Chemotherapy & Side Effects
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How can you take care of yourself during chemotherapy? You can eat
the right foods to build up your strength. Stay away from people who have
colds or the flu. Get the rest you need and pace yourself. Talk about your
feelings to deal with any sadness, anger, or fear you may have. Work as a
team with your health care providers. Knowing how to help yourself can make
you feel more in control. These are just a few of the ways that you can help
yourself and begin to feel in control again.
This information is designed to help you become an informed partner
in your care, but it is only a guide. Self-help can never take the place
of professional health care. Ask your doctor and nurse any questions you
may have about chemotherapy. Also don't hesitate to tell them about any side
effects you may have. They want and need to know.
What Is Chemotherapy?
Chemotherapy is the treatment of cancer with drugs that can destroy cancer
cells. These drugs often are called "anticancer" drugs.
How Does Chemotherapy Work?
Normal cells grow and die in a controlled way. When cancer occurs,
cells in the body that are not normal keep dividing and forming more cells
without control. Anticancer drugs destroy cancer cells by stopping them from
growing or multiplying. Healthy cells can also be harmed, especially those
that divide quickly. Harm to healthy cells is what causes side effects. These
cells usually repair themselves after chemotherapy.
Because some drugs work better together than alone, two or more drugs
are often given at the same time. This is called combination chemotherapy.
Other types of drugs may be used to treat your cancer. These may include
certain drugs that can block the effect of your body's hormones. Or doctors
may use biological therapy, which is treatment with substances that boost
the body's own immune system against cancer. Your body usually makes these
substances in small amounts to fight cancer and other diseases. These substances
can be made in the laboratory and given to patients to destroy cancer cells
or change the way the body reacts to a tumor. They may also help the body
repair or make new cells destroyed by chemotherapy.
What Can Chemotherapy Do?
Depending on the type of cancer and how advanced it is, chemotherapy can be
used for different goals:
- To cure the cancer. Cancer is considered cured when the patient
remains free of evidence of cancer cells.
- To control the cancer. This is done by keeping the cancer from spreading; slowing
the cancer's growth; and killing cancer cells that may have spread to other
parts of the body from the original tumor.
- To relieve symptoms that the cancer may cause. Relieving symptoms such as pain
can help patients live more comfortably.
Is Chemotherapy Used With Other Treatments?
Sometimes chemotherapy is the only treatment a patient receives. More often,
however, chemotherapy is used in addition to surgery, radiation therapy, and/or
biological therapy to:
- Shrink a tumor before surgery or radiation therapy. This is
called neo-adjuvant therapy.
- Help destroy any cancer cells that may remain after surgery and/or radiation
therapy. This is called adjuvant chemotherapy.
- Make radiation therapy and biological therapy work better.
- Help destroy cancer if it recurs or has spread to other parts of the body from
the original tumor.
Which Drugs Are Given?
Some chemotherapy drugs are used for many different types of cancer, while
others might be used for just one or two types of cancer. Your doctor recommends
a treatment plan based on:
- What kind of cancer you have.
- What part of the body the cancer is found.
- The effect of cancer on your normal body functions.
- Your general health.
What About Clinical Trials?
Clinical trials, also called cancer treatment studies or research studies,
test new treatments in people with cancer. Clinical trials test many types
of treatments such as new drugs, new approaches to surgery or radiation therapy,
new combinations of treatments, or new methods such as gene therapy. The goal
of this research is to find better ways to treat cancer and help cancer patients.
There are different types of clinical trials, called Phase I, Phase II, and
Phase III trials. Each is one of the final stages of a long and careful cancer
research process. If your doctor does not suggest you take part in a clinical
trial, you may want to ask about clinical trials as a treatment choice for
benefits of clinical trials include:
- Clinical trials offer high-quality cancer care.
- If a new treatment approach is proven to work and you are taking it, you may
be among the first to benefit.
- By looking at the pros and cons of clinical trials and other treatment choices,
you are taking an active role in a decision that affects your life.
- You have the chance to help others and improve cancer treatment.
- New treatments under study are not always better than, or even
as good as, standard treatment.
- Even if a new treatment has benefits, it may not work for you.
- In a study, if you are randomly assigned to have standard treatment instead of
the new treatment being tested, it may not be as effective as the new approach.
- Health insurance and managed care providers do not always cover all patient care
costs in a study.
Before deciding to join a clinical trial you will want to ask important
questions such as: What are the possible short- and long-term risks, side
effects, and benefits to me? How could the study affect my daily life? Will
I have to pay for any treatment, tests, or other charges?
Questions to Ask Your Doctor
- Why do I need chemotherapy?
- What are the benefits of chemotherapy?
- What are the risks of chemotherapy?
- Are there any other possible treatment methods for my type of cancer?
- What is the standard care for my type of cancer?
- Are there any clinical trials for my type of cancer?
About Your Treatment
- How many treatments will I be given?
- What drug or drugs will I be taking?
- How will the drugs be given?
- Where will I get my treatment?
- How long will each treatment last?
About Side Effects
- What are the possible side effects of the chemotherapy?
When are side effects likely to occur?
- What side effects are more likely to be related to my type of cancer?
- Are there any side effects that I should report right away?
- What can I do to relieve the side effects?
About Contacting Medical Staff
- How do I contact a health professional after
hours, and when should I call?
Hints for Talking with Your Doctor
These tips might help you keep track of the information you learn
during visits with your doctor:
- Bring a friend or family member to sit with
you while you talk with your doctor. This person can help you understand
what your doctor says during your visit and help refresh your memory
- Ask your doctor for printed information that is available on your cancer and
- You, or the person who goes with you, may want to take notes during your appointment.
- Ask your doctor to slow down when you need more time to write.
- You may want to ask if you can use a tape recorder during your visit. Take notes
from the tape after the visit is finished. That way, you can review
your conversation later as many times as you wish.
Some people with cancer want to know every detail about their condition
and their treatment. Others prefer only general information. The choice of
how much information to seek is yours, but there are questions that every
person getting chemotherapy should ask.
This list is just a start. Always feel free to ask your doctor, nurse, and pharmacist
as many questions as you want. If you do not understand their answers, keep
asking until you do. Remember, there is no such thing as a "stupid" question, especially about cancer or your treatment. To make sure you get all
the answers you want, you may find it helpful to draw up a list of questions
before each doctor's appointment. Some people keep a "running list" and jot down each new question as it occurs to them.
Where Will I Get Chemotherapy?
Chemotherapy can be given in many different places: at home, a doctor's
office, a clinic, a hospital's outpatient department, or as an "inpatient" in a hospital. The choice of where you get chemotherapy depends on which drug
or drugs you are getting, your insurance, and sometimes your own and your
doctor's wishes. Most patients receive their treatment as an "outpatient" and are not hospitalized. Sometimes, a patient starting chemotherapy may need
to stay at the hospital for a short time so that the medicine's effects can
be watched closely and any needed changes can be made.
How Often and for How Long Will I Get Chemotherapy?
How often and how long you get chemotherapy depends on:
- The kind of cancer you have.
- The goals of the treatment.
- The drugs that are used.
- How your body responds to them.
You may get treatment every day, every week, or every month. Chemotherapy
is often given in cycles that include treatment periods alternated with rest
periods. Rest periods give your body a chance to build healthy new cells
and regain its strength. Ask your health care provider to tell you how long
and how often you may expect to get treatment.
Sticking with your treatment schedule is very important for the drugs to work
right. Schedules may need to be changed for holidays and other reasons. If
you miss a treatment session or skip a dose of the drug, contact your doctor.
Sometimes, your doctor may need to delay a treatment based on the results of
certain blood tests. Your doctor will let you know what to do during this
time and when to start your treatment again.
How Is Chemotherapy Given?
Chemotherapy can be given in several different ways: intravenously (through
a vein), by mouth, through an injection (shot), or applied on the skin.
vein (intravenous, or IV, treatment)
Chemotherapy is most often given intravenously (IV), through a vein. Usually
a thin needle is inserted into a vein on the hand or lower arm at the beginning
of each treatment session and is removed at the end of the session. If you
feel a coolness, burning, or other unusual sensation in the area of the needle
stick when the IV is started, tell your doctor or nurse. Also report any
pain, burning, skin redness, swelling, or discomfort that occurs during or
after an IV treatment.
can also be delivered by IV through catheters, ports, and pumps.
A catheter is a soft, thin, flexible tube that is placed in a large vein in
the body and remains there as long as it is needed. Patients who need to have
many IV treatments often have a catheter, so a needle does not have to be used
each time. Drugs can be given and blood samples can be drawn through this catheter.
Sometimes the catheter is attached to a port — a small round plastic or metal
disc placed under the skin. The port can be used for as long as it is needed.
A pump, which is used to control how fast the drug goes into a catheter or
port, is sometimes used. There are two types of pumps. An external pump remains
outside the body. Most are portable; they allow a person to move around while
the pump is being used. An internal pump is placed inside the body during surgery,
usually right under the skin. Pumps contain a small storage area for the drug
and allow people to go about their normal activities. Catheters, ports, and
pumps cause no pain if they are properly placed and cared for, although a person
is aware they are there.
are usually placed in a large vein, most commonly in your chest, called a
central venous catheter. A peripherally inserted central catheter (PICC)
is inserted into a vein in the arm. Catheters can also be placed in an artery
or other locations in your body, such as:
- intrathecal. Delivers drugs into the spinal fluid.
- Intracavitary (IC) catheter. Placed in the abdomen, pelvis, or chest.
By mouth (orally)
The drug is given in pill, capsule, or liquid form. You swallow the drug,
just as you do many other medicines.
A needle and syringe are used to give the drug in one of several ways:
- Intramuscularly, or IM. (Into a muscle)
- Subcutaneously, or SQ or SC. (Under the skin)
- Intralesionally, or IL. (Directly into a cancerous area in the skin)
The drug is applied on the surface of the skin.
Will I Feel During Chemotherapy?
Most people receiving chemotherapy find that they tire easily, but many feel
well enough to continue to lead active lives. Each person and treatment is
different, so it is not always possible to tell exactly how you will react.
Your general state of health, the type and extent of cancer you have, and the
kind of drugs you are receiving can all affect how well you feel.
may want to have someone available to drive you to and from treatment if,
for example, you are taking medicine for nausea or vomiting that could make
you tired. You may also feel especially tired from the chemotherapy as early
as one day after a treatment and for several days. It may help to schedule
your treatment when you can take off the day of and the day after your treatment.
If you have young children, you may want to schedule the treatment when you
have someone to help at home the day of and at least the day after your treatment.
