Download about cancer - Aasha

CANCER & CHEMOTHERAPY
INDEX
WHAT IS CANCER?
TYPES OF CANCER
CAUSES OF CANCER
RISK FACTORS FOR CANCER
WARNING SIGNES
CANCER SCREENING
DIAGNOSIS
TREATMENT
UNDERSTANDING CHEMOTHERAPY
What is cancer?
Cancer is a general term used to describe cells that grow and spread around the body in
an uncontrolled way.
*Our body is made up of millions of tiny cells which replace themselves whenever
necessary. For example, they replace themselves when they get wornout, old or
injured.
*The cells of our bodies grow and multiply in a process known as cell division. It
must be extremely tightly controlled if all the cells in our body are to grow in the right
place, and for all our organs and tissues to function properly. If cells divide too quickly
the consequences can be disastrous.
* Cancer is essentially a disease of cell division. Uncontrolled cell division can have
many causes and can happen in any type of cell in the body, but it usually results from
defects or damage in one or more of the genes involved in cell division.
If these genes become damaged (mutated) in some way for example by exposure to
cigarette smoke or ultraviolent radiation, the cell can start to divide uncontrollably. These
defective cells can multiply to form a lump of abnormal tissue called a tumor.
What do the terms benign and malignant mean?
A tumor may be benign or malignant:
*A benign tumor is not cancer, does not spread, can usually be completely removed, is
not likely to recur and does not usually present a serious threat to health.
*A malignant tumor is cancer, and can invade neighboring tissue and organs through
your blood or lymph system (this is the system which helps fight infection) this is called
metastasis and can start new or secondary cancers.
*The cells in almost any part of the body can become cancerous (only the hair nails and
teeth can not get cancer) There are several hundred types of different types of cancers.
Each happens for different reasons and each type of cancer is different. Some cancers
develop slowly some quickly, some cancers have known causes whilst others have
unknown causes.
*When cancer comes back in a person who appeared to be free of the disease after
treatment, it is called recurrence
How does cancer spread?
A malignant tumor is made up of cancer cells when it first develops, this malignant tumor
may be confined to its original site. This is known as cancer in situ (or carcinoma in situ)
if these cells are not treated, they may spread beyond their normal boundaries and into
surrounding tissues, becoming invasive cancer.
Some benign tumors are precancerous and may progress to cancer if left untreated. Other
benign tumors do not develop into cancer.
For cancer yo grow bigger than the head of the pin it must grow its own blood vessels.
This is called angiogenesis. Sometimes cells move away from the original (primary)
cancer , either by the tissue fluid channels(lymphatics) or in the blood stream, and invade
other organs. When these cells reach a new site, they may continue to grow and form
another tumor at that site. This is called a secondary cancer or metastasis.
How does cancer make you ill?
*Cancerous cells divide uncontrollably.
*On its own a single tumor can make you quite ill, for example by pressing against
nerves, blocking the digestive system or blood vessels, or by releasing hormones that can
affect the normal workings of your body.
*Things can get much worse, however, if the cancer becomes malignant and spreads.
*This happens when a single cancerous cell breaks away from the main tumor and starts
growing and dividing elsewhere in the body. Once a tumor metastasizes, it is much more
difficult to treat and can make you much more ill because more areas of the body are
affected.
*A cancer may also cause generalized symptoms such as fever, fatigue or weight loss.
This may be caused by cancer cells releasing substances that change body’s metabolism
or the cancer may cause the immune system to react in ways that produce this system.
How many different types of cancer are there?
*From one point of view, there are as many types of cancer as there are different people,
because everyone’s genes are different and so no two cancers are exactly alike.
From another point of view, there are as many different types of human cell – just over
200.
*However cancers can be broadly grouped into different types, depending on which
tissues they come from.
Carcinomas the most common types of cancer, arise from the cells known as epithelial
cells that cover external and internal body surfaces Lungs , breast and colon are the most
frequent cancers of this type
Sarcomas are cancers arising from cells found in the supporting tissues of the body such
as bone, cartilage, fat connective tissue and muscle.
Lymphomas are cancers that arise in the lymph nodes and tissues of the body,s immune
system.
Leukemia are cancers of the immature blood cells that grow in the bone marrow and
tend to accumulate in large numbers in the blood stream
Adenomas are tumors that come from glandular tissue like the thyroid the pituitary gland
they are often benign.
What causes cancer?
*There is no one single cause for cancer. Scientists believe that it is the interaction of
many factors together that produces cancer. The factors involved may be genetic
environmental or constitutional characteristics of the individual.
*Anything that damages the genes in our cells can ultimately cause cancer the vast
majority of cancers are caused by DNA damage that accumulates over a person’s lifetime
(sporadic cancer). Cancers that are directly caused by genetic faults inherited from a
parent are less common.
What are the risk factors for cancer?
A risk factor is anything that may increase a person’s chance of developing a disease .A
risk factor does not necessarily cause the disease, but it may make the body less resistant
to it. The following risk factors and mechanisms have been proposed as contributing to
the development of cancer.
Lifestyle factors
Smoking,tobacco in any form, high-fat diet, lack of exercise or exposure to chemicals
(cancer-causing substances) in the work place a over long period of time may be risk
factors for some cancers.
Genetic factors
*Family history, inheritance and genetics may play an important role in some adult and
childhood cancers. It is possible for cancer of varying forms to be present more than once
in a family. Some gene alterations are inherited. However, this does not necessary mean
that the person will develop cancer. It indicates that the chance of developing cancer
increases.
*There are two important types of genes that, when mutated can cause cancer-tumor
suppressor genes and oncogenes.
Environmental hazards
During the course of a day, we are continually exposed to things that damage our DNA.
Things that damage DNA are called carcinogens, and they include
Tobacco, car exhaust fumes, the sun, Natural and man made radiation, Asbestos,
pesticides, fertilizers.
Many of these things cause damage because they react with the molecules in our cells to
form free radicals. Free radicals are highly damaging molecules, and can wreak havoc on
the sensitive machinery inside a cell.
Age
Age is an important risk factor for cancer. Cancer can occur at any age, but the risk of
developing cancer increases with age. Over 70% of all newly diagnosed cancers occur in
people aged 60 years or more. This is because the longer we live, the greater the number
of potentially cancer-causing mutations in our DNA.
Viruses
Some viruses are linked to certain types of cancer. Possibly, the virus alters a cell in some
way. This does not mean that these cancers spread from person to person like an
infection, and does not mean that every one infected with these viruses will develop
cancer.
E.g.: Human papilloma virus(HPV) cervical cancer , Hepatitis B and C viruses-primary
liver cancer , Human T-cell leukaemia, virus leukaemia,Eppstein-Barr virus (EBV) can
occasionally cause some types of childhood cancers ,carcinomas and lymphomas ,Human
immunodeficiency virus is linked to several cancers as it weakens the immune system.
What are the warning signs of cancer?
The chances of curing cancer increase with early detection
The Indian Cancer Society and other organizations recommend paying attention to the
seven warning signs of cancer:
1. Changes in bowel or bladder habits
2. Unusual bleeding or discharge
3. A sore that does not heal
4. Indigestion or difficulty swallowing
5. A nagging cough or hoarseness
6. A thickening or lump in the breast or elsewhere
7. An obvious change in a wart or mole
A physician can detect cancer by taking a medical history, performing routine check ups,
cancer screening tests, imaging techniques and tissue biopsy.
What is cancer screening?
They are tests designed to detect cancer when one does not have any symptoms. They
include:
1 Digital rectal examination
2 Pelvic examinations
3 Breast self examination
4 Pap test
5 Mammography
How is cancer diagnosed?
There is no single test that can accurately diagnose cancer. The complete evaluation of a
patient usually requires a thorough history and physical examination along with
diagnostic testing. Many tests are needed to determine whether a person has cancer, or if
another condition (such as an infection) is mimicking the symptoms of cancer. Effective
diagnostic testing is used to confirm or eliminate the presence of disease, monitor the
disease process, and to plan for and evaluate the effectiveness of treatment.
There are number of ways to diagnose cancer.
Diagnostic blood tests- They are designed to identify a tumor caused impairment.
Blood tests like
CBC-Complete blood counts and Differential white blood cell counts.
Tumor markers: Tumor markers are substances either released by cancer cells into the
blood or urine or substances created by the body in response to cancer cells. Tumor
markers are used to evaluate how well a patient has responded to treatment and to check
for tumor recurrence. E. g., Alpha fetoprotein (AFP) carcinoembryonic antigen (cea),
prostate specific antigen (psa), etc are used to indicate the presence of tumor.
IMAGING TECHNIQUES - imaging is the process of producing valuable pictures of
body structures and organs. It is used to detect tumors and other abnormalities.
To determine the extent of disease, and to evaluate the effectiveness of treatment.
Imaging may also be used when performing biopsies and other surgical procedures.
X-RAYS_ X-rays are .diagnostic tests that use invisible electromagnetic energy beams to
produce images of internal tissues ,bones ,and organs on film-rays may be taken of any
part of the body to detect tumor (or cancer)cells.
Computed Tomography Scan (Also called a CT SCAN OR Computed Axial
Tomography or CAT scan)CAT scan is a diagnostic imaging procedure that uses a
combination of x-rays and computer technology to produce cross-sectional images(often
called slices) both horizontally and vertically, of the body. A CT scan shows detailed
images of any part of the body, including the bones muscle, fat, and organs. CT scans are
more detailed than general x-rays. CT scans can also be a huge help in planning surgery
or radiotherapy.
MRI scans (Magnetic Resonance Imaging): MRI, uses magnetism rather than x-rays to
build up picture of the insides of your body.
MRI scan can be used like a CT scan to view slices through the body, or can make 3D
images of your organs. It usually produces a more detailed view of the body than x-rays,
so doctors often use MRI to examine your head and brain. It can also be used to measure
blood flow.
PET scan (Positron Emission Tomography) This test uses a form of sugar that contains
a radioactive atom. Cancer cells absorb high amounts of this sugar. A special camera can
then spot these cells.PET is useful when the doctor thinks the cancer has spread but
doesn’t know where. It may also be useful in checking lymph nodes for cancer before
they are removed.
Ultrasound: Ultrasound, or sonography, is the most commonly used type of reflection
imaging. This technique uses high frequency sound waves and computer to create
images, called sonograms, of blood vessels, tissue, and organs. Sonograms are used to
view internal organs as they function and to assess blood flow through various vessels.
Tumors in the abdomen, liver and kidneys can often be seen with an ultrasound.
Mammogram: mammogram is an x-ray examination of the breast. It is used to detect
and diagnose breast disease in women. Mammography can not prove that an abnormal
area is cancerous, but if it raises a significant suspicion of cancer, a biopsy may be
performed.
Bone scan: This test can help show whether the cancer has spread to the bones
Tissue biopsy: A biopsy is a procedure performed to remove tissue or cells from the
body for examination under a microscope to determine whether it is cancerous.
Endoscopic biopsy: This type of biopsy is performed through a fiberoptic endoscope(a
long thin tube that has a close-focusing telescope on the end for viewing) through a
natural body orifice(i. e. rectum) or a small incision. The endoscope is used to view the
organ in question for abnormal or suspicious areas, in order to obtain a small amount of
tissue for study.
Excisional or incisional biopsy: This type of biopsy is often used when wider or deeper
portion of the skin is needed. When the entire tumor is removed, it is called excisional
biopsy technique. If only a portion of the tumor is removed it is called incisional biopsy
technique.
