For people who know people with cancer excellent info14:12 Oct 15 2009
Times Read: 518
When someone close to you who has cancer starts to talk about the disease, do you change
the subject? Do you stand in silence, worried that you'll say the wrong thing? If so, you share
these feelings with many others.
How do you talk to someone who has cancer?
When talking with someone who has cancer, it is important to listen. Try to hear and
understand what the person is saying about how they feel. Don't make light of what they are
saying or try to change the way they are feeling or acting. Put your own feelings and fears
aside. Let the person know that you are open to talking whenever he or she feels like talking.
Or if the person doesn't feel like talking, that's OK too.
Here we will share some ideas on how to be supportive and helpful when you talk with
someone who has cancer. You can learn how to make the person with cancer know that they
have someone they can truly count on. We call this kind of communication "listening with
your heart."
:
About cancer
Cancer touches people of all ages, races, and incomes. This means that, at some time in their
life, everyone will talk with a person who has cancer. There are no rules to follow when
talking with them, because each person and situation is unique.
The word "cancer" itself is upsetting because it often makes people think about death. But
death is not the outcome for many people with cancer. More than 11 million people who
have had cancer are alive today. New tests and treatments are always being developed. And
(2 of 14)
more and more cancers are being found early -- when they're easier to treat. So the fear you
might feel when you learn that someone you care about has cancer can and should be mixed
with hope. Most cancers can be treated, and research is constantly finding new and better
ways to treat cancer.
Some people live many years with cancer. This means that they may have to adjust to
different types of treatment at different stages of the disease. Family and friends must also
adjust to these changes and provide emotional support and hope along the way.
In many cases, having cancer doesn't mean there is a clear beginning, middle, and end to the
experience. There may be a beginning and an end to a treatment plan. And perhaps a time
when there is no sign of the cancer. But for some people, there may be a time when cancer
returns. And sometimes treatment can go on for years just to keep the cancer under control.
Hearing the news
Waiting
When a lump or a symptom means a trip to the doctor, there are often several days of waiting
for test results to come in and not knowing what you might be dealing with. All kinds of
thoughts can go through the person's mind and through yours. This can be a very scary time.
If the person who might be facing cancer confides in you, it is probably because he or she
needs to share that anxiety. This is when you should listen and help your friend or loved one
keep hoping for the best. Waiting is always hard, but having someone to wait with eases the
burden.
Some people may sense that they have cancer before they get the diagnosis from their doctor.
Each person will receive and react to the diagnosis in a different way. Some may want to talk
about what the doctor said in detail. Others may not want to talk about it at all. Sometimes,
the person's need to talk will change from day to day. Simply asking the person if he or she
wants to talk about it is a direct and respectful way to find out the best way to help.
Finding out it's cancer
If cancer is found, it should be the doctor who tells your loved one about the diagnosis. Think
about whether or not you should be there when the doctor discusses test results. Sometimes
when the doctor talks with the patient and the family at the same time, it gives the patient a
feeling of support to have others with him or her. But some people with cancer prefer to keep
their talks with the doctor private. Just ask the patient what he or she would like to do.
(3 of 14)
How the doctor shares the news with the person who has cancer depends on the doctor's
personal style and sense of the patient's needs and feelings. These factors also influence how
much information the doctor gives the patient. The doctor will also take the family's cues and
questions into account when family members are with the patient. Most doctors make it a
policy to be honest about the diagnosis, treatment options, and treatment outlook. Having an
honest approach from the start sets the stage for a trusting relationship among the doctor,
patient, and loved ones. This allows for talks to be open, and allows for give and take
between the doctor and patient or family.
People are often shocked when they first hear the word cancer. It may be hard for them to
hear or remember anything else after that. Many people can take in only small amounts of
upsetting information. If a family member or friend is there, they should pay close attention.
Later on they may be needed to help remember and explain what was said.
If you sense that your loved one with cancer is having trouble taking in information, don't get
into a lot of detail all at once. Ask if you've given too much information or if you should stop
talking. If the discussion is too much at the time, you can assure him or her that loved ones
and the health care team are available and concerned. Remind your loved one that these
people will be ready to talk about the illness in the future, if that's what is needed.
If you are not comfortable talking about cancer, you may not be the best person for the
patient to talk with at this time. You may need some time and an expert to help you work
through your own feelings. You can even explain to your friend or family member that you
are having trouble talking about their cancer. Tell them that you would like to talk, but don't
feel you are the best person. A social worker or counselor or other friend or family member
may be able to offer more support at this time. You can suggest that they seek support from
them. Make sure the person with cancer understands that your trouble talking is your issue,
not theirs. You may also want to mention that you want to be there for them in spite of this,
and hope to be there in the future.