Ask your doctor when your greatest fatigue or other side effects are likely
Most people can continue working while receiving chemotherapy. However, you may
need to change your work schedule for a while if your chemotherapy makes
you feel very tired or have other side effects. Talk with your employer about
your needs and wishes. You may be able to agree on a part-time schedule,
find an area for a short nap during the day, or perhaps you can do some of
your work at home.
Under Federal and state laws, some employers may be required to let you work
a flexible schedule to meet your treatment needs.
Can I Take Other Medicines While I Am Getting Chemotherapy?
Some medicines may interfere or react with the effects of your chemotherapy.
Give your doctor a list of all the medicines you take before you start treatment.
- the name of each drug
- the dosage
- the reason you take it
- how often you take it
Remember to tell your doctor about all over-the-counter remedies,
including vitamins, laxatives, medicines for allergies, indigestion, and
colds, aspirin, ibuprofen, or other pain relievers, and any mineral or herbal
supplements. Your doctor can tell you if you should stop taking any of these
remedies before you start chemotherapy. After your treatments begin, be sure
to check with your doctor before taking any new medicines or stopping the
ones you are already taking.
How Will I Know if My Chemotherapy Is Working?
Your doctor and nurse will use several ways to see how well your treatments
are working. You may have physical exams and tests often. Always feel free
to ask your doctor about the test results and what they show about your progress.
and exams can tell a lot about how chemotherapy is working; however, side
effects tell very little. Sometimes people think that if they have no side
effects, the drugs are not working, or, if they do have side effects, the
drugs are working well. But side effects vary so much from person to person,
and from drug to drug, that side effects are not a sign of whether the treatment
is working or not.
Questions to Ask About Side Effects
- What are the short-term side effects that may
- What are the long-term side effects that may occur?
- How serious are the side effects likely to be?
- How long will the side effects last?
- What can I do to relieve or lessen the side effects?
- When should I call the doctor or nurse about side effects?
- What can I do to feel better emotionally while trying to cope with the side effects?
What Causes Side Effects?
Because cancer cells may grow and divide more rapidly than normal
cells, many anticancer drugs are made to kill growing cells. But certain
normal, healthy cells also multiply quickly, and chemotherapy can affect
these cells, too. This damage to normal cells causes side effects. The fast-growing,
normal cells most likely to be affected are blood cells forming in the bone
marrow and cells in the digestive tract (mouth, stomach, intestines, esophagus),
reproductive system (sexual organs), and hair follicles. Some anticancer
drugs may affect cells of vital organs, such as the heart, kidney, bladder,
lungs, and nervous system.
You may have none of these side effects or just a few. The kinds of side effects
you have and how severe they are, depend on the type and dose of chemotherapy
you get and how your body reacts. Before starting chemotherapy, your doctor
will discuss the side effects that you are most likely to get with the drugs
you will be receiving. Before starting the treatment, you will be asked to
sign a consent form. You should be given all the facts about treatment including
the drugs you will be given and their side effects before you sign the consent
How Long Do Side Effects Last?
Normal cells usually recover when chemotherapy is over, so most side
effects gradually go away after treatment ends, and the healthy cells have
a chance to grow normally. The time it takes to get over side effects depends
on many things, including your overall health and the kind of chemotherapy
you have been taking.
Most people have no serious long-term problems from chemotherapy. However, on
some occasions, chemotherapy can cause permanent changes or damage to the
heart, lungs, nerves, kidneys, reproductive or other organs. And certain
types of chemotherapy may have delayed effects, such as a second cancer,
that show up many years later. Ask your doctor about the chances of any serious,
long-term effects that can result from the treatment you are receiving (but
remember to balance your concerns with the immediate threat of your cancer).
Great progress has been made in preventing and treating some of chemotherapy's
common as well as rare serious side effects. Many new drugs and treatment
methods destroy cancer more effectively while doing less harm to the body's
The side effects of chemotherapy can be unpleasant, but they must be measured
against the treatment's ability to destroy cancer. Medicines can help prevent
some side effects such as nausea. Sometimes people receiving chemotherapy
become discouraged about the length of time their treatment is taking or
the side effects they are having. If that happens to you, talk to your doctor
or nurse. They may be able to suggest ways to make side effects easier to
deal with or reduce them.
Below you will find suggestions for dealing with some of the more common side
effects of chemotherapy.
feeling tired and lacking energy, is the most common symptom reported by cancer
patients. The exact cause is not always known. It can be due to your disease,
chemotherapy, radiation, surgery, low blood counts, lack of sleep, pain, stress,
poor appetite, along with many other factors.
Fatigue from cancer feels different from fatigue of everyday life. Fatigue caused
by chemotherapy can appear suddenly. Patients with cancer have described
it as a total lack of energy and have used words such as worn out, drained,
and wiped out to describe their fatigue. And rest does not always relieve
it. Not everyone feels the same kind of fatigue. You may not feel tired while
someone else does or your fatigue may not last as long as someone else's
does. It can last days, weeks, or months. But severe fatigue does go away
gradually as the tumor responds to treatment.
How can I cope with fatigue?
- Plan your day so that you have time to rest.
- Take short naps or breaks, rather than one long rest period.
- Save your energy for the most important things.
- Try easier or shorter versions of activities you enjoy.
- Take short walks or do light exercise if possible. You may find this helps with
- Talk to your health care provider about ways to save your energy and treat your
- Try activities such as meditation, prayer, yoga, guided imagery, visualization,
etc. (See the section "Complementary Therapies.") You may find that these help with fatigue.
- Eat as well as you can and drink plenty of fluids. Eat small amounts at a time,
if that is helpful.
- Join a support group. Sharing your feelings with others can ease the burden of
fatigue. You can learn how others deal with their fatigue. Your health
care provider can put you in touch with a support group in your area.
- Limit the amount of caffeine and alcohol you drink.
- Allow others to do some things for you that you usually do.
- Keep a diary of how you feel each day. This will help you plan your daily activities.
- Report any changes in energy level to your doctor or nurse.
Nausea and Vomiting
Many patients fear that they will have nausea and vomiting while receiving
chemotherapy. But new drugs have made these side effects far less common and,
when they do occur, much less severe. These powerful antiemetic or antinausea
drugs can prevent or lessen nausea and vomiting in most patients. Different
drugs work for different people, and you may need more than one drug to get
relief. Do not give up. Continue to work with your doctor and nurse to find
the drug or drugs that work best for you. Also, be sure to tell your doctor
or nurse if you are very nauseated or have vomited for more than a day, or
if your vomiting is so bad that you cannot keep liquids down.
can I do if I have nausea and vomiting?
- Drink liquids at least an hour before or after mealtime, instead
of with your meals. Drink frequently and drink small amounts.
- Eat and drink slowly.
- Eat small meals throughout the day, instead of one, two, or three large meals.
- Eat foods cold or at room temperature so you won't be bothered by strong smells.
- Chew your food well for easier digestion.
- If nausea is a problem in the morning, try eating dry foods like cereal, toast,
or crackers before getting up. (Do not try this if you have mouth or throat
sores or are troubled by a lack of saliva.)
- Drink cool, clear, unsweetened fruit juices, such as apple or grape juice or
light-colored sodas such as ginger ale that have lost their fizz and do
not have caffeine.
- Suck on mints, or tart candies. (Do not use tart candies if you have mouth or
- Prepare and freeze meals in advance for days when you do not feel like cooking.
- Wear loose-fitting clothes.
- Breathe deeply and slowly when you feel nauseated.
- Distract yourself by chatting with friends or family members, listening to music,
or watching a movie or TV show.
- Use relaxation techniques. (See the section "Complementary Therapies.")
- Try to avoid odors that bother you, such as cooking smells, smoke, or perfume.
- Avoid sweet, fried, or fatty foods.
- Rest but do not lie flat for at least 2 hours after you finish a meal.
- Avoid eating for at least a few hours before treatment if nausea usually occurs
- Eat a light meal before treatment.
Chemotherapy drugs can cause some side effects that are painful. The drugs
can damage nerves, leading to burning, numbness, tingling or shooting pain,
most often in the fingers or toes. Some drugs can also cause mouth sores, headaches,
muscle pains, and stomach pains.
everyone with cancer or who receives chemotherapy experiences pain from the
disease or its treatment. But if you do, it can be relieved. The first step
to take is to talk with your doctor, nurse, and pharmacist about your pain.
They need to know as many details about your pain as possible. You may want
to describe your pain to your family and friends. They can help you talk
to your caregivers about your pain, especially if you are too tired or in
too much pain to talk to them yourself.
You need to tell your doctor, nurse, and pharmacist and family or friends:
- Where you feel pain.
- What it feels like — sharp, dull, throbbing, steady.
- How strong the pain feels.
- How long it lasts.
- What eases the pain, what makes the pain worse.
- What medicines you are taking for the pain and how much relief you get from them.
Using a pain scale is helpful in describing how much pain you are
feeling. Try to assign a number from 0 to 10 to your pain level. If you have
no pain, use a 0. As the numbers get higher, they stand for pain that is
getting worse. A 10 means the pain is as bad as it can be. You may wish to
use your own pain scale using numbers from 0 to 5 or even 0 to 100. Be sure
to let others know what pain scale you are using and use the same scale each
time, for example, "My pain is 7 on a scale of 0 to 10."
The goal of pain control is to prevent pain that can be prevented,
and treat the pain that can't. To do this:
- If you have persistent or chronic pain, take your pain medicine
on a regular schedule (by the clock).
- Do not skip doses of your scheduled pain medicine. If you wait to take pain medicine
until you feel pain, it is harder to control.
- Try using relaxation exercises at the same time you take medicine for the pain.
This may help to lessen tension, reduce anxiety, and manage pain.
- Some people with chronic or persistent pain that is usually controlled by medicine
can have breakthrough pain. This occurs when moderate to severe pain "breaks through" or is felt for a short time. If you experience this pain, use a short-acting
medicine ordered by your doctor. Don't wait for the pain to get worse.
If you do, it may be harder to control.
There are many different medicines and methods available to control
cancer pain. You should expect your doctor to seek all the information and
resources necessary to make you as comfortable as possible. If you are in
pain and your doctor has no further suggestions, ask to see a pain specialist
or have your doctor consult with a pain specialist. A pain specialist may
be an oncologist, anesthesiologist, neurologist, neurosurgeon, other doctor,
nurse, or pharmacist.
loss (alopecia) is a common side effect of chemotherapy, but not all drugs
cause hair loss. Your doctor can tell you if hair loss might occur with the
drug or drugs you are taking. When hair loss does occur, the hair may become
thinner or fall out entirely. Hair loss can occur on all parts of the body,
including the head, face, arms and legs, underarms, and pubic area. The hair
usually grows back after the treatments are over. Some people even start
to get their hair back while they are still having treatments. Sometimes,
hair may grow back a different color or texture.
