An explanation of the cancer diagnosis and side effects, including bleeding and mucositis.
What is Cancer?
Cancer is a disease where there is uncontrolled growth of abnormal cells. Normal cells grow in a controlled way. As each cell is worn out a new cell is made to replace it, so there are never more cells than are needed. Cancer cells grow in an uncontrolled way. Sometimes cancer cells can break away from their original site and spread to other parts of the body; this is called cancer metastasis.
What is chemotherapy?
Chemotherapy is a type of cancer treatment using chemicals (drugs). The word comes from two words that mean “chemical” and “treatment”. Chemotherapy destroys cancer cells by interfering with their growth or by stopping them from multiplying. There are many types of chemotherapy drugs.
Different types of cancer are best treated with specific chemotherapy drugs. One drug or a group of drugs that work together may be used in your treatment. The chemotherapy drug may be taken by mouth, injection or given into a vein. How often and how long your chemotherapy takes will depend on the type of cancer you have. It may be given daily, weekly or monthly. Sometimes chemotherapy is given in an on and off cycle to allow your body to rest and make healthy new cells.
Chemotherapy drugs act on rapidly dividing cells, like cancer cells. Some rapidly dividing normal cells in the body may be affected by chemotherapy drugs. The normal cells that are most often affected by chemotherapy include those in the bone marrow, gastrointestinal tract, reproductive system and hair follicles. Most normal cells can recover when treatment is over. Since these normal cells can be affected by cancer chemotherapy, some unwanted side effects may occur. Different drugs cause different side effects.
What are some of the side effects of chemotherapy?
Expect to feel more tired and plan your activities with rest periods. Ask family and friends for help. Save your energy for what’s important. Talk with your doctor and nurse about your energy concerns.
Losing hair depends on the type of chemotherapy. Your providers can tell you if you can expect hair loss.
Loss of appetite
Eat small, regular meals that are high in protein and calories. Add supplements like Ensure, Boost and Carnation Instant Breakfast. Ask to speak with the dietitian if you are having trouble.
Prone to infection
Avoid people with infections. Avoid children who have recently received “live” vaccinations. Have a working thermometer in your home. Call the clinic if your temperature is 100.5 or you feel that you have an infection such as a productive cough, burning with urination, skin sores. Practice good hand washing and personal hygiene. Check with your doctor before having any dental work done. If antibiotics are prescribed, finish them entirely, even if you feel better.
Prone to bleeding
Use Acetaminophen (Tylenol) for headaches or minor discomfort. Avoid taking Aspirin, Ibuprofren (Motrin, Advil) and Naprosyn (Aleve). Report any unexplained bleeding, bruising or rashes (see section on Bleeding below.)
Drink more fluids. Add fiber to your diet as able. Use a laxative such as senna (Senokot). The store brand is fine. (Start with one tablet twice a day and increase to two tablets as needed.) If no bowel movement in three-four days, call the clinic or the covering MD.
TO HELP CONTROL CONSTIPATION:
- Drink plenty of liquids throughout the day
(eight to ten 8 oz. cups/day).
- Increase foods high in fiber—see suggestions below under ‘Diarrhea’.
- Keep a normal activity level if you can
- Notify your doctor if constipation persists despite diet. Laxatives and stool softeners may be needed.
Take loperamide (Imodium AD) as directed, no prescription needed. Avoid milk products and high fiber foods while having diarrhea. Drink more fluids; eat bananas and applesauce.
TO HELP CONTROL DIARRHEA:
- Drink plenty of liquids throughout the day; you need to replace what you have lost (eight to ten
8 oz. cups a day).
- Eat frequent, small meals throughout the day.
- Eat plenty of foods that contain sodium (salt) and potassium such as bananas, peach and apricot nectar, potatoes, Gatorade, bouillon.
- If dairy products increase the diarrhea, try Lactaid brand products or lactase enzymes when dairy products are eaten.
- Gradually add foods high in fiber such as brown rice, oatmeal, fruits and vegetables, whole-wheat toast and whole-wheat crackers.
- Avoid citrus fruit and fruit juices (such as orange and grapefruit).