If you would like to find out more on living with cancer and its treatment, the American
Cancer Society offers another booklet, After Diagnosis: A Guide for Patients and Families.
You can get it by calling us at 1-800-ACS-2345 (1-800-227-2345).
Ways of coping
Venting feelings
During their illness, people with cancer may express anger and frustration to those around
them. This can upset family members and friends, but it may help to remember that people
often displace their feelings onto people close to them. They do this because the people
closest to them are a safe outlet. They know you will still be there for them, even if they
(4 of 14)
behave badly or create tension. Often, the person is really frustrated and angry about the
cancer and the losses it brings, but that is hard to put into words. So they may take their
angry feelings out on family, friends, or anyone who happens to be around at the time.
Acting different
Some people with cancer can act like children and become needy during illness. It can be
very hard for an adult child to see a parent act this way. Try to understand that this is one
way of acting out feelings of helplessness or weakness. These are quite normal feelings to
have during a cancer illness.
Though the disease may limit some daily activities, it is usually best for the person with
cancer to keep living as they did before as much as possible. Continuing to be a responsible
adult can give the person with cancer a sense of meaning, confidence, and control. Giving in
to feelings of dependence may make the person with cancer feel even more helpless and like
a victim. Sometimes we feel so sorry for the person with cancer that we may try to
overprotect them, but in the long run that probably isn't helpful.
The cancer diagnosis and treatment phase is usually an anxious time for people. There is fear
about the changes that come with having cancer, such as possible pain, money and job
changes, body changes, and adjustments in personal relationships. Because they have so
much anxiety in their lives, sometimes people with cancer may seem upset or frightened for
no reason that you can see. Sometimes this anxiety may come across as a harsh attitude
toward you. Or you may find that you have fights when you only want to be supportive. Try
to not react emotionally to this type of attitude. Understand that it is probably temporary and
due to all of the fear and anxiety that comes with having and dealing with cancer. During this
time, you will need to overlook some of this type of behavior and be ready to offer extra
forgiveness, understanding, and support. Try to put yourself in your loved one's shoes. Think
about how scared you would be if this were happening to you. Then you will be able to let go
of minor arguments and troubles and move on.
The "blame game"
Sometimes people with cancer blame themselves for getting the disease because of
something they did or did not do. As a friend or family member you may also feel guilty and
express this by changing the way you act toward the person with cancer. You may try to
make up for what you see as your failures in the past. Blaming ourselves and each other can
be barriers to a healthy relationship. Try not to play the "blame game." Encourage your loved
one not to blame him -- or herself for what's going on. The time has passed for that anyway.
Moving forward is the only option. If you feel guilty as a friend or loved one, it's OK to
(5 of 14)
express your regrets, apologize, and move on too. Try not to live in the past, but focus on the
hopeful and positive future you and your loved one have.
Communication
One of the most important ways to help communication is not only to ask "How are you
feeling?" but also "What are you feeling?" If you think about it, "How are you?" is one of the
most common questions we ask, but it can be a rather thoughtless one. The expected
response is "Fine" or "Good." It doesn't allow for much discussion. When you ask, "What are
you feeling?" you are digging a little deeper. Someone who is asked that question will get the
impression you want to know how they really are doing.
When you ask the question, "What are you feeling?" be prepared to hear anything. The
person could say they think a lot about death or they are worried about what the future holds
for their children. Or maybe they are afraid they will not survive a year. Be ready to really
listen and hear the answer they give you. You do not have to have a reply, but you must be
ready to hear the pain or harsh thoughts that the question might provoke.
People with cancer sometimes like to get the opinions of those closest to them about their
illness, treatment, and treatment outlook. Be open and honest, but don't try to answer
questions that you don't know the answers to. The person with cancer will sense your honesty
and appreciate it. If you want to know more about this, please see our document, When
Someone You Know Has Cancer. You can get it by calling our toll free number or visiting
our Web site. (See the "Additional resources" section below.)
Living with cancer
Cancer is often a disease that lasts a long time, and people may be treated for it for many
years. Sometimes, people close to the patient who were very involved at first grow distant as
the treatment continues over the course of months or years. It is understandable that you can
become "burned out" when supporting a person with cancer. Still, people with cancer need
emotional support throughout the entire course of their illness. Remember that the
encouragement and support of those around them can help people with cancer get a new
perspective and even have more hope when they feel beaten down by cancer or its treatment.
Also, the support of family and friends helps people with cancer try to get on with their old
activities and return to as normal a life as their illness will allow. So if you are going to be a
support for a person with cancer, try to hang in there for the long term. Being there and then
leaving can be very painful for your loved one, and can feel even worse than not ever being
there at all.