Fine needle aspiration {FNA} biopsy: this type of biopsy involves using a thin
needle to remove fluid or very small pieces from a tumor. A computed
tomography scan (CT OR CAT scan)-an x-ray procedure that produces cross
sectional images of the body may be used to guide a needle into a tumor in an
internal organ such as the lung or liver.
These techniques are essential for locating and sampling tumors.
Endoscopy: An endoscope is a small, flexible tube with a light and a lens on the
end used to look into the esophagus, stomach, duodenum, colon or rectum. It can
also be used to take tissue from the body for testing or to take colour photographs
of the inside of the body.
What are the treatment methods available for cancer?
There is no single treatment for cancer-doctors have a range of options available and
must decide which is best for the patient. They will often combine several types of
treatment for greater effect taking into account all sorts of factors.
There are currently many different ways to treat cancer.
Surgery
Surgery is complete or partial removal of tumor. It is used in several ways to help
cancer patients. It provides the best chance to stop many types of cancer and it also
plays a part in diagnosing, staging and supporting cancer treatment. Several types of
surgery are helpful to people with cancer.
Some surgeries are used in combination with other types of treatment.
The goal of surgery is to eliminate the cancer or in the case of advanced disease;
relieve symptoms and achieve long term remission. The goal is to:
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Remove the primary cancer.
Leave an area around the cancerous site that is free of cancer cells. Therefore no
cancer cells are present in the tissue surrounding the surgery site.
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Remove nearby lymph nodes. The nodes are then examined to see if they
contain any cancer cells.
This is the important to correctly stage the cancer.
Having surgery for cancer is different for every patient depending on the type of surgery;
the type of cancer and the patient’s health.
2 RADIATION THERAPY
Radiotherapy uses precisely targeted high-energy rays to kill cancer cells. It does this by
damaging a cells internal components (molecules) causing the cells to commit suicide by
apoptosis.
Radiotherapy is usually required for one of the following reasons:
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As a stand –alone treatment to cure cancer.
To shrink a cancer before surgery.
To reduce the risk of a cancer coming back after surgery.
To complement chemotherapy.
To control symptoms and improve quality of life if a cancer is too advanced to
cure.
Radiation therapy is given through different methods; depending on the type of
cancer, the location of the cancer and the patient’s health. Sometimes, radiation
therapy is used in combination with others treatments .The following are some of
the different types of radiation therapies:
 External radiation ( external beam therapy)
Radiation is administered bye large machine, outside the body, that points the
energy waves directly at the tumor.
 Internal radiation (brachytherapy,implant radiation)
With internal radiation (brachytherapy, implant radiation), a high dose of
radiation is given inside the body as close to the cancer as possible. The
radiation treatment may be swallowed, injected, or implanted directly into the
tumor. Aim is to administer a higher dose of radiation in a shorter time span.
3. Chemotherapy:
Chemotherapy is the treatment of cancer with drugs that can destroy cancer
cells. These drugs often are called “anticancer”drugs.Specific treatment will
be based on:
 Your overall health and medical history
 The type and the stage of cancer
 Your tolerance for specific medications and procedures
 Expectations for the course of disease
 Your opinion or preference
The oncologist will also determine how long and how often you will have
chemotherapy treatments. Chemotherapy treatments are often given in cycles;
a treatment for a period of time, followed by a recovery period, then another
treatment.
Chemotherapy may be used alone for some types of cancer or in combination
with other treatments such as radiation or surgery.
4. Immunotherapy:
The use of drugs that enhance the immune system’s ability to kill cancer
cells.
Local immunotherapy delivers the treatment to the affected area. For
example, the BCG vaccine can be injected into the bladder to treat
bladder cancer, as it causes inflammation that can cause the tumor to
shrink.
Systemic therapy treats the whole body and is useful for targeting cancer
that may have spread .eg: Alpha interferon, Interferon is now used to
treat several different types of cancer.
5. Hormonal therapy:
The use of drugs that block the effects of hormones that stimulate the
proliferation of cancer cells.
6 Gene therapy:
A cancer is a disease caused by damaged DNA. Many researchers have
tried to find ways to correct this damage by correcting the DNA itself
Gene therapy is in its infancy. There are many concerns over the safety of
modifying a patients’DNA.To date no successful gene-based treatment has
been approved for routine use on cancer patients, but a huge amount of
research is being carried out in this area.
UNDERSTANDING CHEMOTHERAPY
How Does Chemotherapy Work? ,
The underlying principle of chemotherapy is to kill the cancer cells by treating with
chemicals that interfere with the process of cell division, thus stopping them from
growing or multiplying. Healthy cells can also be harmed, especially those that
divide quickly. Harm to healthy cells is what causes side effect. These cells usually
repair themselves after chemotherapy. Chemotherapy is used in different ways:
*Adjuvant therapy chemotherapy that is given after surgery, either alone or with
radiation (or another type of therapy), and that is designed to kill cells that have
metastasized.
*Neoadjuvant chemotherapy used prior to shrink a tumor, usually in conjunction
with radiotherapy.
*Primary therapy used alone when a leukemia or lymphoma is present. Also, used
alone in the management of other cancers when no hope for cure is present and
chemotherapy is given to control symptoms.
*Combination chemotherapy use of two or more chemotherapeutic agents. This
allows for each medication to enhance the action of the other or for the two to work
synergistically
What Is Chemotherapy Used For?
Chemotherapy is given for the following reasons:
*Cure-To cure the cancer so that it disappears (is killed off) and does not return.
*Control-If cure is not possible, chemotherapy aims to control the growth and
spread of the cancer
*Palliation-If cure and control are not possible, chemotherapy is given to relive
symptoms caused by the cancer.
Chemotherapy is used to treat many different types of cancer. The type location
and stage of the cancer as well as your general health will largely determine if
chemotherapy is appropriate and which agents ought to be used.
How Often and for How Long Will I Get Chemotherapy?
How often and how long you get chemotherapy depends on:
* The kind of cancer you have
* The goals of the treatment
* The drugs that are used
* How your body responds to them
You may get treatment every day every week or every month.
Chemotherapy is often given in cycles that include treatment periods alternate with
rest periods. Rest periods give your body a chance to build healthy new cells and
regain its strength. Ask your health care provider to tell you how long and how
often you may expect to get treatment
Sticking with your treatment schedule is very important for the drugs to work right.
Schedules may need to be change for holidays and other reasons. If you miss a
treatment session or skip a dose of drug contact your doctor.
Sometimes, your doctor may need to delay a treatment based on the results of
certain blood tests. Your doctor will let you know what to do during this time and
when to start your treatment again..
How Is Chemotherapy Given?
Chemotherapy can be administered via several routes. The most common method is
intravenously. Intravenously or IV means the drug is given by vein. A thin needle is
inserted into a vein on the hand or lower arm at the onset of the treatment session
and is removed at the conclusion.
Chemotherapy can also be delivered by IV through catheters, ports, and pumps a
catheter is a soft, thin flexible tube that is placed in a large vein in the body. It
remains in place as long as necessary. Sometimes the catheter is attached to a port,
which is a small round plastic or metal disc
A central venous catheter is placed in a large vein, most commonly in your chest. A
peripherally inserted central catheter (PICC) is inserted into a vein in your arm and
threaded to the deeper, central veins. An intrathecal catheter delivers
chemotherapeutic drugs directly into the spinal fluid. An intracavity catheter(IC) is
placed in the abdomen, pelvis or chest.
Other chemotherapeutic delivery methods include the following
 Orally, drug is given in pill, capsule or form and swallowed.
 Intralesionally (IL), directly into the cancerous area of the skin.
 Topically, drug is applied to the surface of the skin.
Which Drugs Are Given?
Some chemotherapy drugs are used for many differently types of cancer, while others
might be unused for just one or two types of cancer. Your doctor recommends a treatment
plan based on:
 What kind of cancer you have.
 What part of the body the cancer is found.
 The effect of cancer on your normal body functions.
 Your general health.
Can I Take Other Medicines While I Am Getting Chemotherapy?
Some medicines may interfere or react with the effects of your chemotherapy. Give your
doctor a list of all the medicines you take before you start treatment.
This includes:
 Name of each drug
 Dosage
 Reason for taking it
 Frequency
Remember to tell your doctor about all over the counter remedies, including vitamins,
laxatives, medicines for allergies, indigestion and colds, aspirin ibuprofen or other pain
relievers, and any mineral or herbal supplements. Your doctor can tell you if you should
stop taking any of these remedies before you start chemotherapy. After your treatments
begin, be sure to check with your doctor before taking any new medicines or stopping the
ones you are already taking.
How Will I Know if My Chemotherapy Is Working?
*Your doctor will use several ways to see how well your treatments are working. You
may have physical exams and tests often. Always feel free to ask your doctor about the
test results and what they show about your progress.
*Tests and exams can tell a lot about how chemotherapy is working, however, side
effects tell very little. Sometimes people think that if they have no side effects the drugs
are not working or they do have side effects the drugs are working well. But side effects
vary so much from person to person and from drug to drug ,that side effects are not sign
of whether the treatment is working or not.
*In case of chemotherapy being given after surgery to treat micrometastasis, tests and
exams can tell little about the effect of chemotherapy.
What Adverse Effects Can Occur with Chemotherapy?
Because chemotherapy can kill healthy cells along with cancer cells, many side effects
are associated with this form of treatment the most common side effects occur in areas
where healthy cells rapidly divide
These include:
 Blood cells
 Hair follicle cells
 Skin cells
 Digestive tract cells
You may experience no side effects or just a few. The kind of side effects and how severe
they are will depend on the type and dose of chemotherapy and how your body reacts.
Some of the more common side effects are described in the GOLDSHIELD SELF-HELP
booklet
SIDE EFFECTS
&
IT’S MANAGEMENT
.INDEX
1 Introduction
2 Nausea and vomiting
3 Hair loss
4 Fatigues
5 Effect on blood cell count
6 Diahorrea
7 Constipation
8 What if don’t feel like eating
9 Eating and weight gain
10 Sore mouth, gums and throat problems
11 Effect on nerves and muscles
12 Effect on kidneys and bladder
13 Effect on skin and nails
14 Pain
15 Effect on sexual organs
16 When do I call my doctor?
INTRODUCTION
The thought of having chemotherapy frightens many people. Almost every one has heard
stories about someone who was on chemo but knowing what chemotherapy is how it
works and what to expect can often help calm your fears. It can also give you a better
sense of control over cancer treatment and cancer experience.
Normally, your cells grow and die in controlled way. Cancer cells keep forming without
control. Chemotherapy is drug therapy that can stop these cells from multiplying.
However it can also harm healthy cells, which causes side effects.
The kind of side effects depends on the type and dose of chemotherapy.
What Causes Side Effects?
 chemotherapy drugs travel throughout the body
 The normal cells most likely to be affected are rapidly growing cells,
blood forming cells in the bone marrow, hair follicles, and cells in the
mouth, digestive tract, and reproductive system
 Some chemotherapy drugs can damage cells in vital organs like heart ,
kidneys, bladder, lungs and nervous system
Each drug has different side effect. Following is the list of chemotherapy side effects,
symptoms within each category.
