of them is a search for more disease. They exist to set the dose and to establish a baseline that later results can be compared against.
"We can skip the dental and fertility appointments and catch up later."
These are the two that genuinely cannot be caught up. Dental work becomes far harder once counts start dropping, and fertility options close once treatment begins. Both are routinely left out in India, and both are worth pushing for.
"An abnormal result means chemotherapy is off."
Very rarely. Far more often it changes the dose, the drug or the order, or adds a short treatment first. Being told your kidney function is low is information the team is using, not a verdict on whether you can be treated.
"Every test will be repeated before every cycle."
Only the blood count is routine before each cycle, sometimes with kidney and liver checks. The heart test and infection screen are done at baseline and repeated only when there is a reason. Ask which apply to you so you can plan the days.
Questions we are asked
Common questions about the tests before chemotherapy
How long before treatment do the tests happen?
Usually across the fortnight before cycle one, though it varies with how quickly appointments come through. Ask for the full list in writing on the first day so you can book them together rather than discovering them one at a time.
Do I need to fast for any of them?
Some blood tests are done fasting and most are not. Ask which, because arriving fasted unnecessarily makes a long hospital morning much harder. The echo and the ECG need no preparation at all.
Why do they want an HIV and hepatitis test?
Because chemotherapy lowers immunity, and an infection that has been sitting quietly can become active once it does. Knowing in advance means it can be covered or watched. It is asked of everybody, not because of anything about you.
Can the tests be done at a laboratory near home?
Often yes for the routine bloods, which helps if travel is difficult. Ask your team first, as some units want their own laboratory for the baseline so that later results are directly comparable. The heart test usually needs the hospital.
What if we cannot afford all of them at once?
Say so plainly. Ask which are essential before cycle one and which can wait, and whether your scheme or insurance covers the pre-treatment workup. Staged testing is common and is far better than quietly skipping a test.
Nobody mentioned a dentist. Should I ask?
Yes. It is one of the most commonly skipped steps here, and an untreated tooth is a real infection risk during the days when counts are lowest. Ask for a check even if your teeth feel completely fine.
Will the results tell us whether treatment will work?
No. They describe how your body will handle the drugs, not how the disease will respond. Response is assessed later with scans and examination. It is a common and understandable confusion when a report arrives full of numbers.
Who explains all these reports to us?
Your oncologist at the planning appointment. Take the file, take someone with you, and write your questions down beforehand. Ask for the explanation in Telugu or whichever language the household uses if that is easier.
Meet the Specialists
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Sources
- Cancer Research UK — Having chemotherapy
- Macmillan Cancer Support — Having chemotherapy
- National Cancer Institute — Chemotherapy to Treat Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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