(6 of 14)
It is often hard to know if you are crossing boundaries or treating the person with cancer too
much like a "cancer patient" and not like your friend or family member. Encourage the
person with cancer to let you know if you cross this line. Every person with cancer
appreciates the friend or family member who remembers that they used to be a person
without cancer -- that they had, and still have, strengths and weaknesses, interests, and parts
of life that have nothing to do with cancer. Sometimes being the person in the "cancer
patient's" life who remembers the whole person is a special gift.
Rehabilitation
Rehabilitation is also a part of cancer treatment. It helps people who have had cancer to be as
physically independent as possible. Among the many specialists who help with rehabilitation
are the patient's doctor, nurse, social worker, physical therapist, and occupational therapist.
Think of these experts as helpful resources when problems come up.
The rehabilitation process is designed to help a person return to day-to-day functions after
going through a serious illness. The services provided by rehabilitation specialists might
include job training, homemaker services, prostheses (such as a replacement of a limb or
body part), or exercise programs.
Rehabilitation can be a long process. Results may come slowly, and it is often frustrating.
Sometimes people feel their efforts are useless or that it is all too hard. Encourage the patient
to actively take part in their rehabilitation program, and offer your support along the way.
One way of putting your support into action would be to go with the patient to their
appointments, or do their exercises with them. If rehabilitation has not been suggested and
you think your loved one might benefit from it, go ahead and discuss it with the doctor.
Sources of support
There are many sources of support for people facing cancer. These include visitation
programs like Reach to Recovery (for women who have been diagnosed with breast cancer),
ostomy rehabilitation (for patients with stomas on the belly), and laryngectomy clubs (for
those who have lost their natural voice because of cancer surgery). The American Cancer
Society I Can Cope program is another good source of support. It provides information about
cancer diagnosis, treatment, side effects, nutrition, and other topics of interest to people with
cancer and those close to them. Some of our local offices may be able to assist with
transportation and can put you in touch with other sources of support. To find out more about
available services in your area, contact your American Cancer Society at 1-800 ACS-2345 or
www.cancer.org.
(7 of 14)
Everyone, no matter how emotionally strong, can be helped by support. Try to understand
what the person is going through -- by listening, offering a hand, and giving encouragement
along the way. Providing encouragement does not mean that you are a cheerleader for the
patient or that you try to make the person feel good if they are feeling bad. It is important to
allow the person with cancer to express anger, frustration and sad feelings. After the person
has vented their negative feelings, you can encourage your friend or family member by
saying things like, "I'm sorry you are feeling so bad. I can't imagine how you feel. I am here
to listen any time you need to talk. You have one more round of chemo. Maybe when that is
over, you will start feeling a little better."
In fact, just listening and not talking is probably more helpful than saying the wrong thing.
Some of the wrong things to say are "I know how you feel," when you clearly don't; or "It
will be better tomorrow," when you can't be sure of that either. Even though you may say
those things with the best of intentions, the person may feel that you really don't understand
and that it just isn't helpful to talk to you. You must listen with your ears and your heart. As
one person with cancer put it, "A long illness is so discouraging." But having a good support
system means the person does not have to face cancer alone.
Concern for the family and caregivers
Just as people with cancer should not spend all their time thinking about their illness, neither
should family members and friends spend every spare minute thinking about or being with
their loved one. Caregivers need relief and rest if they are to stay emotionally and physically
fit and continue to be helpful to their loved one with cancer. If you are a caregiver, plan time
for yourself. Ask friends or other members of the family for help. Tell them exactly what
they can do to be helpful. Many times they are just waiting to be asked. For more information
please our document, Caregiving: How to Care for A Loved One with Cancer -- And
Yourself.
If you are not the main caregiver of the person with cancer, it helps to think about that person
as well. Caregivers often focus most of their energies and spare time on their loved one with
cancer and may not have time to take care of themselves. You may be able to offer help so
that they can have a much-needed break. Just a couple of hours may be a big deal for
someone whose loved one is very ill. Even if you are not able to do this, the caregiver might
like to hear someone ask how they are doing and what they are feeling. It can be very lonely
and stressful to be the main supporter for a person with cancer. With everyone concerned
over the person with cancer, it's easy for the caregiver to be overlooked.
Help and information
(8 of 14)
It is painful to see a loved one in pain or suffering through side effects of cancer treatment. If
you feel that you need help coping with your feelings about a loved one's cancer illness, there
is help available. The social services department at the hospital or your doctor's office may
be able to help you or direct you to someone who can help. They may be able to suggest
support groups for friends and families of people with cancer in your area. Sometimes the
hospital chaplain or your own clergy can help. Asking around in your community for good
counselors can be another good way to get the support and help you need. Helping yourself
may be the best way to help your loved one.
