cancer treatments

Cancer Cancer TreatmentsTreatments

Therapies & Side EffectsTherapies & Side Effects

Goals of TherapyGoals of Therapy

CureCure• refers to prolonged absence of refers to prolonged absence of

detectable diseasedetectable disease

ControlControl• when cure is unrealisticwhen cure is unrealistic• prevent new cancer growthprevent new cancer growth

Goals of Therapy Goals of Therapy (cont.)(cont.)

PalliationPalliation• when cure or control is impossiblewhen cure or control is impossible• reduce side effects/symptoms of reduce side effects/symptoms of

diseasedisease

Types of TreatmentTypes of Treatment

SurgerySurgery Radiation TherapyRadiation Therapy ChemotherapyChemotherapy Hormone TherapyHormone Therapy

Therapies can be used alone or in Therapies can be used alone or in combinationcombination

SurgerySurgery

Removal of cancerous tissue from Removal of cancerous tissue from the bodythe body

Local treatmentLocal treatment Can also be used for: diagnosis, Can also be used for: diagnosis,

staging, relief of side effects, or to staging, relief of side effects, or to ease painease pain

Side Effects of SurgerySide Effects of Surgery

Depends on type of surgery & Depends on type of surgery & overall health of personoverall health of person

Most common side effect is PainMost common side effect is Pain Other side effects include: Other side effects include:

bleeding, constipation, fatigue, bleeding, constipation, fatigue, wound care, and management of wound care, and management of drainsdrains

Surgical TreatmentsSurgical Treatments

CervicalCervical Cryosurgery, laser surgery, conization, Cryosurgery, laser surgery, conization,

hysterectomyhysterectomy Feel less womanly, incision, bleedingFeel less womanly, incision, bleeding

BreastBreast Lumpectomy, mastectomyLumpectomy, mastectomy Feel less womanly, balance, Feel less womanly, balance,

numbness/tingling, drains, numbness/tingling, drains, lymphademalymphadema

Surgical Treatments Surgical Treatments

ColonColon Colectomy, resectionColectomy, resection Altered bowel function, colostomyAltered bowel function, colostomy

LungLung Resection, lobectomy, Resection, lobectomy,

pneumonectomypneumonectomy Chest tube, respirator, short of Chest tube, respirator, short of

breathbreath

Surgical TreatmentsSurgical Treatments

ProstateProstate Prostatectomy, orchiectomyProstatectomy, orchiectomy Impotence, incontinence, libidoImpotence, incontinence, libido

Radiation TherapyRadiation Therapy

High energy x-rays High energy x-rays to kill cancer cellsto kill cancer cells

Local treatmentLocal treatment Given externally Given externally

or internallyor internally Skin may be Skin may be

marked by tattoos marked by tattoos to direct beamsto direct beams

Daily treatments Daily treatments

Side Effects of Side Effects of RadiationRadiationSide effects depend on targeted areaSide effects depend on targeted area Skin irritation Skin irritation Hair lossHair loss Digestive problemsDigestive problems FatigueFatigue Urinary & Bladder problemsUrinary & Bladder problems Sexual/Fertility problemsSexual/Fertility problems Bleeding/Infection*Bleeding/Infection*

*Risks associated with implanted radiation source*Risks associated with implanted radiation source

Skin ChangesSkin Changes

May start a few weeks after May start a few weeks after radiation begins & last a few radiation begins & last a few weeks after radiation endsweeks after radiation ends

Redness Redness ItchingItching Dry, PeelingDry, Peeling Sores, ulcersSores, ulcers SwollenSwollen

Management of Skin Management of Skin ChangesChanges

ClinicalClinical May hold treatmentMay hold treatment Prescribe special Prescribe special

creamscreams May prescribe May prescribe

medications for pain, medications for pain, itching, or infectionitching, or infection

At HomeAt Home Use mild soap with Use mild soap with

lukewarm waterlukewarm water Do not rub or scratch areaDo not rub or scratch area Loose clothing, soft fabricsLoose clothing, soft fabrics Sun protectionSun protection Sitz bathsSitz baths Check with Provider Check with Provider

before using any skin before using any skin productsproducts

Hair LossHair Loss

Also called alopeciaAlso called alopecia Only happens on the part of body Only happens on the part of body

being treated being treated Hair loss starts 2 to 3 weeks after first Hair loss starts 2 to 3 weeks after first

treatment treatment Hair may grow back 3 to 6 months Hair may grow back 3 to 6 months

after treatment is over after treatment is over New hair may not look or feel the way New hair may not look or feel the way

it did before it did before

Management of Hair Management of Hair LossLoss

Clinical Clinical Prescription for Prescription for

wigwig ““Look Good, Feel Look Good, Feel

Better”Better”

