Cancer treatments are tailored to the specific needs of the patient. Increasingly, it is common to use several treatments or modalities at the same time or in sequence in order to prevent both local recurrence and recurrence throughout the body. When modalities are combined to treat cancer, this is referred to as a Multi-Modality Treatment (MMT). The different other modalities are:

A. CHEMOTHERAPY:

Many people fear chemotherapy because they have heard that it can have uncomfortable side effects. But side-effect management has come a long way over the last few decades. Today, many side effects once associated with chemotherapy can be prevented or controlled. With some types of chemotherapy, you may experience only minimal side effects. And chemotherapy may be your best option for a successful outcome. You can help achieve a successful outcome by understanding how side effects can impact your treatment. Learn how best to manage chemotherapy side effects.

Chemotherapy is the general term for any treatment involving the use of chemical agents to stop cancer cells from growing. Chemotherapy can eliminate cancer cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.

More than half of all people diagnosed with cancer receive chemotherapy. For millions of people, chemotherapy helps treat their cancer effectively, enabling them to enjoy full, productive lives.

A chemotherapy regimen (a treatment plan and schedule) usually includes drugs to fight cancer plus drugs to help support completion of the cancer treatment at the full dose on schedule. Most doctors agree that staying on your chemotherapy schedule gives you the best opportunity for a successful result.

To get the most from chemotherapy, it's important to stick to a schedule of treatment. Find out more about chemotherapy cycles and schedules.

How Chemotherapy Works

Chemotherapy is designed to kill cancer cells. Chemotherapy can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill, depending on which drug is used.

Chemotherapy works by destroying cancer cells; unfortunately, it cannot tell the difference between a cancer cell and some healthy cells. So chemotherapy eliminates not only the fast-growing cancer cells but also other fast-growing cells in your body, including, hair and blood cells.

Some cancer cells grow slowly while others grow rapidly. As a result, different types of chemotherapy drugs target the growth patterns of specific types of cancer cells. Each drug has a different way of working and is effective at a specific time in the life cycle of the cell it targets. Your doctor will determine the chemotherapy drug that is right for you. To understand more about the different ways chemotherapy is given, read about how people receive chemotherapy.

Discussing the Effectiveness of Cancer Treatment

Understand the goals and risks of each treatment option so you can work with your doctor to decide which treatment is best for you. Balance potential benefits against the risks of treatment.

Some risks of cancer treatments may include time away from family and friends, uncomfortable side effects, or long-term complications. Cancer treatment may be inconvenient, prolonged, or unavailable close to home. These are important considerations when evaluating treatment options, but they are not typically mentioned in medical journals reporting the results and benefits of new treatments.

Once you and your doctor have decided on a treatment plan, talk with your doctor about all you can do to make sure you get the full dose of your cancer treatment on schedule. You can make note of subjects to discuss and questions to ask by using Tools for Organizing Your Cancer Information.

Importance of Full Dose on Schedule

Studies show that for certain types of cancer, chemotherapy produces the best long-term results when patients receive the full dose on time, every time.

Your doctor will develop a treatment plan scientifically designed for you, based on your type of cancer, its stage of advancement, and your overall health. It will consist of specific chemotherapy agents, at specific doses and intervals. These are called your scheduled cycles. Generally, treatments are given daily, weekly, or monthly. Your doctor will help you determine the most effective treatment schedule for you.

The goal is to make your chemotherapy as effective, timely, and problem-free as possible. But while your chemotherapy treatment works to fight your cancer, it also can cause side effects such as a lowered white blood cell count. A low white blood cell count means your immune system isn't as strong as it could be, which can increase your risk of infection. It also can require your doctor to change your dose or schedule of your chemotherapy.

A chemotherapy-induced low white blood cell count, caused by healthy cells lost during chemotherapy, is an expected side effect of your treatment. Therefore, you can plan ahead so it is less likely to disrupt your treatment schedule. A low white blood cell count typically occurs after the administration of certain types of chemotherapy and may continue for several days. To help reduce side effects like low white blood cell count that may interfere with your treatment schedule, learn more about managing chemotherapy side effects.

Under certain circumstances, your doctor may decide your body is too weak to receive chemotherapy. A low white blood cell count can temporarily disrupt your cancer treatment or result in having your chemotherapy dose decreased. These changes to your treatment plan could make your cancer treatment less effective than it should be.

To get the most from chemotherapy, it's important to stick to a schedule of treatment. Find out about chemotherapy cycles and schedules.

Chemotherapy Side Effects - An undesirable consequence of chemotherapy affecting your body-not related to your cancer-is referred to as a complication of treatment - a side effect. Read about the common side effects of chemotherapy under its section in this same page.

Some side effects may be temporary and uncomfortable. Some can cause dose reductions and treatment delays or even be life-threatening.

For example, one of the most serious potential side effects of chemotherapy is a low count of infection-fighting white blood cells-a condition called neutropenia. Neutropenia can interrupt your chemotherapy schedule and put you at risk for infections that may require hospitalization and may even be life-threatening.

Fortunately, significant progress has been made in the development of "proactive" therapies that help you manage the side effects of chemotherapy-ideally, before they interrupt your treatment schedule.

Take an active role in managing side effects. Learn all you can, use your tools for organizing your cancer information to note any side effects you experience, and be sure to discuss them with your doctor. You can make note of subjects to discuss and questions to ask by using your Tools for Organizing Your Cancer Information.

