(6) Cancer Symptoms & Treatment
Breast cancer - Symptoms and treatment
Radiation Therapy
Why do cancer treatments cause side effects? Is my treatment more likely to work if I get more severe side effects?
Despite the most careful precautions for treating a cancer safely, most treatments cause side effects. For many types of cancer, surgery to remove the tumor is an important part of the treatment. However, depending on the type of cancer and the extent of surgery performed, there may be changes in how your body looks or functions. Chemotherapy and radiation therapy work primarily by attacking the cancer cell’s ability to divide. Because normal cells also need to divide for the body to function normally, they may also be damaged by treatment, causing side effects. Radiation therapy and some types of chemotherapy may also injure organs in the body.
Some side effects occur during or shortly after treatment and resolve completely after treatment is completed. Acute or early side effects generally resolve within weeks or a few months after treatment is completed.
Examples are drops in blood counts, nausea, vomiting, diarrhea, and mouth sores. Long-term side effects may persist for months or years after treatment. Examples are nerve damage or fatigue. Late side effects may not show up for months or years after treatment are completed.
Examples are infertility, heart or lung problems, or cataracts. Although these are rarer than early or long-term effects, these are permanent and can cause significant problems. Planning treatment for any one person always involves balancing the risks of treatment with the potential benefits.
Your doctor will discuss these with you before you begin treatment so that you understand the goals of treatment and the potential side effects you may experience. A common myth is that the severity of side effects indicates the effectiveness of treatment. Some people might even avoid taking medication to relieve their side effects, thinking that their treatment will work better. This is not true. Some people who have successful treatment with a long-term cure have minimal side effects. Unfortunately, others have very severe side effects during treatment, even requiring hospitalization, and yet their cancer does not respond to treatment and continues to grow and spread.
The severity of side effects is usually linked to the type of treatment you are receiving. Some treatments are known to cause significant side effects; others are very well tolerated. Your general state of health, your level of activity, and how well you are eating and drinking can also affect how you tolerate treatment. Taking medication to manage side effects does not interfere with the treatment. In fact, it helps you feel better so that you can eat and drink well and maintain your usual activities as much as possible.
Lisa’s comment:
Even though I uttered the word myth countless times to my own patients, when I experienced minimal side effects from chemotherapy and radiation therapy (at first) I found myself thinking: “I wonder if this is working!” Intellectually, I knew it was, but emotionally. . . . Funny.
Planning treatment always involves balancing the risks with the potential benefits. The severity of side effects is usually linked to the type of treatment you are receiving.
How does my doctor evaluate whether my treatment is working? What if my treatment doesn’t work?
During regular visits throughout your treatment, your doctor evaluates how you are doing. These visits are necessary to see how you are tolerating the treatment, if you are having side effects, and, if so, how severe they are. The doctor may order medication to relieve the side effects and may even make adjustments in your treatment dose or schedule. Another reason for these visits is to see how your cancer is responding to the treatment. If you have had the cancer removed by surgery or destroyed by chemotherapy or radiation therapy, the doctor wants to be sure that the cancer has not recurred (reappeared). If the cancer could not be removed or destroyed, the doctor wants to be sure it is not progressing (growing) or metastasizing (spreading to other areas). The doctor reviews any symptoms you are having and performs a physical examination.
Blood tests are done, and at periodic intervals radiologic studies, such as CT, MRI, or PET, are performed to see images of the body. The specific types of studies depend on the type of cancer you have. If you are tolerating treatment well and there is no sign that the disease has recurred, progressed, or metastasized, your doctor will continue the treatment.
Depending on your situation, the treatment may be planned for a defined period of time (e.g., 6 months) or given indefinitely. However, if you develop a recurrence or if the tumor progresses or metastasizes while you are on treatment, the cancer cells may have become resistant to the treatment you are getting. If so, your doctor will recommend discontinuing your current treatment and discuss other options with you.
If your energy level is good, if your weight is fairly stable, and if you are able to be up and around most of the day, you are more likely to have a good response to active treatment, so your doctor will probably recommend a new type of treatment.
If you have been hoping for a cure, hearing that your disease has recurred or spread is distressing. You may find yourself experiencing again many of the feelings you had when you were first diagnosed: anger, sadness, worry, or even difficulty accepting the reality of what the doctor is telling you. You may feel frightened that you will develop new physical symptoms. You may feel concerned about family and friends. You may be worried about the financial implications for your family.