You can also support the person who has cancer by learning more about the disease. Talk
with an expert such as a doctor, nurse, social worker, and call your American Cancer Society
at 1-800-ACS-2345 for information. The more you understand cancer, the better prepared
you will be to cope with it.
Visiting
Some people may have a hard time visiting people with cancer, especially those who look
and feel very sick. When someone is very sick and suddenly looks very different, it can be
shocking and upsetting. Sometimes just seeing a lot of medical equipment around a loved
one can be disturbing. Try to remember that this is the same person you have always known
and cared about. If possible, try to relate to them in the same way you have in the past. Doing
so will help both of you think about what's going on the inside, not on the outside. The
pleasure you give by your visit and the warmth you are able to communicate will be
appreciated. When words seem too little, a loving look or touch can say a lot.
If you find it hard to not cry, it's all right. Explain to your friend or relative how much you
care about them and how upset you are that they are going through such a difficult
experience. Don't be afraid to show your feelings, but make sure the person with cancer
doesn't have to comfort you. That may be too much for most people to manage at this stage.
You may need to make the visit short if you have trouble controlling your tears.
When treatment stops
There are times when you and your loved one will not agree on decisions that are made.
Perhaps one of those times will be when your loved one reaches the point when he or she
decides that treatment aimed at fighting the cancer is no longer worth the physical and
emotional cost. You may feel that your loved one is giving up and that can be extremely
upsetting.
It is important that you give each other the right to feel the way you do. You can try to
understand that your loved one is tired of getting treatment and feeling sick without seeing
(9 of 14)
any clear benefits. You also may feel sad and upset that your loved one has decided to not
seek further treatment -- letting the disease run its course. This is not the outcome either of
you wanted. You are both upset.
Even though you do not agree with your loved one's decision to end cancer-fighting
treatments, it would be sad if you let your disagreement interfere with the loving, supportive
relationship you have shared. Once you stop and think about it, you may decide to let go of
your dream of having more time with your loved one and focus on the quality of time that
you have left. This is probably in the best interest of both of you. You might even have a
discussion together where you "agree to disagree" but can still be loving and caring toward
each other in your relationship.
If your loved one refuses cancer treatment
There are people who choose not to get any cancer treatment. This can be very hard for loved
ones, who may not agree with this choice. But for the most part, people who are able to make
decisions for themselves have the right to refuse any and all treatment. As someone who
loves and supports the person with cancer, you may wonder why they would make this
choice. Sometimes, the person has health problems that may make cancer treatment harder or
more risky. Others may feel that with their age and life history, it's just "their time."
Sometimes, the person's religious beliefs come into play. There are many different reasons
not to get treatment.
It is OK to ask your loved one why they have decided to refuse treatment. Even though the
answer may be hard to hear, you have to respect their choice. Often times their reasons
makes sense, and gives you a better idea of where they're coming from. It is also OK to tell
them what you think. You may say something like, "I hadn't thought about it that way, and
I'm glad you shared your point of view with me." Or, "I wish you would talk to a doctor
about treatment options, but I will support your choice and help you through this time the
best that I can."
Even after a person refuses cancer treatment, loved ones will want to make sure that those
with cancer understand their options. They may ask the person to talk with a doctor about the
decision and any possible treatments that may help the patient. Some patients will agree to
talk with the doctor, and others won't. But loved ones shouldn't be surprised if, after talking
with a doctor, the person still refuses cancer treatment. Again, this person has the right to feel
this way, just as you have the right to feel the way you do. Try to see it from the point of
view of the person with cancer, and continue to offer your support and friendship.
Palliative care can usually even help those people who are sure that they don't want to be
treated for cancer. Palliative care works to keep the person with cancer from having severe
pain and other symptoms, whether they are getting cancer treatment or not. And the person
who refuses cancer care may still want to enter hospice. Hospice workers use palliative care
(10 of 14)
so that symptoms can be controlled as the cancer runs its course. They also try to help the
family and the patient make the most of the time he or she has left. A patient who is
competent to make decisions may elect to refuse this care, too. If that happens, loved ones
usually work with the situation as best they can, but should keep offering hospice as an
option. This can be especially crucial as the patient's condition gets worse -- it can become
impossible for family and loved ones to manage without help.
Facing the final stage of life
Some people have cancer that no longer responds to treatment and they must face the fact
that they will probably die. This is scary for the person who is sick and for those around
them. The person with cancer may be in pain, may be in bed or able to walk only a few steps,
or may be confused. It is hard to watch someone you love go through this process of decline.