Full Dose on Schedule!

Certain side effects may prevent doctors from delivering your full dose of chemotherapy on schedule.

This can be a problem, since your best results typically depend on receiving treatment at the full dose and on your scheduled plan.

Impact of Delaying Treatment or Reducing Doses (Amgen)

A 2003 study reported in The Journal of Clinical Oncology by Dr. Gary Lyman (oncologist and Professor at the University of Rochester, New York) found that many breast cancer patients did not receive the full doses of their chemotherapy on schedule. due to the following:

Most delays and reductions in the planned doses of chemotherapy were due to concerns about side effects.

Delays or reductions in the planned doses of chemotherapy were likely to affect the likelihood of a successful outcome. In many cases, such delays and reductions were preventable.

"The odds of curing breast cancer are highest when a patient completes a full course of chemotherapy" concluded Dr. Lyman.

How People Receive Chemotherapy:

People receive chemotherapy in one of the following four (4) ways, or a combination of them:

You can receive many types of chemotherapy at home. Through instruction, you and your family members can learn how to administer chemotherapy in pill form or by injection with small syringes and needles similar to those that people with diabetes use to administer insulin.

In some cases, a nurse will administer chemotherapy in an outpatient clinic. In other cases, it may be necessary to go to the hospital to receive treatment.

Because different drugs damage cancer cells during different times, combining different chemotherapy drugs into a regimen can result in more cancer cells being killed and improve your outcome.

Chemotherapy Cycles and Schedules

Chemotherapy Cycles

Chemotherapy is typically given in cycles with rest periods between the cycles.

It may take a relatively short period of time to receive some chemotherapy drugs, while others may take hours. It all depends on the treatment regimen that your doctor prescribes.

If your chemotherapy is given through an IV, your doctor may suggest an implanted VAD (Vascular Access Device) such as an implanted catheter or port - VADs are surgically placed in a large vein near the heart and can stay in place for long periods of time. A VAD eliminates the need to have smaller catheters repeatedly placed in arm veins.

Chemotherapy Schedules

How often you receive chemotherapy depends on the type of cancer you have and the drug or combination of drugs you receive. Different drugs work at varying times in the cancer cell growth process. Taking all of these factors into consideration, your doctor will help you determine the most effective treatment schedule for you. Chemotherapy may also be used in combination with surgery.

Chemotherapy given before surgery is referred to as Neoadjuvant Chemotherapy - The goal of neoadjuvant chemotherapy is to shrink the cancer before it is surgically removed.

Chemotherapy after surgery is referred to as Adjuvant Chemotherapy - The goal of adjuvant chemotherapy is to kill any cancer cells left in the body after surgery.

*Note: Chemotherapy side effects can interfere with treatment schedules

The Goal of Chemotherapy: Cancer Remission

The most common term used to describe the effectiveness of cancer treatment is remission.

Remission means that the cancer has disappeared, based on clinical evaluation or resolution of symptoms. Oncologists use the terms:

A cancer cannot be cured without a remission; however, a remission does not always ensure that a cancer is cured.

The best ways to evaluate the benefits of treatment are to examine the duration of remission, survival, and disease-free survival or cure.

It often takes many years to determine whether a new treatment is better than a previous treatment; therefore, remission rates may be useful for comparing therapies when patients have not been evaluated long enough to know whether their chance for cure or survival is improved.

Chemotherapy side effects can interfere with the goal of therapy.

Understanding & Managing Chemotherapy Side Effects:

Some side effects may be temporary and uncomfortable. Some can cause dose reductions and treatment delays or even be life-threatening.

Neutropenia (Low White Blood Cell Count)

Chemotherapy is usually given in cycles, with periods of rest that give your body time to regain strength and replace healthy cells lost during treatment. However, a low count of infection-fighting white blood cells or "Neutropenia" is a common side effect of certain types of chemotherapy that can disrupt your chemotherapy schedule.

A low white blood cell count means your immune system isn't as strong as it could be and that you are at increased risk for infection. The fewer white blood cells you have and the longer you remain without enough, the more at risk you become for developing a potentially life-threatening infection.

Your first step in managing blood-related side effects is understanding CBC or complete blood count.

As a result, your doctor may need to delay treatment or reduce your chemotherapy dose until your white blood cell count increases and the possibility of infection is reduced. Under certain circumstances, you may need to be admitted to the hospital until your infection is cured and your number of white blood cells returns to levels high enough to fight infections in the future. The good news is you can prepare for chemotherapy and help lower your risk of infection.

Your doctor has carefully determined your chemotherapy dose and schedule to produce the best opportunity for a successful outcome. Reducing or altering either can affect your results. Studies show that for certain types of cancer, chemotherapy produces the best results when patients receive the full dose on schedule.2-7

To get the most from chemotherapy, it's important to stick to a schedule of treatment. Find out more about chemotherapy cycles and schedules.

Diagnosing Infection

Fever is a sign of infection, sometimes the only sign. If you develop a fever (temperature higher than 100.4°F, or 38°C), notify your doctor immediately. Infection associated with a low white blood cell count can be life-threatening.

While on chemotherapy, you should take your temperature every day-and record it in your progress chart, which is one of your Tools for Organizing Your Cancer Information.

An infection can occur in any number of places throughout the body. Specific symptoms can indicate the site of your infection and help target your treatment.

