Symptoms and Side Effects
Anxiety is one of the most common emotional responses to cancer. It is a natural reaction. Questions like 'How will I cope?', 'What is going to happen?', 'Will I get better?' and 'Will the treatment work?', will probably go through your mind.
Anxious feelings may be present all of the time, or may come and go. They can also vary in how severe and disruptive they are. Anxiety may show itself as physical symptoms such as:
- breathing too fast
- tense muscles
- a dry mouth
- feeling sick
- chest pain or discomfort
- a 'lump in the throat'
- pins and needles
- reddening of the face and neck (flushing).
It can be easy to confuse the symptoms of cancer, or cancer treatment, with the symptoms of anxiety. Anxiety and the illness can act together to make the symptoms worse.
Dealing with anxiety
When anxiety levels are high, the symptoms can be difficult to control and may be experienced as a 'panic attack'. Relaxation techniques can help you to get back in control. Take some slow deep breaths and concentrate on what is happening right at that moment, not what you worry may happen.
Your doctor will be able to help you to work out whether your symptoms are related to anxiety or the cancer itself. Understanding the reason for your symptoms can be reassuring, but if you are still very anxious, counselling or psychotherapy can help. Medication can be prescribed if necessary.
Fatigue means feeling exhausted all, or most of the time. It is one of the most common, and sometimes one of the most difficult, problems for people with cancer. It is different to normal tiredness as it is not related to how busy or active you have been and does not go away if you sleep longer at night. Almost everyone undergoing chemotherapy or radiotherapy will experience fatigue but it may also be due to advanced disease or as a result of other symptoms, such as breathlessness, anemia (a low red blood cell count) or pain.
Some people find that their tiredness is mild and doesn't interfere much with their daily life. Other people find that it really disrupts their life.
Some of the more common effects are:
- difficulty doing everyday tasks
- having no energy
- feeling weak
- difficulty thinking or concentrating
- becoming forgetful
- dizziness or light-headedness
- difficulty sleeping
- a lower sex drive
- feeling irritable, emotional and tearful.
There are different ways of treating fatigue depending on the cause, so let your doctor and nurse know how you are feeling. Sometimes treating other symptoms can help you to become less tired. For example, if you are anaemic a blood transfusion may help. Make sure you are getting adequate intake of food and fluids as dehydration and poor nutrition can make fatigue worse. Complementary therapies such as yoga and massage can be effective too.
There are also steps that you can take to plan your day, to make it easier to cope and save your energy for doing things that are most important to you. This may mean being more willing to accept help from others, or making simple changes to the way you do things around the home. Fatigue is often worse in the afternoon so plan to do things in the morning when your energy levels are at their best.
Research has found that exercise and keeping active can help to raise energy levels. Thirty minutes of moderate physical activity such as walking on a daily basis has been shown to improve fatigue. However, don't feel that you have to exercise, or keep going with your daily schedule if you are too tired. It may help to discuss how you feel with a physiotherapist or an occupational therapist at the hospital. They can suggest simple exercises or ways to help you cope with the tiredness.
Being told that you have cancer and that treatment may make you infertile is very difficult to come to terms with. The prospect of losing your fertility can be overwhelming no matter whether or not you already have children, or have considered having them.
Your doctor will talk to you about the risk of infertility before your treatment starts as all treatments can affect your fertility. It may also be helpful to discuss whether there is anything that can be done to lessen the effects of treatment on your fertility. Many men find that their feelings about becoming a father change over the years.
Before your treatment starts, it is important to know if your fertility is likely to be affected. You can then decide whether you want to look at options that may be available to you, such as storing embryos (fertilised eggs) or storing sperm for future use (sperm banking).
If you have a partner, it might be helpful for you both to be present during these discussions.
Don't be afraid to raise this with your doctor or specialist nurse and ask to be referred to a fertility specialist.
Although treatment may affect your fertility it is very important that you or your partner do not become pregnant whilst receiving chemotherapy or radiotherapy and for some time after as these treatments are very harmful to a developing baby. Effective contraception such as condoms should be used.
Some people having cancer treatment find that it doesn't affect their hair at all. However, some chemotherapy drugs or other medicines can affect the condition and growth of your hair. Some people find that their hair becomes thinner and in some, it falls out completely. People who have surgery or radiotherapy may find they have areas where their hair doesn't grow back. The scalp is the most common site of hair loss for people who are receiving chemotherapy that causes hair loss but hair all over the body will be affected such as eye lashes and eyebrows. Hair loss elsewhere tends to be less severe.
