Methods of Treatment and Their Side Effects
Treatment for cancer can be either local or systemic . Local treatments affect cancer cells in the tumor and the area near it. Systemic treatments travel through the bloodstream, reaching cancer cells all over the body. Surgery and radiation therapy are types of local treatment. Chemotherapy, hormone therapy, and biological therapy are examples of systemic treatment.
It is hard to protect healthy cells from the harmful effects of cancer treatment. Because treatment does damage healthy cells and tissues, it often causes side effects. The side effects of cancer treatment depend mainly on the type and extent of the treatment. Also, the effects may not be the same for each person, and they may change for a person from one treatment to the next.
A patient's reaction to treatment is closely monitored by physical exams, blood tests, and other tests. Doctors and nurses can explain the possible side effects of treatment, and they can suggest ways to reduce or eliminate problems that may occur during and after treatment.
Surgery is therapy to remove the cancer; the surgeon may also remove some of the surrounding tissue and lymph nodes near the tumor. Sometimes surgery is done on an outpatient basis, or the patient may have to stay in the hospital. This decision depends mainly on the type of surgery and the type of anesthesia . The side effects of surgery depend on many factors, including the size and location of the tumor, the type of operation, and the patient's general health.
Although patients are often uncomfortable during the first few days after surgery, this pain can be controlled with medicine. Patients should feel free to discuss ways of relieving pain with the doctor or nurse. It is also common for patients to feel tired or weak for a while after surgery.
The length of time it takes to recover from an operation varies among patients. Some patients have concerns that cancer will spread during surgery.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. For some types of cancer, radiation therapy may be used instead of surgery as the primary treatment. Radiation therapy also may be given before surgery ( neoadjuvant therapy ) to shrink a tumor so that it is easier to remove. In other cases, radiation therapy is given after surgery ( adjuvant therapy ) to destroy any cancer cells that may remain in the area.
Radiation also may be used alone, or along with other types of treatment, to relieve pain or other problems if the tumor cannot be removed. Radiation therapy can be in either of two forms: external or internal . Some patients receive both. External radiation comes from a machine that aims the rays at a specific area of the body. Most often, this treatment is given on an outpatient basis in a hospital or clinic. There is no radioactivity left in the body after the treatment.
With internal radiation (also called implant radiation, interstitial radiation, or brachytherapy ), the radiation comes from radioactive material that is sealed in needles, seeds, wires, or catheters and placed directly in or near the tumor. Patients may stay in the hospital while the level of radiation is highest. They may not be able to have visitors during the hospital stay or may have visitors for only a short time. The implant may be permanent or temporary. The amount of radiation in a permanent implant goes down to a safe level before the person leaves the hospital.
The doctor will advise the patient if any special precautions should be taken at home. With a temporary implant, there is no radioactivity left in the body after the implant is removed. The side effects of radiation therapy depend on the treatment dose and the part of the body that is treated. Patients are likely to become extremely tired during radiation therapy, especially in the later weeks of treatment. Extra rest is often necessary, but doctors usually encourage patients to try to stay as active as they can between rest periods.
With external radiation, there may be permanent darkening or "bronzing" of the skin in the treated area. In addition, it is common to have temporary hair loss in the treated area and for the skin to become red, dry, tender, and itchy. Radiation therapy also may cause a decrease in the number of white blood cells , cells that help protect the body against infection.
Although radiation therapy can cause side effects, these can usually be treated or controlled. Most side effects are temporary, but some may be persistent or occur months to years later.
Chemotherapy is the use of drugs to kill cancer cells. The doctor may use one drug or a combination of drugs. Chemotherapy may be the only kind of treatment a patient needs, or it may be combined with other forms of treatment.
Neoadjuvant chemotherapy refers to drugs given before surgery to shrink a tumor; adjuvant chemotherapy refers to drugs given after surgery to help prevent the cancer from recurring. Chemotherapy also may be used (alone or along with other forms of treatment) to relieve symptoms of the disease.
Chemotherapy is usually given in cycles: a treatment period (one or more days when treatment is given) followed by a recovery period (several days or weeks), then another treatment period, and so on. Most anticancer drugs are given by injection into a vein ( IV ); some are injected into a muscle or under the skin; and some are given by mouth.
Often, patients who need many doses of IV chemotherapy receive the drugs through a catheter (a thin, flexible tube) that stays in place until treatment is over. One end of the catheter is placed in a large vein in the arm or the chest; the other end remains outside the body. Anticancer drugs are given through the catheter.
Patients who have catheters avoid the discomfort of having a needle inserted into a vein for each treatment. Patients and their families learn how to care for the catheter and keep it clean. Sometimes the anticancer drugs are given in other ways. For example, in an approach called intraperitoneal chemotherapy , anticancer drugs are placed directly into the abdomen through a catheter.
To reach cancer cells in the central nervous system (CNS), the patient may receive intrathecal chemotherapy . In this type of treatment, the anticancer drugs enter the cerebrospinal fluid through a needle placed in the spinal column or a device placed under the scalp.
Usually a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given, the dose, how they are given, and the patient's general health, a short hospital stay may be needed. The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. As with other types of treatment, side effects vary from person to person.
Generally, anticancer drugs affect cells that divide rapidly. In addition to cancer cells, these include blood cells, which fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, patients are more likely to get infections, may bruise or bleed easily, and may feel unusually weak and very tired.