Infections are serious and can delay your treatment. Other side effects can also signal a serious problem. Find out when to call your doctor about chemotherapy side effects.

Preventing Infection

Given the option, most patients would prefer to prevent infection rather than have to deal with its results. Your first line of defense should always be prevention. Take these simple but effective steps to help protect yourself against infection:

Always wash your hands with soap and plenty of water. Many infections are transmitted through hands and things that you touch, such as doorknobs. Washing your hands thoroughly is the most important thing you can do to prevent infection.

Prepare yourself for chemotherapy by lowering your risk for infection.

Be Proactive Against Infection and Treatment Interruptions

Patients receiving chemotherapy may be at risk of a low white blood cell count, especially patients who already have a low count or who have previously received chemotherapy or radiation treatment. Older patients and patients with other conditions affecting their immune system may be at risk of more severe infection and longer hospitalizations.

Being proactive is one of the best ways to help protect yourself from the risks associated with a low white blood cell count.

On average, fewer than 10% of patients receive protection from a low white blood cell count at the beginning of their chemotherapy, before their counts drop.14 Yet up to half of patients receiving chemotherapy develop dangerously low white blood cell counts, placing them at risk of having to change their cancer treatment plan or developing infections.11,15-17

Fortunately, with today's medical technology, scientists have developed white blood cell boosters to increase white blood cell production and help reduce the risk for chemotherapy-related infection.

White Blood Cell Boosters: White blood cell boosters help restore white blood cell counts, reducing the risk of chemotherapy-related infection and prolonged, dangerously low white blood cell counts.

Thrombocytopenia (Low Platelet Count)

Platelets, also called thrombocytes (THROM-boh-sites), are fragments of bone marrow cells that are found in the circulating blood and are critical in stopping bleeding. Platelets rush to the site of an injury and work with other blood factors to form a blood clot, which helps stop the bleeding. A low platelet count is called thrombocytopenia.

Causes of a Low Platelet Count

Thrombocytopenia is a common side effect of chemotherapy. Chemotherapy works by destroying cells that grow rapidly, such as cells in the bone marrow that generate platelets. Normally, there are billions of platelets in the blood; however, certain chemotherapy drugs can lower the platelet count.

A low platelet count typically occurs 6 to 10 days following administration of chemotherapy and continues for several days before the number of platelets increases to an adequate level. Infrequently, cancer patients may also experience a low platelet count from other medications or as a consequence of their underlying cancer.

Monitoring Your Platelet Count

A low platelet count puts you at risk of certain side effects. Bleeding is the most important:

If you do not have enough platelets to form a clot, you will not be able to stop bleeding.

Even a small cut can cause you to lose a dangerous amount of blood.

The fewer platelets you have in your blood, the more susceptible you are to experiencing bleeding.

Another reason a low platelet count is important is that, in some cases, it can be severe enough that chemotherapy treatments may need to be delayed or dose-reduced, which may also reduce some patients' chance for the most optimal result. When patients develop a low platelet count, doctors may have to delay treatment or reduce the doses of the chemotherapy until the platelet count has increased.

To get the most from chemotherapy, it's important to stick to a schedule of treatment. Find out more about chemotherapy cycles and schedules.

If you have a severely low platelet count, you may require treatment with platelet transfusions and, occasionally, admission to the hospital until the platelets return to sufficient levels in the blood to prevent bleeding. A platelet transfusion is the addition of platelets into your blood from an outside source, such as a blood bank. Platelet transfusions carry the risk of complications, including allergic reactions that may range from mild to life-threatening. Ask your doctor about options for treating low platelet counts.

Before you begin treatment, it is important to learn how best to manage blood-related side effects. Your first step should be to understand CBC, or complete blood count.

Lowering Your Risk of Bleeding

If your platelet count is low, you should try to avoid situations that may cause injury, bruising, or bleeding.

It is important to know that, in addition to blood-related side effects, chemotherapy can result in other side effects.

Anemia (Low Red Blood Ceel Count)

Numbness and Tingling (Peripheral Neuropathy)

Numbness and tingling in your hands and feet is a condition called peripheral neuropathy. Peripheral neuropathy can be a side effect associated with certain chemotherapy drugs. It is caused by damage to the nerves that transmit signals between the extremities and the central nervous system (CNS).

These nerves include those that transmit sensation from the extremities to the CNS or those that carry signals for muscle movement from the CNS to the extremities.

Depending on the type of nerve damage, an individual with peripheral neuropathy may fully recover without residual effects or may partially recover but have long-term problems in his or her ability to feel or move.

If severely affected, it is possible to develop atrophy (muscle deterioration) and chronic muscular weakness.

Causes of Peripheral Neuropathy

There are many possible causes of numbness and tingling. Some of the more common include:

In addition to numbness and tingling, other symptoms of peripheral neuropathy include:

Areas of the body most commonly affected by peripheral neuropathy are the fingers and toes.

Symptoms usually start at the end of the extremity and gradually move upward.

Bowel function may also be compromised, causing or worsening constipation and eventually causing blockage of the intestines.

Sometimes side effects signal a serious problem. Find out when to call your doctor about chemotherapy side effects.

Treating Peripheral Neuropathy

The treatment for peripheral neuropathy caused by chemotherapy is to stop the treatment or change to a different drug that does not cause damage to the nerves. If immediate steps are not taken when symptoms start, peripheral neuropathy can become a long-term problem.