Even if your hair does not fall out, treatment can make it dry, brittle and more difficult to manage.
Preparing for hair loss
You could think about having your hair cut short before your treatment starts. If your hair is shorter it will feel like you are losing less hair when it does fall out. If you're used to long hair you might find it easier to have it cut in stages to give you time to adjust to a new length.
Some people prefer to shave their heads completely before they start losing their hair. This can give a sense of control over what is going to happen and you may prefer to do this, rather than wait for your hair to fall out.
Some people may not want to cut their hair for cultural or religious reasons, and may find alternative headwear helpful.
Looking after your hair
If your hair is dry or brittle during or after cancer treatment:
- Use only gentle hair products and non-medicated shampoo.
- Brush or comb your hair gently using a brush with wide prongs or a wide-toothed comb.
- At night, wear a soft cap or turban around your head to stop your hair becoming tangled and to collect any loose hair - women may find it easier to wear a hairnet.
- Eat a well balanced diet with plenty of fruit, vegetables, protein and carbohydrates to help keep your hair in good condition as a poor diet can make the condition of your hair worse.
- Avoid using excessive heat from hairdryers or heated rollers, as this can over-dry the hair and make it break.
- Avoid wearing your hair in a tight band, as this can damage and break your hair. If you plait your hair, plait it gently.
- Avoid perming your hair as this can make it even more dry and brittle
Lymphoedema is the swelling of an arm, leg or other part of the body because of an abnormal build-up of a fluid called lymph in the body tissues.
Causes of lymphoedema
If a lymph vessel or node becomes blocked, the lymph fluid is unable to pass along it. Because the excess tissue fluid cannot drain away normally, it builds up and causes swelling. The medical name for swelling is oedema (pronounced e-dee-ma). When the swelling is due to a problem in the lymph system, it is called lymphoedema.
Lymphoedema is not always related to cancer.
Also called secondary lymphoedema, this is caused by cancer or its treatment. It can occur if the lymph nodes are blocked with cancer or if they have been removed by surgery. Radiotherapy can also cause lymphoedema by causing a build-up of scar tissue within the lymph nodes. It is most common in people with breast, gynaecological and prostate cancer and melanoma.
Not everyone who has radiotherapy to the lymph nodes will get lymphoedema. Lymphoedema is more likely to occur if surgery and radiotherapy are both given together to the same area - for example, when lymph nodes are removed from the armpit during surgery for breast cancer and the area is then treated with radiotherapy.
Surgery or radiotherapy given on their own to a part of the body is less likely to result in lymphoedema.
Lymphoedema can occur very soon after treatment or may occur many years later.
If you are at risk of developing lymphoedema there are steps that you can take to minimise your risk.
Infection and swelling increases your risk so use sunscreen to avoid sunburn. Insect repellants should be applied to reduce the risk of insect bites. Any insect bites or scratches or cuts should be treated promptly by cleaning and applying antiseptic cream.
Movement is crucial to lymph drainage and you should maintain an active lifestyle. Daily exercise such as walking or swimming is recommended. Weight should be kept within healthy limits because being overweight increases the risk of lymphoedema developing.
If you do develop any swelling ask for referral to a lymphoedema therapist. Early referral means treatment is less intensive and much more likely to be successful.
The effects of cancer or its treatment can lead to mouth problems such as a dry mouth, infection or ulcers. These can affect eating and drinking as well as your ability to talk comfortably. Following a regular mouth care routine can help to prevent or lessen mouth problems.
Mouth care routine
- Brush your teeth every morning and evening using a small, soft-bristled toothbrush and a toothpaste with fluoride.
- Provided it isn't sore, gently brush your tongue when cleaning your teeth.
- Use water or an alcohol-free mouthwash to rinse your mouth after meals. You can do this more often if needed to keep your mouth fresh. You can make a mouthwash with one teaspoon of salt dissolved in 250ml of fresh water.
- Rinse dentures after meals.
- If your doctor prescribes a mouthwash for you, use it regularly as prescribed.
- Use dental tape or floss daily (gently).