Hair loss does not always happen right away. It may begin several weeks after
the first treatment or after a few treatments. Many people say their head
becomes sensitive before losing hair. Hair may fall out gradually or in clumps.
Any hair that is still growing may become dull and dry.
How can I care for my scalp and hair during chemotherapy?
- Use a mild shampoo.
- Use a soft hair brush.
- Use low heat when drying your hair.
- Have your hair cut short. A shorter style will make your hair look thicker and
fuller. It also will make hair loss easier to manage if it occurs.
- Use a sun screen, sun block, hat, or scarf to protect your scalp from the sun
if you lose hair on your head.
- Avoid brush rollers to set your hair.
- Avoid dying, perming, or relaxing your hair.
Some people who lose all or most of their hair choose to wear turbans,
scarves, caps, wigs, or hair pieces. Others leave their head uncovered. Still
others switch back and forth, depending on whether they are in public or
at home with friends and family members. There are no "right" or "wrong" choices; do whatever feels comfortable for you.
If you choose to cover your head:
- Get your wig or hairpiece before you lose a lot of hair. That way, you
can match your current hair style and color. You may be able to buy a wig
or hairpiece at a specialty shop just for cancer patients. Someone may even
come to your home to help you. You also can buy a wig or hair piece through
a catalog or by phone.
- You may also consider borrowing a wig or hairpiece, rather than buying
one. Check with the nurse or social work department at your hospital about
resources for free wigs in your community.
- Take your wig to your hairdresser or the shop where it was purchased for
styling and cutting to frame your face.
- Some health insurance policies cover the cost of a hairpiece needed because
of cancer treatment. It is also a tax-deductible expense. Be sure to check
your policy and ask your doctor for a "prescription."
Losing hair from your head, face, or body can be hard to accept. Feeling
angry or depressed is common and perfectly all right. At the same time, keep
in mind that it is a temporary side effect. Talking about your feelings can
help. If possible, share your thoughts with someone who has had a similar
Chemotherapy can reduce the bone marrow's ability to make red blood cells,
which carry oxygen to all parts of your body. When there are too few red blood
cells, body tissues do not get enough oxygen to do their work. This condition
is called anemia. Anemia can make you feel short of breath, very weak, and
tired. Call your doctor if you have any of these symptoms:
- Fatigue (feeling very weak and tired).
- Dizziness or feeling faint.
- Shortness of breath.
- Feeling as if your heart is "pounding" or beating very fast.
Your doctor will check your blood cell count often during your treatment.
She or he may also prescribe a medicine that can boost the growth of your
red blood cells. Discuss this with your doctor if you become anemic often.
If your red count falls too low, you may need a blood transfusion or a medicine
called erythropoietin to raise the number of red blood cells in your body.
Things you can do if you are anemic (See the section "Fatigue")
- Get plenty of rest. Sleep more at night and take naps during the day if
- Limit your activities. Do only the things that are essential or most important
- Ask for help when you need it. Ask family and friends to pitch in with
things like child care, shopping, housework, or driving.
- Eat a well-balanced diet. (See the section "Eating Well During Chemotherapy.")
- When sitting, get up slowly. When lying down, sit first and then stand.
This will help prevent dizziness.
Central Nervous System Problems
Chemotherapy can interfere with certain functions in your central nervous system
(brain) causing tiredness, confusion, and depression. These feelings will go
away once the chemotherapy dose is lowered or you finish chemotherapy. Call
your doctor if these symptoms occur.
Chemotherapy can make you more likely to get infections. This happens because
most anticancer drugs affect the bone marrow, making it harder to make white
blood cells (WBCs), the cells that fight many types of infections. Your doctor
will check your blood cell count often while you are getting chemotherapy.
There are medicines that help speed the recovery of white blood cells, shortening
the time when the white blood count is very low. These medicines are called
colony stimulating factors (CSF). Raising the white blood cell count greatly
lowers the risk of serious infection.
infections come from bacteria normally found on your skin and in your mouth,
intestines and genital tract. Sometimes, the cause of an infection may not
be known. Even if you take extra care, you still may get an infection. But
there are some things you can do.
How can I help prevent infections?
- Wash your hands often during the day. Be sure to wash them before you
eat, after you use the bathroom, and after touching animals.
- Clean your rectal area gently but thoroughly after each bowel movement.
Ask your doctor or nurse for advice if the area becomes irritated or if
you have hemorrhoids. Also, check with your doctor before using enemas or
suppositories. (See the section "Constipation.")
- Stay away from people who have illnesses you can catch, such as a cold,
the flu, measles, or chicken pox.
- Try to avoid crowds. For example, go shopping or to the movies when the
stores or theaters are least likely to be busy.
- Stay away from children who recently have received "live virus"
vaccines such as chicken pox and oral polio, since they may be contagious
to people with a low blood cell count. Call your doctor or local health
department if you have any questions.
- Do not cut or tear the cuticles of your nails.
- Be careful not to cut or nick yourself when using scissors, needles, or
- Maintain good mouth care. (See the section "Mouth, Gum and Throat
- Do not squeeze or scratch pimples.
- Take a warm (not hot) bath, shower, or sponge bath every day. Pat your
skin dry using a light touch. Do not rub too hard.
- Use lotion or oil to soften and heal your skin if it becomes dry and cracked.
- Clean cuts and scrapes right away and daily until healed with warm water,
soap, and an antiseptic.
- Avoid contact with animal litter boxes and waste, bird cages, and fish
- Avoid standing water, for example, bird baths, flower vases, or humidifiers.
- Wear protective gloves when gardening or cleaning up after others, especially
- Do not get any immunizations, such as flu or pneumonia shots, without
checking with your doctor first.
- Do not eat raw fish, seafood, meat, or eggs.
- Use an electric shaver instead of a razor to prevent breaks or cuts in
Symptoms of Infection
Call your doctor right away if you have any of these
- Fever over 100° F or 38° C.
- Chills, especially shaking chills.
- Loose bowel movements.
- Frequent urgency to urinate or a burning feeling when you urinate.
- A severe cough or sore throat.
- Unusual vaginal discharge or itching.
- Redness, swelling, or tenderness, especially around a wound, sore, ostomy, pimple,
rectal area or catheter site.
- Sinus pain or pressure.
- Earaches, headaches, or stiff neck.
- Blisters on the lips or skin.
- Mouth sores.
Report any signs of infection to your doctor right away, even if it
is in the middle of the night. This is especially important when your white
blood cell count is low. If you have a fever, do not take aspirin, acetaminophen,
or any other medicine to bring your temperature down without checking with
your doctor first.
Blood Clotting Problems
Anticancer drugs can affect the bone marrow's ability to make platelets, the
blood cells that help stop bleeding by making your blood clot. If your blood
does not have enough platelets, you may bleed or bruise more easily than usual,
even without an injury.
Call your doctor if you have any of these symptoms:
- unexpected bruising.
- small, red spots under the skin.
- reddish or pinkish urine.
- black or bloody bowel movements.
- bleeding from your gums or nose.
- vaginal bleeding that is new or lasts longer than a regular period.
- headaches or changes in vision.
- warm to hot feeling of an arm or leg.
Your doctor will check your platelet count often while you are having
chemotherapy. If your platelet count falls too low, the doctor may give you
a platelet transfusion to build up the count. There are also medicines called
colony stimulating factors that help increase your platelets.
How to Help Prevent Problems If Your Platelet Count Is Low
- Check with your doctor or nurse before taking
any vitamins, herbal remedies, including all over-the-counter medicines.
Many of these products contain aspirin, which can affect platelets.
- Before drinking any alcoholic beverages, check with your doctor.
- Use a very soft toothbrush to clean your teeth.
- When cleaning your nose blow gently into a soft tissue.
- Take extra care not to cut or nick yourself when using scissors, needles, knives,
- Be careful not to burn yourself when ironing or cooking.
- Avoid contact sports and other activities that might result in injury.
- Ask your doctor if you should avoid sexual activity.
- Use an electric shaver instead of a razor.
Mouth, Gum, and Throat Problems
Good oral care is important during cancer treatment. Some anticancer
drugs can cause sores in the mouth and throat, a condition called stomatitis
or mucositis. Anticancer drugs also can make these tissues dry and irritated
or cause them to bleed. Patients who have not been eating well since beginning
chemotherapy are more likely to get mouth sores.
In addition to being painful, mouth sores can become infected by the many germs
that live in the mouth. Every step should be taken to prevent infections,
because they can be hard to fight during chemotherapy and can lead to serious
How can I keep my mouth, gums, and throat healthy?
- Talk to your doctor about seeing your dentist at least several weeks before
you start chemotherapy. You may need to have your teeth cleaned and to take
care of any problems such as cavities, gum abscesses, gum disease, or poorly
fitting dentures. Ask your dentist to show you the best ways to brush and
floss your teeth during chemotherapy. Chemotherapy can make you more likely
to get cavities, so your dentist may suggest using a fluoride rinse or gel
each day to help prevent decay.
- Brush your teeth and gums after every meal. Use a soft toothbrush and
a gentle touch.
Brushing too hard can damage soft mouth tissues. Ask your doctor, nurse,
or dentist to suggest a special toothbrush and/or toothpaste if your gums
are very sensitive. Rinse with warm salt water after meals and before bedtime.
- Rinse your toothbrush well after each use and store it in a dry place.
- Avoid mouthwashes that contain any amount of alcohol. Ask your doctor
or nurse to suggest a mild or medicated mouthwash that you might use. For
example, mouthwash with sodium bicarbonate (baking soda) is non-irritating.
If you develop sores in your mouth, tell your doctor or nurse. You
may need medicine to treat the sores. If the sores are painful or keep you
from eating, you can try these ideas:
How can I cope with mouth sores?
- Ask your doctor if there is anything you can apply directly to the sores
or to prescribe a medicine you can use to ease the pain.
- Eat foods cold or at room temperature. Hot and warm foods can irritate
a tender mouth and throat.
- Eat soft, soothing foods, such as ice cream, milkshakes, baby food, soft
fruits (bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled
or scrambled eggs, yogurt, cottage cheese, macaroni and cheese, custards,
puddings, and gelatin. You also can puree cooked foods in the blender to
make them smoother and easier to eat.
- Avoid irritating, acidic foods and juices, such as tomato and citrus (orange,
grapefruit, and lemon); spicy or salty foods; and rough or coarse foods
such as raw vegetables, granola, popcorn, and toast.
How can I cope with mouth dryness?
- Ask your doctor if you should use an artificial saliva product to moisten
- Drink plenty of liquids.
- Ask your doctor if you can suck on ice chips, popsicles, or sugarless
hard candy. You can also chew sugarless gum. (Sorbitol, a sugar substitute
that is in many sugar-free foods, can cause diarrhea in many people. If
diarrhea is a problem for you, check the labels of sugar-free foods before
you buy them and limit your use of them.)
