This section will be updated periodically as new information becomes available and we develop a sound base of knowledge to share.
By Wilma Ariza, Caregiver -Survivor & Thyroid Cancer Advocate
Cancer signs and symptons
Cancer and cancer treatment can cause many side effects; some are easily controlled and others require specialized care. If you or your loved one is facing cancer, it's important to know that there are many new medical advances that can prevent or reduce treatment and treatment sequale side effects.
The following overview of some come side effects of cancer diagnosis and treatment will help you recognize symptons easily and give you some tips for managing them. It is a general list of all possible side effects associated with cancers and cancer treatment and not thyroid cancer specific, although it is certainly helpful and comprehensive.
Información sobre cómo controlar los posibles efectos secundarios del cáncer y del tratamiento contra el cáncer.
Extreme fatigue-
Feeling extreme fatigue and tiredness and/or weakness are common complaints among cancer patients - for many patients it's the first recognizable sign of illness. No matter what your leve of fatigue, don't ignore it as it can strongly affect your quality of life.
Early symptons are sometimes vague and may include:
- Difficulty concentrating or thinking clearly.
- Difficulty completing daily activities.
- Overall weakness with a heavy feelign in your arms and legs.
- Low energy leve and increased need to rest after normal (not strenuous) physical activity
Note: Having treatment related tiredness does not mean that your cancer is getting worse. You may need treatment for a specific condition that's causing or contributing to your tiredness. Your fatigue may be caused by the following:
- Low thyroid gland function or loss of it's function
- Side effects of some medications
- Not getting proper nutrition
- Depression and/or anxiety
- Sleep disturbances
- Unrelieved pain
-
Anemia
Managing extreme fatigue
Try to maint a daily exercise routine. Exercse increases your ability to expend energy and actually helps you be more active while feeling less tired.
- Prioritize your activities to conserve energy. Schedule important activities earlier in the day when your energy levels are higher.
- Ask others to help with daily living tasks or less important activities such as house cleaning, errands or work related duties.
- Keep a daily diary to help you identify when your energy levels are high or low.
- Try to eat nutrionally balanced meals- Food provides energy for your body.
- Maintain a normal sleep routine. Too much or too little can cause fatigue.
- Limit daytime naps to 30 minutes to 1 hour. Avoid caffeine.
The most importan thing you can do is discuss with your healthcare team an individualized nutrition and exercise program for long term wellness as a long term lifestyle change that will always benefit you !
Anxiety-
A feeling of distress, fear or uneasiness. While feelling anxious is a natural response for someone with cancer or their loved ones, it can develop into a debilitating disorder for some people. There are several types of anxiety disorders, but they all have the common symptons of excessive, irrational fear and dread. If left untreated, anxiety disorders can grow progressively worse, making it difficult to function in everyday life.
Some symptons of generalized anxiety include:
-
Difficulty sleeping (insomnia)
-
Feeling a loss of control
-
Difficulty breathing
-
Muscular pains
-
Racing pulse
-
Exhaustation
-
Trembling
-
Dizziness
Coping with Anxiety:
- Realize that anxiey is a normal reaction to a cancer diagnosis and treatment. Occasional anxiety indicates that you are mentally processing your journey through diagnosis, treatment and survivorship.
- Realize that your loved ones may be experiencing anxiety over the unknowns and unanswered questions in this journey. Communicate your thoughts and feelings to help strengthen each other.
- Try relaxation techniques such as meditation, deep breathing, guided imagery, positive affirmations, prayer, yoga or tai chi, listen to music or take a warm bath.
- Try to get some light exercise each day. A brisk walk around the block or in the park releases natural hormones that can help you feel better.
- Talk to your doctor about what you are experiencing and see if he or she thinks an antianxiety medication and counseling or supportive relaxation therapies would be appropriate for you or your family as a group.
- Make sure you and your loved one try to get enough sleep. A sleep deprived state enhances irritability and dismishes your ability to concentrate.
- Join a cancer support group online, in your community or seek out one on one peer support. It may help you deal with your anxiety and learn coping skills.
- Keep a cancer treatment journal and jot down your feelings and side effects.