Being there
No matter how hard it may be, it is still important to try to be there for the person. The person
with cancer may feel lonely even if there are people around. This is because the people
nearby may not be really in tune with what is going on with the person. You can be the
person who is in sync with your loved one every step of the way. Just by staying close and
listening with a smile or gentle touch, you show you are there for your friend or family
member. It takes courage and extra energy to be in this situation.
Sometimes the person with advanced cancer may pull away from people and seem to be
withdrawing as he or she enters the dying process. This is usually a natural process and is one
way of disconnecting from life. The best thing you can do if this happens is to take the
person's cue, and simply stay in the background and be available. Try not to take this
withdrawal personally or feel hurt when the person pulls away. It likely has nothing to do
with you.
Talking about death and dying
Many people worry about what to say when a person talks about dying. But this is something
that commonly happens. Some people want talk about different parts of the dying process --
they want to know what to expect. Some want to know how they will die, and ask, "What
will happen when I'm actually dying?" For answers to these questions, you will need to find
experts in hospice care or care of the terminally ill. If you don't know the answers to specific
questions, you can say, "I don't know, but we will call some people who can help us with
those answers." These professionals can guide you and the person with cancer by explaining
(11 of 14)
the things that might happen as death gets closer. Hospice staff is used to answering these
questions, and they are skilled in answering doing it in a supportive, caring way. In many
communities, hospice organizations give expert, compassionate care for people with
advanced disease. If you would like to read more about end of life issues or about hospice
care, please see our other documents, Nearing the End of Life and Hospice Care. Information
on advanced cancer and caring for the cancer patient at home is also available by calling our
toll free number or visiting our Web site. (See the "Additional resources" section below.)
You may be asked, "Why is this happening to me?" It is very hard to hear this question
because there is no answer, and it is heart wrenching to feel the pain that lies within such a
question. This is a question where the simple answer "I don't know" and the holding of a
hand and letting the person cry or talk about their sadness and regrets is the best you can do.
Allowing a person to do this is a true help because so many people avoid the topic of dying
and won't allow themselves to feel this pain with their loved one.
Some people who know they are going to die may feel the need to get some things off their
chests. They may want to talk about some of the things they did in their life that they are not
proud of or regret. They may want to apologize about these things. They may want to give
you instructions about what to do for them in the future. Respectfully listening and, of
course, forgiveness and a loving attitude are all that is necessary. There are no magic words
for the dying person, but often your presence is like magic and having an open heart is
priceless.
Summing up: Tips on talking with the person with cancer
• Let them take the lead. If they want to talk, be a good listener. Listen to what is said
and how it is said.
• Try to be OK with silence. It may help the person with cancer to focus their thoughts.
Constantly talking because you are nervous can be irritating. Sometimes silence is
comforting and allows the person to express even more of what they are feeling.
• Try to maintain eye contact. This gives the person a sense that you are really with
them and listening carefully.
• Touching, smiling, and warm looks can get past the barriers of the illness to the
person you know and love.
• Try not to give advice. Giving advice is hard when you are not in the person's
situation. They probably just want you to ask questions or listen.
• Do not say, "I know how you feel." The person may become angry because you have
not been in their shoes, and you really don't know how he or she feels.
(12 of 14)
• If you are feeling tearful, explain this to the person with cancer. Be brief in your
explanation. Stay away from the person until you can be near them without them
having to comfort you.
• People with cancer do not always want to think or talk about their disease. That
makes them feel like their only identity is as "cancer patient." Laughing and talking
about other things are often welcome distractions.
• Try to do as many things together as possible. If you used to play cards -- play cards
now! If you used to go to the movies together -- keep going to movies. Use your
judgment about your loved one's energy level. Or ask about the need to take rest
breaks in between activities. Try not to take the effects of the illness too lightly but
don't be overprotective. Keep inviting and urging the person to do things with you
and others.
• Encourage other friends to visit. Maybe they would be willing to do errands, cook
meals, or care for the children. If they can't visit, ask them to write, email, or call.
• Continue to visit. Put the person with cancer on your weekly "to do" list. Cancer can
be a very lonely and isolating experience. Your loved one can't always ask for help
because he or she may not even know what will help! Stay in touch.
• Most of all, be yourself and try not to worry about whether you are doing things the
right way. Let your words and your actions come from your heart. Your compassion
and genuine caring are the most important things you can express to your loved one
right now.
Additional resources
More information from your American Cancer Society
We have selected some related information that may also be helpful to you. You may order
these materials by calling our toll-free number, 1-800-ACS-2345 (1-800-227-2345).
