Cancer Treatments

Cancer Treatments Therapies & Side Effects

Goals of Therapy Cure • refers to prolonged absence of detectable disease Control • when cure is unrealistic • prevent new cancer growth

Goals of Therapy (cont.) Palliation • when cure or control is impossible • reduce side effects/symptoms of disease

Types of Treatment • Surgery • Radiation Therapy • Chemotherapy • Hormone Therapy Therapies can be used alone or in combination

Surgery • Removal of cancerous tissue from the body • Local treatment • Can also be used for: diagnosis, staging, relief of side effects, or to ease pain

Side Effects of Surgery • Depends on type of surgery & overall health of person • Most common side effect is Pain • Other side effects include: bleeding, constipation, fatigue, wound care, and management of drains

Surgical Treatments Cervical • Cryosurgery, laser surgery, conization, hysterectomy • Feel less womanly, incision, bleeding Breast • Lumpectomy, mastectomy • Feel less womanly, balance, numbness/tingling, drains, lymphadema

Surgical Treatments Colon • Colectomy, resection • Altered bowel function, colostomy Lung • Resection, lobectomy, pneumonectomy • Chest tube, respirator, short of breath

Surgical Treatments Prostate • Prostatectomy, orchiectomy • Impotence, incontinence, libido

Radiation Therapy • High energy x-rays to kill cancer cells • Local treatment • Given externally or internally • Skin may be marked by tattoos to direct beams • Daily treatments

Side Effects of Radiation Side effects depend on targeted area • Skin irritation • Hair loss • Digestive problems • Fatigue • Urinary & Bladder problems • Sexual/Fertility problems • Bleeding/Infection* *Risks associated with implanted radiation source

Skin Changes May start a few weeks after radiation begins & last a few weeks after radiation ends • Redness • Itching • Dry, Peeling • Sores, ulcers • Swollen

Clinical May hold treatment Prescribe special creams May prescribe medications for pain, itching, or infection At Home Use mild soap with lukewarm water Do not rub or scratch area Loose clothing, soft fabrics Sun protection Sitz baths Check with Provider before using any skin products Management of Skin Changes

Hair Loss • Also called alopecia • Only happens on the part of body being treated • Hair loss starts 2 to 3 weeks after first treatment • Hair may grow back 3 to 6 months after treatment is over • New hair may not look or feel the way it did before

Clinical Prescription for wig “Look Good, Feel Better” At Home Cut hair short or shave head Buy a wig (before loss) Wash hair gently Avoid harsh products Protect scalp Stay warm Management of Hair Loss

Digestive Changes Changes depend on amount of radiation and concurrent chemotherapy • Diarrhea • Mouth/Throat changes • Nausea & Vomiting

Diarrhea • Frequent bowel movements which may be soft, formed, loose, or watery • Can occur at any time • Radiation to the abdomen or pelvis may cause diarrhea

Clinical I.V. Fluids Electrolyte replacement Imodium or other anti-diarrheal medications At Home Drink 8 to 12 cups of clear liquids per day Eat 5 or 6 small meals and snacks Eat foods that are low in fiber, fat, and lactose Avoid spicy foods Management of Diarrhea

Mouth & Throat Changes Radiation to head or neck can cause: • Dry mouth and throat • Difficulty swallowing • Mouth sores • Loss or changes in taste • Tooth decay • Infections Some side effects my last for months or years after treatment ends

Clinical Dental exam Prescribe special mouthwash for pain or infection At Home Avoid tobacco, alcohol Eat moist, soft foods that are cool or room temperature Eat 5-6 small meals high in calories & protein Drink 6-8 cups of fluid each day Management of Changes to Mouth/Throat

Nausea & Vomiting • Nausea and vomiting may occur 30 minutes to many hours after radiation therapy session ends • Patients are likely to feel better on days off from radiation • Those receiving radiation to the abdomen & certain parts of the brain are at risk

Clinical I.V. fluids Electrolyte replacement Prescribe anti-nausea meds At Home Eat bland, easy-to-digest foods and drinks Eat small meals and snacks (5-6 meals a day) Have foods and drinks that are warm or cool Management of Nausea & Vomiting

Fatigue Feeling weak, weary, worn out, heavy, or slow Possible Causes: • Anemia • Anxiety • Depression • Infection • Lack of activity • Medicines Fatigue may last even after therapy is over

Clinical Assess for underlying cause Treat patient for anemia, anxiety, depression or infection as indicated At Home Try to sleep at least 8 hours each night Plan time to rest Exercise Adjust work schedule Let others help at home Management of Fatigue

Urinary & Bladder Changes • Frequency, burning or pain • Trouble starting or emptying bladder • Incontinence • Blood in urine • Spasms • Starts 3-5 weeks after therapy begins • Most problems go away 2-8 weeks after therapy is over.