- Moisten dry foods with butter, margarine, gravy, sauces, or broth.
- Dunk crisp, dry foods in mild liquids.
- Eat soft and pureed foods.
- Use lip balm or petroleum jelly if your lips become dry.
- Carry a water bottle with you to sip from often.
When chemotherapy affects the cells lining the intestine, it can cause diarrhea
(watery or loose stools). If you have diarrhea that continues for more than
24 hours, or if you have pain and cramping along with the diarrhea, call your
doctor. In severe cases, the doctor may prescribe a medicine to control the
diarrhea. If diarrhea persists, you may need intravenous (IV) fluids to replace
the water and nutrients you have lost. Often these fluids are given as an outpatient
and do not require hospitalization. Do not take any over-the-counter medicines
for diarrhea without asking your doctor.
can I help control diarrhea?
- Drink plenty of fluids. This will help replace those you have lost through
diarrhea. Mild, clear liquids, such as water, clear broth, sports drinks
such as Gatorade, or ginger ale, are best. If these drinks make you more
thirsty or nauseous, try diluting them with water. Drink slowly and make
sure drinks are at room temperature. Let carbonated drinks lose their fizz
before you drink them.
- Eat small amounts of food throughout the day instead of three large meals.
- Unless your doctor has told you otherwise, eat potassium-rich foods. Diarrhea
can cause you to lose this important mineral. Bananas, oranges, potatoes,
and peach and apricot nectars are good sources of potassium.
- Ask your doctor if you should try a clear liquid diet to give your bowels
time to rest. A clear liquid diet does not provide all the nutrients you
need, so do not follow one for more than 3 to 5 days.
- Eat low-fiber foods. Low-fiber foods include white bread, white rice or
noodles, creamed cereals, ripe bananas, canned or cooked fruit without skins,
cottage cheese, yogurt without seeds, eggs, mashed or baked potatoes without
the skin, pureed vegetables, chicken, or turkey without the skin, and fish.
- Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber
foods include whole grain breads and cereals, raw vegetables, beans, nuts,
seeds, popcorn, and fresh and dried fruit.
- Avoid hot or very cold liquids, which can make diarrhea worse.
- Avoid coffee, tea with caffeine, alcohol, and sweets. Stay away from fried,
greasy, or highly spiced foods, too. They are irritating and can cause diarrhea
- Avoid milk and milk products, including ice cream, if they make your diarrhea
Some anticancer medicines, pain medicines, and other medicines can
cause constipation. It can also occur if you are less active or if your diet
lacks enough fluid or fiber. If you have not had a bowel movement for more
than a day or two, call your doctor, who may suggest taking a laxative or
stool softener. Do not take these measures without checking with your doctor,
especially if your white blood cell count or platelets are low.
What can I do about constipation?
- Drink plenty of fluids to help loosen the bowels. If you do not have mouth
sores, try warm and hot fluids, including water, which work especially well.
- Check with your doctor to see if you can increase the fiber in your diet
(there are certain kinds of cancer and certain side effects you may have
for which a high-fiber diet is not recommended). High fiber foods include
bran, whole-wheat breads and cereals, raw or cooked vegetables, fresh and
dried fruit, nuts, and popcorn.
- Get some exercise every day. Go for a walk or you may want to try a more
structured exercise program. Talk to your doctor about the amount and type
of exercise that is right for you.
Nerve and Muscle Effects
Sometimes anticancer drugs can cause problems with your body's nerves.
One example of a condition affecting the nervous system is peripheral neuropathy,
where you feel a tingling, burning, weakness, or numbness or pain in the
hands and/or feet. Some drugs can also affect the muscles, making them weak,
tired, or sore.
Sometimes, these nerve and muscle side effects, though annoying, may not be serious.
In other cases, nerve and muscle symptoms may be serious and need medical
attention. Be sure to report any nerve or muscle symptoms to your doctor.
Most of the time, these symptoms will get better; however, it may take up
to a year after your treatment ends.
Some nerve and muscle-related symptoms include:
- weakness or numbness in the hands and/or feet
- pain when walking
- weak, sore, tired or achy muscles
- loss of balance
- difficulty picking up objects and buttoning clothing
- shaking or trembling
- walking problems
- jaw pain
- hearing loss
- stomach pain
How can I cope with nerve and muscle problems?
- If your fingers are numb, be very careful when grasping objects that are
sharp, hot, or otherwise dangerous.
- If your sense of balance or muscle strength is affected, avoid falls by
moving carefully, using handrails when going up or down stairs, and using
bath mats in the bathtub or shower.
- Always wear shoes with rubber soles (if possible).
- Ask your doctor for pain medicine.
Effects on Skin and Nails
You may have minor skin problems while you are having chemotherapy,
such as redness, rashes, itching, peeling, dryness, acne, and increased sensitivity
to the sun. Certain anticancer drugs, when given intravenously, may cause
the skin all along the vein to darken, especially in people who have very
dark skin. Some people use makeup to cover the area, but this can take a
lot of time if several veins are affected. The darkened areas will fade a
few months after treatment ends.
Your nails may also become darkened, yellow, brittle, or cracked. They also may
develop vertical lines or bands.
While most of these problems are not serious and you can take care of them yourself,
a few need immediate attention. Certain drugs given intravenously (IV) can
cause serious and permanent tissue damage if they leak out of the vein. Tell
your doctor or nurse right away if you feel any burning or pain when you
are getting IV drugs. These symptoms do not always mean there is a problem,
but they must always be checked at once. Don't hesitate to call your doctor
about even the less serious symptoms.
Some symptoms may mean you are having an allergic reaction that may need to be
treated at once. Call your doctor or nurse right away if:
- you develop sudden or severe itching.
- your skin breaks out in a rash or hives.
- you have wheezing or any other trouble breathing.
How can I cope with skin and nail problems?
- Try to keep your face clean and dry.
- Ask your doctor or nurse if you can use over-the-counter medicated creams or
Itching and dryness
- Apply corn starch as you would a dusting powder.
- To help avoid dryness, take quick showers or sponge baths. Do not take long,
hot baths. Use a moisturizing soap.
- Apply cream and lotion while your skin is still moist.
- Avoid perfume, cologne, or aftershave lotion that contains alcohol.
- Use a colloid oatmeal bath or diphenhydramine for generalized pruritis.
- You can buy nail-strengthening products in a drug store. Be
aware that these products may bother your skin and nails.
- Protect your nails by wearing gloves when washing dishes, gardening, or doing
other work around the house.
- Be sure to let your doctor know if you have redness, pain, or changes around
- Avoid direct sunlight as much as possible, especially between 10 a.m.
and 4 p.m. when the sun's rays are the strongest.
- Use a sun screen lotion with a skin protection factor (SPF) of 15 or higher
to protect against sun damage. A product such as zinc oxide, sold over the
counter, can block the sun's rays completely.
- Use a lip balm with a sun protection factor.
- Wear long-sleeve cotton shirts, pants and hats with a wide brim (particularly
if you are having hair loss), to block the sun.
- Even people with dark skin need to protect themselves from the sun during
Some people who have had radiation therapy develop "radiation
recall" during their chemotherapy. During or shortly after certain anticancer drugs
are given, the skin over an area that had received radiation turns red — a
shade anywhere from light to very bright. The skin may blister and peel. This
reaction may last hours or even days. Report radiation recall reactions to
your doctor or nurse. You can soothe the itching and burning by:
- Placing a cool, wet compress over the affected area.
- Wearing soft, non-irritating fabrics. Women who have radiation for breast cancer
following lumpectomy often find cotton bras the most comfortable.
Kidney and Bladder Effects
Some anticancer drugs can irritate the bladder or cause temporary
or permanent damage to the bladder or kidneys. If you are taking one or more
of these drugs, your doctor may ask you to collect a 24-hour urine sample.
A blood sample may also be obtained before you begin chemotherapy to check
your kidney function. Some anticancer drugs cause the urine to change color
(orange, red, green, or yellow) or take on a strong or medicine-like odor
for 24-72 hours. Check with your doctor to see if the drugs you are taking
may have any of these effects.
Always drink plenty of fluids to ensure good urine flow and help prevent problems.
This is very important if you are taking drugs that affect the kidney and
bladder. Water, juice, soft drinks, broth, ice cream, soup, popsicles, and
gelatin are all considered fluids.
Tell your doctor if you have any of these symptoms:
- Pain or burning when you urinate (pass your water).
- Frequent urination.
- Not being able to urinate.
- A feeling that you must urinate right away ("urgency").
- Reddish or bloody urine.
- Chills, especially shaking chills.
Some people feel as though they have the flu for a few hours to a few days
after chemotherapy. This may be especially true if you are receiving chemotherapy
in combination with biological therapy. Flu-like symptoms — muscle and joint
aches, headache, tiredness, nausea, slight fever (usually less than 100°F),
chills, and poor appetite — may last from 1 to 3 days. An infection or the
cancer itself can also cause these symptoms. Check with your doctor if you
have flu-like symptoms.
Your body may retain fluid when you are having chemotherapy. This may be due
to hormonal changes from your therapy, to the drugs themselves, or to your
cancer. Check with your doctor or nurse if you notice swelling or puffiness
in your face, hands, feet, or abdomen. You may need to avoid table salt and
foods that have a lot of salt. If the problem is severe, your doctor may prescribe
a diuretic, medicine to help your body get rid of excess fluids.
on Sexual Organs
Chemotherapy may — but does not always — affect sexual organs (testis
in men, vagina and ovaries in women) and functioning in both men and women.
The side effects that might occur depend on the drugs used and the person's
age and general health.
MenChemotherapy drugs may lower the number of sperm cells and reduce their ability
to move. These changes can result in infertility, which may be temporary
or permanent. Infertility affects a man's ability to father a child, but
not a man's ability to have sexual intercourse. Other possible effects of
these drugs are problems with getting or keeping an erection and damage to
the chromosomes, which could lead to birth defects.
What You Can Do:
- Before starting treatment, talk to your doctor about the possibility of
sperm banking — a procedure that freezes sperm for future use — if infertility
may be a problem. Ask about the cost of sperm banking.
- Use birth control with your partner during treatment. Ask your doctor
how long you need to use birth control.
- Use a condom during sexual intercourse for the first 48 hours after the
last dose of chemotherapy because some of the chemotherapy may end up in
- Ask your doctor if the chemotherapy will likely affect your ability to
father a child. If so, will the effects be temporary or permanent?
WomenEffects on the ovaries. Anticancer drugs can
affect the ovaries and reduce the amount of hormones they produce. Some women
find that their menstrual periods become irregular or stop completely while
having chemotherapy. Related side effects may be temporary or permanent.