A
Abdominal pain
Allergic reactions
Alopecia(Hair loss)
Anemia
Loss of appetite
D
Deep vein thrombosis
Dehydration
Depression
Diarrhoea
Dry mouth
Dry skin
Dyspepsia
G
Genital infection
B
Bone pain
Bleeding
Blood pressure changes
Bruising
E
Edema
Electrolyte imbalance
Esophagitis
H
Hair loss
C
Cardio toxicity
Cataract
Chest pain
Constipation
Cystitis(inflammation of the
urinary bladder)
Central neuro toxicity
F
Fatigue
Fever
Flatulence
Flu like syndrome
I
Impotance
Granulocytopenia
Gynecomastia
Glaucoma
J
Joint pain
M
Mouth sore
Myalgia
Myocarditis
Myelosuppersion
P
Pericarditis
Peripheral neuropathy
Pneumonia
Proteinuria
Pulmonary embolism
T
Taste changes
Thrombocytopenia
Tingling
Tinnitus
W
Weakness
Weight loss
Hearing loss
Heart failure
Heart burn
Hemorrhagic cystitis
Hepato toxicity
K
Kidney problem
N
Nausea
Nephrotoxicity
Neutropenia
Numbness
R
Rash
Rhinitis
Ringing ears
U
Urinary tract infection
Infection
Insomnia Itching
L
Leukopenia
Loss of libido
Lung infection
O
Ototoxicity
S
Seizures
Stomach sour
Stomatitis
V
Vaginal bleeding
Vaginal infection Vertigo
Vomiting
X
Xerostomia(dry mouth due
to lack of saliva)
THE MOST COMMON SIDE EFFECTS OF CHEMOTHERAPY
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Nausea and vomiting
Loss of appetite
Hair loss
Dry discoloured skin
Increased chance of bruising and bleeding
Anemia
Infection-gastro intestinal, respiratory tract
RULES TO REMEMBER ABOUT SIDE EFFECTS
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Every person does not get every side effect, and some people get few,if
any
The severities of side effects vary greatly from person to person. Be sure
to talk to your doctor and nurse about which side effects are most likely
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to occur with your chemotherapy, how long they might last, how serious
they might be and when you should seek medical attention for them
Your doctor may prescribe medications to prevent some side effects
before they appear
Many people have no long-term problems from chemotherapy.And
although side effects can be unpleasant, they must be measured against
the treatment’s ability to destroy cancer.
HOW LONG DO SIDE EFFECTS LAST
 Most side effects gradually disappear after treatment ends because the
healthy cells recover quickly. The time it takes to get over some side
effects and regain energy varies from person to person and depends on
many factors , including your overall health and the specific drugs you
are receiving.
 Although many side effects go away fairly rapidly , some may take
months or years to disappear completely
 Sometimes the side effects can last a lifetime, such as when
chemotherapy causes permanent damage to the heart, lungs, kidneys or
reproductive organs
 Certain types of chemotherapy occasionally cause delayed effects such
as a second cancer that may show up many years later.
RULES TO REMEMBER
 Before starting the treatment, you will be asked to sign a consent form.
 You should be given all the facts about the treatment including the drugs
you will be given and their side effects before you sign the consent form
WHAT CAN I DO ABOUT NAUSEA AND VOMITING?
 Nausea and vomiting are two of the most common and most dreaded
side effects of chemotherapy. How often you feel these side effects and
how severe they may be depend on the drugs you are receiving and how
they affect you.
 Nausea and vomiting may start during treatment and last a few hours.
Sometimes, but less often, severe nausea and vomiting can last for a few
days. Be sure to tell your doctor or nurse if you are very nauseated, if
you have been vomiting for more than a day , or if your nausea is so bad
that you can not keep liquids down.
 The good news is that the powerful anti-emetic and anti-nausea drugs
can prevent or lessen nausea and vomiting in most patient
 About half of the people receiving chemotherapy treatment feel
nauseous even before a treatment session begins. This is called
anticipatory nausea, when during the first cycle vomiting is not managed
well
TECHNIQUES TO HELP WITH NASUEA AND VOMITING
 Avoid big meals so your stomach won’t be too full. Eat frequent small
meals throughout the day instead of 1, 2, or 3 large meals
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Drink liquids at least an hour before or after mealtime instead of with
your meals
Eat and drink slowly
Stay away from sweet, fried or fatty foods.
Eat foods cold or at room temperature so you won’t be bothered by
strong smells.
Chew your food well for easier digestion.
Drink cool, clear unsweetened fruit juices such as apple or grape juice
light colored soda such as ginger aye that has lost its fizz and do not
have caffeine
Have ice cubes,mints,or tart candies(Don’t eat tart candies if you have
mouth or throat sores)
Try to avoid odors that bother you such as cooking smells, smoke or
perfume
Rest in a chair after eating, but don’t lie flat for at least 2 hours after you
have finished your meal
Wear loose fitting clothes
Breathe deeply and slowly when you feel nauseated.
Distract yourself by talking with friends or family members, listening to
music watching movie or TV show.
Use relaxation techniques.
Avoid eating at least a few hours before treatment if nausea occurs
during chemotherapy.
Eat light meal before treatment.
HOW DO I DEAL WITH LOSING MY HAIR?
 Not all chemotherapy drugs will make you lose your hair. Some people
experience only mild thinning that is noticeable only to them. Doctor
will be able to tell you if your medication is likely to make you lose your
hair
 Hair will almost always grow back after the treatment is over. However
it might be a different color or texture
 Hair loss can occur on all parts of the body, not just the head Facial,
arm, leg under armband pubic hair all may be affected. More often hair
loss begins after few treatments. At that point hair may fall out gradually
or in clumps Any hair that remains may become dull and dry
 Hair loss does not always happen right away
 It may begin several weeks after the first treatment or after a few
treatments
 The head becomes sensitive before losing hair
TECHNIQUES TO HELP WITH HAIR LOSS
 Use mild shampoos
 Use soft hair brushes
 Use low heat if you use a hair dryer
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Don’t use brush rollers to set your hair
Avoid dyeing perking or relaxing your hair
Have your hair cut short
A shorter style will make your hair look thicker and fuller
It also will make hair loss easier to manage if it occurs
Use a sunscreen,hat,scarf, or wig to protect your scalp from the sun
Use satin pillowcase
SHOULD I COVER MY HEAD?
 Some people who lose all or most of their hair choose to wear turbans
Scarves, caps, wigs or hair pieces. Others leave their heads uncovered
HERE ARE TIPS TO FOLLOW IF YOU CHOOSE TO COVER YOUR
HEAD WITH A WIG OR HAIRPIECE
 Shop for your wig or hairpiece before you lose a lot of hair so you can
 match your natural color, texture and style
 You may be able to buy a wig or hairpiece at a specialty shop just for
cancer patients
 A sales associate may be able to come to your home to help you
 Be sure to check policy and ask your doctor to write a prescription for a
hair prosthesis(is a custom –made wig specifically designed for patients
who have lost their hair as result of medical conditions or treatment)
WHAT ABOUT FATIGUE?
 Fatigue is one of the most common side effects of chemotherapy. It can
range from mild lethargy to feeling completely wiped out It is different
from feeling tired and dose not get better with rest or sleep
 Fatigue tends to be worst at the beginning and at the end of a treatment
cycle. Like most other side effects, it will disappear once chemotherapy
is complete
HOW TO COPE WITH FATIGUE?
The exact cause of fatigue is not known.
TECHNIQUES TO COPE WITH FATIGUE
 Plan your day so that you have time to rest
 Take short naps or breaks, rather than one long rest period
 Save your energy for the most important things
 Try easier or shorter versions of activities you enjoy
 Take short walks or do light exercise if possible.
 Try activities such as meditation, prayer yoga guided imagery
visualization
 Join a support group. Sharing feelings with others can ease burden of
fatigue
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Limit the amount of caffeine and alcohol
Keep a diary of how you feel each day. This will help you to plan your
daily activities
HOW WILL CHEMOTHERAPY AFFECT MY BLOOD CELL COUNT?
 Avoid chemotherapy treatments destroy some some of the bone marrow
 A drop in the levels of any of these cells(red blood cells white blood
cell splatelates) results in specific side effects
1 Drop in RBC-Anemia
2 Drop in WBC-Infection
3 Drop in platelets-Bleeding
 Your doctor will check your blood cell count often during your
treatment and may give you growth factors to help your bone marrow
make new blood cells
Anemia
 When you have too few red blood cells, your body tissue doesn’t get
enough oxygen to do their work. This condition is called anemia. You
may have these symptoms:
 Fatigue
 Dizziness
 Paleness
 A tendency to feel cold
 Shortness of breath
 Weakness
 A racing heart rate
TECHNIQUES TO COPE WITH ANEMIA
Get plenty of rest. Sleep more at night and take naps during day time
Limit your activities. Do only the things which are essential for you
 Eat a balanced diet
 Report any symptoms to your doctor or nurse. Your doctor will check
your blood cell count (also called blood count)often during your
treatment
 If your red blood cell count falls too low you may need a blood
transfusion or treatment with a growth factor to boost your bone
marrow’s red blood cell production.
INFECTION
 infections can begin in almost any part of the body and most often start
in your mouth skin lungs urinary tract and rectum
 If your white blood cell count drops too much , your doctor may
postpone treatment, give you a lower dose of chemotherapy, or prescribe
treatment with a growth factor that boosts white blood cells production
in the bone marrow
TECHNIQUES TO PREVENT INFECTIONS
 Wash your hands often during the day, especially before you eat and
after you use the bathroom
 Avoid crowds
 Stay away from people who have diseases you can catch, such as a cold,
the flu measles or chickenpox
 Do not get any immunization shots without checking first with your
doctor
 Stay away from people who recently have immunizations such as
vaccines for chicken pox , small pox , or the flu(check with your doctor
about which vaccines are important and for how long you should stay
away
 Clean your rectal area gently but thoroughly after each bowl movement .
Ask your doctor or nurse for advice if the area becomes irritated or if or
if you have hemorrhoids (piles). Also check with your doctor before
using enemas or suppositories
 Don’t cut, bite or tear the cuticles of your nails.
 Be careful not to cut or nick yourself when using scissors, needles or
knives.
 Use an electric shaver instead of a razor to prevent breaks or cuts in your
skin
 Use an extra soft toothbrush that won’t hurt your gums and talk to your
doctor before using dental floss.
 Don’t squeeze or scratch pimples.
 Take a warm (not hot) bath, shower or sponge bath every day. Pat your
skin dry using a light touch. Don’t rub.
 Use lotion or oil to soften and heal your skin if it becomes dry and
cracked.
 Clean cuts and scraps right away with warm water, soap, and an
antiseptic
 Wear protective gloves when gardening or cleaning up after animals and
others, especially small children
 Wear mask while visiting crowed places
 Don’t eat raw fish sea food meat or eggs
 Maintain good mouth care
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THE SYMPTONS OF INFECTION INCLUDE
Fever of 100.5F
Chills
Sweating
Mouth sore
Loose bowls(This can also be a side effect of chemotherapy)
A burning feeling when you urinate
A severe cough or sore throat
Unusual vaginal discharge or itching
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Redness , swelling or tenderness especially around a wound, sore pimple
intravenous catheter site or vascular access device
Abdominal pain
Report any signs of infections to your doctor immediately. If you have
fever don’t use aspirin acetaminophen, or any other medicine to bring
your tempeture down without first checking with your doctor
BLEEDING OR CLOTTING PROBLEMS
Chemotherapy drugs can affect the bone marrows ability to make
platelets. If your blood does not have enough platelets , you may bleed
or bruise more easily than usual even from minor injury
Report these signs to your doctor
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Unexpected bruising
Small red spots under the skin
Reddish or pinkish urine
Black or bloody bowel moments
Any bleeding from your gums or nose
Bad headaches
Dizziness
Pain in joints and muscles
Headache and changes in vision
Warm to hot feeling of arms and legs
Your doctor will check your platelet count often during your treatment .