At HomeAt Home Cut hair short or Cut hair short or

shave head shave head Buy a wig (before Buy a wig (before

loss)loss) Wash hair gently Wash hair gently Avoid harsh productsAvoid harsh products Protect scalp Protect scalp Stay warm Stay warm

Digestive ChangesDigestive Changes

Changes depend on amount of Changes depend on amount of radiation and concurrent radiation and concurrent chemotherapychemotherapy

DiarrheaDiarrhea Mouth/Throat changes Mouth/Throat changes Nausea & Vomiting Nausea & Vomiting

DiarrheaDiarrhea

Frequent bowel Frequent bowel movements which movements which may be soft, formed, may be soft, formed, loose, or wateryloose, or watery

Can occur at any Can occur at any time time

Radiation to the Radiation to the abdomen or pelvis abdomen or pelvis may cause diarrheamay cause diarrhea

Management of Management of DiarrheaDiarrhea

ClinicalClinical I.V. FluidsI.V. Fluids Electrolyte Electrolyte

replacementreplacement Imodium or other Imodium or other

anti-diarrheal anti-diarrheal medicationsmedications

At HomeAt Home Drink 8 to 12 cups Drink 8 to 12 cups

of clear liquids per of clear liquids per day day

Eat 5 or 6 small Eat 5 or 6 small meals and snacks meals and snacks

Eat foods that are Eat foods that are low in fiber, fat, and low in fiber, fat, and lactose lactose

Avoid spicy foodsAvoid spicy foods

Mouth & Throat Mouth & Throat ChangesChangesRadiation to head or neck can cause: Radiation to head or neck can cause: Dry mouth and throatDry mouth and throat Difficulty swallowingDifficulty swallowing Mouth sores Mouth sores Loss or changes in taste Loss or changes in taste Tooth decay Tooth decay InfectionsInfections

Some side effects my last for months or Some side effects my last for months or years after treatment endsyears after treatment ends

Management of Management of Changes to Changes to Mouth/ThroatMouth/ThroatClinicalClinical Dental examDental exam Prescribe special Prescribe special

mouthwash for mouthwash for pain or infectionpain or infection

At HomeAt Home Avoid tobacco, Avoid tobacco,

alcoholalcohol Eat moist, soft foods Eat moist, soft foods

that are cool or that are cool or room temperatureroom temperature

Eat 5-6 small meals Eat 5-6 small meals high in calories & high in calories & proteinprotein

Drink 6-8 cups of Drink 6-8 cups of fluid each dayfluid each day

Nausea & VomitingNausea & Vomiting

Nausea and vomiting may occur 30 Nausea and vomiting may occur 30 minutes to many hours after radiation minutes to many hours after radiation therapy session ends therapy session ends

Patients are likely to feel better on Patients are likely to feel better on days off from radiationdays off from radiation

Those receiving radiation to the Those receiving radiation to the abdomen & certain parts of the brain abdomen & certain parts of the brain are at riskare at risk

Management of Management of Nausea & VomitingNausea & VomitingClinicalClinical I.V. fluidsI.V. fluids Electrolyte Electrolyte

replacementreplacement Prescribe anti-Prescribe anti-

nausea medsnausea meds

At HomeAt Home Eat bland, easy-to-Eat bland, easy-to-

digest foods and digest foods and drinksdrinks

Eat small meals Eat small meals and snacks (5-6 and snacks (5-6 meals a day)meals a day)

Have foods and Have foods and drinks that are drinks that are warm or cool warm or cool

FatigueFatigue

Feeling weak, weary, worn out, heavy, or Feeling weak, weary, worn out, heavy, or slowslow

Possible Causes:Possible Causes: Anemia Anemia Anxiety Anxiety Depression Depression Infection Infection Lack of activity Lack of activity Medicines Medicines

Fatigue may last even after therapy is over Fatigue may last even after therapy is over

Management of Management of FatigueFatigue

ClinicalClinical Assess for Assess for

underlying causeunderlying cause Treat patient for Treat patient for

anemia, anxiety, anemia, anxiety, depression or depression or infection as infection as indicated indicated

At HomeAt Home Try to sleep at Try to sleep at

least 8 hours each least 8 hours each night night

Plan time to rest Plan time to rest Exercise Exercise Adjust work Adjust work

schedule schedule Let others help at Let others help at

home home

Urinary & Bladder Urinary & Bladder ChangesChanges Frequency, burning or Frequency, burning or

painpain Trouble starting or Trouble starting or

emptying bladderemptying bladder IncontinenceIncontinence Blood in urineBlood in urine SpasmsSpasms Starts 3-5 weeks after Starts 3-5 weeks after

therapy begins therapy begins Most problems go away Most problems go away

2-8 weeks after therapy 2-8 weeks after therapy is over. is over.