- Infertility. Damage to the ovaries may result in infertility, the inability
to become pregnant. The infertility can be either temporary or permanent.
Whether infertility occurs, and how long it lasts, depends on many factors,
including the type of drug, the dosage given, and the woman's age.
- Menopause. A woman's age and the drugs and dosages used will determine
whether she experiences menopause while on chemotherapy. Chemotherapy may
also cause menopause-like symptoms such as hot flashes and dry vaginal tissues.
These tissue changes can make intercourse uncomfortable and can make a woman
more prone to bladder and/or vaginal infections. Any infection should be
treated right away. (See "Infection.") Menopause may be temporary
Help for hot flashes:
- Dress in layers.
- Avoid caffeine and alcohol.
- Try meditation or other relaxation methods.
Relieving vaginal symptoms and preventing infection:
- Use a water or mineral oil-based vaginal lubricant at the time of intercourse.
- There are products that can be used to stop vaginal dryness. Ask your
pharmacist about vaginal gels that can be applied to the vagina.
- Avoid using petroleum jelly, which is difficult for the body to get rid
of and increases the risk of infection.
- Wear cotton underwear and pantyhose with a ventilated cotton lining.
- Avoid wearing tight slacks or shorts.
- Ask your doctor about prescribing a vaginal cream or suppository to reduce
the chances of infection.
- Ask your doctor about using a vaginal dilator if painful intercourse continues.
Pregnancy. Although pregnancy may be possible during chemotherapy,
it still is not advisable because some anticancer drugs may cause birth defects.
Doctors advise women of childbearing age, from the teens through the end
of menopause, to use some method of birth control throughout their treatment,
such as condoms, spermicidal agents, diaphragms or birth control pills. Birth
control pills may not be appropriate for some women, such as those with breast
cancer. Ask your doctor about these contraceptive options.
If a woman is pregnant when her cancer is discovered, it may be possible to delay
chemotherapy until after the baby is born. For a woman who needs treatment
sooner, the possible effects of chemotherapy on the fetus need to be evaluated.
Feelings About Sexuality
Sexual feelings and attitudes vary among people during chemotherapy.
Some people find that they feel closer than ever to their partners and have
an increased desire for sexual activity. Others experience little or no change
in their sexual desire and energy level. Still others find that their sexual
interest declines because of the physical and emotional stresses of having
cancer and getting chemotherapy. These stresses may include:
- worries about changes in appearance.
- anxiety about health, family, or finances.
- side effects of treatment, including fatigue, and hormonal changes.
A partner's concerns or fears also can affect the sexual relationship.
Some may worry that physical intimacy will harm the person who has cancer.
Others may fear that they might "catch" the cancer or be affected by the drugs. Both you and your partner should feel
free to discuss sexual concerns with your doctor, nurse, social worker, or
other counselor who can give you the information and the reassurance you
You and your partner also should try to share your feelings with each other.
If talking to each other about sex, cancer, or both, is hard, you may want
to speak to a counselor who can help you talk more openly. People who can
help include psychiatrists, psychologists, social workers, marriage counselors,
sex therapists, and members of the clergy.
If you were comfortable with and enjoyed sexual relations before starting chemotherapy,
chances are you will still find pleasure in physical intimacy during your
treatment. You may discover, however, that intimacy changes during treatment.
Hugging, touching, holding, and cuddling may become more important, while
sexual intercourse may become less important. Remember that what was true
before you started chemotherapy remains true now: There is no one "right" way to express your sexuality. You and your partner should decide together what
gives both of you pleasure.
Return to top
It is very important to eat well while you are getting chemotherapy.
Eating well during chemotherapy means choosing a balanced diet that contains
all the nutrients the body needs. Eating well also means having a diet high
enough in calories to keep your weight up and high enough in protein to rebuild
tissues that cancer treatment may harm. People who eat well can cope with
side effects and fight infection better. Also, their bodies can rebuild healthy
What If I Don't Feel Like Eating?
On some days you may feel you just cannot eat. You can lose your appetite
if you feel depressed or tired. Or, side effects such as nausea or mouth
and throat problems may make it difficult or painful to eat . In some cases,
if you cannot eat for a long period of time, your doctor may recommend that
you be given nutrition intravenously until you are able to eat again.
When a poor appetite is the problem, try these suggestions:
- Eat frequent, small meals or snacks whenever you want, perhaps four to
six times a day. You do not have to eat three regular meals each day.
- Keep snacks within easy reach, so you can have something whenever you
feel like it.
- Even if you do not want to eat solid foods, try to drink beverages during
the day. Juice, soup, and other fluids like these can give you important
calories and nutrients.
- Vary your diet by trying new foods and recipes.
- When possible, take a walk before meals; this may make you feel hungrier.
- Try changing your mealtime routine. For example, eat in a different location.
- Eat with friends or family members. When eating alone, listen to the radio
or watch TV.
- Ask your doctor or nurse about nutrition supplements.
- Speak with your dietician about your specific nutrition needs.
Can I Drink Alcoholic Beverages?
Small amounts of alcohol can help you relax and increase your appetite.
On the other hand, alcohol may interfere with how some drugs work and/or
worsen their side effects. For this reason, some people must drink less alcohol
or avoid alcohol completely during chemotherapy. Ask your doctor if and how
much beer, wine, or other alcoholic beverages you can drink during treatment.
Can I Take Extra Vitamins and Minerals?
You can usually get all the vitamins and minerals you need by eating
a healthy diet. Talk to your doctor, nurse, registered dietician, or a pharmacist
before taking any vitamin or mineral supplements. Too much of some vitamins
and minerals can be just as dangerous as too little. Find out what is recommended
Return to top
Chemotherapy, like cancer, can bring major changes to a person's life.
While it can help cure your cancer, it can sometimes affect overall health,
cause stress, disrupt day-to-day schedules, and strain personal relationships.
It is no wonder, then, that some people feel tearful, anxious, angry, or
depressed at some point during their chemotherapy.
These emotions can be perfectly normal, but they can also be disturbing. Fortunately,
there are ways to deal with these emotional side effects, just as there are
ways to cope with the physical side effects of chemotherapy.
How Can I Get Support?
You can draw on many sources of support. Here are some of the most
Doctors, nurses, and other health professionals. If you have questions or worries about your cancer treatment, talk with members
of your health care team. Tell them if you are feeling anxious or depressed,
or if you are experiencing other emotional or physical changes.
Counseling professionals. There are many kinds of counselors who can help you express, understand, and
cope with your feelings. If you are depressed, you should consider seeking
professional help. Feeling hopeless, worthless, guilty, or that life is not
worth living are signs of depression. Depending on your preferences and needs,
you may want to talk with a psychiatrist, psychologist, social worker, sex
therapist, or member of the clergy. There are also medicines that can be
used to treat depression. Many cancer centers have "psycho-oncology" programs with psychiatrists, psychologists, and social workers trained to work
with cancer patients. Your doctor, nurse, or social worker may be able to
suggest who to contact.
Friends and family members. Talking with friends or family members can help you feel a lot better. Often,
they can comfort and reassure you in ways that no one else can. However,
you may need to help them help you. At a time when you might expect that
others will rush to your aid, you may have to make the first move.
Asking friends and family for help. Many people do not understand cancer, and may withdraw from you because they
are afraid of your illness and not know what to do to help you. Others may
worry that they will upset you by saying "the wrong thing." You can help by being open in talking with others about your illness, your treatment,
your needs, and your feelings. By talking openly, you can correct mistaken
ideas about cancer. You can also let people know that there is no single "right" thing to say, as long as their caring comes through loud and clear. Once people
know they can talk with you honestly, they may be more willing and able to
open up and lend their support. Accepting help may be hard. When you allow
others to help, you make them feel less helpless. In a sense, you are helping
others deal with your illness.
Support groups. Support groups are made up of people who are going or have gone through the
same kinds of experiences as you. Many people with cancer find they can share
thoughts and feelings with group members that they do not feel comfortable
sharing with anyone else. Support groups also can serve as an important source
of practical information about living with cancer. Some studies suggest that
not only can support groups help with how you are feeling emotionally, but
may also help you recover physically from your cancer.
Support can also be found in one-to-one programs that put you in touch with another
person very similar to you in age, sex, type of cancer, and so forth. In
some programs, this person comes to visit you. In others, a "hotline" puts you in touch with someone you can talk with on the telephone. Later, you
may want to help others who are going through the same experience you did.
Sources for information about support programs, counseling advice, financial
assistance, transportation to and from treatment, and information about cancer
include neighborhood organizations, local health care providers, and your
hospital, clinic, or medical center where you are being treated. At public
libraries and patient libraries at hospitals, a librarian can help you find
books and articles through a literature search.
How Can I Make My Daily Life More Enjoyable?
- Share your feelings with friends and family.
- Watch funny movies.
- Help someone else.
- Listen to music.
- Try new hobbies and learn new skills.
- Exercise, if you can.
- Do things that interest you.
Many people with cancer are exploring complementary therapies. These
methods focus on the mind, body, and spirit. They do not take the place of
medical therapies, but add to them. They can reduce stress, lessen side effects
from cancer and cancer treatments, and enhance well-being. And they can help
you feel more in control; it is something you can do for yourself.
A few of the therapies available are described here. Many more therapies exist
such as art therapy, humor, journaling, reiki, music therapy, pet therapy
and others. You may want to check with your doctor before using these techniques,
especially if you have lung problems. A social worker, psychologist, or nurse
may be able to help you with these therapies. You may also want to read books,
listen to audiotapes, and watch videotapes about these techniques.
With training in biofeedback, you can control body functions such
as heart rate, blood pressure, and muscle tension. A machine will sense when
your body shows signs of tension and lets you know in some way such as making
a sound or flashing a light. The machine also gives you feedback when you
relax your body. Eventually, you can control your relaxation responses without
having to depend on feedback from the machine. Your doctor, nurse, or social
worker can refer you to someone trained in teaching biofeedback.
Distraction is the use of an activity to take your mind off your worries or
discomforts. Talking with friends or relatives, watching TV, listening to the
radio, reading, going to the movies, or working with your hands by doing needlework
or puzzles, building models, or painting are all ways to distract yourself.
Many cancer centers now have music or creative art therapists who can be very
helpful to you while you are getting treatment for your cancer. Ask your nurse
or social work department about possible resources in your area.
Hypnosis puts you in a deeply-relaxed state that can help reduce discomfort
and anxiety. You can be hypnotized by a qualified person, or you can learn
how to hypnotize yourself. If you are interested in learning more, ask your
doctor, nurse, or social worker to refer you to someone trained in the technique.