- Keep your lips moist by using Vaseline, or a flavoured lip balm.
- Avoid smoking and alcohol
- If your mouth does become sore, cut food into small pieces and mix with sauces and gravy to make chewing and swallowing more comfortable. Avoid rough or dry foods, spicy and salty foods and citrus fruits as they will cause irritation. Applying a mouth gel before eating may help too.
Cancer, or cancer treatment, can sometimes cause nausea (feeling sick) or vomiting (being sick). This can be unpleasant and distressing.
Nausea may be caused by various things including:
- some painkillers
- a high level of calcium in the blood (hypercalcaemia)
- irritation of the stomach lining
- blockage of the bowel.
Your doctors will want to find out why you are feeling sick as this helps them to choose the treatment that is most likely to help. Whenever possible, the cause, such as pain or a high calcium level, should be treated.
You may be prescribed an anti-sickness (anti-emetic) drug. These are usually given as tablets, but if you can't keep tablets down there are other ways to take them. Some anti-sickness drugs can be dissolved under the tongue, others can be given by injection or they can be given as a suppository.
Anti-sickness drugs often work better when taken regularly so that the sickness doesn't have a chance to come back. Sometimes, it may not be possible to completely control the sickness caused by chemotherapy, but much can be done to reduce it.
Helpful tips for reducing nausea
- If possible have someone else prepare your food.
- Try to eat when you feel less sick.
- Fatty foods, foods with a strong smell, or fried foods make your nausea worse.
- Eat cold or warm food if the smell of hot food makes you feel sick.
- Eat small snacks during the day and chew the food well.
- Have small, regular meals if possible.
- Take plenty of liquids. Drink slowly, taking small sips.
- Try not to drink too much fluid before you eat.
- Sea-bands (acupressure wristbands) can help to reduce nausea - these are available from many chemist shops.
- Ginger can be helpful - try eating ginger biscuits or drinking ginger beer.
Some people with cancer never have any pain, but some people may have pain due to the cancer or its treatment. If pain occurs, it can usually be successfully controlled.
The causes of pain are now well understood and there are many effective ways of treating it. There is rarely any need for anyone to suffer uncontrolled pain.
Pain is different for each of us. Even people with the same illness have very different experiences. Your experience of pain is unique and should be treated according to your own particular needs. It is important to tell the doctors and nurses looking after you if you are in pain, so that it can be effectively treated.
The amount of pain you have is not related to how severe your cancer is. Having pain does not necessarily mean that the cancer is advanced, or more serious than if you have no pain. Pain does not automatically get worse as the cancer develops. About three in 10 people having treatment for cancer will have some pain. If the cancer is advanced (has come back or spread) around seven in 10 people will have pain.
Pain may occur for a number of reasons:
- A cancer may press on the tissues around it, or on a nerve.
- Infection can cause pain by creating inflammation in the affected part of the body.
- Damage to tissues or nerves following surgery or radiotherapy may lead to pain.
- A cancer may spread from its original (primary) place in the body to form other tumours (secondaries or metastases). These may cause pain, especially in the bones.
- Sometimes, pain is felt in parts of the body far away from the cancer that is causing it. This type of pain is called referred pain.
Diarrhoea may occur due to infection, or a side effect of cancer treatments such as chemotherapy, or radiotherapy to the pelvis. Some medicines can cause diarrhoea, and some types of cancer may prevent food from being absorbed properly from the bowel. Sometimes severe constipation can be mistaken for diarrhoea. When the bowel is blocked by constipation, liquid faeces pass around the solid faeces (sometimes called overflow) so it may seem as though the person has diarrhoea.
Helpful tips if you have diarrhoea
- While you have diarrhoea cut down on your fibre intake from cereals, fruit and vegetables. Eat peeled and cooked fruit and vegetables instead of raw ones.
- Avoid milk and dairy products, such as cheese, until the diarrhoea has stopped.
- Drink plenty of fluids to replace the water lost with the diarrhoea, but not alcohol or coffee. Avoid fizzy drinks, which can cause wind and stomach cramps.
- Eat small, frequent meals made from light foods - white fish, chicken, eggs (well cooked), white bread, pasta or rice.
- Eat your meals slowly.
If the diarrhoea continues for more than two days, tell your doctor, who can investigate the cause, and prescribe some anti-diarrhoea medicines for you.
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