Management of Management of Urinary ChangesUrinary ChangesClinicalClinical Urine sample to Urine sample to

rule out infectionrule out infection Prescribe meds to Prescribe meds to

help with spasms, help with spasms, burning or painburning or pain

Refer to a Refer to a therapist for therapist for exercises to exercises to improve bladder improve bladder controlcontrol

At HomeAt Home Drink 6-8 cups of Drink 6-8 cups of

fluid each dayfluid each day Avoid coffee, Avoid coffee,

black tea, black tea, alcohol, spices, alcohol, spices, and all tobacco and all tobacco productsproducts

Continence pads Continence pads

Sexual & Fertility Sexual & Fertility ChangesChanges Radiation to Radiation to

pelvic areapelvic area Can cause sexual Can cause sexual

changes: loss of changes: loss of interest in or interest in or ability to have ability to have sex sex

It can also affect It can also affect fertilityfertility

ManagementManagement

Patients should talk to their Provider:Patients should talk to their Provider:

FertilityFertility: Before starting radiation, let your doctor : Before starting radiation, let your doctor know if you think you might want to father children know if you think you might want to father children in the future. in the future.

ImpotenceImpotence: The doctor can let you know whether : The doctor can let you know whether you are likely to become impotent and how long it you are likely to become impotent and how long it might last. Your doctor can prescribe medicine or might last. Your doctor can prescribe medicine or other treatments that may help.other treatments that may help.

SexSex: Ask if it is okay for you to have sex during : Ask if it is okay for you to have sex during radiation therapy. Most men can have sex, but it is radiation therapy. Most men can have sex, but it is a good idea to ask and be sure.a good idea to ask and be sure.

Long-term Side EffectsLong-term Side Effects

Radiation can sometimes have long Radiation can sometimes have long lasting effects:lasting effects:

Second cancerSecond cancer FatigueFatigue InfertilityInfertility Heart problemsHeart problems Gastrointestinal problemsGastrointestinal problems Lung fibrosisLung fibrosis Neurologic problemsNeurologic problems

ChemotherapyChemotherapy

Variety of drugs used Variety of drugs used to kill cancer cellsto kill cancer cells

Systemic treatment: Systemic treatment: damages healthy damages healthy cells along with cells along with cancer cellscancer cells

Given orally, IV, or Given orally, IV, or by injection into by injection into various sitesvarious sites

Side Effects of Side Effects of ChemotherapyChemotherapy Bone MarrowBone Marrow

CardiacCardiac

PulmonaryPulmonary

Nerves Nerves

GastrointestinalGastrointestinal

Mouth & ThroatMouth & Throat

Kidney & BladderKidney & Bladder

Hair, Skin & NailsHair, Skin & Nails

MyelosuppressionMyelosuppression

Refers to the suppression of the bone Refers to the suppression of the bone marrowmarrow

Bone marrow produces:Bone marrow produces: White blood cellsWhite blood cells Red blood cellsRed blood cells PlateletsPlatelets

Nadir Nadir Point at which the lowest blood cell Point at which the lowest blood cell

count is reached after chemotherapycount is reached after chemotherapy

NeutropeniaNeutropenia

• A low number of white blood cells A low number of white blood cells (neutrophils)(neutrophils)

• White blood cells help fight infectionsWhite blood cells help fight infections

• The most common dose-limiting side effect The most common dose-limiting side effect of chemotherapyof chemotherapy

• A fever of 100.4 F or higher may be the only A fever of 100.4 F or higher may be the only sign of infection for neutropenic patientssign of infection for neutropenic patients