Imagery is a way of daydreaming that uses all your senses. It is usually done
with your eyes closed. To begin, breathe slowly and feel yourself relax. Imagine
a ball of healing energy-- perhaps a white light--forming somewhere in your
body. When you can "see" the
ball of energy, imagine that as you breathe in you can blow the ball to any
part of the body where you feel pain, tension, or discomfort such as nausea.
When you breathe out, picture the air moving the ball away from your body,
taking with it any painful or uncomfortable feelings. (Be sure to breathe naturally;
do not blow.) Continue to picture the ball moving toward you and away from
you each time you breathe in and out. You may see the ball getting bigger and
bigger as it takes away more and more tension and discomfort. To end the imagery,
count slowly to three, breathe in deeply, open your eyes, and say to yourself, "I feel alert and relaxed."
The idea that touch can heal is an old one. The first written records of massage
date back 3,000 years ago to China. Massage therapy involves touch and different
methods of stroking and kneading the muscles of the body. A licensed massage
therapist should do the therapy. Talk to your doctor before beginning this
Meditation is a relaxation technique that allows you to focus your energy and
your thoughts on something very specific. This is especially helpful when your
mind and body are stressed from cancer treatment. For example, you may want
to repeat a word (over and over), or look at an object, such as a picture.
Another form of meditation is allowing your thoughts, feelings, and images
to flow through your mind. For patients who believe in a higher spiritual power,
prayer can provide strength, comfort and inspiration throughout the cancer
experience. Whether you pray alone, with family and friends, or as a member
of a religious community, prayer may help. A member of the clergy or your spiritual
advisor can help you incorporate prayer into your daily life.
Tension and Release
Lie down in a quiet room. Take a slow, deep breath. As you breathe
in, tense a particular muscle or group of muscles. For example, you can squeeze
your eyes shut, frown, clench your teeth, make a fist, or stiffen your arms
or legs. Hold your breath and keep your muscles tense for a second or two.
Then breathe out, release the tension, and let your body relax completely.
Repeat the process with another muscle or muscle group. You also can try
a variation of this method, called "progressive relaxation." Start with the toes of one foot and, working upward, progressively tense and
relax all the muscles of one leg. Next, do the same with the other leg. Then
tense and relax the rest of the muscle groups in your body, including those
in your scalp. Remember to hold your breath while tensing your muscles and
to breathe out when releasing the tension.
Exercise can help lessen pain, strengthen weak muscles, restore balance,
and decrease depression and fatigue. After getting approval from your doctor,
you may want to begin by walking 5-10 minutes twice a day and later increasing
Get in a comfortable position and relax all your muscles. If you keep
your eyes open, focus on a distant object. If you close your eyes, imagine
a peaceful scene or simply clear your mind and focus on your breathing.
Breathe in and out slowly and comfortably through your nose. If you like, you
can keep the rhythm steady by saying to yourself, "In, one two; out, one two." Feel yourself relax and go limp each time you breathe out.
You can do this technique for just a few seconds or for up to 10 minutes. End
your rhythmic breathing by counting slowly and silently to three.
Visualization is similar to imagery. With visualization, you create
an inner picture that represents your fight against cancer. Some people getting
chemotherapy use images of rockets blasting away their cancer cells or of
knights in armor battling their cancer cells. Others create an image of their
white blood cells or their drugs attacking the cancer cells.
All you need is a quiet, comfortable place and some time each day
to practice breathing, stretching, and meditation. To learn about yoga you
may want to take a class and review books, audiotapes, or videotapes on yoga.
Ask your social worker, psychologist, or psychiatrist about yoga classes
in your area.
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Tell your doctor if you get any side effects from
Tell the doctor if you have any of these problems:
- Feeling tired
- Sores in your mouth or throat
- Coughing a lot
- Feeling tingling in your fingers and toes
- Ringing in your ears
- Red dots under your skin
- Black and blue marks
- Feeling sick to your stomach or throwing up
- Loose or runny bowel movements
- A fever of 101 degrees of higher
Ask your doctor before you take any other medicine
Taking other medicine during treatment can cause problems. To get
the best results:
- Tell your doctor about all other
medicines you take, even if they're for birth control.
- Tell your doctor about medicines another doctor gave you or that you bought at
- Don't take aspirin unless your doctor says it's O.K. Aspirin is in a lot of drugs.
Ask the pharmacist if there's aspirin in any drug you're thinking about
- Don't take any medication unless your doctor says it's okay.
Take care of your health
- Keep your weight about the same
- Try not to lose or gain.
- Drink lots of liquids
- If your stomach is not upset, eat foods like these each day:
Take good care of your mouth, even if it is sore
- Try to brush your teeth after every meal.
- Use a soft toothbrush and regular flavored toothpaste
- If you can't brush, rinse your mouth with water.
Stay away from people who have colds or the flu
Their germs could make you sick
Have all the blood tests your doctor orders
Blood tests help your doctor watch your health
Take care of your health Talk about your feelings
Being treated for cancer can change the way you feel about things.
It can make you feel sad or mad or scared. That's normal. But it can help
to talk about it.
Some people talk to their friends or family. Some talk to others who have had
cancer or to a counselor. Your nurse or social worker can tell you more.
Many people also have questions about sex and birth control. Talk to your doctor
or nurse about your choices.
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This patient summary on oral complications of
cancer and cancer therapy is adapted from the summary written for health
professionals by cancer experts. This and other accurate, credible information
about cancer treatment, screening, prevention, supportive care, and ongoing
clinical trials is available from the National Cancer Institute. Oral complications
are common in cancer patients, especially those with head and neck cancer.
This summary describes oral complications caused by chemotherapy and radiation
therapy and various methods of prevention and treatment.
Oral complications are common in patients
receiving chemotherapy or undergoing radiation therapy to the head and
The oral cavity is at high risk of side effects
from chemotherapy and radiation therapy for a number of reasons.
- Chemotherapy and radiation therapy stop the growth of rapidly dividing
cells, such as cancer cells. Since normal cells in the lining of the mouth
also divide rapidly, anticancer treatment can prevent cells in the mouth
from reproducing, making it difficult for oral tissue to repair itself.
- The mouth contains hundreds of different bacteria, some helpful and some
harmful. Chemotherapy and radiation therapy can cause changes in the lining
of the mouth and production of saliva and upset the healthy balance of bacteria.
These changes may lead to mouth sores, infections, and tooth decay.
- Wear and tear occur from normal use of the mouth, teeth, and jaws, making
healing more difficult.
Preventive measures may lessen the severity
of oral complications.
Oral side effects may make it difficult for
a patient to receive all of his or her cancer treatment. Sometimes treatment
must be stopped. Preventing and controlling oral complications will enhance
both the patient's quality of life and the effectiveness of cancer therapy.
Preventing and treating oral complications of
cancer therapy involve identifying the patient at risk, starting preventive
measures before cancer therapy begins, and treating complications as soon
as they appear.
Radiation therapy and chemotherapy may cause
some of the same oral side effects, including the following:
- Mucositis (an inflammation of the mucous membranes in the mouth).
- Infections in the mouth or that travel through the bloodstream, reaching and
affecting cells all over the body.
- Taste changes.
- Dry mouth.
- Changes in dental growth and development in children.
- Malnutrition (lack of nutrients needed by the body for health, often caused by
the inability to eat).
- Dehydration (lack of water needed by the body for health, often caused by the
inability to drink).
- Tooth decay and gum disease.
Complications may be caused directly or
indirectly by anticancer therapy.
Oral complications associated with chemotherapy
and radiation therapy may be caused directly by the treatment or may result
indirectly from side effects of the treatment. Radiation therapy may directly
damage oral tissue, salivary glands, and bone. Areas treated may scar or
Slow healing and infection are indirect complications
of cancer treatment. Both chemotherapy and radiation therapy can affect the
ability of cells to reproduce, which slow the healing process in the mouth.
Chemotherapy may reduce the number of white blood cells and weaken the immune
system (the organs and cells that defend the body against infection and disease),
making it easier for the patient to develop an infection.
Complications can be acute or chronic.
Acute complications are those that occur during
therapy. Chemotherapy usually causes acute complications that heal after
Chronic complications are those that continue
or develop months to years after therapy ends. Radiation can cause acute
complications but may also cause permanent tissue damage that puts the patient
at a lifelong risk of oral complications. The following chronic complications
commonly continue after radiation therapy to the head and/or neck has ended:
- Dry mouth.
- Tooth decay.
- Taste changes.
- Problems using the mouth and jaw due to tissue and bone loss and/or the growth
of benign tumors in the skin and muscle.
Invasive dental procedures can cause additional
problems. The dental care of patients who have undergone radiation therapy
will therefore need to be adapted to the patient's ongoing complications.
Finding and treating oral problems before
anticancer therapy begins can prevent or lessen the severity of oral complications.
Oral complications in patients undergoing treatment
for head and neck cancer may be reduced by aggressive prevention measures
taken before treatment begins. This will get the mouth and teeth in the best
possible condition to withstand treatment.
Preventive measures include the following:
- Eating a well-balanced diet. Proper nutrition can help the body tolerate
the stress of cancer treatment, maintain energy, fight infection, and rebuild
- Learning how to care for the mouth and teeth during and after anticancer
therapy. Good dental hygiene helps prevent cavities, mouth sores, and infections.
- Having a complete oral health exam by a dentist familiar with the oral
side effects of anticancer treatments.
The cancer care team should include the patient's
dentist. It is important to choose a dentist familiar with the oral side
effects of chemotherapy and/or radiation therapy. An evaluation of the patient's
oral health at least a month before treatment begins usually provides enough
time for the mouth to heal after dental work. The dentist will identify and
treat teeth at risk for infection or decay, so the patient may avoid having
invasive dental treatment during anticancer therapy. The dentist may also
provide appropriate preventive care to lessen the severity of dry mouth,
a common complication of radiation therapy to the head and neck.
A preventive oral health exam will check
for the following:
- Mouth sores or infections.
- Tooth decay.
- Gum disease.
- Dentures that do not fit well.
- Problems moving the jaw.
- Problems with the salivary glands.
Patients undergoing high-dose chemotherapy,
stem cell transplant, and/or radiation therapy need an oral care plan in
place before treatment begins.
The goal of the oral care plan is to find and
treat oral disease that may produce complications during treatment and to
continue oral care throughout treatment and recovery. Different oral complications
may occur during the different phases of transplantation. Steps can be taken
ahead of time to prevent or lessen the severity of these side effects.
Ongoing oral care during radiation therapy will
depend on the specific needs of the patient; the dose, locations, and duration
of the radiation treatment; and the specific complications that occur.
It is important that patients who have
head or neck cancer stop smoking.
Continued smoking slows recovery and increases
the risk that the head or neck cancer will recur or that a second cancer
Routine Oral Care
Continuing good dental hygiene during and after
cancer treatment can reduce complications such as cavities, mouth sores,
and infections. It is important to clean the mouth after eating. The following
are guidelines for everyday oral care during chemotherapy and radiation therapy:
- Brush teeth and gums with a soft bristle brush 2 to 3 times a day for
2 to 3 minutes.