A Message of Hope: Coping With Cancer in Everyday Life (also available in Spanish)
Advanced Cancer (also available in Spanish)
After Diagnosis: A Guide for Patients and Families (also available in Spanish)
Caregiving: How to Care for A Loved One with Cancer -- And Yourself
(13 of 14)
Caring for the Patient With Cancer at Home: A Guide for Patients and Families (also
available in Spanish)
Hospice Care
Nearing the End of Life (also available in Spanish)
Talking With Friends and Others About Your Cancer
When Someone You Know Has Cancer (also available in Spanish)
When Someone You Work With Has Cancer (also available in Spanish)
Where to Turn - Patient and Family Support Program Overview (pamphlet only; also
available in Spanish)
National organizations and Web sites*
Along with the American Cancer Society, other sources of patient information and support
include:
U.S. Equal Employment Opportunities Commission
Toll free number: 1-800-669-4000
Web site: www.eeoc.gov
International Association of Laryngectomees (IAL)
Toll free number: 1-866-425-3678 (1-866-IAL-FOR U)
Web site: www.larynxlink.com
Job Accommodation Network (JAN)
Toll free number: 1-800-526-7234
Toll free TTY: 1-877-781-9403
Web site: www.jan.wvu.edu/indiv/index.htm#on
National Association for Home Care and Hospice
Toll free number: 1-202-547-7424
Web site: www.nahc.org/consumer/home.html
National Hospice and Palliative Care Organization (NHPCO)
Toll free number: 1-800-658-9989 (End-of-Life Consumer Helpline)
Web site: www.caringinfo.org/
(1 of 39)
UNDERSTANDING CHEMOTHERAPY:
A GUIDE FOR PATIENTS AND FAMILIES
You've been told you have cancer. You've studied your treatment options and you and your
doctor have agreed that chemotherapy is your best choice. Now you may have questions
about your treatment.
The American Cancer Society knows you may have concerns about chemotherapy, and we
have answers to your questions. Remember that, along with reading about your treatment,
you can also count on your doctor and nurse to answer your questions.
At the end of this document you will find a glossary that gives definitions of some of the
words and terms used by your health care team. The words that are in italic type the first time
they are used are also in the glossary. You can use the glossary to help you better understand
the talks you have with your health care team. Open and honest talks with your cancer care
team are the best way to understand what is going on with you, your body, and the cancer.
What is chemotherapy and how does it work?
Chemotherapy is the use of medicines or drugs to treat disease. Many times this treatment is
called just “chemo.†Surgery and radiation therapy remove, kill, or damage cancer cells in a
certain area, but chemo works throughout the whole body. Chemo can kill cancer cells that
have metastasized or spread to parts of the body far away from the primary (original) tumor.
More than 100 chemo drugs are used in many combinations. A single chemo drug can be
used to treat cancer. But for the most part, the drugs work better when used in certain
combinations. Your chemo treatment will likely include more than one drug. This is called
combination chemotherapy. A combination of drugs with different actions can work together
to kill more cancer cells. It can also reduce the chance that the cancer may become resistant
to any one chemo drug.
(2 of 39)
You and your doctor will decide what drug or combination of drugs you will get. Your
doctor will choose the doses, how the drugs will be given, and how often and how long you
will get treatment. All of these decisions will depend on the type of cancer, where it is, how
big it is, and how it is affecting your normal body functions and overall health.
What is the goal of chemo?
Depending on the type of cancer and its stage of development, chemo can be used to:
• cure the cancer
• keep the cancer from spreading
• slow the cancer’s growth
• kill cancer cells that may have spread to other parts of the body from the original
tumor
• relieve symptoms caused by cancer
Your doctor will talk to you about the goal of your chemo before you start treatment.
Will chemo be my only treatment for cancer?
Sometimes chemo is the only treatment you will need. More often, chemo is used along with
surgery or radiation therapy or with both. Here’s why:
• Chemo may be used to shrink a tumor before surgery or radiation therapy.
• It may be used after surgery or radiation therapy to help kill any remaining cancer
cells.
• It may be used with other treatments if your cancer returns.
When chemo is given after surgery to kill any cancer cells that may still be present, it is
called adjuvant therapy. When chemo is used to shrink a tumor before surgery or radiation
therapy, it is called neoadjuvant therapy.
A checklist of questions to ask your doctor or nurse
(3 of 39)
Before choosing chemo as a treatment option, you should understand the expected benefits,
side effects, and risks. Consider asking your doctor or nurse the questions below. It may help
you to write down questions to take with you to your next visit. Our information and the
information you get from your doctor should give you what you need to know about your
treatment and give you a good idea of the expected outcome.
• What is the goal of chemo for my cancer?
• What are the chances that the chemo will work?
• After chemo, will I be cured, in remission, or relieved of my symptoms?
• Are there other ways to get to the same goals?