Anemia-
Related to a decrease in red blood cells and hemoglobin ( a protein that helps your blood carry oxygen.) This results in your blood being unable to carry oxygen throughout your body as well as it should. Cancer-related anemia can be caused by the cancer itself, iron deficiency, blood loss, chemotherapy, radiation or a combination of these and/or other factors.
Your doctor can check to see if you have anemia by ordering a complete blood count (CBC). Anemia can make you feel extremely fatigued and tired. It may also include the following symptons:
- Difficulty thinking or cognitive dysfunction
- Shortness of breath with mild exertion
- Dizziness and generalized weakness
- Rapid heartbeat or palpitations
- Feeling cold all the time
- Chest pain
- Depression
- Pale skin
Your healthcare provider can easily treat your anemia with prescriptions suitable for your individual case so be sure to always ask what your hemoglobin count is. If it's too low, you may feel some symptons of anemia. Many patients keep a record of their hemoglobin levels. The goal of your anemia treatment is to raise your hemoglobin to a normal level, so that symptons go away. When your hemoglobin counts are low take your time getting up from a lying or sitting position. Getting up to fast can make you dizzy and cause you to fall or faint. Treating your anemia is an important quality of life issue so talk to your healthcare team about anemia treatment and monitoring as a regular part of your overall healthcare strategy.
Dealing with anemia
- Be as active as you can. Maintain a daily routine of 10 to 30 minutes of mild exercise or physical activity.
- Balance activity with short periods of rest. Don't hesitate to ask for help with daily activities or chores.
- Eat small, nutrionally balanced meals every 2 to 3 hours. *Your doctor may prescribe an iron supplement.
Pain
Can often be a side effect of the cancer itself or a side effect of treatment, such as surgery, chemotherapy or radiation sequale. There are many effective treatments for pain control today. Often medications are used in combination with other therapies to for best pain relief and control. The type of medication you will be prescribed depends on the intensity of your pain measured on a scale from 0 to 10 ( 0 is equal to no pain with 10 being the worst pain imaginable).
- Mild to Moderate (1-3): You may be given an over the counter medication.
- Moderate to Severe (4-6): You may be prescribed an opioid.
- *Opioids are the strongest pain relieving medication available.
- Severe (7-10): In this instance you may receive a combination treatment with several drugs or a stronged class opioid as determined by your healthcare team.
There are many ways to receive pain medication: orally (pill, capsule, liquid), locally (ointment, patch applied to skin), rectally (suppository), subcutaneously (injection directly under the skin), intramuscularly (injection directly into muscle) and intravenously (injection into vein or IV drop).
Managing Pain
- Keep a pain journal to discuss and review with your healthcare team.
- Take your medication as prescribed. If your pain medication instruction is "take as needed" take it before your pain becomes severe.
- If pain medication relief does not last long ask about extended release medications and supportive therapies such as guided imagery.
- Ask about exercise (physical therapy) meditation, accupuncture, massage, counseling and other pain reducing approaches.
- Always notify your doctor is your pain becomes worse or is not controlled with the medications or supportive therapies prescribed.
- Report any pain medication side effects to your health care team.
Remember there are many medications, combinations of medications dosage or supportive therapies you can try that will help you manage or relieve pain that will work.Do not worry about becoming addicted to strong pain medicine. Addiction is rarely a problem. Discuss this concern with your healthcare team and keep an open mind.
Common Chemotherapy Side Effects:
Chemotherapy is a systemic treatment to kill cancer cells located anywhere in the body. Chemotherapy drugs work by killing rapidly dividing cancer cells. Unfortunately, these drugs also kill rapidly dividing healthy cells in the process, such as those in hair follicles and the lining of the mouth, stomach and intestines. This leads to side effects, such as thinning or loss, diarrhea, nausea, vomiting and mouth sores. There are many different types of chemotherapy drugs used in various combinations or regimens. The side effects you experience will depend on the type and amount of chemotherapy you receive.
Nausea & Vomiting-
Chemotherapy drugs can trigger nausea and vomiting. Medications, called antiemetics, can help reduce or prevent these side effects. Some antiemetics are given while you're undergoing treatment to prevent nausea and vomiting. Others are given once you experience symptons. You may need to try more than one medication before finding the one that works for you so talk to your healthcare team about this option before you begin treatment.