When feeling nauseated, eat lightly and drink often, in small amounts. Maintain your fluid intake, about eight cups of liquid a day. Foods such as toast, crackers and white rice are easy to digest. Take nausea medicines as prescribed for persistent nausea or during times that you have experienced persistent nausea in prior cycles.
- Ondanestron (Zofran)
- Prochlorperazine (Compazine)
- Lorazepam (Ativan)
TO HELP CONTROL NAUSEA AND VOMITING:
Eat small amounts slowly and frequently throughout the day.
Avoid eating in a room that is stuffy, too warm or has cooking odors that may disagree with you.
Drink fewer liquids with meals to avoid a full, bloated feeling.
Drink or sip liquids frequently between meals. Using a straw may help.
Drink cool or chilled beverages. Try freezing your favorite beverages in ice cube trays.
Eat foods at room temperature or cooler; hot foods may add to nausea.
Avoid fatty, greasy, fried foods; very sweet foods such as candy, cookies or cake; spicy or hot foods with strong odors.
Try toast and crackers, yogurt, sherbert, pretzels, angel food cake, oatmeal, skinned chicken (baked not fried), fruits and vegetables that are soft and bland such as canned peaches, clear liquids—sip slowly, ice chips.
If vomiting, avoid eating or drinking until vomiting is under control.
Oral hygiene is very important! Tell your providers if you are having problems with your teeth or gums. Brush your teeth and rinse your mouth after meals and at bedtime. Use a soft toothbrush and alcohol free mouthwash only. Rinse with baking soda (1/2 tsp) in 1/4 cup of warm water, Biotene mouth rinse. Call the clinic if you develop oral sores or a white coating.
Let your nurse know if you feel flushed, short of breath during treatment take medications as prescribed for prior to treatment if needed.
Use extra precautions in the sun, wear sunscreen greater than SPF 15.
Why is bleeding a concern after chemotherapy?
Chemotherapy may lower your bone marrow’s production of platelets. Platelets help your blood to clot so that when you cut yourself you stop bleeding. If your platelet count gets too low, you many need a transfusion of platelets.
What are signs that your platelets are low?
- Bleeding gums
- Easy bruising
- Tiny red or purple spots on your skin
- Prolonged bleeding from a cut
What should you do when your platelet count is low?
- Report unusual bruising or bleeding to your doctor or nurse.
- Be careful using knives or sharp tools.
- Use electric shavers instead of razors when needed.
- Wear protective gloves when working in the garden.
- Avoid alcoholic drinks.
- Use a soft toothbrush and do not floss.
- Avoid contact sports or other activities that could cause injuries.
- Avoid straining for bowel movements.
- Apply pressure to cuts with a clean cloth for several minutes.
- Clean your nose by gently blowing.
- Avoid aspirin or ibuprofen because these tend to increase your risk of bleeding. Products to avoid include: Bufferin, Alka-seltzer, Pepto-Bismol, Anacin, Bayer and Ecotrin, Motrin, Aleve and Doan’s pills.
- Have your blood count test done as ordered, so that your doctor and nurse can watch your platelet count closely.
Why are you at risk for Mucositis?
Mucositis is the name for mouth sores, tender gums and a sore throat that can occur after you have chemotherapy. These may be similar to a canker sore in your mouth or a cold sore on your lip. The normal cells that line the mouth and throat can be affected seven to 14 days after chemotherapy. Mouth sores may vary from mild redness and tingling to open sores that may hurt.
What can you do to prevent mouth sores?
- Drink plenty of fluids (8 oz cups/day).
- Avoid all over-the-counter mouthwashes containing alcohol because they can dry out your mouth.
- Inform your dentist that you are on chemotherapy before any dental cleanings or procedures.
- Keep mouth and gums clean to prevent infection.
What can you do to treat mouth sores?
- If you develop symptoms, call your doctor.
- Use sugarless hard candy or gum to increase mouth moisture.
- Moisten dry food with butter, gravies, sauces or broth.
- Avoid spicy, salty, high acidic food and drinks: tomatoes, oranges, grapefruits.
- Avoid tobacco and alcohol.
- Suck on ice or popsicles.
- Eat soft, moist food.
- Use lip lubricant.
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