Recovery from peripheral neuropathy is usually slow, but steps can be taken to encourage regeneration of the damaged nerves. Approaches include:

Acupuncture which is believed to relieve pain associated with peripheral neuropathy in certain cases. Ask your doctor for more details and the name of a licensed acupuncturist.

Massage which increases blood flow and may provide pain relief associated with peripheral neuropathy.

Physical therapy which uses range-of-motion and stretching exercises that may help strengthen muscles that are weak and improve other symptoms of peripheral neuropathy.

Transcutaneous nerve stimulation (TENS) which uses a special device that transmits electrical impulses through electrodes attached to your skin. TENS has been shown to provide pain relief and may promote nerve regeneration.

Fatigue

Hair Loss

It grows back!

Hair typically begins to grow back about two to three weeks after you finish chemotherapy treatment. Hair may grow back looking different than it did before treatment. For example, color or texture (curly or straight) may change.

Chemotherapy not only damages rapidly dividing cells such as cancer cells, but also healthy cells, such as hair follicles. Chemotherapy-related damage to hair follicles leads to hair loss, also called alopecia.

Hair loss typically begins two or three weeks after the first chemotherapy treatment.

In addition to hair on your head, you may lose eyebrows, eyelashes, facial hair, pubic hair, underarm hair, and leg hair. The amount of hair you lose depends on the type of chemotherapy drug you take.

Taking Action to Cope With Hair Loss

Remember, hair loss associated with chemotherapy is almost always temporary. The hair will grow back!

In the meantime, here are a few tips to help you cope with the temporary loss:

Cut your hair before it falls out. The experience of losing hair is sometimes worse than dealing with it once it's gone. If you expect to lose all or a lot of your hair, cutting it first may be easier.

Plan ahead. Shop for a wig before your hair is gone, especially if you wish to match your natural color. Or take this opportunity to try a different color.

Try hats or head scarves; these are good alternatives or a complement to a wig.

Remember to cover your head or use sunscreen on your scalp. Skin that has been covered with hair may be particularly sensitive to the sun's UV rays.

Some insurance companies cover the cost of a wig. Talk with your insurer.

Treat your new hair gently once it grows back. Avoid chemicals, bleach, peroxide, or colors.

Materials available covering cranial prosthesis (wig) information and pointers on head coverings are available at: The American Cancer Society's program "Look Good...Feel Better" has - you can get your free copy by calling 1-800-395-LOOK. Or access: www.heartofgoldwigs.com.

Pain

Causes of Pain

Pain is one of the most common and feared symptoms of cancer. However, modern medications can help control pain. If you experience pain, talk with your doctor about the type of medication that is best for your condition.

You and your doctor also may discuss other methods of controlling pain, including exercises, acupuncture, massage, and more.

Pain may be a side effect of cancer or cancer treatment. If not adequately managed, pain may have a tremendous effect on quality of life.

Always notify your doctor if you have pain or if your existing pain increases. Your doctor can help you find the medication or combination of medications and dose to control your pain. Always take your medication as prescribed.

Pain Grading Scale: 1 -10

Doctors rate pain on a scale of 1 to 10, with 1 being no pain and 10 being the worst pain

Treating Pain With Drugs

World Health Organization (WHO) has outlined guidelines that your doctor may follow and is based on the Pain Scale - The type of pain medication a doctor may use depends on how severe your pain is:

Mild-to-Moderate Pain (1-3)

For pain at the low end of the 1 to 10 scale, your doctor may recommend over-the-counter (OTC) medications, such as acetaminophen (Tylenol®) or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil®, Motrin®, etc).

Moderate-to-Severe Pain (4-6)

If over-the-counter medication does not relieve your pain, or you have moderate-to-severe pain, your doctor may prescribe an opioid. Also known as narcotics, opioids are similar to natural substances produced by the body to control pain, called endorphins. These are the strongest pain relievers available. Opioids prescribed for moderate-to-severe pain may include:

Severe Pain (7-10)

For severe pain or pain not relieved with medications recommended for pain on the scale from 1 to 6, your doctor may prescribe a stronger opioid:

Your doctor also may recommend adding a nonopioid analgesic or a supporting drug as needed.

How Pain Medication Is Given

Pain medication may be given in many different ways:

"As Needed"

If your doctor gives you pain medication with instructions to "take as needed," take it before the pain becomes severe. Medication takes time to work. If you wait too long to take it, you may experience unnecessary discomfort.

Long-Lasting

If your pain relief does not last long enough, ask your doctor about extended-release medicines, which can control pain for a longer period of time. Morphine and oxycodone are made in extended-release forms. Also, a skin patch that releases the opioid fentanyl can be used.

Immediate Relief

If your pain is controlled most of the time, but occasionally gets bad enough that your medication does not appear to work, your physician may prescribe a rapid-acting medicine, such as immediate-release morphine or oxycodone, to give you more pain relief when it is needed.

Dose Adjustments

Your doctor may adjust your dose as you get used to a medication. You may build a tolerance to medication, which means that you stop getting the same relief from your medication. If this happens, your doctor may increase the dose, prescribe a new medication, or add an additional medication.

Concerns About Addiction to Pain Medication

Pain medications are prescribed for controlling the type of pain that cancer patients frequently encounter. Usually, pain medication is only necessary for a short period of time, such as while you are healing from treatment. In some circumstances, you may be taking pain medication daily for a longer period of time.