ClinicalClinical Treatment with Treatment with

colony colony stimulating stimulating factorsfactors

Avoid invasive Avoid invasive proceduresprocedures

No live No live vaccinationsvaccinations

At HomeAt Home Frequent hand Frequent hand

washingwashing Wash fresh fruits & Wash fresh fruits &

vegetablesvegetables Avoid raw meats/fishAvoid raw meats/fish Avoid crowds, sick Avoid crowds, sick

peoplepeople Avoid animal excretaAvoid animal excreta

AnemiaAnemia

• A low number of red blood cellsA low number of red blood cells

• Red blood cells help transport Red blood cells help transport oxygen from the lungs to body oxygen from the lungs to body tissuestissues

• Symptoms can include fatigue, Symptoms can include fatigue, shortness of breath, chest pain, shortness of breath, chest pain, dizziness/lightheadeddizziness/lightheaded


ClinicalClinical Blood transfusionBlood transfusion EPO EPO

administrationadministration Iron supplementsIron supplements Oxygen therapyOxygen therapy

At HomeAt Home Plan activities to Plan activities to

conserve energyconserve energy Sleep at least 8 Sleep at least 8

hours each nighthours each night Maintain optimal Maintain optimal

level of physical level of physical activityactivity

Well balanced Well balanced diet (iron & diet (iron & protein rich)protein rich)

ThrombocytopeniaThrombocytopenia

A low number of platelets A low number of platelets (thrombocytes)(thrombocytes)

Platelets stick together to form a Platelets stick together to form a clot in order to stop bleedingclot in order to stop bleeding

Overt bleeding or petechiae (a Overt bleeding or petechiae (a purplish red rash) could signify a purplish red rash) could signify a low platelet countlow platelet count


ClinicalClinical Platelet Platelet

transfusiontransfusion IL 11 injectionsIL 11 injections Avoid invasive Avoid invasive

proceduresprocedures Prescribe stool Prescribe stool

softenerssofteners

At HomeAt Home Avoid injuriesAvoid injuries Electric razor, soft Electric razor, soft

toothbrushtoothbrush High protein diet, High protein diet,

non-irritating foodsnon-irritating foods Avoid aspirin, Avoid aspirin,

NSAIDSNSAIDS

HeartHeart

Cardiac toxicityCardiac toxicity Usually dose relatedUsually dose related May be irreversibleMay be irreversible Symptoms: fast heartbeat, Symptoms: fast heartbeat,

shortness of breath, cough, ankle shortness of breath, cough, ankle swelling swelling

Cardiac ManagementCardiac Management

ClinicalClinical Discontinue or Discontinue or

reduce reduce medicationmedication

Order tests: Order tests: EKG, MUGA, EKG, MUGA, Holter monitorHolter monitor

At HomeAt Home Avoid alcohol and Avoid alcohol and

tobaccotobacco Modify diet as Modify diet as

indicatedindicated Report symptomsReport symptoms

PulmonaryPulmonary

Risk increases with chest radiation, Risk increases with chest radiation, underlying lung disease, patient is a underlying lung disease, patient is a smokersmoker

Hypersensitivity, inflammatory, fluid Hypersensitivity, inflammatory, fluid retentionretention

Symptoms: cough, shortness of Symptoms: cough, shortness of breath, fatigue, restlessness, rapid breath, fatigue, restlessness, rapid respirationsrespirations

Pulmonary Pulmonary ManagementManagement

ClinicalClinical May discontinue May discontinue

medicationmedication Prescribe home Prescribe home

oxygenoxygen Further testsFurther tests

At HomeAt Home Refrain from Refrain from

smokingsmoking Use a fanUse a fan Elevate head of Elevate head of

bedbed Conserve energyConserve energy Restrict fluids as Restrict fluids as

indicatedindicated Report symptomsReport symptoms

NervesNerves

Central, Peripheral, Central, Peripheral, and Cranial and Cranial NervesNerves

Symptoms depend Symptoms depend on which nerves on which nerves are damagedare damaged

Symptoms Include:Symptoms Include: HearingHearing VisionVision Touch, SensoryTouch, Sensory PainPain BalanceBalance StrengthStrength


ClinicalClinical May discontinue May discontinue

drugdrug Treat vitamin Treat vitamin

deficiencydeficiency Prescribe pain Prescribe pain

medicationmedication Consult Consult

neurologistneurologist

At HomeAt Home Ensure safe Ensure safe

environmentenvironment Report symptomsReport symptoms

Gastrointestinal Gastrointestinal

Nausea, Vomiting, DiarrheaNausea, Vomiting, Diarrhea Acute or DelayedAcute or Delayed

ConstipationConstipation Decreased intakeDecreased intake MedicationsMedications DepressionDepression Advanced cancer stageAdvanced cancer stage