Coping with Nausea & Vomiting
In addition to using prescribed antiemetics, the following may help:
- On the day of your chemotherapy treatment eat a light meal (nothing heavy or greasy). This will help reduce nausea. If you do feel nauseous practice relaxation techniques
- and other soothing distractions.
- Drink at least sixo 8 ounce glasses of water-based liquids the day before, the day of and the day after chemotherapy. Talk to your doctor if you cannot keep liquids down.
- Avoid spicy or acidic foods on an empty stomach. Let other people cook for you when possible -- smells may bring on nausea and vomiting.
- Have food prepared outside the home, eat pre-prepared meals, closed doors and remain in another part of the home during food preparations if possible so that you are not exposed to strong food odors before before eating.
- Eat small frequent meals slowly. Chew food well and eat food cold or at room temperature. Don't wait to feel hungry, carry snacks with you and remember to eat frequently as you go about your daily activities. Rest after eating to help your digestion, but be careful not to lie flat for a couple of hours after eating.
Contact your healthcare team if these techniques do not help. Your antiemetic medications may need adjustment. Today there is absolutely no reason to suffer from uncontrolled nausea and vomiting associated with chemotherapy without complete or reasonable relief.
Decreased appetite-
Chemotherapy drugs may cause food to taste different. Sour and bitter tastes may become more intense, and sweet food may taste bland, or you may have a metallic taste in you mouth. These changes may last 2 to 3 months or longer after treatment ends. You may have lost your appetite because of changes in taste or because of cancer itself.
You may feel full without eating much (or anything at all). This is known as early satiety. You may have less desire to eat if you're feeling anxiety or depression related to your overall health but proper nutrition is especially important while you are undergoing treatment.
If you are unable to maintain your weight or eat sufficiently, your health care team may recomment a nutriotional supplement to give you enough calories, vitamins and minerals. In some cases your doctor may prescribe medication.
If your condition is serious, you may require nutritional support. The 2 most common treatments available are:
- Total parenteral nutrition: you receive a nutrionally complete solution intravenously. This short term treatment is used if you have severe malnutrition.
- Enteral nutrition: you receive your nutrition solution through a tube directly into your stomach. This treatment is used if you cannot eat, chew or swallow food.
Managing Decreased Appetite
- Avoid unplesant or strong odors.
- Add flavorings to your food or suck on hard candy.
Try small portions of sweet or tart food.
- Try chilled or frozen foods such as natural fruit bars or soups.
- Try ginger ale or mint tea which can help that metallic taste.
- Use plastic utensils to reduce unpleasant metallic taste
Constipation-
This is known as the difficulty in passing stools or a decrease in normal between bowel movements. It can be accompanied by nausea, gas-related pain, or pressure in your abdomen. Anything that slows movement through the intestines may be a cause, including some chemotherapy drugs, some antiemetics and pain medications, lack of physical activity, decreased fluid intake, or poor nutrition. Constipation can be very uncomfortable and the stools may be difficult to pass. It is a common side effect of cancer treatment at some point.
Constipation can be dangerous if you have heart or respiratory illnesses. If you have one of these conditions and are constipated, straining to have a bowel movement can cause difficulty breathing, chest pains and even fainting. If you have been prone to constipation before commencing cancer treatment you most likely will be more prone to it now. Prevention is key.
Preventing and relieving constipation
- Make sure you are having six to eigh glasses of fluids a day. Warm or hot liquids (if tolerated) help stimulate your bowels to move.
- Include fiber in your diet. Fiber helps stool move through your GI track. High fiber foods include vegetables, fruits , whole grains and beans.
- Exercise daily to help stimulate your digestion. Even mild exercise, such as walking, can help stimulate your bowels to move.
Call your doctor if you have any of the following:
- Blood in your stool.
- Vomiting with constipation.
- No bowel movement in 3 days.