Pain Medication Side Effects

Pain medication may make you feel sleepy, cause you to become constipated, or cause nausea and vomiting. Below are tips on dealing with these common side effects.

Sleepiness Due to Pain Medication

Try planning a rest time just after you take your pain medication. Your doctor also may recommend that you take a caffeine drink with your pain medication.

Constipation Due to Pain Medication

Increase fluid and fiber intake to prevent constipation. Your doctor may prescribe a laxative.

Nausea and Vomiting Due to Pain Medication

For nausea and vomiting, a variety of drugs can help relieve your symptoms. Taking your medication with food may also help.

Not everyone experiences these side effects, and not every pain medication causes them to the same degree. Talk to your doctor if you experience side effects with your pain medication.

Non-Drug Treatments for Pain

There are many additional techniques for controlling pain that you may wish to try or discuss with your doctor. These are described below.

Acupuncture

In acupuncture, a licensed specialist inserts thin needles into the body at certain points and at various depths and angles. Each point controls the pain sensation of a different part of the body.

When the needle is inserted, a slight ache, dull pain, tingling, or electrical sensation is felt for a few seconds.

Once the needles are in place, no further discomfort should be experienced.

The needles are usually left in place between 15 and 30 minutes, depending on the condition treated.

Acupuncture is now a widely practiced method of pain relief. Ask your doctor for more details and the name of a licensed acupuncturist.

Biofeedback

Learning this technique requires the help of a licensed biofeedback technician. With the help of special machines, people can learn to control certain body functions, such as:

You may use biofeedback techniques to help you relax and, in concert with other pain relief methods, to help you cope with pain.

Emotional Support and Counseling

Anxiety or depression may make your pain seem worse. Also, pain can cause you to feel worried, depressed, or easily discouraged. These are normal feelings that can be relieved.

Try to talk about your feelings with someone you feel comfortable with-doctors, nurses, social workers, family or friends, a member of the clergy, or other people with cancer.

You may also wish to talk with a counselor or a mental health professional. Your doctor, nurse, or the social services department at your local hospital can help you find a counselor who is specially trained to help people with chronic illnesses.

Imagery

Imagery involves using your imagination to create mental pictures of situations. The way imagery relieves pain is not completely understood.

Imagery can be thought of as a deliberate daydream that uses all of your senses-sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis.

Massage

Many forms of massage may help reduce pain. Some massage therapists specialize in chronic pain. You can also ask friends or family members to help. You also may be able to do massage on yourself. Try using a slow, steady, circular motion. Massage over or near the area of pain with just your bare hand or with hand lotion or warm oil. Check with your doctor before getting a massage to make sure that it is acceptable for your condition.

Meditation

Meditation is the practice of quieting the mind and focusing it on breathing or a mantra (a repeated sound or phrase). Meditation may help you focus your mind on something other than the pain and give you the strength to better cope with pain.

Menthol

Many menthol preparations are available for pain relief. There are creams, lotions, liniments, and gels that contain menthol. When rubbed into the skin, they increase blood circulation to the affected area and produce a warm (sometimes cool) soothing feeling that lasts for several hours.

Other Actions to Manage Pain

It's hard to be motivated to exercise when you are in pain. In fact, it's probably the very last thing you want to do! However, regular exercise can help you combat pain in a variety of ways:

Talk with your doctor to determine whether exercise is appropriate for you.

Medications to Manage Pain - Narcotic Analgesics: Help relieve pain:

CHEMOBRAIN - Forgetfulness & Inability to Concentrate: 

"Chemobrain" - Some cancer patients refer to the forgetfulness or inability to concentrate that chemotherapy can have on cognitive functioning as "chemobrain." How chemotherapy might cause cognitive deficits is not clear at this time.

Premature menopause and infertility also are potential side effects of chemotherapy. The older you are when you begin treatment, the more likely you are to develop these problems. In rare cases, certain chemotherapy medications may lead to cancer of the white blood cells (acute myeloid leukemia) - often years after treatment ends.

Reproductive & Sexual Side Effects

Not all chemotherapy treatment will result in side effects related to reproductive ability or sexuality, but some may.

It is perfectly natural for people who have been diagnosed with cancer to be concerned about the effect of their illness on their sexuality. Especially right after the diagnosis, you may temporarily lose interest in sex as you focus on understanding your cancer and the treatments available. During or after treatment, you may have difficulty accepting the way your body looks or functions and may have fears about your partner's acceptance of the changes.

Possible Chemotherapy-Related Side Effects

Changes in your reproductive abilities or sexuality due to cancer treatment may include:

Some of these side effects will resolve after treatment is completed; others may be more long-term.

Managing Sexual Dysfunction

Coping with sexual dysfunction is very difficult. Maintaining open communication with your doctor and your partner, as well as taking steps to improve your self-esteem, may help.

Communicate

One of the most common problems regarding cancer and sexuality is people's reluctance to talk about it with their sexual partner and their health care team. However, communication is the key to coping with this difficult topic. Cancer care specialists are accustomed to addressing these sensitive issues every day.

Perhaps more importantly, sharing your thoughts, feelings, and any fears you may have regarding sexual dysfunction with your partner is essential to maintaining an intimate relationship with that person.