- Rinse the toothbrush in hot water every 15 to 30 seconds to soften the
bristles, if needed.
- If it is necessary to use a foam toothbrush, use it with an antibacterial
rinse, when possible.
- Allow the toothbrush to air dry between brushings.
- Choose toothpaste with care:
- Use a mild-tasting toothpaste; flavoring may irritate the mouth.
- If toothpaste irritates the mouth, brush with a solution of 1 teaspoon
of salt added to 4 cups (1 quart) of water.
- Use a fluoride toothpaste.
- Rinse the mouth 3 or 4 times while brushing.
- Avoid rinses containing alcohol.
- One of the following rinses made with salt and/or baking soda may be used:
- 1 teaspoon of salt in 4 cups of water.
- 1 teaspoon of baking soda in 1 cup (8 ounces) of water.
- ½ teaspoon salt and 2 tablespoons baking soda in 4 cups of water.
- An antibacterial rinse may be used 2 to 4 times a day for gum disease.
Rinse for 1 to 2 minutes.
- If dry mouth occurs, rinsing may not be enough to clean the teeth after
a meal. Brushing and flossing may be needed.
- Use lip care products to prevent drying and cracking.
Mucositis is an inflammation of mucous
membranes in the mouth.
The terms "oral mucositis" and "stomatitis" are
often used in place of each other, but their meanings are different.
- Mucositis is an inflammation of mucous membranes in the mouth. It usually
appears as red, burn-like sores or as ulcer-like sores throughout the mouth.
- Stomatitis is an inflammation of tissues in the mouth, such as the gums,
tongue, roof and floor of the mouth, and tissues inside the lips and cheeks.
It includes infections of mucous membranes.
Mucositis may be caused by either radiation
therapy or chemotherapy. In patients receiving chemotherapy, mucositis will
heal by itself, usually in 2 to 4 weeks when there is no infection. Mucositis
caused by radiation therapy usually lasts 6 to 8 weeks, depending on the
duration of treatment.
The following problems may occur:
- Bleeding, in patients receiving chemotherapy. Patients undergoing radiation therapy
usually do not have a bleeding risk.
- Inability to breathe and eat normally.
Swishing ice chips in the mouth for 30 minutes
may help prevent mucositis from developing in patients who are given fluorouracil.
Care of mucositis during chemotherapy
and radiation therapy focuses on cleaning the mouth and relieving the symptoms.
Treatment of mucositis caused by either radiation
therapy or chemotherapy is generally the same. After mucositis has developed,
proper treatment depends on its severity and the patient's white blood cell
count. The following are guidelines for treating mucositis during chemotherapy,
stem cell transplantation, and radiation therapy:
Cleaning the mouth
- Try topical medications for pain. Rinse the mouth before applying the
medication onto the gums or lining of the mouth. Wipe mouth and teeth gently
with wet gauze dipped in saltwater to remove particles.
- Painkillers may provide relief when topical medications do not. Nonsteroidal
anti-inflammatory drugs (NSAIDS, aspirin-type painkillers) should not be
used by patients receiving chemotherapy because these patients have a bleeding
- Capsaicin, the active ingredient in hot peppers, may be used to increase
a person's ability to tolerate pain. When capsaicin is put on inflamed tissues
in the mouth, mucositis pain may decrease as the burning feeling from the
capsaicin decreases. The side effects of capsaicin are not known.
Damage to the lining of the mouth and
a weakened immune system make it easier for infection to occur.
Oral mucositis breaks down the lining of the
mouth, allowing germs and viruses to get into the bloodstream. When the immune
system is weakened by chemotherapy, even good bacteria in the mouth can cause
infections, as can disease-causing organisms picked up from the hospital
or other sources. As the white blood cell count gets lower, infections may
occur more often and become more serious. Patients who have low white blood
cell counts for a long time are more at risk of developing serious infections.
Dry mouth, common during radiation therapy to the head and neck, may also
raise the risk of infections in the mouth. Preventive dental care during
chemotherapy and radiation therapy can reduce the risk of mouth, tooth, and
The following types of infections may
Treatment of bacterial infections in patients
who have gum disease and receive high-dose chemotherapy may include the following:
- Medicated and peroxide mouth rinses.
- Brushing and flossing.
- Wearing dentures as little as possible.
Bacterial infections in patients undergoing
radiation therapy are usually treated with antibiotics.
The mouth normally contains fungi that can exist
on or in the body without causing any problems. An overgrowth of fungi, however,
can be serious and requires treatment.
Antibiotics and steroid drugs are often used
when a patient receiving chemotherapy has a low white blood cell count. These
drugs change the balance of bacteria in the mouth, making it easier for a
fungal overgrowth to occur. Fungal infections are common in patients treated
with radiation therapy.
Drugs may be given to prevent fungal infections
from occurring. Treatment of surface fungal infections in the mouth only
may include mouthwashes and lozenges that contain antifungal drugs. These
are used after removing dentures, brushing the teeth, and cleaning the mouth.
An antibacterial rinse should be used on dentures and dental appliances and
to rinse the mouth.
Deeper fungal infections, such as those in
the esophagus or intestines, are treated with drugs taken by mouth or injection.
Patients receiving chemotherapy, especially
those with weakened immune systems, are at risk of mild to serious viral
infections. Finding and treating the infections early is important. Drugs
may be used to prevent or treat viral infections.
Herpesvirus infections may recur in radiation
therapy patients who have these infections.
Bleeding may occur during chemotherapy
when anticancer drugs affect the ability of blood to clot.
Areas of gum disease may bleed on their own
or when irritated by eating, brushing, or flossing. Bleeding may be mild
(small red spots on the lips, soft palate, or bottom of the mouth) or severe,
especially at the gumline and from ulcers in the mouth. When blood counts
drop below certain levels, blood may ooze from the gums.
With close monitoring, most patients
can safely brush and floss throughout the entire time of decreased blood
Continuing regular oral care will help prevent
infections that may further complicate bleeding problems. The dentist or
doctor can provide guidance on how to treat bleeding and safely keep the
mouth clean when blood counts are low.
Treatment for bleeding during chemotherapy
may include the following:
- Medications to reduce blood flow and help clots form.
- Topical products that cover and seal bleeding areas.
- Rinsing with a mixture of one part 3% hydrogen peroxide to 2 or 3 parts saltwater
solution (1 teaspoon of salt in 4 cups of water) to help clean oral wounds.
Rinsing must be done carefully so clots are not disturbed.
Dry mouth (xerostomia) occurs when the
salivary glands produce too little saliva.
Saliva is needed for taste, swallowing, and
speech. It helps prevent infection and tooth decay by neutralizing acid and
cleaning the teeth and gums. Chemotherapy and radiation therapy can damage
salivary glands, causing them to produce too little saliva. The mouth is
less able to clean itself. Acid in the mouth is not neutralized, and minerals
are lost from the teeth. Tooth decay and gum disease are more likely to develop.
Symptoms of dry mouth include the following:
- Thick, stringy saliva.
- Increased thirst.
- Changes in taste, swallowing, and speech.
- A sore or burning feeling (especially on the tongue).
- Cuts or cracks in the lips or at the corners of the mouth.
- Changes in the surface of the tongue.
- Difficulty wearing dentures.
Salivary glands usually return to normal
after chemotherapy ends.
Dry mouth during chemotherapy is usually temporary.
The salivary glands often recover 2 to 8 weeks after chemotherapy ends.
Salivary glands may not recover completely
after radiation therapy ends.
Saliva production drops within 1 week after
starting radiation therapy to the head and/or neck and continues to decrease
as treatment continues. The severity of dry mouth depends on the dose of
radiation and the number of glands irradiated. The salivary glands in the
upper cheeks near the ears are more affected than other salivary glands.
Partial recovery of salivary glands may occur
in the first year after radiation therapy, but recovery is usually not complete,
especially if the salivary glands were directly irradiated. Salivary glands
that were not irradiated may become more active to offset the loss of saliva
from the destroyed glands.
Careful oral hygiene can help prevent
mouth sores, gum disease, and tooth decay caused by dry mouth.
The following are guidelines for managing
- Clean the mouth and teeth at least 4 times a day.
- Floss once a day.
- Use a fluoride toothpaste when brushing.
- Apply fluoride gel once a day at bedtime, after cleaning the teeth.
- Rinse 4 to 6 times a day with a solution of salt and baking soda (mix ½ teaspoon
salt and ½ teaspoon baking soda in 1 cup of warm water). Avoid foods and
liquids that contain a lot of sugar. Sip water to relieve mouth dryness.
A dentist can provide the following treatments:
- Solutions to replace minerals in the teeth.
- Rinses to fight infection in the mouth.
- Saliva substitutes or medications to stimulate the salivary glands.
- Fluoride treatments to prevent tooth decay.
Dry mouth and changes in the balance of oral
bacteria increase the risk of tooth decay. Meticulous oral hygiene and regular
care by a dentist can help prevent cavities.
Changes in taste are common during chemotherapy
and radiation therapy.
Change in the sense of taste (dysgeusia) is
a common side effect of both chemotherapy and head and/or neck radiation
therapy. Foods may have no taste or may not taste as they did before therapy.
These taste changes are caused by damage to the taste buds, dry mouth, infection,
and/or dental problems. Chemotherapy patients may experience unpleasant taste
related to the spread of the drug within the mouth. Radiation may cause a
change in sweet, sour, bitter, and salty tastes.
In most patients receiving chemotherapy and
in some patients undergoing radiation therapy, taste returns to normal a
few months after therapy ends. For many radiation therapy patients, however,
the change is permanent. In others, the taste buds may recover 6 to 8 weeks,
or later, after radiation therapy ends. Zinc sulfate supplements may help
with the recovery for some patients.
Taste changes can lead to a loss of
appetite and malnutrition.
Unpleasant changes in the taste of food can
cause a patient with cancer to lose the desire to eat. The patient's quality
of life and nutritional well-being may be affected by loss of appetite. The
following suggestions may help patients with cancer manage taste changes
and meet nutritional needs:
- Change the texture of food. Serving food chopped, ground, or
blended can reduce the amount of time it needs to stay in the mouth before
- Eat between-meal snacks to add calories and nutrients.
- Choose foods high in calories and protein.
- Take supplements that provide vitamins, minerals, and calories.
Nutritional counseling may be helpful during
and after therapy.
Cancer patients who are undergoing high-dose
chemotherapy and/or radiation therapy often experience fatigue (lack of energy)
that is related to either the cancer or its treatment. Some patients may
have difficulty sleeping. The patient may feel too tired to perform routine
oral care, which may further increase the risk for mouth ulcers, infection,
Certain anticancer drugs can cause nerve
damage that may result in oral pain.