If it falls too low , you may need a platelet transfusion
TECHNIQUES TO AVOID PROBLEMS IF YOU’RE PLATELET
COUNT IS LOW
Don’t take any medicine without first checking with your doctor or
nurse. This includes aspirin and aspirin free pain relievers including
acetaminophen, ibrufen and any other medicines you can buy without
prescription. Some of these medication can weaken the platelets and
make bleeding problems worse
Don’t drink any alcoholic beverages unless your doctor says it’s all right
Use an extra soft toothbrush to clean your teeth and talk to your doctor
before using dental floss
If you have runny nose , blow gently into a soft tissue
Take care not to cut or nick yourself when using scissors needles ,
knives or tools
Be careful not to burn yourself when ironing or cooking. Use padded
gloves when reach into the oven
Avoid contact sports and other activities that result in injury
Avoid becoming constipated
Use an electric shaver instead of razor
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When bending over keep your head above your heart
WHAT IF I GET DIARRHOEA?
When chemotherapy affects the cells lining the intestine, the result can
be diarrhoea
Diarrhoea is generally defined as 2 or more loose stools in a four hour
time period
If you have diarrhoea that continues for more than 24 hours, or if you
have pain and cramping along with it call your doctor
In severe cases the doctor may prescribe an antidiahheral medicines but
don’t take any over the counter antidiarrhoeal medicines without asking
your doctor first
TECHNIQUES TO HELP CONTROL DIARRHOEA
Eat smaller amount of food but more often
Avoid coffee, tea alcohol and sweets
Avoid high fiber foods , which can lead to diahhrea and cramping
High fiber foods include whole grain breads and cereals ,raw vegetables
beans, nuts, seeds, popcorn, fresh and dried fruit
Eat low fiber foods instead, such as white bread white rice or noodles ,
creamed cereals ripe bananas, canned or cooked fruit without skins
cottage cheese yoghurt eggs mashed or baked potatoes without skin ,
pured vegetables chicken or turkey without the skin, and fish
Stay away from fried greasy or spicy foods
Avoid milk and milk products if they make your diarrhoea worse
Eat more potassium-rich foods such as bananas, oranges, potatoes, peach
and apricot nectars
Drink plenty of fluids to replace those you have lost through diarrhoea
Mild clear liquids such as apple juice water weak tea broth or ginger ale
are the best. Make sure they are at room temperature and drink them
slowly. Let carbonated drinks lose their fizz before you drink them
Your diarrhoea is severe (meaning that you have had 7 or 8 loose stools
in 24 hours) tell your doctor right away. Ask if you should try a clear
liquid diet to give your bowels time to rest
As you feel better, gradually add the low fiber foods. Clear liquid diet
doesn’t have all the nutrients you need, so don’t follow one for more
than 3 or 4 days.
If your diarrhea does not improve , you may need to get intravenous
fluids to replace the water and nutrients you have lost
IS CONSTIPATION COMMON?
Some people become constipated from chemotherapy. Other may
become constipated because they are less active or less nourished than
usual, because diet changes or because they are taking certain pain
medications
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Tell your doctor if you have not had a bowel moment in 2 or more days.
You may need to take laxative or stool softener but don’t use these
remedies unless you have checked with your doctor especially if your
white blood cell count or platelet count is low
TECHNIQUES TO DEAL WITH CONSTIPATION
Drink plenty of fluids to help loosen your bowels. Warm and hot fluids
work especially well
Eat a lot of high fiber foods High fiber foods include bran whole wheat
breads and cereals raw or cooked vegetables fresh and dried fruit, nuts,
and popcorn
Get some exercise. Simply getting out for a walk can help, as a
structured exercise programme. Be sure to check with your doctor before
increasing physical activity
WHAT IF I DO NOT FEEL LIKE EATING?
There may be days when you just can’t eat because of nausea or mouth
and throat problems.You also can lose your appetite if you feel
depressed or tired when a poor appetite is your problem
Loss of appetite is due to depression nausea mouth sores and tiredness
WHEN A POOR APPETITE IS YOUR PROBLEM TRY THESE TIPS
 Eat small meals or snacks whenever you want. You don’t have to eat 3
regular meals each day
 Vary your diet and try new foods and recipes
 Take a walk before meals whenever possible. This may make you feel
hungrier
 Change your mealtime routine
For example eat by candlelight or in different location eat with friends or family
members. When eating alone, listen to the radio or watch TV
 If you live alone you might want to arrange for meals on wheels or a
similar program to bring food to you
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WHAT ABOUT EATING AND WEIGHT GAIN?
Some people usually women, put on weight during chemotherapy.
Although the reasons are unclear, weight gain may be related to intense
food cravings that develop despite the nausea. The average weight gain
for women is 7 pounds
Whether you gain weight or not good nutrition is extremely important
during treatment.
People who eat well cope with side effects better and fight infection
more easily In addition , their bodies can rebuild healthy tissues faster
Eating well during chemotherapy means choosing a balanced diet that
contains all nutrients your body needs, including foods from each of the
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following food groups: fruits and vegetables, poultry fish and meat,
cereals and breads and dairy products.
You also should consume enough calories to keep your weight up and,
most importantly enough protein to build and repair skin, hair muscles
and organs.
You also may need to drink extra amount of fluid to protect your bladder
and kidneys during your treatment.
CAN I DRINK ALCOHOLIC BEVERAGES?
Small amounts of alcohol can help you relax and increase your appetite
On the other hand, alcohol may interact with some drugs to reduce their
effectiveness or worsen their side effects.
Be sure to ask your doctor if you can drink beer, wine or other alcoholic
beverages.
WHAT ABOUT SORE MOUTH, GUMS AND THROAT
PROBLEMS?
Good oral care is important during cancer treatment
Chemotherapy drugs can cause sores in the mouth and throat and can
make them dry and irritated or cause them to bleed
Mouth sores are not only painful they become infected by the many
germs that normally live in your mouth
Infections can be hard to fight during chemotherapy and can lead to
serious problems. It’s important to take every possible step to prevent
them.
WAYS TO KEEP YOUR MOUTH GUMS AND THROAT HEALTHY
See your dentist before you start chemotherapy to have your teeth
cleaned and to take care of any cavities, abscesses, gum disease , or
poorly fitting dentures
Ask your dentist to show the best ways to brush and floss your teeth
during chemotherapy
Ask about a daily fluoride rinse or gel to help prevent decay because
chemotherapy can make you more likely to get cavities
Brush your teeth and gums after every meal. Use an extra soft
toothbrush and gentle touch, brushing too hard can damage soft mouth
tissues
Ask your dentist to special type of toothbrush, floss or dental ribbon, and
toothiest if your gums are very sensitive.
Rinse your toothbrush well after each use and store it in a dry place
Avoid commercial mouthwashes, because they contain large amount of
irritating salts or alcohol. Instead, ask your doctor or nurse about a mild
mouthwash or a mouthwash with antibiotics to help prevent mouth
infections
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If you develop sores in your mouth(stomatitis)contact your doctor or
nurse because you may need medical treatment
IF THE SORE ARE PAINFUL OR KEEP YOU FROM EATING TRY
THESE IDEAS
Ask your doctor if there is anything you can apply directly to the sores
and if he or she can prescribe medicine to ease the pain
Eat foods cold or at room temperature. Hot and warm foods can irritate a
tender mouth and throat
Choose soft , soothing foods , such as ice-cream, milkshakes baby food ,
soft fruits(banana and applesauce),mashed potatoes , cooked cereals ,
soft boiled or scrambled eggs , cottage cheese , macaroni, and cheese ,
Custer puddings and gelatin. You also can puree cooked foods in the
blender to make them smoother and easier to eat
Avoid irritating , acidic foods , such as tomatoes citrus fruit and fruit
juice(orange, grapefruit and lemon), spicy or salty foods, and rough
coarse , or dry foods such as raw vegetables, granola and toast
IF YOUR MOUTH IS DRY AND BOTHERS OR MAKE IT
HARD FOR YOU TO EAT , TRY THESE TIPS
Ask your doctor if you should use an artificial saliva product to moisten
your mouth
Drink plenty of liquids
Have ice cubes, pop slices, or sugarless hard candy
Chew sugarless gum
Moisten dry foods with butter, margarine, gravy sauces or broth
Dip crisp, dry foods in mild liquids
Eat soft and pureed food
Use lip balm/ petroleum jelly, if your lips become dry.
Take mouth wash containing sodium bicarbonate, it is not irritating
SHOULD I TAKE VITAMIN OR MINERAL SUPPLIMENTS?
You can usually get all the vitamins and minerals you need by eating a
healthy diet
But , you should not take any supplements without your doctor’s
knowledge and consent
WILL CHEMOTHERAPY AFFECT MY NERVRS AND
MUSCELS?
Certain chemotherapy drugs can produce peripheral neuropathy, a
condition that causes tingling and burning sensations, weakness or
numbness in your hands and feet. You may feel the following nerve
related symptoms
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Loss of balance
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Clumsiness
Difficulty picking up objects and buttoning
Clothing
Walking problems
Shaking or trembling
Jaw pain
Hearing loss
Vision changes
Stomach pain
Constipation
In addition to affecting the nerves, certain chemotherapy drugs also can
affect the muscles and make them weak tired or sore
Nerve and muscle effects are frustrating, yet in most cases they are not
serious if caught early. They are usually temporary and get better
However, it is important to report any nerve or muscle symptoms
immediately. They can worsen and become quite painful if left untreated
Your doctor might want to stop the chemotherapy for awhile or offer
you treatment to ease these symptoms
WILL MY KIDNEYS OR BLADDER BE AFFECTED?
Some chemotherapy drugs can irritate your bladder or cause temporary
or permanent kidney damage
 They may cause your urine to change color (orange, red or yellow)or on
strong medicine for short time, the color and odour of semen may be
affected as well
Ask your doctor if your chemotherapy drugs are among those that have these
effects, and notify the doctor if you have any symptoms that might indicate a
problem
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WATCH FOR THESE SIGNS
Pain or burning when you urinate.
Frequent urination
A feeling that you must urinate away
Reddish or bloody urine (some chemotherapy drugs will change the
color of your urine. Tell your doctor or nurse if this occurs)
Fever chills
TECHNIQUES TO COPE WITH KIDNEY AND BLADDER
PROBLEMS
Drink plenty of fluids to ensure good urine flow and help prevent
problems. Water juice coffee , tea , soup, soft drinks, ice cream ,pop
slices and gelatin are considered fluids
WILL MY SKIN AND NAILS BE AFFECTED?
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You may have minor skin problems during treatment, including redness
itching peeling dryness and acne
YOU CAN TAKE CARE OF MOST OF THESE PROBLEMS
YOURSELF USING THE FOLLOWING TECHNIQUES
If you develop acne , try to keep your face clean and dry
For itching , apply cornstarch as dusting powder
To help avoid dryness , take quick warm showers rather than long hot
baths
Apply creams or lotions while your skin is still moist
Avoid perfume, cologne, or aftershave lotion. These products often
contain alcohol which can make the skin dry
Use a colloid oatmeal bath or diphenhydramines for generalized
purities(is an itch or a sensation that makes a person want to scratch
Certain chemotherapy drugs, when given through an IV, may darken
your skin along the vein. This discoloration will usually fade a few
months after treatment ends
Most skin problems are not serious, but few demand immediate
attention. For example , certain drugs given through an IV can cause
serious and permanent tissue damage if they leak out of the vein
Tell your doctor or nurse right away if you feel any burning or pain
when you are getting IV drugs. These symptoms don’t always mean
there is a problem , but they should always be checked out immediately
Let your doctor or nurse know right away if you develop sudden or
severe itching, if your skin breaks out in a rash or hives, or if you have
wheezing or any other trouble breathing.