Diarrhea-
Chemotherapy can damage cells in your gastrointestinal tract, causing watery bowel movements; or diarrhea. If you have diarrhea many times a day, it can lead to weakness and dehydration. Diarrhea can be a potentially life-threatening condition if not controlled due to the possibility of severe dehydration and related complications. Tell your healthcare team if you have fever, severe cramps or bloody stools with your diarrhea of if the diarrhea has not cleared up in 24 hours.
You can relieve the symptons of diarrhea by restricting what you eat, drinking plenty of fluids, and by using an anti-diarrhea medication as prescribed by your doctor. Remember to talk to your healthcare team about any over the counter medications you take for diarrhea.
Managing and preventing diarrhea:
Don't be embarrassed to discuss diarrhea with your healthcare team. Diarrhea caused by chemotherapy requires treatment as soon as possible.
- Avoid very hot or very cold beverages. Room temperature beverages are best tolerated by chemotherapy patients.
- Avoid milk and milk products including caffeinated and gas producing beverages such as carbonated sodas, coffee and some teas. Avoid acidic juices like tomato or orange juice.
- * Remember; water, juice, sports drinks, gellatin or clear broth work best.
- Drink at least six to eight full glasses of fluids per day to prevent dehydration.
- Avoid spicy, fatty and fried foods or any gas producing foods and vegetables that irritate your GI system.
- Avoid high fiber foods that can make your diarrhea worse such as whole grains, beans, popcorn, nuts some fresh fruits and raw or cooked vegetables.
- Eat smaller amounts of food all day, instead of three large meals which can be hard to digest.
- Eat low fiber food such as white bread and eggs, rice and potatoes, skinless fish and chicken.
- Eat foods that are high in potassium, such as bananas and potatoes.
- Limit sugar substitutes. Sorbitol the sweetener used in sugar free products can cause diarrhea if taken regularly.
Neutropenia & Infection
Many cheomtherapy drugs cause a lowering of infection fighting white blood cells in your in your body- a condition known as neutropenia. This serious condition can increase your risk of developing an infection and affect your chemotherapy schedule. A simple blood test, called a complete blood count (CBC), detects neutropenia. Fortunately, neutropenia is easily prevented or reduced. If needed your doctor will prescribe pegfilgrastim or filgrastim. These medications help your body, produce more white blood cells and prevent the complications of neutropenia.
You may be at greater risk of developing an infection if you have previously received chemotherapy or radiation treatment, you are receiving intensive chemotherapy, you are over 60, or you have open wounds or other conditions that affect your immune system. In those cases pegfilgrastim is given with the first cycle of chemotherapy and then with each remaining chemotherapy dose. This can reduce the risk of infection (neutropenia with fever) by more than 90%.
** contact you healthcare team immediatelly if you have any sign of infection while on chemotherapy
Managing neutropenia & infection
Check you temperature once daily or as recommended by your physician. Call your healthcare team if you have symptons of an infection including:
- Fever of 100.5 F or higher -Shaking or chills
- Shortness of Breath -Coughing
- Burning or stinging pain with urination
- Diarrhea with fever
- Unusual vaginal discharge
- Redness, swelling, pus or pain surrounding a wound or cut.
Reducing infection risk
- Avoid crowds. Stay away from people that are sick with a cold, the flu or other infections.
- Wash your hands frequently with warm soapy water, specially after using the bathroom and before eating.
- Make sure your foods are washed well and avoid raw vegetables and fruits, if instructed to do so.
- Eggs, fish and meat should be well cooked at all times without exception.
- Prevent infection around your rectum by cleaning the area gently after each bowel movement.
- Eat a high fiber diet as long as you don't have diarrhea and the doctor recommends it.
- No matter what drink at least 6 glasses water based fluids each day to avoid constipation or dehydration.
- Do not cut your cuticles. Be extra careful cutting your nails and shaving.
- Clean any cuts with soap and water right away and apply an antibiotic ointment.
Peripheral neuropathy
Certain chemotherapy drugs may affect the nerves in your body. Irritation or damage to the nerve endings in the hands and feet causes peripheral neuropaty, a burning tingling numbness or freezing pain, that may or may not include prickling sensations. It's important to report numbness or tingling symptons to your health care team.