Through open communication, you and your partner can work toward finding other ways to express yourselves beyond intercourse, such as gentle touching, holding hands, kissing, hugging, and sharing emotional closeness.

Support a Positive Self-Image

Concerns about the impact of cancer and treatment on sexuality are often closely linked to issues of self-esteem and body image.

Cancer treatment often involves surgery; surgery can leave scars and cause physical or neurologic damage. Radiation treatment and chemotherapy can produce side effects such as hair loss and extreme fatigue. These effects and others can strongly influence how a person with cancer feels about his or her body and sexuality.

To support a positive self-image, follow these suggestions that have helped many people with cancer:

The ACS publications "Sexuality for Women and Their Partners" and "Sexuality for Men and Their Partners" may also be helpful to you.

Managing Reproductive Issues

If you think you may want to have children after treatment, and the cancer treatment is likely to cause sterility, you may wish to bank eggs or sperm. However, you must do this before you receive your treatment.

Talk to your doctor about your wish to have children in advance so that you can take steps to ensure that you have this choice later.

Treating Reproductive and Sexual Problems

There are now several drug treatments for men with erectile dysfunction . There are also medications available to help women deal with the symptoms of menopause.

Make sure to tell your doctor what symptoms you are experiencing so that proper steps can be taken to find some relief.

Nausea & Vomiting

Nausea and vomiting are frequent side effects of chemotherapy and radiation therapy. These used to be among the most debilitating side effects of chemotherapy, but the development of more effective antiemetic (antivomiting) drugs has provided relief. Now, due to these treatments, nausea and vomiting can be significantly reduced.

Nausea is feeling queasy or sick to your stomach, as though you're going to throw up. Vomiting is emptying your stomach by throwing up. Chemotherapy-induced nausea and vomiting can be acute (within the first 24 hours), delayed (vomiting that occurs after 24 hours), or anticipatory. Anticipatory vomiting is a conditioned response, which means it happens in response to a stimulus, chemotherapy. With this type of nausea and vomiting, the symptoms usually occur after initial exposure to chemotherapy drugs and before subsequent treatments.

Reasons Why Cancer Patients Experience Nausea and Vomiting

A specific location in the brain controls emesis (vomiting): the "vomiting center." Emesis occurs when the vomiting center receives a signal from the brain, the gastrointestinal tract, or the inner ear, which detects motion.

Chemotherapy causes the release of a substance called serotonin (5-HT) and other chemicals in the small intestine, which signal the vomiting center in your brain to induce emesis.

Cancer Treatments Likely to Cause Nausea and Vomiting

Certain chemotherapy drugs are more likely to cause nausea and vomiting than others. Chemotherapy drugs are classified as mildly, moderately, or highly likely to cause nausea and vomiting. Certain types of chemotherapy are frequently associated with a high probability of nausea and vomiting, and doctors usually recommend appropriate antiemetics.

Many chemotherapy treatment plans use more than one drug. The amount of nausea and vomiting produced by combination chemotherapy treatment is typically greater than the nausea expected from any single drug.

Your doctor will determine the chemotherapy drug that is right for you. To understand more about the different ways chemotherapy is given, read about how people receive chemotherapy.

Preventing Nausea and Vomiting

The best way to treat nausea and vomiting is to prevent them from occurring. Medicines for controlling nausea and vomiting, called antiemetics, have been developed over the last several years. These drugs block the signal in the brain and gut that causes nausea and vomiting.

There are many different kinds of antiemetics; your doctor may have you try more than one before finding the prescription that works best for you.

Other Actions to Manage Nausea and Vomiting

There are several things you can do to help prevent nausea and vomiting.

First and foremost, make sure you receive and take your antiemetics as your doctor has ordered.

Let your health care professional know if your drugstore does not have them or if you are not sure how to take them. Also, call your doctor or nurse if you experience the following:

In addition to taking your medication, the following general suggestions may help you prevent or control nausea and vomiting:

Controlling Anticipatory Nausea and Vomiting

Anticipatory nausea and vomiting are poorly controlled with standard antiemetic treatment. In some clinical studies, drugs that treat anxiety (benzodiazepines) have provided some relief.

A number of non-drug approaches, also called cognitive and behavioral intervention, may help:

Gastric Acid Inhibitors - Help control acid reflux, ulcers and stomach pain with:

Mouth Sores

Mouth sores are a common side effect of certain chemotherapy drugs as well as radiation to the head.

Chemotherapy and radiation therapy kill rapidly dividing cells, such as cancer cells. However, the gastrointestinal (GI) tract, including the mouth and the throat, is made up of cells that divide rapidly.

For this reason, the GI tract is particularly susceptible to damage from chemotherapy and radiation treatment. Chemotherapy- or radiation-induced damage to the cells lining the mouth, throat, and gastrointestinal tract is called mucositis. This side effect of cancer treatment can significantly affect quality of life and may cause delays in treatment.

While side effects can cause delays in treatment, it's important to stick to a treatment schedule for best results. Find out more about chemotherapy cycles and schedules.

Diagnosing Mouth Sores

Symptoms of mouth sores commonly occur 3 to 10 days following treatment with chemotherapy. You may experience a burning sensation followed by ulcers, and your mouth may appear red (inflammation) with sores (ulcerations). You may also experience discomfort and pain.

Mouth sores can make chewing and swallowing difficult, interfering with your nutrition and food intake, resulting in weight loss.

Your speech may also be compromised.