You may feel spiritually distressed. There are ways to cope. Getting accurate information from your doctor is particularly important as you consider what comes next. Some people find it helpful to have their doctor fully explain the details of their illness and prognosis. Others prefer not to hear the details and just focus on the plan. Decide what you want to know and communicate this to your family and doctor.
In making decisions about treatment if your cancer recurs or spreads, talk with your doctor about the goal of the treatment being recommended. Consider whether this matches your own goals. Talk with your family and doctor about what is most important to you at this time in your life. A resource that may be helpful during this time is When Cancer Returns, published by the National Cancer Institute.
If you have been hoping for a cure, hearing that your disease has recurred or spread is distressing. There are ways to cope.
What happens after my cancer treatment is completed? How do I adjust to being a survivor?
Completing treatment for cancer and becoming a survivor bring new challenges. When your treatment is completed, your doctor will schedule regular follow-up visits to be sure you are recovering from treatment, to make sure you have not developed any long-term side effects from treatment, and to evaluate the status of your tumor. Your doctor will ask about symptoms, perform a physical examination, draw blood for laboratory analysis, and order radiologic studies, such as CT, MRI, or PET. The specific blood tests and radiologic studies depend on the type of cancer you have. These studies help the doctor determine whether the tumor has grown back (recurrence) or cells have begun to grow in other parts of the body (metastasis). If all the tests are negative, if you have no signs or symptoms of cancer, and if there is “no evidence of disease,” the doctor may say you are in remission. When these circumstances continue over a number of years, the doctor may say you are cured.
Initially, your doctor may want to see you every 2 to 3 months. Over time, the visits will be farther apart, going to every 6 months and then to once a year. If you have received combined treatments, clarify with your doctors-your surgeon, medical oncologist (who prescribes chemotherapy), and radiation oncologist (who prescribes radiation therapy)-when you should see each of them.
For many people, the days immediately before their doctor’s appointments and the days waiting for the results of diagnostic tests are times of anxiety and worry. Completing treatment for cancer brings other challenges as well. Among these may be adjusting to changes in your body, recovering strength after treatment, resuming your usual activities, returning to work, and explaining your illness to friends and colleagues. In addition, despite the fact that your treatment is over, you may find it difficult at times to balance the hopefulness that the disease will not come back with the knowledge that the future is always uncertain. Each of these challenges presents a new hurdle to overcome.
Give yourself time as you transition into feeling “normal” again. Draw on your usual methods of coping, as well as those you learned after your diagnosis and during your treatment.
Three resources may be helpful to you as you adjust to your life as a cancer survivor:
1. Facing Forward Series: Life After Cancer Treatment, published by the National Cancer Institute, covers post-treatment issues such as follow-up medical care, physical and emotional changes, changes in social relationships, and workplace issues.
2. The Cancer Survivors Network of the American Cancer Society (http://csn.cancer.org/) offers recorded discussions on issues and provides an opportunity to interact with other survivors.
3. The National Coalition for Cancer Survivorship (www.canceradvocacy.org), an advocacy organization for cancer survivors, has valuable information, including a Cancer Survival Toolbox.
Despite the fears and uncertainties, some people find that being diagnosed with cancer gives them the opportunity to think about their lives in new ways.
Relationships often become stronger and enriched by the experience. Sometimes people choose to shift the priorities in their life, ensuring that they are spending their time doing what is most important to them.
Mary Ann’s comment:
After my cancer treatment was completed 3 years ago, my oncologist followed up with CT scans on a scheduled basis—first year, every 3 months; second year, every 6 months.
There were also follow-up blood and urine tests. Fortunately for me, the CT scan picked up a recurrence of my cancer at the 2-year marker. Tiny tumors appeared in the lining of my right lung and on the tail of my pancreas. It was a very scary time for me and my family. However, because of the good follow-up care, these tumors were caught at a very early stage and I was fortunate enough to be eligible for a clinical trial at Memorial Sloan-Kettering Cancer Center. I am in my 8th month of this trial and today I can say that it appears that my tumors have shrunk and calcified. Am I out of the woods permanently? Probably not but with good follow-up care, I expect to live for a long time.
Term:
Remission - A disappearance of all signs and symptoms of cancer.
Completing treatment for cancer and becoming a survivor bring new challenges.