Clinical Urine sample to rule out infection Prescribe meds to help with spasms, burning or pain Refer to a therapist for exercises to improve bladder control At Home Drink 6-8 cups of fluid each day Avoid coffee, black tea, alcohol, spices, and all tobacco products Continence pads Management of Urinary Changes

Sexual & Fertility Changes • Radiation to pelvic area • Can cause sexual changes: loss of interest in or ability to have sex • It can also affect fertility

Management Patients should talk to their Provider: • Fertility: Before starting radiation, let your doctor know if you think you might want to father children in the future. • Impotence: The doctor can let you know whether you are likely to become impotent and how long it might last. Your doctor can prescribe medicine or other treatments that may help. • Sex: Ask if it is okay for you to have sex during radiation therapy. Most men can have sex, but it is a good idea to ask and be sure.

Long-term Side Effects Radiation can sometimes have long lasting effects: • Second cancer • Fatigue • Infertility • Heart problems • Gastrointestinal problems • Lung fibrosis • Neurologic problems

Chemotherapy • Variety of drugs used to kill cancer cells • Systemic treatment: damages healthy cells along with cancer cells • Given orally, IV, or by injection into various sites

Bone Marrow Cardiac Pulmonary Nerves Gastrointestinal Mouth & Throat Kidney & Bladder Hair, Skin & Nails Side Effects of Chemotherapy

Myelosuppression Refers to the suppression of the bone marrow Bone marrow produces: • White blood cells • Red blood cells • Platelets Nadir Point at which the lowest blood cell count is reached after chemotherapy

Neutropenia • A low number of white blood cells (neutrophils) • White blood cells help fight infections • The most common dose-limiting side effect of chemotherapy • A fever of 100.4 F or higher may be the only sign of infection for neutropenic patients

Clinical Treatment with colony stimulating factors Avoid invasive procedures No live vaccinations At Home Frequent hand washing Wash fresh fruits & vegetables Avoid raw meats/fish Avoid crowds, sick people Avoid animal excreta Management

Anemia • A low number of red blood cells • Red blood cells help transport oxygen from the lungs to body tissues • Symptoms can include fatigue, shortness of breath, chest pain, dizziness/lightheaded

Clinical Blood transfusion EPO administration Iron supplements Oxygen therapy At Home Plan activities to conserve energy Sleep at least 8 hours each night Maintain optimal level of physical activity Well balanced diet (iron & protein rich) Management

Thrombocytopenia • A low number of platelets (thrombocytes) • Platelets stick together to form a clot in order to stop bleeding • Overt bleeding or petechiae (a purplish red rash) could signify a low platelet count

Clinical Platelet transfusion IL 11 injections Avoid invasive procedures Prescribe stool softeners At Home Avoid injuries Electric razor, soft toothbrush High protein diet, non-irritating foods Avoid aspirin, NSAIDS Management

Heart • Cardiac toxicity • Usually dose related • May be irreversible • Symptoms: fast heartbeat, shortness of breath, cough, ankle swelling

Clinical Discontinue or reduce medication Order tests: EKG, MUGA, Holter monitor At Home Avoid alcohol and tobacco Modify diet as indicated Report symptoms Cardiac Management

Pulmonary • Risk increases with chest radiation, underlying lung disease, patient is a smoker • Hypersensitivity, inflammatory, fluid retention • Symptoms: cough, shortness of breath, fatigue, restlessness, rapid respirations

Clinical May discontinue medication Prescribe home oxygen Further tests At Home Refrain from smoking Use a fan Elevate head of bed Conserve energy Restrict fluids as indicated Report symptoms Pulmonary Management

Central, Peripheral, and Cranial Nerves Symptoms depend on which nerves are damaged Symptoms Include: Hearing Vision Touch, Sensory Pain Balance Strength Nerves

Clinical May discontinue drug Treat vitamin deficiency Prescribe pain medication Consult neurologist At Home Ensure safe environment Report symptoms Management

Gastrointestinal Nausea, Vomiting, Diarrhea • Acute or Delayed Constipation • Decreased intake • Medications • Depression • Advanced cancer stage

Clinical May suggest a fiber supplement, laxative, stool softener, or enema At Home Drink at least 8 cups of fluids each day Be active every day Eat high fiber foods Contact Provider if not had a bowel movement in 2 days Management of Constipation

Mouth & Throat • Dry mouth (having little or no saliva) • Changes in taste and smell • Infections of gums, teeth, or tongue • Increased sensitivity to hot or cold foods Mucositis • Inflammation of the GI mucosa • Symptoms: pain/difficulty swallowing, hoarseness, changes in color to oral mucosa, ulcers

Appetite Changes Causes include: • Nausea • Mouth and throat problems • Changes in taste • Feeling depressed or tired Appetite loss may last for a day, a few weeks, or even months.

Clinical Prescribe vitamins or nutrition supplements Prescribe medications that increase appetite receive nutrition through an IV At Home Eat 5 to 6 small meals each day Drink milkshakes, smoothies, juice, or soup Use plastic forks and spoons Increase your appetite by doing something active Management for Loss of Appetite

Kidneys & Bladder Bladder • burning, pain, blood Kidneys • Impaired water excretion • Proteinuria • Weight gain • Little urine output

Cancer Treatments