• How will I know if the chemo is working?
• If the chemo does not work, are there other treatments for me?
• What are the risks and side effects of the chemo I will be taking? How do side effects
of this chemo compare with side effects of other treatments?
• How will I get the chemo, how often, and for how long?
• Where will I be given the drugs?
• What can I do to get ready for treatment and decrease the chance of side effects?
• Will I need to change my diet in any way? My activities? My work? Exercise? Sexual
activities?
• Will I also need surgery, radiation, or both? If so, when and why? What results can I
expect from each type of treatment?
• If I have chemo after surgery or radiation, will it kill any remaining cancer cells?
Could chemo be used alone?
• Could I take part in a clinical trial ?
• How much will chemo cost? Will my health insurance cover it?
• If the insurance company asks for a second opinion, or if I would like to get one, can
you suggest someone for me to see?
Here are some tips to help you remember your doctor’s answers:
(4 of 39)
•
• Take notes during your visits. Don't feel shy about asking your doctor to slow down if
you need more time to write. Ask questions if you don't understand something.
• If you can, use a tape recorder during your visit so you won’t miss anything.
• Consider taking a friend or relative with you to help you understand what your doctor
says during your visit and to refresh your memory afterward.
You might want to look at After Diagnosis: A Guide for Patients and Families for more
information you and your family will need to know.
Should I get a second opinion?
One way to find out if a suggested treatment is the best one for you is to get the opinion of at
least one other doctor before starting your treatment. Your doctor should not mind if you get
a second opinion. In fact, some insurance companies require you to get one. Often, the results
of any tests you have already had can be sent to the second doctor, so you won’t have to
repeat any of them.
If your insurance is provided by a managed care group, such as a health maintenance
organization (HMO), find out if the company covers second opinions before you get one.
Where will I get chemo?
The place you get your treatment depends on which chemo drugs you are getting, the drug
doses, your hospital's policies, your insurance coverage, what you prefer, and what your
doctor recommends.
You may be treated with chemo:
• at home
• in your doctor's office
• in a clinic
• in your hospital's outpatient department
• in a hospital
Some of these settings may have private treatment rooms, while others treat many patients
together in one large room. It is important to be in a setting that is comfortable for you. Talk
to your doctor ahead of time so that you know what to expect your first day.
(5 of 39)
How often will I need to get chemo and how long will it last?
How often you get chemo and how long your treatment lasts depend on the kind of cancer
you have, the goals of the treatment, the drugs being used, and how your body responds to
them. You may get treatments daily, weekly, or monthly, but they are usually given in onand-
off cycles. These breaks allow rest periods so that your body can build healthy new cells
and regain its strength.
Many people wonder how long the actual drugs stay in their body and how they are removed.
Most chemo drugs are broken down by your kidneys and liver and then removed from your
body through your urine or stool. The time it takes your body to get rid of the drugs depends
on many things including the type of chemo you get, other medicines you take, your age, and
your kidney and liver functions. Your doctor will tell you if you will need to take any special
precautions because of the drugs you are getting.
If your cancer returns, chemo may be used again. This time you may be given different drugs
to relieve symptoms or to slow the cancer’s growth or spread. Side effects may be different,
depending on the drug, the dose, and how it is given.
How will the chemo be given to me?
Most chemo drugs are given to you through a tiny plastic tube, or catheter, which is put into
a vein in your forearm or hand. This method is called intravenous, or IV. Intravenous drugs
are given in these ways:
•
• The drugs can be given quickly through IV tubing right from a syringe over a few
minutes; this is called an IV push.
• An IV infusion can last 30 minutes to a few hours. A mixed drug solution flows from
a plastic bag.
• Continuous infusions are sometimes needed and can last from 1 to 7 days.
Catheters and needles can scar or weaken veins with ongoing chemo. Another option is the
central venous catheter (CVC). The CVC is a catheter that placed in the chest or upper arm
area during surgery. It can stay in place to give access to a large vein. Blood can be drawn
from these catheters. Drugs can be injected directly into the CVC, or through an IV
connected to the CVC. Many different kinds of CVCs are available. Many people talk about
this option with their doctor even before starting treatment. Some find out during treatment
that they need a CVC because their hand and arm veins are not good enough to complete the
(6 of 39)
planned chemo. Your doctor can help you decide if you need a CVC, and the right type of
CVC for you.
Depending on the drugs and where the cancer is located, your chemo also may be given in
one or more of these ways:
•
• Orally or PO – This means by mouth. You swallow the drug in a pill, capsule, or
liquid form just as you do other medicines. This method is usually more convenient
and may be less expensive because the drugs can be taken at home. If you take chemo
drugs by mouth, it is very important to take the exact dosage, at the right time, for as
long as it has been prescribed for you. For more information please call us and ask for
Oral Chemotherapy: What You Need to Know.
