Symptom Management

Most cancer therapy produces a range of side effects that varies from life-threatening to merely making you feel miserable. Surgery, for example, not only cures, it also kills. Someone who is older and sick, whether from the cancer alone or also from another serious disease, may be a high risk for a major operation. This puts the surgeon and the cancer patient between a rock and a hard place, especially when surgery offers the only chance of a cure. It takes time to recover fully from the anesthesia, the blood loss, and the trauma. Expect to feel tired and weak, at least for a little while. The hospital may want to send you home before you’ve fully recovered. If you’re too weak to take care of yourself properly at home, you have the right to refuse to leave.

The side effects from radiotherapy depend on the dose you receive and the part of the body being treated. For example, radiating a malignancy in the head and neck, or the tongue, can cause tooth loss and so inflame the tissues of the mouth and throat that eating and swallowing are difficult and painful. The rays can also hurt the bone marrow, reducing its production of white blood cells that protect the body against infection. Generally speaking, however, the most common side effects of radiation are fatigue, rash, redness in the treated area, and loss of appetite. Most of these side effects can be prevented or controlled with the new equipment that pinpoints the target tissue with greater accuracy and reduces the risk of overdosing.

Chemotherapy causes the most troublesome side effects because most of the drugs used also damage healthy cells. It can affect the bone marrow (so that it makes fewer white blood cells that fight infection), platelets (responsible for normal clotting), and red blood cells (that carry oxygen). As a result, you don’t resist infections nearly as well, you bruise and bleed more easily, and you’re tired because you’re anemic. There are now medications that can stimulate a damaged marrow to make enough white cells and red cells to keep you going. However, if the drug (or radiation) has hurt the bone marrow badly enough, you may require a total marrow transplant or replacement of just the specific tissue that performs blood cells (peripheral stem cell support).

Chemotherapy can also affect the digestive tract and cause nausea, vomiting, and sores in the mouth. Acupuncture can minimize some of these effects. Hair loss is a major concern too, especially in women. The hair either thins out or is lost throughout the body (alopecia) for the duration of the therapy, which may be many months. However, hair usually begins to grow back after the treatment is completed. Chemotherapy also impairs fertility in both sexes, either temporarily or permanently.

Hormone therapy can also cause side effects. Women may develop swelling, weight gain, hot flashes, and vaginal dryness, and become infertile. In men with prostate cancer, the antitestosterone drugs that control the spread of their tumor, also invariably result in temporary or permanent impotence, loss of sexual desire, and loss of fertility. Nausea and vomiting can occur in both sexes.

The side effects of biological therapy and immunotherapy depend on the specific agents being used. Interferon, for example, causes flu-like symptoms that are often severe: chills, fever, muscle aches, weakness, anusea, loss of appetite, vomiting, and diarrhea. Some patients also develop a rash and bleeding. However, these symptoms are usually transient, and they will clear up after the treatment is completed.