These symptoms may mean you are having an allergic reaction that
needs immediate attention
Some chemotherapy drugs may make you more sensitive to the sun.
Check with your doctor or nurse about using sun block
You may need to completely avoid direct sunlight wear long sleeved
cotton shirts , hats, and pants to block the sunlight
Avoid sunlight as much as possible especially between 10 a. m. to 4 p.m.
Use a sunscreen lotion with as a skin protection factor of 15 or higher
to protect against sun damage A product such as zinc oxide, sold over
the counter, can block the sun rays completely
Wear long sleeve cotton shirts , pants and hats with a wide brim
Even people with dark skinned to protect themselves from the sun
during the chemotherapy
Your nails may become darkened, brittle or cracked or they may develop
vertical lines or bands
Protect your nails by wearing gloves when washing dishes gardening or
performing other work around the house. Some over the counter
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products might strengthen your nails but these products may cause
irritation
Get further advice from your doctor if these skin and nail problems don’t
respond to your efforts
Be sure to let your doctor know if you have redness pain or changes
around your cuticles
PAIN
The drugs can damage nerves, leading to burning numbness tingling or
shooting pains most often in the fingers or toes
Some drugs can also cause mouth sores , headache muscle pain and
stomach pain
Using the pain scale is useful in describing how much pain you are
feeling
Try to assign a number from 0 to 10
TECHNIQUES TO CONTROL PAIN
Take the pain medicine on regular schedule by the clock
Do not skip the scheduled dose till you get the pain , then it becomes
harder to control Try relaxation exercises
Some people with chronic or persistent pain that is usually controlled by
medicine can have breakthrough pain. This occurs when moderate to
severe pain ‘breakthrough’ or is felt short time. Consult the doctor for
the medicine. Don’t wait for the pain to get worse.
EFFECTS ON SEXUAL ORGANS
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MEN
Chemotherapy drugs may lower the number of sperms cells, reduce their
ability to move
These changes can result in infertility, which may be temporary or
permanent
It may damage the chromosome which could lead to birth defects
TECHNIQUES TO COPE WITH SEXUAL PROBLEMS
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MEN
Before starting treatment , talk to doctor about the possibility of sperm
banking
Use birth control measures
Use condom during sexual intercourse for the first 48 hours after the last
dose of chemotherapy because some of the drugs may end up in the
sperm
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WOMEN
Chemotherapy drugs can affect the ovaries and reduce the amount of
hormones they produce, menstrual period become irregular or stop
completely while having chemotherapy.
Infertility damage to ovaries may result in temporary / permanent
infertility.
Menopause: chemotherapy can cause menopause like symptoms such as
hot flashes, dry vaginal tissues.
TECHNIQUES TO COPE WITH HOT FLASHES
Dress in layers
Avoid caffeine and alcohol
Exercise
Try meditation or other relaxation methods
TECHNIQUES TO COPE WITH VAGINAL SYMPTOMS
Use a water or mineral oil based vaginal lubricants at the time of
intercourse
Wear cotton under wear with ventilated cotton lining
WHEN DO I CALL MY DOCTOR?
Although some side effects are fleeting and minor, others signal potentially
serious problems. You should not be the judge. Alert your doctor immediately if you
suffer from any of the following symptoms during your chemotherapy treatment
 A fever of 100.5 F or greater
 Bleeding or unexplained bruising
 A rash or allergic reaction, such as swelling or severe itching or
wheezing
 Intense chills
 Pain or soreness at the chemotherapy inject onsite or catheter site
 Unusual pain, including intense headaches
 Shortness of breath
 Prolonged diarrhoea or vomiting
 Bloody stools or blood in your urine
CONSULT YOUR DOCTOR BEFORE TAKING ANY
MEDICATION TO HELP CONTROL SIDE EFFECTS
SELF –HELP THAT HELPS
INDEX
PREFACE
CHEMOTHERAPY AND YOU
NAUSEA AND VOMITING
DIARRHOEA
CONSTIPATION
FATIGUE
LOSS OF APPETITE
HAIR LOSS
MOUTH, GUM AND THROAT PROBLEMS
SKIN AND WOUND CARE
INFECTION
ANAEMIA
BLOOD CLOTTING PROBLEMS
PAIN
DEPRESSION
REPRODUCTION AND SEXUAL PROBLEMS
MORE ENJOYABLE DAILY LIFE
PREFACE
Batting cancer is a tough time in anyone’s life perhaps the toughest
It is very important to properly care for yourself during treatment
Taking care of yourself is the best thing you can do during your
treatment and after. You will undoubtedly need assistance from friends
and family Ask for it. You will have many emotions including fear and
depression during this time. Talk about them! Eat well and exercise. And
last develop good communication with your doctor and the rest of your
team they are there for you
This booklet is for patients who are receiving chemotherapy for cancer.
It describes what to expect during chemotherapy and what you can do to
take care of yourself. What can you do? Eat the right foods to build up
your strength. Stay away from the people who have colds or flu. Get the
rest you need and pace yourself talk about your feelings to deal with any
sadness anger or fear you may have work as a team with your health
care providers. Knowing how to help yourself can make you feel more
in control. These are just a few of the ways that you can help yourself
and begin to feel in control again.
This booklet is designed to help you become an informed partner in your
care, but it is only a guide. Self-help can never take the place of
professional health care. Ask your doctor and nurse any questions you
may have about chemotherapy. Also do not hesitate to tell them about
any side effects you may have. They want and need to know.
CHEMOTHERAPY AND YOU
HOW WILL I FEEL DURING CHEMOTHERAPY?
Most people receiving chemotherapy find that they are tired easily, but
many feel well enough to continue to lead active lives. Each person and
treatment is different, so it is not always possible to tell exactly how you
will react. Your general state of health, the type of and extent of cancer
you have, and the kind of drugs you are receiving can all affect how well
you feel. You may want to have someone available to drive you to and
from treatment if, for example you are taking medicine for nausea or
vomiting that could make you tired. You may also feel especially tired
from the chemotherapy as early as one day after treatment and for
several days. It may help to schedule your treatment when you can take
off the day and the day after your treatment. If you have young children
you may want to schedule the treatment when you have someone to help
at home the day of and at least the day after your treatment. Ask your
doctor when your greatest fatigue or other side effects are likely to
occur.
Most people can continue working while receiving chemotherapy.
However, you may need to change your work schedule for a while if
your chemotherapy makes you feel very tired or have other side effects.
Talk with your employer about your needs and wishes. You may be to
agree on a part-time schedule, find an area for a short nap during the
day, or perhaps you can do some of your work at home.
HOW CHEMOTHERAPY EFFECTS YOUR EMOTIONS?
Chemotherapy can bring huge changes to your life. It can affect overall
health, disrupt day-to-day schedules, and put a strain on your personal
life. Many people feel fearful, worried, angry or depressed at some point
during their chemotherapy.
These emotions are normal and understandable, but they also can be
disturbing. Fortunately, there are ways to cope with these emotional side
effects just as there are ways to cope with the physical side effects of
chemotherapy
HOW CAN I GET THE SUPPORT I NEED
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There are many sources of support you can draw on. Here are some of
the most important:
Doctors and nurses. If you have questions or worries about your
treatment, talk with members of your health care team.
Counseling professionals. There are many kinds of counselors who can
help you express, understand and cope with the emotions cancer
treatment can cause. Depending on your preferences and needs, you
might want to talk with a psychiatrist, psychologist, social worker, sex
therapist, or member of the clergy.
Friends and family members .Talking with friends or family members
can help you feel a lot better. Often they can comfort and reassure you in
ways that no one else can. You may find though, that you will need to
help them help you. At a time when you might expect that others will
rush to your aid, you may have to make the first move
Other patients; many people find it helpful to speak to other people in
their situation Strike up conversation with another person in the waiting
area. You may be surprised to find how similar your thoughts are. It
helps some people to feel that they are not alone.
Many people do not understand cancer, and they may pull away from
you because they are afraid of your illness. Others may worry that they
will offend you by saying the wrong thing.
You can help these fears by being open. Talk with others about your
illness, your treatment your needs and your feelings. This way you
correct mistaken ideas about cancer. You can also let people know that
there is no single right thing to say so long as caring comes through loud
and clear. Once people know they can talk with you honestly, they may
be more willing and able to open up and lend their support.
Support groups: Support groups are made up of people who are going
through the same kinds of experiences as you. Many people with cancer
find they share thoughts and feelings with group members that they do
not feel comfortable sharing with any one else. Support groups also can
serve as an important source of practical information about living with
cancer.
WHAT CAN I DO TO MAKE THE CHEMOTHERAPY VISIT
MORE PLEASANT ?
Bring reading materials, crafts (needlepoint, knitting, drawing
materials), CD player or radio with headphones, and other items that can
help pass the time. Some patients get a metal taste in their mouth as a
result of the chemotherapy; mint or mint-flavoured gum can help
eliminate this taste. You may also want to bring small packets of
crackers or cookies, depending on the length of your visit. A family
members or friend is usually welcome. It is helpful to have a friend or
family member drive you to and from treatment in case you are not
feeling well. Getting to know the other patients and families who are
also going through chemotherapy can be a very positive experience
HOW CAN I MAKE DAILY LIFE EASIER?
Here are some tips to help you while you are getting chemotherapy
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Try to keep your treatment goals in mind. This will help you keep a
positive attitude on days when the going gets rough
Remember that eating well is very important. Your body needs food to
rebuild tissues and regain strength
Take care of yourself. Some days you will want stay at home and have a
pajama day this can be very therapeutic. However, as much as you can
try to keep your daily personal care routine intact. If you have lost your
hair and wear a wig, make sure you know how to care for your wig. If
you need help, ask for it.
Learn as much as you want to know about your disease and treatment.
This can lessen your fear of the unknown and increase your feeling of
control
Keep a journal or diary while you are in treatment that can help you
understand the feelings you have as you go through treatment, and
remember questions you need to ask your doctor or nurse.
You also can use your journal to record the steps you take to cope with
side effects, and how well those steps work. That way you will know
which methods worked best for you in case worked best for you in case
you have the same side effects again.
Set realistic goals and do not be too hard on yourself. You may not have
as much energy as usual , so try to get as much rest as you can, let the
small stuff side, and only do the things that are most important to you
Try new hobbies and learn new skills. Exercise if you can. Using your
body can make you feel better about yourself help you get rid of tension
or anger, and build your appetite . Ask your doctor or nurse about a safe
and practical exercise program.
COPING WITH SIDE EFFECTS
WHAT CAUSES SIDE EFFECTS?
Because cancer cells may grow and divide more rapidly than normal
cells, many anticancer drugs are made to kill growing cells but certain
normal healthy cells also multiply quickly and chemotherapy can affect
cells too. This damage to normal cells causes side effects. The fast
growing normal cells most likely to be affected are blood cells forming
in the bone marrow and cells in the digestive tract (mouth, stomach,
intestines, and esophagus) reproductive system (sexual organs) and hair
follicles. Anticancer drugs may affect cells of vital organs such as the
heart kidney bladder, lungs and nerves system
You may have none of these side effects or just a few .The kinds of side
effects you have and how severe they are depend on the type and dose of
chemotherapy you get and your body reacts. Before starting
chemotherapy, your doctor will discuss the side effects that you are most
likely to get with drugs you will be receiving. Before starting the
treatment, you will be asked to sign consent form. You should be given
all the facts about the treatment including the drugs you will be given
and their side effects before you sign the consent form
HOW LONG DO SIDE EFFECTS LAST?
Normal cells usually recover when chemotherapy is over so most side
effects gradually go away after treatment ends, and the healthy cells
have a chance to grow normally. The time it takes to get over side
effects depends on many things including your overall health and the
kind of chemotherapy you have been taking.