Management of Management of ConstipationConstipation

ClinicalClinical May suggest a May suggest a

fiber supplement, fiber supplement, laxative, stool laxative, stool softener, or softener, or enemaenema

At HomeAt Home Drink at least 8 Drink at least 8

cups of fluids each cups of fluids each dayday

Be active every day Be active every day Eat high fiber foods Eat high fiber foods Contact Provider if Contact Provider if

not had a bowel not had a bowel movement in 2 days movement in 2 days

Mouth & ThroatMouth & Throat

Dry mouth (having little or no saliva)Dry mouth (having little or no saliva) Changes in taste and smell Changes in taste and smell Infections of gums, teeth, or tongueInfections of gums, teeth, or tongue Increased sensitivity to hot or cold foodsIncreased sensitivity to hot or cold foods

MucositisMucositis Inflammation of the GI mucosa Inflammation of the GI mucosa Symptoms: pain/difficulty swallowing, Symptoms: pain/difficulty swallowing,

hoarseness, changes in color to oral hoarseness, changes in color to oral mucosa, ulcersmucosa, ulcers

Appetite ChangesAppetite Changes

Causes include:Causes include: Nausea Nausea Mouth and throat problems Mouth and throat problems Changes in tasteChanges in taste Feeling depressed or tired Feeling depressed or tired

Appetite loss may last for a day, a few Appetite loss may last for a day, a few weeks, or even months.weeks, or even months.

Management for Loss Management for Loss of Appetiteof Appetite

ClinicalClinical Prescribe vitamins Prescribe vitamins

or nutrition or nutrition supplements supplements

Prescribe Prescribe medications that medications that increase appetite increase appetite

receive nutrition receive nutrition through an IV through an IV

At HomeAt Home Eat 5 to 6 small Eat 5 to 6 small

meals each daymeals each day Drink milkshakes, Drink milkshakes,

smoothies, juice, or smoothies, juice, or soupsoup

Use plastic forks and Use plastic forks and spoonsspoons

Increase your Increase your appetite by doing appetite by doing something activesomething active

Kidneys & BladderKidneys & Bladder

BladderBladder burning, pain, bloodburning, pain, blood

KidneysKidneys Impaired water excretionImpaired water excretion ProteinuriaProteinuria Weight gainWeight gain Little urine outputLittle urine output


ClinicalClinical IV fluidsIV fluids Bladder irrigationBladder irrigation DiuresisDiuresis Monitor Monitor

electrolyteselectrolytes

At HomeAt Home Increase oral fluidsIncrease oral fluids Empty bladder Empty bladder

frequentlyfrequently Call provider: unable Call provider: unable

to urinate for more to urinate for more than 12 hours; urine than 12 hours; urine dark & concentrated; dark & concentrated; producing only small producing only small amounts of urineamounts of urine

Hair LossHair Loss

May lose some or all hair May lose some or all hair Can happen anywhere on the bodyCan happen anywhere on the body Starts 2 to 3 weeks after therapy beginsStarts 2 to 3 weeks after therapy begins Scalp may hurt at first Scalp may hurt at first It takes about 1 week for hair to fall outIt takes about 1 week for hair to fall out Almost always, hair will grow back 2 to 3 Almost always, hair will grow back 2 to 3

months after chemotherapy is over months after chemotherapy is over Hair may start growing back even while Hair may start growing back even while

on therapyon therapy

Skin & NailsSkin & Nails

Itching, dryness, redness, rashes, and Itching, dryness, redness, rashes, and peelingpeeling

Darker veinsDarker veins Sensitivity to the sun Sensitivity to the sun Nail problemsNail problems Radiation recallRadiation recall Allergic reactionsAllergic reactions Chemotherapy leaking from IVChemotherapy leaking from IV

FatigueFatigue

Most common and most Most common and most distressing symptom associated distressing symptom associated with cancer treatmentwith cancer treatment

Hormonal TherapyHormonal Therapy

May improve May improve prognosis more prognosis more than chemotherapythan chemotherapy

If taken by mouth, If taken by mouth, must be taken must be taken everydayeveryday

Usually given for 5-Usually given for 5-10 years10 years

In Stage IV disease, In Stage IV disease, can control cancer can control cancer for many yearsfor many years

Side Effects of Side Effects of TreatmentTreatment Usually tolerated wellUsually tolerated well Hot flashesHot flashes Joint painsJoint pains Blood clotsBlood clots

cancer treatments

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