Peripheral neuropathy can range from mild to severe. It may start during treatment and persist after treatment has been completed. Most patients recover long after from peripheral neuropathy after treatment is completed but in some cases nerve damage is permanent. If you have peripheral neuropathy, your doctor may need to decrease the dose of chemotherapy or change the drug used so your nerve damage does not become too severe.
Another type of neuropathy occurs with exposure of the hands, feet, mouth and throat to cold temperatures or objects. This type of neuropathy usually occurs within the first few days of taking the chemotherapy drug oxaliplatin. Your healthcare team should ask you about symptons of neuropathy before each chemotherapy treatment. Tell them about any symptons, including the location, intensity and duration. Keep a dairy of your symptons to review with your healthcare team
Coping with Neuropathy
- Be extra careful when using hot, sharp or other potentially harmful objects. Reduced sensation in you fingers and increased clumsiness can make you more prone to injury.
- Avoid extreme temperatures if you can. Peripheral neuropathy may make areas of your body more sensitive to cold or hot.
- Avoid cold drinks during chemotherapy and for a few days after treatment. It may help to wear light gloves to reach into the refrigerator and take your snacks, food and drinks at room temperature.
- Wear socks, shoes, slippers, gloves and hats to protect your skin from temperature sensitivity.
- If you are having problems with your balance, ask your healthcare team about seeing a physical therapist to help improve your balance-coordination and/or any other physical movement abilities.
- If your peripheral neurophaty does not go away, your doctor may prescribe vitamins or other medications to relieve your symptons.
Hair Loss
Sometimes a quirky side effect of chemotherapy is hair loss, but not everyone will experience it and even the same patient undergoing chemotherapy more than once may or may not loose their hair. Your healthcare team is pretty good at letting you know if your treatment dosage or medication combination will cause hairloss. In general hair loss begins 2 to 3 weeks after chemotherapy treatment starts. You may experience thinning or loss of hair on your head, and loss of your eyebrows, eyelashes, facial hair, pubic hair, underarm and leg hair.
The amount of hair you lose is related to the type of chemotherapy you receive. The good news is that your hair will grow back ! You can expect your hair to begin growing back typically 1 to 2 months after chemotherapy ends. It may take 6 months or more for your hair to grow fully back.
It can be difficult to prepare yourself for the loss of your hair. This change in your self-image is often a visual reminder to you and others that you are undergoing cancer treatment. Some people grieve immensely the loss of their hair. It's OK to feel emotionally vulnerable over your hair loss, after all hair is an important part of your self image. Encourage children and loved ones to express their thoughts and emotions about your hair loss but remind yourself and others that losing your hair does not change who YOU are as a person.
Dealing with hair loss
Get a short haircut before you begin your treatment. It my help you adjust to and manage the loss, specially if you have long hair.
- Be gentle with your hair. Use mild shampoos and soft hair brushes. Avoid chemical hair treatments including hair dyes, bleach and peroxide.
- Shaving your head when your hair begins thinning out and before your hair starts to "actively" fall out can give you a sense of control over the situation.
- Taking control of your hair loss in this way may help you and your loved ones cope with what is many time the first obvious signs of a life changing illness.
- Shop for a wig before your hair is gone, specially if you wish to match your natural color (Be sure to ask your insurance if it covers the cost of wigs as a prosthetic )
- Besides wigs, try hats, scarves and turbans. You may prefer these to a wig or you may decide not to cover your head at all. It's really up to you and your comfort zone. Don't make the mistake of "pleasing" someone elses idea in this issue.
- Remember to cover your head or use sunscreen with SPF of at least 15 on your scalp. Your scalp and "skin" may be particularly sensitive to ultraviolet rays.
Common Radiation Side Effects
Radiation therapy uses high energy rays to kill cancer cells and shrink tumors or stop them from growing. This may be the only cancer treatment you need, or it may be part of a plan that also includes chemotherapy. Radiation is a local treatment confined to the tumor or part of your body being treated. It is painless and may be delivered internally or externally.
External radiation uses a machine outside your body to deliver the rays directly to the cancer. Internal radiation (brachytherapy) places pellets, or seeds of radioactive material directly into the cancerous tumor or near it. With either method, healthy cells in the treatment area can be injured or destroyed, leading to side effects.