Because the lining of your mouth also serves to protect you against infection, mouth sores make you more susceptible to bacterial, fungal, or viral infections in the mouth.

Ultimately, mouth sores can become severe enough that it is necessary to reduce your chemotherapy dose or delay your treatment in order to allow your mouth to heal.

Treatment That Makes Mouth Sores Worse

While mouth sores can occur with any treatment for cancer, oral mucositis is more severe if you receive the following:

The technique used to administer radiation may also impact the severity and duration of mouth sores. The following radiation techniques tend to produce less severe mouth sores:

Hyperfractionated radiation involves lower doses administered more frequently, resulting in less severe mouth sores.

Intensity-modulated radiation therapy (IMRT) spares normal tissues, reducing mouth sores, while still delivering the full radiation dose or even an increased dose to the cancer.

Your doctor may suggest combining chemotherapy with radiation therapy (Find out more about how cancer is treated with radiation therapy).

Other Factors That Make Mouth Sores Worse

A number of other factors contribute to the severity of mouth sores, including:

Preventing and Treating Mouth Sores

Treatment for mouth sores generally consists of good oral care, mouthwashes, and cryotherapy (sucking on ice chips).

Oral Care

Good oral care helps prevent mouth sores:

Mouthwashes

A mouthwash of salt and soda may relieve mouth sores as well as medicated mouthwashes and is less expensive.28

Cryotherapy (Ice Chips)

You can relieve mouth pain by sucking ice chips when the chemotherapy drug is most concentrated in the body.

This technique, called cryotherapy, works by decreasing blood flow to the cells in the mouth, reducing exposure to the drug and decreasing the risk of developing mouth sores.

Constipation & Diarrhea

A. Constipation

Constipation is difficulty passing stools or a decrease in the number of stools. It may be accompanied by gas, abdominal cramping, or pressure in the lower abdomen. Constipation may lead to stool impaction, a severe form of constipation where the stool will no longer pass through the colon or rectum.

Causes of Constipation

Constipation is caused by a slowing of the intestinal activity. The normal wave-like action of the intestines, called peristalsis, serves to continually move stools out of the body. When peristalsis slows, the stools become hard, dry, and difficult to pass.

Constipation can have a number of causes, including:

Chemotherapy drugs can cause either an increase or a decrease in peristalsis. An increase in intestinal activity may cause stools to travel faster and be less formed, resulting in cramping or diarrhea. A decrease in intestinal activity may cause stools to travel more slowly, becoming hard and dry and more difficult to pass, which is constipation.

Diagnosing Constipation

Symptoms of constipation include:

Preventing Constipation

It is easier to prevent constipation with lifestyle changes than to treat it once it happens. Here are some tips:

Drink plenty of water. Fluids keep the stool soft. Try to drink six to eight (8 ounce) glasses of fluid a day.

Eat foods high in fiber, such as fruit, vegetables, and beans. High-fiber foods stimulate the intestines to move.

Avoid cheese, meat, processed food, and other low-fiber foods that cause constipation.

If your doctor approves, exercise daily. Exercise helps stimulate digestion and prevent constipation. Moderate activity such as walking will help.

It may also help to keep track of your bowel movement schedule so you can learn which lifestyle measures work best for you. If you miss a bowel movement, try increasing your fluid intake or adjusting your diet. Call your doctor if your bowels have not moved in 2 days.

Sometimes side effects signal a serious problem. Find out when to call your doctor about chemotherapy side effects.

Treating Constipation

If you have tried the above lifestyle changes and still experience constipation, your doctor may prescribe laxatives. Laxatives are available in liquid, tablet, gum, powder, and granule forms. There are several different kinds that work in different ways.

Laxatives should be used only for a short period of time in order to retrain the bowel to pass stools naturally. If you use laxatives continually, you may become dependent on them. For most people, slowly stopping use of the laxative will restore the colon's natural ability to contract.

Laxatives and Stool Softeners - You can treat constipation with:

B. Diarrhea

Take diarrhea seriously! - Diarrhea can sometimes be severe enough that you are unable to tolerate your prescribed chemotherapy treatments. Commonly, chemotherapy treatments are delayed if diarrhea persists. A disruption or delay in chemotherapy may diminish the effect of your cancer treatment.

Chemotherapy can damage healthy cells such as those that line the interior of the digestive tract. The result can be a disruption in the delicate fluid balance that these cells maintain. Specifically, absorption of fluid from the gastrointestinal (GI) tract back into the body is decreased, and secretion of fluid and electrolytes in the stool is increased. This causes watery bowel movements, otherwise known as diarrhea.

The Challenge of Managing Diarrhea

Diarrhea not only is an inconvenient side effect of cancer treatment, but also can be life-threatening if not adequately managed. It may lead to:

At its extreme, diarrhea can cause the critical electrolytes sodium and potassium to reach dangerously low levels, known as hyponatremia and hypokalemia, respectively. The body continually regulates sodium in order to maintain levels within a narrow range. Diarrhea can disrupt this delicate balance by excreting too much sodium in the stool.

Factors That Make Diarrhea Worse

Some factors may make chemotherapy-related diarrhea worse. For example:

Damage to the intestines as a result of surgery or radiation may make the GI system more susceptible to irritation.

Other medications (such as antibiotics), diabetes, irritable bowel syndrome, reduced pancreas function, or other conditions may also worsen diarrhea.