The side effects of chemotherapy can be unpleasant but they must be
measured against the treatment‘s ability to destroy cancer Medicines can
help prevent some side effects such as nausea. Sometimes people
receiving chemotherapy become discouraged about the length of time
their treatment is taking or the side effects they are having. If that
happens to you, talk to your doctor or nurse. They may be able suggest
ways to make side effects easier to deal with or reduce them.
Here are suggestions for dealing with some of the more common side
effects of chemotherapy.
NASUEA AND VOMITING
Nausea is a feeling of sickness in the stomach characterized by an urge
to vomit. Nausea and vomiting are very common side effects of
chemotherapeutic drugs Nausea and /or vomiting may arise due to
chemotherapeutic drugs or the cancer itself or as a result of certain pain
medications like opioids
Nausea and vomiting can be very distressing and unpleasant. There are
many anti-emetic anti – nausea drugs available to prevent and treat these
symptoms but certain lifestyle changes can control these symptoms to a
great extent
WHAT FOODS MAY INCLUDE OR INCREASE NASUEA
AND VOMATING ?
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Fatty or fried foods
Very spicy foods
Very sweet foods
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Acidic foods like tomatoes oranges, lemon, grapefruit,
Alcohol, fizzy drinks and too much coffee
WHAT CAN I DO IF I HAVE NASUEA AND VOMITING ?
Eat small and frequent meals throughout the day instead of less frequent
large meals
Drink frequently and small amounts.
Eat more of bland food like bananas, rice, toast, kanji and potatoes(not
fried), white bread, skinned chicken, boiled or baked fish, clear soup
Chew your food thoroughly.
Sniffing a cut surface of fresh ginger can help with mild nausea
Eat and drink slowly
For early morning nausea eat dry biscuits, toast cereals before getting
out the bed
Eat foods cold or at room temperature
Do not skip meals. An empty stomach may increase nausea
Drink plenty of fluids, especially clear liquids like unsweetened fruit
juices
Drink at least one hour before or after meals. Avoid drinking during the
meals this might result in bloating
Sit straight while having meal
Rest but do not lie at least for 2 hours after meals
Watching TV listening to music talking with friends and relatives will
distract you and help in reducing nausea
Drink plenty of water after cancer treatment and avoid solid food soon
after cancer treatment
Keep a track of what foods cause you to feel nauseous or make you
vomit
Avoid unpleasant or strong odors
Wear loose fitting clothes so as not to add pressure to stomach and throat
Rinse your mouth frequently to remove unpleasant tastes
DO NOT force yourself to drink fluids during periods of vomiting
DO NOT lie flat on your back during periods of vomiting If you are
unable to get out of bed, turn on to your side so that vomit will not be
inhaled or aspirated into the lungs
HOW SHOULD I USE MEDICINES FOR NASUEA AND
VOMITING ?
Make sure you get your medicines to control nausea and vomiting
Take the medicine on consistent schedule as prescribed
If you have vomiting and can not take medicine call your doctor
If your medicine lessens your nausea and vomiting but not as much as
you would like call your doctor. Your medicine may need to be adjusted
Taking your medicine 30 minutes before meals may help you eat
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CALL YOUR DOCTOR RIGHT AWAY IF
There is blood or coffee ground looking material in the vomit
You can not keep any liquids or food down
You are unable to take or keep your nausea medication down
You have nausea that lasts for more than a few days that keeps you from
doing what is important to you
The vomit shoots out for a distance this is called projectile vomiting
You are vomiting and feel light-headed, dizzy, or confused
You are vomiting many times and your urine is dark yellow and are not
going to bathroom as often as you normally do.
You have severe stomach pain while vomiting
DIARRHOEA
DIARRHOEA is defined as more than two loose or watery stools per
day
Loose or watery stools may start two weeks after your cancer treatment
begin. If left untreated diarrhea can result in weakness, weight loss skin
soreness and poor nutrition. You need to learn strategies for controlling
diarrhea.
In severe cases the doctor may prescribe a medicine to control the
diarrhoea. If diarrhoea persists, you may need intravenous (IV) fluids to
replace the water and nutrients you have lost do not take any over-thecounter medicines for diarrhea without asking your doctor
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WHAT ARE THE CAUSES OF DIARRHOEA?
Radiation over your bowels
Chemotherapy(chemotherapy affects the cells lining
the intestine and cause diarrhea)
Anxiety or stress
Surgery on small or large bowel or pelvic infection
Antibiotics, antacids containing magnesium, laxatives, stool softeners
Malnutrition
Whatever the case diarrhoea must be managed, as it will otherwise
deplete you of needed hydration and electrolytes very quickly
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WHAT CAN I DO TO PREVENT OR MANAGE DIARRHOEA?
Drink plenty of fluids (at least 8 glasses per day) this will help replace
those you have lost through diarrhea. Mild clear liquids, such as water
unsweetened juices diluted juices are best. Drink slowly and make sure
drinks are at room temperature
Eat small amounts of food throughout the day instead of three large
meals
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Exercise daily. If you are unable to increase your exercise, tighten and
relax the muscles in your abdomen and move your legs often while
sitting or in bed
Try to maintain a schedule that allows for bathroom time
Avoid coffee, tea with caffeine, alcohol and sweets. Stay away from
fried greasy or highly spiced foods,too they are irritating and can cause
diarrhea and cramping
Avoid milk and milk products if they make your diarrhea worse
Eat low fiber foods. Low fiber foods include white bread white rice or
noodles ripe bananas canned or cooked fruit without skins, cottage
cheese,yogurt,eggs,mashed or baked potatoes without skin pureed
vegetables, chicken, or turkey without the skin, and fish
Avoid high –fiber foods which can lead to diarrhea and cramping. Highfiber foods, include whole grain breads and cereals, raw vegetables,
beans, nuts seeds popcorn and fresh and dried fruit
Keep anal area skin clean with soap and water if the skin is broken down
Use anti-diarrhoeal medicines only on your doctor’s advice
CALL YOUR DOCTOR RIGHT AWAY IF:
You have blood in stools
You have loose watery stools >2/day
You have temperature of 100.5F(38C)or greater
You are unable to keep down liquids
You become dizzy
You notice your urine becoming dark yellow in color or more
concentrated
You develop abdominal pain
CONSTIPATION
Constipation means being unable to move your bowels, having to push
harder to move your bowels, or moving them less often than usual. Bowel movements
will be small, dry and hard.
Constipation can cause pain, discomfort and sometimes bleeding from the rectum.
WHAT ARE THE CAUSES OF CONSTIPATION?
 Decreased activity level
 Decreased food and liquid intake
 Certain pain medicines
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WHAT ARE THE SIGNS AND SYMPOTOMS OF CONSTIPATION?
Small, hard bowel movements
No regular bowel movement in 3 days
Leaking small amounts of soft stool(like diarrhea)from the rectum
Frequent and or persistent stomach aches or cramps
Passing large amount of gas or frequent belching
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Blown up or enlarged belly
Nausea and or vomiting
WHAT CAN I DO TO PREVENT OR MANAGE
CONSTIPATION ?
Drink enough liquids. Eight(8) glasses of water , juice or proffered
liquid daily
Eat foods that are high in fiber such as raw and cooked vegetables, dried
fruits, raw fruits (plum, papayas, and apples), cereals and whole –wheat
grains.
Avoid or decrease your intake of foods that can cause constipation like
cheese, chocolate, eggs.
Exercise daily. If you are unable to increase your exercise, tighten and
relax the muscles. Walk around in your home or soutside at least 3 times
per day for at least 15 minutes.
Try to maintain a schedule that allows for bathroom time
Use a daily stool softner or laxative on your doctor’s advice
CALL YOUR DOCTOR RIGHT AWAY IF:
You develop cramps, abdominal pain or excessive gas.
You become weak or faint.
The laxatives recommended by your health care team are not effective.
When your bowels have not moved for 3 days, or you have exceed your
regular pattern.
You have loose stool , but still feel like you need to have a bowel
movement
You see blood or around anal area, in the stool, on the toilet paper or in
the toilet bowel.
FATIGUE
Fatigue is a feeling of weariness, tiredness or lack of energy. The exact
cause is not always known. It can be due to your disease, chemotherapy,
radiation, surgery, low blood counts, lack of sleep pain, stress, poor
appetite, along with many other factors.
Fatigue can last for several days but it usually goes away gradually as
your body starts responding to treatment.
Being flexible, planning understanding what is happening to you makes
it possible to deal with fatigue. Using your energy wisely is important.
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WHAT ARE THE SYMPTOMS OF CANCER RELATED
FATIGUE ?
The symptoms of cancer fatigue include not only feeling tired but leg
pain , difficulty climbing stairs or walking short distances shortness of
breath after light activity and difficulty performing ordinary tasks such
as cooking cleaning shaving brushing your teeth, taking shower or
making bed.
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Feeling bored sleepy exhausted.
Apathy, lethargy.
Feeling a lack of motivation and interest in things that are normally
important.
Trouble concentrating, thinking speaking or making decisions
Loss of appetite
Lack of interest in sex
Feeling tired even after a good night’s sleep and or not being able to
sleep at night.
Generalized (whole body) weakness or tiredness.
Irriitability, impatience, sadness changes in mood.
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HOW CAN I COPE UP WITH FATIGUE ?
Plan your day so that you have ample time to rest
.Take several short naps or breaks rather than one long one
Use your energy for the most important things
Try easier or shorter versions of activities you enjoy.
Get some exercise-stretch, walk, do yoga. A few minutes of exercise a
day will help you maintain your muscle strength and feel more alert
Eat healthy and limit the amount of caffeine and alcohol you drink
Eat as well as you can and drink plenty of fluids. Eat small amounts at a
time it is helpful
Allow others help you with your daily activities
Try to keep the bedroom free from activities such as reading or
watching TV
Join a support group. Sharing your feeling with others can ease the
burden of fatigue. You can learn how others deal with their fatigue.
Talking and discussion helps with your feelings and family members
would benefit from this also
Keep a diary of how you feel each day. This will help you plan your
daily activities
Report any changes in energy level to your doctor
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CALL YOUR DOCTOR RIGHT AWAY IF
You experience a sudden and dramatic decrease in your level of energy
You develop confusion or any other change in mental status
You are feeling extremely dizzy
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LOSS OF APPETITE
cancer or its treatments can cause a loss of appetite However you can
also lose your appetite, if you are very anxious or depressed. This may
make you lose weight.
You may experience changes in your usual eating habits. You may find
that you are not hungry and just not eating the way that you did before
your therapy
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WHAT ARE THE CAUSES OF LOSS OF APPETITE
Nausea and/ or vomiting
Constipation
Pain or other difficulty with chewing or swallowing due to mucositis,
inflamed mouth inflamed esophagus etc.
Changes in taste, smell or saliva
Poor teeth, ill-fitting denture
Anxiety, depression
Fear
Pain
Medications
Fatigue
Loss of sleep
Difficulty breathing
Bloating
Diarrhea
Therapeutic diets (special diets prescribed by your health professional)
Food aversions (specific foods that you find particularly unpleasant)
Unpleasant odours or sight
Social isolation
WHAT CAN I DO TO INCREASE MY APPETITE ?