If an anticancer drug is causing the pain,
stopping the drug usually stops the pain. Because there may be many causes
of oral pain during cancer treatment, a careful diagnosis is important. This
may include obtaining a medical history, performing physical and dental exams,
and taking x-rays of the teeth.
Tooth sensitivity may occur in some patients
weeks or months after chemotherapy has ended. Fluoride treatments and/or
toothpaste for sensitive teeth may relieve the discomfort.
Pain in the teeth or jaw muscles may
occur from tooth grinding or stress.
Pain in the teeth or jaw muscles may occur
in patients who grind their teeth or clench their jaws, often because of
stress or the inability to sleep. Treatment may include the following:
- Muscle relaxers.
- Drugs to treat anxiety.
- Physical therapy (moist heat, massage, and stretching).
- Mouthguards to wear while sleeping.
A long-term complication of radiation therapy
is the growth of benign tumors in the skin and muscles. These tumors may
make it difficult for the patient to move the mouth and jaw normally. Oral
surgery may also affect jaw mobility. Management of jaw stiffness may include
Tissue and Bone Loss
- Physical therapy.
- Oral appliances.
- Pain treatments.
Radiation therapy can cause tissue and bone
in the treated area to waste away. When tissue death occurs, ulcers may form
in the soft tissues of the mouth, grow in size, and cause pain or loss of
feeling. Infection becomes a risk. As bone tissue is lost, fractures can
occur. Preventive care can lessen the severity of tissue and bone loss.
Treatment of tissue and bone loss may include
- Eating a well-balanced diet.
- Wearing removable dentures or appliances as little as possible.
- Not smoking.
- Not drinking alcohol.
- Using topical antibiotics.
- Using painkillers.
- Undergoing surgery to remove dead bone or to reconstruct bones of the mouth and
- Receiving hyperbaric oxygen therapy, a method of delivering oxygen under pressure
to the surface of a wound to help it heal.
Patients who have received transplants
are at risk of graft-versus-host disease.
Graft-versus-host disease (GVHD) is a reaction
of donated bone marrow or stem cells against the patient's tissue. Symptoms
of oral GVHD include the following:
- Sores that appear in the mouth 2 to 3 weeks after the transplant.
- Dry mouth.
- Pain from spices, alcohol, or flavoring (such as mint in toothpaste).
Biopsies taken from the lining of the mouth
and salivary glands may be needed to diagnose oral GVHD. Treatment of oral
GVHD may include the following:
- Topical rinses, gels, creams, or powders.
- Antifungal drugs taken by mouth or injection.
- Psoralen (a drug used with ultraviolet light to treat skin disease).
- Drugs that promote the production of saliva.
- Fluoride treatments.
- Treatments to replace minerals lost from teeth by acids in the mouth.
Dentures, braces, and oral appliances
require special care during high-dose chemotherapy and/or stem cell transplant.
The following are guidelines for the care
and use of dentures, braces, and other oral appliances during high-dose chemotherapy
and/or stem cell transplant:
- Remove brackets, wires, and retainers before high-dose chemotherapy
- Wear dentures only when eating during the first 3 to 4 weeks after the transplant.
- Brush dentures twice a day and rinse them well.
- Soak dentures in an antibacterial solution when they are not being worn.
- Clean denture soaking cups and change denture soaking solution every day.
- Remove appliances or dentures when cleaning the mouth.
- If mouth sores are present, avoid wearing removable appliances until the mouth
Dental treatments may be resumed when
the transplant patient's immune system returns to normal.
Routine dental treatments, including scaling
and polishing, should be delayed until the transplant patient's immune system
returns to normal. Caution is advised for at least a year after the transplant.
Cancer survivors who received chemotherapy or
a transplant or who underwent radiation therapy are at risk of developing
a second cancer later in life. Oral squamous cell cancer is the most common
second cancer occurring in transplant patients. The lips and tongue are the
sites most often affected.
The social aspects of oral complications can
make them the most difficult problems for cancer patients to cope with. Oral
complications affect eating and speaking and may make the patient unable
or unwilling to take part in mealtimes or to dine out. Patients may become
frustrated, withdrawn, or depressed, and they may avoid other people. Some
drugs that are used to treat depression may not be an option because they
cause side effects that make oral complications worse.
Education, supportive care, and the treatment
of symptoms are important for patients who have mouth problems that are related
to cancer therapy. Patients will be closely monitored for pain, ability to
cope, and response to treatment. Supportive care from health care providers
and family can help the patient cope with cancer and its complications.
A change in dental growth and development is
a special complication for cancer survivors who received high-dose chemotherapy
and/or radiation therapy to the head and neck for childhood cancers. Changes
may occur in the size and shape of the teeth; eruption of teeth may be delayed;
and development of the head and face may not reach full maturity. The role
and timing of orthodontic treatment for patients with altered dental growth
and development is under study. Some treatments have been successful, but
standard guidelines have not yet been established.
- What are targeted cancer therapies?
Targeted cancer therapies use drugs that block the growth and spread
of cancer. They interfere with specific molecules involved in carcinogenesis
(the process by which normal cells become cancer cells) and tumor growth.
Because scientists call these molecules “molecular targets,” these therapies
are sometimes called “molecular-targeted drugs,” “molecularly targeted
therapies,” or other similar names. By focusing on molecular and cellular
changes that are specific to cancer, targeted cancer therapies may be
more effective than current treatments and less harmful to normal cells.
Most targeted cancer therapies are in preclinical testing (research with
animals), but some are in clinical trials (research studies with people),
or have been approved by the U.S. Food and Drug Administration (FDA).
Targeted cancer therapies are being studied for use alone, in combination
with each other, and in combination with other cancer treatments, such
- What are some of the cellular changes that lead to cancer?
Normally, cells grow and divide to form new cells as the body needs them.
When cells grow old, they die, and new cells take their place. Sometimes
this orderly process goes wrong. New cells form when the body does not
need them, and old cells do not die when they should. These extra cells
can form a mass of tissue called a growth or tumor. The cells in malignant
(cancerous) tumors are abnormal and divide without control or order. They
can invade and damage nearby tissues and organs. Also, cancer cells can
break away from a malignant tumor and spread to other parts of the body.
Normal cell growth and division are largely under the control of a network
of chemical and molecular signals that give instructions to cells. Genetic
alterations (changes) can disrupt the signaling process so that cells
no longer grow and divide normally, or no longer die when they should.
Alterations in two types of genes can contribute to the cancer process.
Proto-oncogenes are normal genes that are involved in cell growth and
division. Changes in these genes lead to the development of oncogenes,
which can promote or allow excessive and continuous cell growth and division.
Tumor suppressor genes are normal genes that slow down cell growth
and division. When a tumor suppressor gene does not work properly, cells
may be unable to stop growing and dividing, which leads to tumor growth.
To use the metaphor of a car, the presence of an oncogene is like having
a gas pedal that is stuck to the floorboard, causing cells to continually
grow and divide. Tumor suppressor genes act like a brake pedal. The loss
of a functioning tumor suppressor gene is like having a brake pedal that
does not work properly, allowing cells to continually grow and divide.
Genetic changes that are not corrected by the cell can lead to the production
of abnormal proteins. Normally, proteins interact with each other as a
kind of relay team to carry out the work of the cell. For example, when
molecules called growth factors (GFs) attach to their corresponding growth
factor receptors (GFRs) on the surface of the cell, a process carried
out by proteins signals the cell to divide. Damaged proteins may not respond
to normal signals, may over-respond to normal signals, or otherwise fail
to carry out their normal functions. Cancer develops when abnormal proteins
inside a cell cause it to reproduce excessively and allow that cell to
live longer than normal cells.
- How do targeted cancer therapies work?
Targeted cancer therapies interfere with cancer cell growth and division
in different ways and at various points during the development, growth,
and spread of cancer. Many of these therapies focus on proteins that are
involved in the signaling process. By blocking the signals that tell cancer
cells to grow and divide uncontrollably, targeted cancer therapies can
help to stop the growth and division of cancer cells.
- What are some types of targeted cancer therapies?
Targeted cancer therapies include several types of drugs. Some examples
are listed below:
- “Small-molecule” drugs block specific enzymes and GFRs involved in
cancer cell growth. These drugs are also called signal-transduction
inhibitors. Gleevec® (STI–571 or imatinib mesylate) is a small-molecule
drug approved by the FDA to treat gastrointestinal stromal tumor (a
rare cancer of the gastrointestinal tract) and certain kinds of chronic
myeloid leukemia (1, 2). Gleevec targets abnormal proteins, or enzymes,
that form inside cancer cells and stimulate uncontrolled growth. Iressa®
(ZD1839 or gefitinib) is approved by the FDA to treat advanced non-small
cell lung cancer. This drug targets the epidermal growth factor receptor
(EGFR), which is overproduced by many types of cancer cells. Other small-molecule
drugs are being studied in clinical trials in the United States.
- “Apoptosis-inducing” drugs cause cancer cells to undergo apoptosis
(cell death) by interfering with proteins involved in the process. Velcade®
(bortezomib) is approved by the FDA to treat multiple myeloma that has
not responded to other treatments (3). Velcade causes cancer cells to
die by blocking enzymes called proteasomes, which help to regulate cell
function and growth. Another apoptosis-inducing drug called Genasense™
(oblimersen), which is only available in clinical trials, is being studied
to treat leukemia, non-Hodgkin’s lymphoma, and solid tumors. Genasense
blocks the production of a protein known as BCL–2, which promotes the
survival of tumor cells. By blocking BCL–2, Genasense leaves the cancer
cells more vulnerable to anticancer drugs.
- Monoclonal antibodies, cancer vaccines, angiogenesis inhibitors, and
gene therapy are considered by some to be targeted therapies because
they interfere with the growth of cancer cells. Information about these
treatments can be found in the following NCI fact sheets, which are
available on the Internet or by calling the Cancer Information Service
(CIS) (see below):
—Biological Therapies: Using the Immune System To Treat Cancer
includes information about monoclonal antibodies and cancer vaccines.
—Herceptin® (Trastuzumab): Questions and Answers contains
information about Herceptin, which is a monoclonal antibody.
—Angiogenesis Inhibitors in the Treatment of Cancer
—Gene Therapy for Cancer:
- What impact will targeted therapies have on cancer treatment?
Targeted cancer therapies will give doctors a better way to tailor cancer
treatment. Eventually, treatments may be individualized based on the unique
set of molecular targets produced by the patient’s tumor. Targeted cancer
therapies also hold the promise of being more selective, thus harming
fewer normal cells, reducing side effects, and improving the quality of