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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
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Surgery
Radiation Therapy
Chemotherapy
Hormone Therapy
Therapies can be used alone or in
combination
Surgery
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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
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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
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Cryosurgery, laser surgery, conization,
hysterectomy
Feel less womanly, incision, bleeding
Breast
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Lumpectomy, mastectomy
Feel less womanly, balance,
numbness/tingling, drains, lymphadema
Surgical Treatments
Colon
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Colectomy, resection
Altered bowel function, colostomy
Lung
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Resection, lobectomy, pneumonectomy
Chest tube, respirator, short of breath
Surgical Treatments
Prostate
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Prostatectomy, orchiectomy
Impotence, incontinence, libido
Radiation Therapy
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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
Management of Skin
Changes
Clinical
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May hold treatment
Prescribe special creams
May prescribe
medications for pain,
itching, or infection
At Home
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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
Hair Loss
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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
Management of Hair Loss
Clinical
 Prescription for wig
 “Look Good, Feel
Better”
At Home
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Cut hair short or shave
head
Buy a wig (before loss)
Wash hair gently
Avoid harsh products
Protect scalp
Stay warm
Digestive Changes
Changes depend on amount of radiation
and concurrent chemotherapy
 Diarrhea
 Mouth/Throat changes
 Nausea & Vomiting
Diarrhea
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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
Management of Diarrhea
Clinical
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I.V. Fluids
Electrolyte
replacement
Imodium or other
anti-diarrheal
medications
At Home
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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
Mouth & Throat Changes
Radiation to head or neck can cause:
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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
Management of Changes
to Mouth/Throat
Clinical
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Dental exam
Prescribe special
mouthwash for pain
or infection
At Home
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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
Nausea & Vomiting
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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
Management of Nausea &
Vomiting
Clinical
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I.V. fluids
Electrolyte
replacement
Prescribe antinausea meds
At Home
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Eat bland, easy-todigest foods and
drinks
Eat small meals and
snacks (5-6 meals a
day)
Have foods and drinks
that are warm or cool
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
Management of Fatigue
Clinical
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Assess for
underlying cause
Treat patient for
anemia, anxiety,
depression or
infection as indicated
At Home
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Try to sleep at least 8
hours each night
Plan time to rest
Exercise
Adjust work schedule
Let others help at
home
Urinary & Bladder
Changes
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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 28 weeks after therapy is
over.
Management of Urinary
Changes
Clinical
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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
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Drink 6-8 cups of
fluid each day
Avoid coffee, black
tea, alcohol, spices,
and all tobacco
products
Continence pads
Sexual & Fertility
Changes
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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:
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Fertility: Before starting radiation, let your doctor know if
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Impotence: The doctor can let you know whether you are
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Sex: Ask if it is okay for you to have sex during radiation
you think you might want to father children in the future.
likely to become impotent and how long it might last.
Your doctor can prescribe medicine or other treatments
that may help.
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
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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
Side Effects of
Chemotherapy

Bone Marrow

Gastrointestinal

Cardiac

Mouth & Throat

Pulmonary

Kidney & Bladder

Nerves

Hair, Skin & Nails
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
Management
Clinical
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Treatment with
colony stimulating
factors
Avoid invasive
procedures
No live vaccinations
At Home
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Frequent hand washing
Wash fresh fruits &
vegetables
Avoid raw meats/fish
Avoid crowds, sick
people
Avoid animal excreta
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
Management
Clinical
At Home
 Blood transfusion  Plan activities to
conserve energy
 EPO administration
 Iron supplements  Sleep at least 8
hours each night
 Oxygen therapy
 Maintain optimal
level of physical
activity
 Well balanced diet
(iron & protein rich)
Thrombocytopenia
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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
Management
Clinical
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Platelet transfusion
IL 11 injections
Avoid invasive
procedures
Prescribe stool
softeners
At Home
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Avoid injuries
Electric razor, soft
toothbrush
High protein diet,
non-irritating foods
Avoid aspirin, NSAIDS
Heart
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Cardiac toxicity
Usually dose related
May be irreversible
Symptoms: fast heartbeat, shortness
of breath, cough, ankle swelling
Cardiac Management
Clinical
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Discontinue or
reduce medication
Order tests: EKG,
MUGA, Holter
monitor
At Home
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Avoid alcohol and
tobacco
Modify diet as
indicated
Report symptoms
Pulmonary
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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
Pulmonary Management
Clinical
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May discontinue
medication
Prescribe home
oxygen
Further tests
At Home
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Refrain from
smoking
Use a fan
Elevate head of bed
Conserve energy
Restrict fluids as
indicated
Report symptoms
Nerves
Central, Peripheral,
and Cranial Nerves
Symptoms depend on
which nerves are
damaged
Symptoms Include:
 Hearing
 Vision
 Touch, Sensory
 Pain
 Balance
 Strength
Management
Clinical
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May discontinue
drug
Treat vitamin
deficiency
Prescribe pain
medication
Consult neurologist
At Home
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Ensure safe
environment
Report symptoms
Gastrointestinal
Nausea, Vomiting, Diarrhea

Acute or Delayed
Constipation
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Decreased intake
Medications
Depression
Advanced cancer stage
Management of
Constipation
Clinical
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May suggest a fiber
supplement,
laxative, stool
softener, or enema
At Home
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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
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
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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.
Management for Loss of
Appetite
Clinical
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Prescribe vitamins or
nutrition
supplements
Prescribe
medications that
increase appetite
receive nutrition
through an IV
At Home
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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
Kidneys & Bladder
Bladder

burning, pain, blood
Kidneys
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Impaired water excretion
Proteinuria
Weight gain
Little urine output
Management
Clinical
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IV fluids
Bladder irrigation
Diuresis
Monitor electrolytes
At Home
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Increase oral fluids
Empty bladder
frequently
Call provider: unable
to urinate for more
than 12 hours; urine
dark & concentrated;
producing only small
amounts of urine
Hair Loss
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May lose some or all hair
Can happen anywhere on the body
Starts 2 to 3 weeks after therapy begins
Scalp may hurt at first
It takes about 1 week for hair to fall out
Almost always, hair will grow back 2 to 3
months after chemotherapy is over
Hair may start growing back even while on
therapy
Skin & Nails
 Itching, dryness, redness, rashes, and
peeling
 Darker veins
 Sensitivity to the sun
 Nail problems
 Radiation recall
 Allergic reactions
 Chemotherapy leaking from IV
Fatigue

Most common and most distressing
symptom associated with cancer
treatment
Hormonal Therapy
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May improve
prognosis more than
chemotherapy
If taken by mouth,
must be taken
everyday
Usually given for 5-10
years
In Stage IV disease,
can control cancer for
many years
Side Effects of Treatment
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Usually tolerated well
Hot flashes
Joint pains
Blood clots