When eating your meals, do so in environment that is soothing and
pleasant to you Try changing your environment or eating with others
Exercise if you are able to .For some patients moderate exercise ending
at least half an hour before mealtime helps stimulates their appetite and
allows them to eat better
Try new recipes or foods
Go out to a restaurant and eat , even if it is just an appetizer, desert or
beverage
Eat little and often if you can not face a big meal
Try to relax and do not do anything else while you are eating
Tempt your taste buds by making food look as attractive as possible
Eat cold food if the smell of hot food makes you feel sick
Keep snacks handy to nibble-such as nuts , crisps grated cheese or dried
fruit
Eat a good breakfast if appetite is better in the morning
Flavor foods with herbs spices , sugar , lemon and tasty sauces
Mouth care
Increase oral hygiene
Rinse your mouth before and after meals
Make sure teeth or dentures are in good condition
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WHAT FOODS SHOULD I AVOID?
Foods with strong odors sometimes make patients nauseated during their
treatment. If this happens to you ,try eating cold foods that do not have
strong odors. Many times patients can tolerate cold foods better
Foods that are greasy or fried may be difficult to digest. Also avoid
foods that produce gas including cabbage, beans, broccoli, radishes,
carbonated drinks and cucumbers.
Fluids may fill up your stomach, making you feel full before your meal
is finished. Drink most of your fluids between meals. When eating your
meals drink only as much as fluid as you need to keep your mouth and
food moistened. Consider fluids with calories and nutrients such as
juices or dairy products
Avoid empty calories
Avoid tobacco products-they suppress appetite
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CALL YOUR DOCTOR IF:
You have eaten poorly for several days
Your amount of urine is decreased
You can not keep any liquids or food down
You feel extremely weak and lethargic
You feel dizzy all time-
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HAIR LOSS
Hair loss (alopecia) due to chemotherapy is one of the most distressing
side effects of chemo treatments but not all drugs cause hair loss. Talk
with your doctor to see if the regimen you are on may cause hair loss.
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HOW DOES CHEMOTHERAPY LEAD TO HAIR LOSS ?
Hair loss happens because the chemotherapy affects all cell in the body;
not just cancer cells The lining of the mouth, stomach and the hair
follicles are especially sensitive because these cells multiply rapidly just
like cancer cells. The difference is that the normal cells will repair
themselves making these side effects temporary.
Hair loss may occur as early as the second or third week after the first
cycle of chemotherapy although it may not happen until after the second
cycle of chemotherapy.
Hair loss can be sudden or slow
You may lose all your hair or just some of it
Often it comes out in clumps rather than an even pattern
Any hair that is still growing may become dull and dry
Hair loss can occur on all parts of the body , including the head ,face ,
arms and legs underarms and pubic area
In almost cases of chemotherapy-induced hair loss, your hair loss, your
hair will resume growth after treatments.
Your hair may start growing back while you are still receiving
chemotherapy or it may take three to six months after therapy is
completed. Your new hair may be slightly different in colour and texture
than your old hair.
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HOW CAN I CARE FOR MY SCALP AND HAIR DURING
CHEMOTHERAPY
Use a mild shampoo
Use a soft hair brush
Use low heat when drying your hair
Have your hair cut short. A shorter style will make your hair look
thicker and fuller. It also will make hair loss easier to manage if it occurs
Use a sun screen. sun block , hat, or scarf to protect your scalp from the
sun if you loose your hair on your head
Avoid brush rollers to set your hair
Avoid dying perking.
Some people who loose all or most of their hair choose to wear turbans,
scarves, wigs. caps or hair pieces
If you plan to purchase a wig get your wig hairpieces before you lose a
lot of hair. That way you can match your current hair style and colour
.You may be able to buy a wig or hair pieces at a fashion store Natural
wigs are generally expensive but synthetic wigs are much cheaper and
look like a natural
Losing hair from your head , face, or body can be hard to accept and
very upsetting. Feeling angry or depressed is common but keep in mind
that it is a temporary side effect. Talking about your feelings can help. If
possible share your thoughts with someone who has had similar
experience
MOUTH ,GUM , AND THROAT PROBLEMS
Cancer treatment can often result in problems with your mouth and
throat . These may include dryness soreness and ulcers. Some anti
cancer drugs can cause sores in the mouth and throat a condition called
steatites. or mucositis. Anti cancer drugs also can these tissues dry and
irritated or cause them to bleed. Patients who have not been eating well
since beginning chemotherapy are more likely to get mouth sores.
Mouth sores occur because chemotherapy not only destroys cancer cells
but also rapidly dividing cells. Such as those that line your mouth and
esophagus Other causes include radiation therapy, infection dehydration
poor mouth care excessive use of alcohol and or tobacco and the lack of
protein in the diet.
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HOW CAN I KEEP MY MOUTH GUMS AND THROAT
HEALTHY
Examine your mouth daily. Use a flashlight and look in your mouth
while standing in front of a mirror
Look for any ulcers, pimples , sores areas of redness white patches or
blood
Report these changes and any mouth pain to your doctor.
Keep your mouth clean and moist
Brush your teeth, gums and tongue. Using a soft tooth brush gently
brush gums and tongue
Gargle after brushing or swabbing gargle with salt water. Mix ¼ tsp of
salt in a cup of warm water. Swish it around your mouth and hold it for a
couple of minutes before spitting it out. Do this even if you do not have
any problems, because gargling will further clean your mouth and help
toughen the tissues.
Rinse your toothbrush well after each use store it in a dry place
Avoid mouthwashes that contain any amount of alcohol
Do not wear dentures at night
Ask your dentist to show you the best ways to brush and floss your teeth
during chemotherapy Chemotherapy can make you more likely to get
cavities so your dentist may suggest using fluorides may rinse or get
each day to help prevent decay.
Talk with your doctor before undergoing any dental procedure
If you develop sores in your mouth tell your doctor. You may need
medicines to treat the sores.
WHAT CAN I DO TO HELP EASE THE PROBLEMS IF THEY
OCCUR
Continue to clean your teeth and mouth as before even though your
mouth is sore.
If it hurts to use soft brush use an oral swab (cleaning stick with soft
sponge tip)
Drink plenty of fluids and suck on ice chips
Eat foods cold or at room temperature. Hot and warm foods can irritate a
tender mouth and throat
Eat soft soothing foods such as ice cream milkshakes baby foods soft
fruits (bananas) mashed potatoes cooked cereals soft-boiled or
scrambled eggs yogurt cottage cheese macaroni and cheese custards and
puddings. You also can puree cooked foods in the blender to make them
smoother and easier to eat.
Avoid irritating, acidic foods and juices such as tomato and
citrus(orange, grapefruit and lemon) spicy or salty foods and rough and
coarse foods such as raw vegetable popcorn and toast
Avoid smoking chewing tobacco mouthwashes that alcohol excessive
alcohol
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Ask your doctor to prescribe or recommend a medicine to ease the pain
there are some medications you can apply directly to the sores
For mouth dryness(xerostomia)
Drink a plenty of liquids
Ask your doctor if you should use an artificial saliva product to moist en
your mouth
Eat soft and pureed foods
Apply lip moisturizer often
Carry a water bottle with you to sip from often
CALL YOUR DOCTOR IF
You are having so much difficulty eating drinking or swallowing that
you are taking a little food and water. This can result in dehydration
If pain is not relieved ask your physician for something stronger
Fever of 100.5 persists
If you develop bleeding anywhere in the mouth
If there is a long standing ulcer
SKIN AND WOUND CARE
There are a number of skin symptoms that can accompany cancer. Such
skin problems include dryness, rash, itching, sores, ulcers, increased
sensitivity to sun and swelling. It is important for you to be aware of
skin problems so that they can be treated as quick as possible in order to
reduce discomfort and infection
Your nails may also become darkened yellow brittle or cracked. They
also may develop vertical lines or bands.
While most of these .problems are not serious and you can take care of
them yourself. A few need immediate attention. Some drugs given
intravenously(IV)can cause serious and permanent tissue damage if they
leak out of the vein. Tell your doctor or nurse right away if you feel any
burning or pain when you are getting IV drugs. These symptoms do not
always mean there is a problem but must be always checked at once. Do
not hesitate to call your doctor about even the less serious symptoms
WHICH ARE THE MOST COMMON SKIN PROBLEMS ?
1) Pressure sores: Blisters or breaks in the skin caused when the body’s
weight stops the flow of the blood to a certain area causing a break
down in the skin.
Most likely to affect those who are bed ridden, under weight,
malnourished or dehydrated
Usually occur in boney areas such as the head, elbows, heels, hips,
shoulders and tailbone
Signs and symptoms:
Red areas on the skins that do not go away when the pressure in
removed
An open sore on the skin’s surface or invading deeper, underlying
tissues
Pain at pressure points
2) Ulcers: Break or breach in the continuity of skin or crater like lesion
on the skin. Usually caused by trauma, inflammation or infection of
the area or due to the maligncy itself
3) Edema: Swelling of the skin that is caused by water and salt
retention. Can occur from certain medications. ; Heart liver or
kidney failure malnutrition and obstruction of veins or lymph nodes.
Signs and symptoms:
Swelling over feet or legs when sitting or walking.
Feeling of tightness in the hands
Swelling in the hands
Distended abdomen
4) Itching: The urge of scratch or rub the skin. It can be due to verity of
reasons like dryness , allergy or side effect of drugs
5) Dryness: Rough scaly, dry, flakey skin due to lack of water or oil in
the skin layers. Can be caused by dehydration , cold weather , heat
and side effects of treatments(such as chemotherapy and radiation)
6) Photosensitivity : Photosensitivity is an enhanced skin response to
ultraviolet radiation(sunlight)
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HOW WILL I PREVENT OR MANAGE SKIN PROBLEMS?
1) Pressure sores:
Keep skin dry and clean
Check skin daily for pressure sores and other skin irritations Pay special
attention to pressure sites
Try to turn a bedridden person every two hours (or as often possible)
alternating positions
Encourages
STOMA CARE FOR CANCER PATIENTS
INDEX
Preface
What are types of stoma.
How does stoma work?
What necessititates a stoma and who is at risk.
Stoma Permanent/temporary
What sort of appliance will I need for my stoma?
Looking after stoma
Diet tips
What can I do about pan caking of stools?
How can I tell if I have blockage
Daily activities while on stoma
Tips on stoma care
Coping with a stoma
STOMA CARE
What is a stoma ?
Stoma is a Greek word meaning mouth or opening. It is surgically
created from the bowel (intestine) through the skin onto abdomen to help
in removal of body wastes such as faeces or urine. It protrudes through
the abdomen wall has a moist soft fleshy feel and is pinkish red in
colour similar to the inside of your mouth
What are the different types of stoma ?
There are three basic types of stoma
Colostomy : This stoma is usually created in the lower left of the
abdomen and the portion of the the large intenstine is brought out
through an opening.The discharge will vary depending on the location of
the large intestine If the discharges are from the descending colon it
tends to be semi formed and empties approximately 1 to 3 times daily
Lleostomy:This stoma is usually created at the lower right of the
abdomen and a section of the small intestine is brought out through the
opening. The discharges are usually watery or semi formed and contain
large amount of salts and enzymes which are corrosive to skin.
Urostomy: This stoma is normally sited on the lower right of the
abdomen. It is created to divert urine through an opening on the
abdomen.
Other less common types are
Gastrostomy an opening from the skin directly into the stomach to allow
feeding
Jejunostomy an opening from the first part of the small bowel also used
for feeding
Sometimes the stoma will have to be sited differently because of
scarring from previous surgery stomas or skin problems. It can be
temporary or permanent. Ordinarily digestion starts in your mouth and
stomach. Partially digested food passes into the small intestine where
nutrients are absorbed. Next it goes into the large intestine where water
is absorbed. When stool reaches the end of large intestine there is very
little water left in the stool. At the end of the digestive system the waste
that remains passes through the rectum and out of the body when a
colostomy or ileostomy is performed a portion of intestine is brought to
an opening made in the abdomen. Stool comes out of this opening rather
than going all the way through the intestines. An ilostomy produces
stool has not completed its usual journey through the digestive tract. The
stool is more liquid. The closer the stoma is to the end of colon the
thicker the stool will be.