The occurence and severity of side effects depends on where the beam of radiation is directed (when external) and the radiation dose. Side effects range from none, to mild to serious. Your overall health may affect how you react to radiation. Your healthcare team will help you manage any side effects.
Mouth & Throat Problems
After a few months of radiation therapy to the head and neck, your mouth and throat may become red, sore and irritated. You may develop a dry cough or feel short of breath. Your gums may bleed easily and your jaw may feel stiff. These symptons usually go away within a month after your treatment ends. In addition radiation may cause dental problems. If you wore dentures before commencing treatment they may not fit as well.
Your voice may sound weak, hoarse, or just different as a result of swollen throat tissue. You may need pain medication for discomfort. A severe side effect of radiation to the head and neck region is a chronic dry mouth condition known xerostomia. It is caused by damage to the salivary glands and reduces saliva or produces thickened saliva.
Xerostomia can make it difficult to talk, chew, swallow and can cause tooth decay.
Coping with mouth & throat problems
- Use a cool air vaporizer in your room, or near you as much as possible.
- Keep a water of bottle with you at all times to keep your throat moist.
- Drink six to eight glasses of water a day, unless otherwise directed.
- Use cough drops, cough medicine and throat sprays as needed.
- Do not go outside on hot, humid days or very cold days
- Do not smoke and avoid being around people who do.
- Pain medication may be necessary for your comfort.
- Pace yourself and plan activities with rest periods.
- Wear light - loose clothing to keep fresh.
Eating & Swallowing Difficulties
Radiation can cause you to lose your appetite or your ability to eat properly. Your body may have a hard time digesting food or absorbing nutrients. You may experience difficulty or pain on swallowing , or you may feel like you have a lump in your throat. Any of these problems can keep you from getting enough nutrition and to lose weight. These symptons are likely to develop if you are receiving external beam radiation to your neck or GI (gastro-intestinal track) and in some radio active iodine patients.
Managing eating & swallowing difficulties
-
Drink at least six to eight glasses of fluids a day.
-
Chew sugarless gum or try sucking sugarless hard candy.
-
Do not wear tight fitting turtle necks or wrap scarfs (tightly) around you neck.
-
Keep your throat moist by using throat spray, artificial saliva preparations, or cough drops.
-
Keep the air in your room or any area you spend lots of time using a vaporizer or humidifier
Skin problems
Although radiation is meant to treat cancer cells inside your body, your skin is also exposed to the beam. Most skin changes disappear a few weeks after radiation is over. However, your skin may remain, slightly darker and more sun sensitive. During radition therapy, your skin may undergo one or more of the following changes, depending on the
area of exposure:
- Radiation dermatitis: Treated skin becomes red and irritated and may look like it is sunburned or suntanned.
-
Dryness: After a few weeks, your skin may become unusually dry. It may feel itchy and uncomfortable.
-
Moist reaction: Your skin may have difficulty drying out and may retain moist skin in fold areas, causing soreness and infection. It can include untreated areas such as your genital or anal area, and under your breasts.
During your course of radiation therapy, your doctor and nurse will examine your skin regularly for any rection. It is very important that you report any skin changes, pain, swelling, irritation. Great strides have been made in managing and even reducing skin related side effects.
Managing Skin Reactions:
- Pat your skin down- Do Not rub dry. *Avoid shaving underarms or legs.
- Use natural, mild or gentle, nondeodorant soaps on your skin
- Use mild deodorant or cornstarch as suggested by your healthcare team.
- Do not use lotions that contain alcohol or glycerin.
- Do not use hot water bottles, heating pads, sun lamps, or ice packs in affected areas.
- When in the sun, use sunscreen with an SPF of at least 15, although I prefer 30.
- Good Idea: Always wear loose, cotton clothing while undergoing cancer treatment but specially if you are receiving radiation therapy.
- Consult with your doctor about applying a moisturizer on your skin before and after treatment.
- Tell your healthcare team if your skin shows signs of burning or irritation right away.
Dealing with People Dealing with Cancer Link Up Resources Program Page Talking with Your Doctor Website Resources Web Content Q & A
-
-
Proceeds Benefits Stevie JoEllie's Cancer Care Fund
(click here)