Treating Diarrhea

Diarrhea can be addressed in different ways:

Diet - Several changes in your diet will help reduce the discomfort of diarrhea:

Avoid foods that irritate the GI system - such as greasy, spicy or fried foods.

Avoid milk and milk products because diarrhea may lead to a loss of the enzyme lactase, which breaks down lactose, the sugar found in milk, resulting in temporary lactose-intolerance.

Because of their high-fiber content, vegetables tend to be difficult to digest and should be avoided during episodes of diarrhea. Cruciferous vegetables, such as cabbage, brussel sprouts, and broccoli, can be particularly problematic.

Your diet should be limited to simple, easy-to-digest foods, and then be expanded as the diarrhea begins to subside.

The BRAT Diet: A diet consisting of bananas, rice, applesauce, toast and clear liquid is a good starting point. Eventually, you can add pasta without sauce, white-meat chicken without skin, scrambled eggs, and other easily digested foods, as tolerated.

Fluids

Staying hydrated (giving your body plenty of liquids) is very important in the management of diarrhea. You must consume enough clear liquids to make up for the volume of fluids lost due to the diarrhea. This amount is in addition to your usual daily intake.

You may need to take in three to four liters or more of fluid per day (?).

In addition to plain water, you should include fluids that contain some sugar and salt, such as broth or Gatorade®. Replacement of fluids with plain water alone can lead to low levels of salt or calcium in the blood. These can be life-threatening conditions.

Sometimes side effects signal a serious problem. Find out when to call your doctor about chemotherapy side effects.

Drug Therapy

An example of a drug to be prescribed for chemotherapy-related diarrhea is loperamide (Imodium® or others). Loperamide slows the gastrointestinal system and reduces the amount of fluid lost in the stool. Loperamide is effective for managing mild to moderate diarrhea, though it may not work for severe diarrhea. It is an inexpensive over-the-counter medication available as a pill.

Antidiarrheals - You can treat diarrhea with:

When Is Surgery Necessary?

Although most patients will have a biopsy performed, not all cancers require surgical treatment.

Some cancers are best treated with chemotherapy or radiation therapy, or both. In some instances, the cancer may be too big or too difficult to remove with surgery.

Your health care team will work with you to decide whether surgery is part of your overall treatment plan. If surgery is necessary, you will undergo a number of tests to determine whether you are an appropriate candidate for surgery.

Diagnosing Cancer With Surgery

One common type of surgery used to help with diagnosing cancer is a biopsy. A biopsy means taking a tissue sample from your body for examination by a specialist in a laboratory.

When surgery is used for treatment, the cancer and some tissue adjacent to the cancer are typically removed. In addition to providing local treatment of the cancer, information gained during surgery is useful in predicting the likelihood of cancer recurrence and whether other treatment modalities will be necessary.

Over the years, continuing advances in surgery have led to less invasive, less complicated, and safer procedures. As a result, some surgeries previously requiring hospitalization are now performed safely in an outpatient setting.

Other types of surgeries are used to treat cancer once it has been diagnosed. Surgery is not without risk or side effects. To play an active role in your treatment, learn more about the types and risks of surgery.

Risks of Surgery

Surgery involves risks and side effects, depending on the type of surgery you have and the expertise and experience of the surgeon and hospital.

Generally, the more invasive or complicated the surgery, the greater the risk of side effects.

If you choose to have surgery, the surgeon will tell you about all of the known possible risks, side effects, and benefits associated with your specific surgical procedure.

*Consider Getting a Second Opinion - Before you have surgery, it may be worthwhile to get a second opinion from another surgeon and ask about the track record of his or her hospital. It is very common and appropriate to get a second opinion.

C. RADIATION THERAPY

Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It's administered by a radiation oncologist at a radiation center. In general, radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancer. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor that has spread to more than four lymph nodes in your armpit.

Radiation is usually started three to four weeks after surgery. You'll typically receive treatment five days a week for five to six consecutive weeks. The treatments are painless and are similar to getting an X-ray. Each takes about 30 minutes. The effects are cumulative, however, and you may become quite tired toward the end of the series. Your breast may be pink, puffy and somewhat tender, as if it had been sunburned.

In a small percentage of women, more serious problems may occur, including arm swelling, damage to the lungs, heart or nerves, or a change in the appearance and consistency of breast tissue. Radiation therapy also makes it somewhat more likely that you'll develop another tumor. For these reasons, it's important to learn about the risks and benefits of radiation therapy when deciding between lumpectomy and mastectomy. You may also want to talk to a radiation oncologist about clinical trials investigating shorter courses of radiation.

D. BIOLOGICAL THERAPY

Biological therapy has many names, including "immunologic therapy," "immunotherapy" or "biotherapy."

Biological therapy uses the body's immune system to help kill cancer cells. Types of biological therapy include the following:

Hormone therapy - similar to chemotherapy - is a systemic (not local) treatment - it may also affect cancer cells throughout the body.

Hormones are naturally occurring substances in the body that stimulate the growth of hormone-sensitive tissues - such as the breast or the prostate gland.

When cancer forms in breast or prostate tissue, its growth and spread may be caused by the body's own hormones. Therefore, ways to fight cancer include drugs that block hormone production or change the way hormones work, and the removal of organs that secrete hormones, such as the ovaries or testicles.

Courtesy of: Mayo Clinic