What necessitates a stoma and who is at risk?
Sometimes a portion of the intestine becomes diseased and it can not
function as normal Surgery is required to remove the diseased portion
thus a stoma may be created to allow digestive system to perform its
function.
A number of conditions call for a stoma as a part of the treatment and
recovery. These include cancer of the colon and rectum trauma
malformations present from birth obstructions of the bowel
complications of diverticulitis and Crohn’s disease. In each of these a
stoma may be the best and safest form of the treatment. Your doctor will
advise you according to your condition.
STOMA CARE
Stomas are carefully sited on the abdominal wall so that they can be
hidden and yet still function. With a colostomy or ileostomy a special
bag is attached to the site that collects the faeces. The opening on the
abdominal wall must be well cared for because bowel contents can
irritate the skin which results in ulceration and infection. Unlike at the
anus no mechanisms are place to regulate the flow of faeces. The use of
the appliances such as bag and seal over and around stoma can in turn
cause damage to the skin from their frequent removal and from allergy
to the materials used
Are all stomas permanent?
No there are also temporary stomas
When is temporary stoma created?
A temporary stoma is created to allow the stools to buy pass the operated
site (the joined portion of the intestine) so that the site is allowed to rest
and heal the closure of the temporary stoma usually takes place a few
months later
When is permanent stoma created?
A permanent stoma is created when the muscles around the anus is not
working properly or need to be removed due to low rectal cancers or
inflammatory diseases
What sort of appliance will I need for my stoma?
The stoma bag can be a one- piece appliance (flange and bag are
moulded together) or a two –piece appliance (flange and bag are
separate pieces that can be fitted together) Modern appliances with
improved adhesives are now available in soft opaque covers and in
various sizes.
All closed appliances and some drainable ones have activated charcoal
filters which allow flatus to be released and absorb the odour making
them more discreet and comfortable there are also a wide varity of
accessories avaible if needed for extra comfort and security
The type of appliance you will wear depend on the stoma
Ileostomy: drainable with clip
Colostomy: closed appliance
Urostomy: appliance with tap
I am nervous about caring for my stoma. How will I look after it?
The practical management of your stoma should be kept as simple as
possible. Always have your requirements ready before you start such as:
a)
b)
c)
d)
A few appliance cut to fit
Warm water
Soft tissues or gauze wipes
Disposable bag (to dispose off old appliance)
How often should I change the pouch?
The adhesiveness and durability of pouching systems vary. Anywhere from three to
seven day is to be expected Itching or burning are signs that the water should be changed.
Changing too frequently or wearing one too long may be damaging to the skin
Changing your appliance
 Empty the appliance (if drainable)
 Wash your hands
 Remove the old appliance carefully from the top down and avoid
dragging skin.
 Wipe excess waste with soft tissue
 Wash the stoma and surround skin gently removing all waste and flange
 Use unperformed soap if needed and rinse the skin well to avoid dryness
 Gently dry the skin with wipes
 Keep the hair around the stoma shaved.
 Check that your stoma has not changed size with the measuring guide
 Place prepared appliance over stoma
 Spend a few minutes moulding flange to skin
 Rest for a few minutes moulding flange to skin
 Do not forget to attach the clip (drainable bag ) or close the tap
(urostomy bag )
 Empty contents of closed bag in toilet
 Place the empty old appliance in the disposable bag and discard in bin
 Wash your hands thoroughly.
Emptying the pouch:
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Empty the pouch when it is third to half full .You will probably need to
empty the pouch 4 to 6 times a day.
Sit on the toilet with the pouch hanging between your legs Or sit on a
chair next to the toilet with the pouch opening aimed into the toilet
Point the opening of the pouch into the toilet and remove the clamp that
keeps the pouch closed Slide your fingers down the outside of the pouch
to squeeze the contents out of the pouch Clean the inside of the pouch
opening with a piece of rolled up toilet paper
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After emptying your pouch you may rinse it out with room temperature
water to do this use a rubber ear syringe to squirt water inside the pouch
Tip the pouch to get the water up into the top Empty it and rinse again if
you like. You may want to rinse the pouch many times to clean it but
you do not need to rinse it each time you empty it.
If you use a pouch deodorant put some into the pouch after you have
finished rinsing it.
Put the clamp back on to the pouch to close it. Wash your hands with
soap and water
Is it possible that my bag could leak?
Leakage of the appliance can happen occasionally especially in the beginning when you
are less experienced. Leakage can cause skin soreness and excoriation so early detection
and correction is advisable
Some of the reasons for leakage are as follows
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Overfull appliance (empty more frequently)
Appliance left on too long (change appliance sooner )
Poor changing technique (re read your information on changing your
appliance )
Poor visions (wear your glasses or use mirror )
Incorrectly fitting appliance (check that the size and shape of stoma and
correct it.)
Inspection of stoma for causes of leakage:
Has your stoma shrunk or enlarged? Measure with measure guide or check with your
stoma nurse
Have you lost or gained weight? You may need to reduce or increase the size of the
flange or change the type appliance to either a one or to piece convex flange or belt.
Discuss this with your stoma care nurse
Have you developed skin folds or creases? Use paste or cohesive seal or consult your
stoma nurse
Have you developed sore skin? Establish whether it is caused by leakage or allergic
reaction to adhesive Use cohesive seals change the type of appliance you are using and
consult your stoma nurse Have you developed a parastomal hernia-change to a soft
flexible flange See your doctor or stoma care nurse for assessment.
I have a problem with embarrassing wind. What can I do to help reduce this?
Certain food will cause more flatus than others so it is important to experiment it is
important to have good balanced diet so do not eliminate food from your diet until you
have tried at less three times. You may be able to reintroduce that particular food a later
date.
Foods that may cause flatus:
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Onion
Beans
Green vegetables
Fizzy drinks
Spiced foods
Cucumber
Spinach
Corn
Beer
Hints to reduce flatus
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Eat small regular meals
Do not skip the meal
Eat with your mouth closed
Do not gulp your food chew well wait until you swallow one mouthful
before taking another
Avoid drinking for about 45 minutes before or after meals
Experiment with foods
Try yogurt buttermilk curd
What can I do about the smell of my stoma as it is making my life miserable?
Odour is always of great concern to people Most modern appliances are now odour proof
provided they are fitted properly You should only be aware of odour while emptying or
changing your appliance
If you think the odour is excessive check what you are eating as some foods do cause
more odours: Fish eggs asparagus garlic some spices beans turnips and foods in cabbage
family (cabbage onion broccoli and cauliflower) and alcohol
Hint to reduce odour: Try taking peppermint oil yogurt or buttermilk
For ileostomy: avoid high fiber (e. g. nuts, beans, and peas) which can cause blockage
For colostomy: take regular fiber diet (e. g. papayas and prunes) to prevent constipation
For urostomy: drink more water to prevent urine infection
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Drink at least 7 glasses of water every day
Eat a well balanced diet
Chew your food properly to avoid indigestion
Take different in moderate amount and do not restrict yourself from
enjoying your food
Foods that may cause loose stools:
 Apple juice
 Baked beans
 Spinach
 Prune juice
 Highly spiced foods
 Beer
 Raw fruits
 Alcoholic beverage
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Foods that may reduce loose stools
Very ripe banana
Yogurt
Rice
Bread
Potatoes
Creamy peanut butter
Pasta
Marshmallows
Constipation may be simply rectified by
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Fluid (water)
Fresh orange juice
A mild laxative perhaps duphalac as per your oncologist’s consultation
Sometimes the faeces sit in the mouth of the stoma and refuse to budge.
What can I do about this?
Pan caking occurs when the stool sits on the stoma and fails to drop
down into the appliance. It can sometime be a problem for people with
colostomies, causing leakage and sore skin.
To avoid pancaking before applying your appliance
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Place filter cover on filter
Place a wet tissue into the appliance
Grease inside of appliance with oil. (Olive oil or baby oil)
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Increase your fluids
If problem persist contact your consultant
How can I tell if I have a blockage?
Blockages are caused by food particles which for some reason have
become stuck in your intestines and unable to pass out through your
stoma. This is why you must make sure that you thoroughly chew all
your food. Usually when you have a blockage there is very little or no
output from your stoma. There will probably be some pain attached to it
too as well as nausea and or fever. If the blockage lasts for more than a
few hours seek medical attention
Foods that can cause a blockage include: nuts, corn, coconut however
they do not cause blockages in everyone. If you wish to try out these
foods add them to your diet in small doses and chew them well. You will
soon learn what types of food are apt to cause a blockage in you.
Daily activities while on stoma
What about showering and bathing? Should I bathe with or without my
pouch?
You may bathe with or without your pouching system in place. If you
wish to take shower or bath with your pouch off you can do so. Normal
exposure to air or contact with soap and water will not harm the stoma
and water does not enter the opening. Choose a time for bathing when
the bowel is less active. You can also leave your pouch on while
bathing.
Will I be able to wear the same clothes as before?
Whatever you wore before surgery you can wear afterward with very
few exceptions. Many pouching systems are made today that are
unnoticeable even when wearing the most stylish form fitting clothing
for men and women
Depending on your stoma location you might find belts uncomfortable
or restrictive. Some people choose to wear higher or looser waistbands
on trousers and skirts. Avoid putting on tight belt and waistbands
directly over the stoma.
Cotton knit or stretch underpants or panty hose may give the support and
security you need. Some men find that jockey type shorts help support
the pouch.
What about sex and intimacy? Will I be able to get pregnant after
surgery?
Sexual relationship and intimacy are important and fulfilling aspects of
your life that should continue after stoma surgery. Your attitude is a key
factor in reestablishing sexual expression and intimacy. A period of
adjustment after surgery is to be expected. Sexual function in women is
usually not impaired while sexual potency of men may sometimes be
affected usually only temporarily. Discuss any problems with your
physician and/or stoma nurse
Your ability to conceive does not change and pregnancy and delivery
should be normal after stoma surgery. However if you are thinking about
becoming pregnant you should first check with your doctor about any
other health problems.
Is travel possible?
All methods of travel are open to you many people with stomas travel
extensively from camping trips to cruise to excursions around the world.
Take along enough supplies to last the entire trip plus some extra double
what you think you may need. Checked luggage sometimes gets lost
carry an extra pouching system and supplies on the plane with you
When travelling by car keep your supplies in the coolest part and avoid
the trunk or back window ledge Seat belts will not harm the stoma when
adjusted comfortably
When travelling abroad take adequate amount of supplies referral lists
for physicians and medical centers and some medication to control
diarrhea and stop the fluid or electrolyte loss. When going through
customs or luggage inspection. A note from your doctor stating that you
need to carry ostomy supplies and medications by hand may be helpful.
Can I participate in sports?
Unless your favorite hobby is a contact sport with lots of potential for
injury you will be free to go back to the activities you enjoy after you
heal from stoma surgery. The only danger is injury to your stoma which
means rough sports may be out. But if you want to continue these
pursuits ask your doctor about special products you can use and
precautions you can take to protect your stoma during these activities
Avoid heavy lifting (greater than 5 pounds) or strenuous activity for
several weeks after you are discharged. Heavy lifting can increase
abdominal pressure which can put a strain on your incision and
Could create a small hernia.
Avoid bending .this is tiring and also increases abdominal pressure. If
you must pick something up bend at your knees.