Rapidly dividing cells in hair roots and cells that line the digestive tract may also be affected. As a result, side effects may include loss of hair, poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Hair loss is a major concern for many people with cancer. Some anticancer drugs only cause the hair to thin, while others may result in the loss of all body hair. Patients may cope better if they prepare for hair loss before starting treatment (for example, by buying a wig or hat).
Most side effects go away gradually during the recovery periods between treatments, and hair grows back after treatment is over. Some anticancer drugs can cause long-term side effects such as loss of fertility (the ability to produce children). Loss of fertility may be temporary or permanent, depending on the drugs used and the patient's age and sex. For men, sperm banking before treatment may be an option.
Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Periods are more likely to return in young women.
Hormone therapy is used against certain cancers that depend on hormones for their growth. Hormone therapy keeps cancer cells from getting or using the hormones they need. This treatment may include the use of drugs that stop the production of certain hormones or that change the way they work.
Another type of hormone therapy is surgery to remove organs (such as the ovaries or testicles) that make hormones. Hormone therapy can cause a number of side effects. Patients may feel tired, have fluid retention, weight gain, hot flashes, nausea and vomiting, changes in appetite, and, in some cases, blood clots. In women, hormone therapy may cause interrupted menstrual periods and vaginal dryness.
Hormone therapy in women may also cause either a loss of or an increase in fertility; women taking hormone therapy should talk with their doctor about contraception during treatment. In men, hormone therapy may cause impotence , loss of sexual desire, or loss of fertility. Depending on the drug used, these changes may be temporary, long lasting, or permanent. Patients may want to talk with their doctor about these and other side effects.
Biological therapy (also called immunotherapy ) helps the body's natural ability ( immune system ) to fight disease or protects the body from some of the side effects of cancer treatment. Monoclonal antibodies , interferon , interleukin-2 , and colony-stimulating factors are some types of biological therapy.
The side effects caused by biological therapy vary with the specific treatment. In general, these treatments tend to cause flu-like symptoms, such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also may bleed or bruise easily, get a skin rash, or have swelling. These problems can be severe, but they go away after the treatment stops.
Bone marrow transplantation (BMT) or peripheral stem cell transplantation (PSCT) may also be used in cancer treatment. The transplant may be autologous (the person's own cells that were saved earlier), allogeneic (cells donated by another person), or syngeneic (cells donated by an identical twin).
Both BMT and PSCT provide the patient with healthy stem cells (very immature cells that mature into blood cells). These replace stem cells that have been damaged or destroyed by very high doses of chemotherapy and/or radiation treatment. Patients who have a BMT or PSCT face an increased risk of infection, bleeding, and other side effects due to the high doses of chemotherapy and/or radiation they receive.
The most common side effects associated with the transplant itself are nausea and vomiting during the transplant, and chills and fever during the first day or so. In addition, graft-versus-host disease (GVHD) may occur in patients who receive bone marrow from a donor. In GVHD, the donated marrow (the graft) reacts against the patient's (the host's) tissues (most often the liver, the skin, and the digestive tract). GVHD can be mild or very severe. It can occur any time after the transplant (even years later).
Drugs may be given to reduce the risk of GVHD and to treat the problem if it occurs.
Nutrition During Cancer Treatment
Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and maintain strength. Eating well often helps people feel better and have more energy. Some people with cancer find it hard to eat because they lose their appetite. In addition, common side effects of treatment, such as nausea, vomiting, or mouth and lip sores, can make eating difficult. Often, foods taste different.
Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired. Doctors, nurses, and dietitians can offer advice on how to get enough calories and protein during cancer treatment.
Pain is a common problem for people with some types of cancer, especially when the cancer grows and presses against other organs and nerves. Pain may also be a side effect of treatment. However, pain can generally be relieved or reduced with prescription medicines or over-the-counter drugs as recommended by the doctor.
Other ways to reduce pain, such as relaxation exercises, may also be useful. It is important for patients to report pain so that steps can be taken to help relieve it.
Rehabilitation is an important part of the overall cancer treatment process. The goal of rehabilitation is to improve a person's quality of life. The medical team, which may include doctors, nurses, a physical therapist, an occupational therapist, or a social worker, develops a rehabilitation plan to meet each patient's physical and emotional needs, helping the patient return to normal activities as soon as possible.
Patients and their families may need to work with an occupational therapist to overcome any difficulty in eating, dressing, bathing, using the toilet, or other activities. Physical therapy may be needed to regain strength in muscles and to prevent stiffness and swelling. Physical therapy may also be necessary if an arm or leg is weak or paralyzed, or if a patient has trouble with balance.
It is important for people who have had cancer to continue to have examinations regularly after their treatment is over. Followup care ensures that any changes in health are identified, and if the cancer recurs , it can be treated as soon as possible. Checkups may include a careful physical exam, imaging procedures, endoscopy, or lab tests.
Between scheduled appointments, people who have had cancer should report any health problems to their doctor as soon as they appear.
Support for People with Cancer
Living with a serious disease is not easy. People with cancer and those who care about them face many problems and challenges. Having helpful information and support services can make it easier to cope with these problems. Friends and relatives can be very supportive. Also, it helps many patients to discuss their concerns with others who have cancer.
People with cancer often get together in support groups, where they can share what they have learned about coping with their disease and the effects of their treatment. It is important to keep in mind, however, that each person is different. Treatments and ways of dealing with cancer that work for one person may not be right for another -- even if they both have the same kind of cancer.
It is always a good idea to discuss the advice of friends and family members with the doctor. People living with cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities.
Meeting with a social worker, counselor, or member of the clergy can be helpful to people who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for help with rehabilitation, emotional support, financial aid, transportation, or home care.