• Intravenous or IV – The chemo is injected through a needle or catheter into a vein.
• Intrathecal or IT – The drug is injected into the spinal canal. You may either get an
injection directly into your spine or into a long-term catheter and port that is put
under the skin on your head during surgery. This is called an Ommaya reservoir. The
port is a small drum-like device that has a small tube attached to it. The tube goes in
to the cerebrospinal fluid (CSF) in your spinal canal.
• Intra-arterial – The chemo drug is injected directly into an artery to treat a single area
(such as the liver, an arm, or leg). This method limits the effect of the drug on other
parts of the body.
• Intracavitary – Chemo drugs are given through a catheter into the abdominal cavity
(the space around the bowels and other organs in the belly) or chest cavity (the space
around the lungs and other organs in the chest).
• Intramuscular or IM – The drug is injected through a needle into a muscle.
• Intralesional – The drug is injected through a needle directly into a tumor in the skin,
under the skin, or in an internal organ.
• Topical – The medicine is put right on to an area of cancer on the skin.
Does chemo hurt?
You already know how it feels to take a pill or rub a medicine on your skin. And you've
probably felt the slight but brief discomfort of an injection before. IV medicines should not
hurt after the first needle stick to put in the catheter. If you feel pain, burning, coolness, or
anything unusual while you are getting chemo, tell your doctor or nurse right away.
(7 of 39)
What are clinical trials?
Clinical trials are carefully designed research studies that test promising new cancer
treatments. You may want to talk to your doctor about this option. Patients who take part in
research studies will be the first to benefit from these treatments. These patients can make an
important contribution to medical care because the study results will also help other patients.
In a clinical trial, you get either standard treatment or an experimental treatment. Studies are
never done to see if you would recover from cancer without treatment at all. As in any other
medical treatment, you are free to withdraw from a clinical trial at any time and seek other
treatment options.
To learn more about clinical trials:
• Ask for our document on clinical trials called Clinical Trials: What You Need To
Know, or read it on our Web site.
• The American Cancer Society also offers a Clinical Trials Matching Service to help
you find clinical trials that might be right for you. The service is available by
telephone Monday through Friday, from 7:30 a.m. to 7:00 p.m. CT at 1-800-303-5691
or you can fill out a screening questionnaire anytime at www.cancer.org/clinicaltrials.
• The National Cancer Institute (NCI) can give you a list of clinical trials based on the
type and stage of your cancer. Call 1-800-4-CANCER (1-800-422-6237) or visit the
NCI’s Web site at www.nci.nih.gov.
Can I take other medicines while I am getting chemo?
Some medicines may interfere with the effects of your chemo. To be sure that your treatment
is as effective as it can be, tell your doctor or nurse about any and all prescription and nonprescription
medicines, herbs, and supplements you are taking.
• Make a list of the name of each drug, the dose, how often you take it, who prescribed
it, and the reason you take it.
• Be sure to include the things you may not think of as medicines. This includes
aspirin, herbal and dietary supplements, vitamins, minerals, and over-the-counter
medicines.
(8 of 39)
Your doctor will tell you if you should stop taking any of these medicines before you start
chemo. After your treatments start, check with your doctor before taking any new medicines
or supplements and before stopping the ones you already take.
Can I be around my family and friends while I am getting
chemo?
Only a few treatments will require you to avoid close contact with loved ones for a short
amount of time. If this is something you will have to do, your doctor will tell you about it
when going over treatment options.
Most chemo drugs do make you less able to fight infection. It is very important that you stay
away from anyone who is sick. The best way to prevent infection is by washing your hands
often and having your family and friends do the same when they are with you. For more
information, see the section “How will chemo affect my blood cell count?"
For more information on being at home with family and friends during treatment, please see
our booklets, Helping Children When A Family Member Has Cancer: Dealing with
Treatment and Caring for the Patient with Cancer at Home: A Guide for Patients and
Families.
How can I protect myself and those I live with while I am getting
chemo?
There are many things you can do during and after chemo to keep yourself and your loved
ones from being affected by the drugs while your body is getting rid of them. It takes about
48 hours for your body to break down and/or get rid of most chemo drugs.
Most of the waste comes out in your body fluids--urine, stool, tears, and vomit. The drugs are
also found in your blood. When these drugs get outside your body, they can harm or irritate
skin--even other people's. Keep in mind that for this reason, toilets can be a hazard for
children and pets and it is important to be careful. Talk to your doctor about these and any
other precautions you should follow.
During and for 48 hours after you get chemo:
• Flush the toilet twice after you use it. Put the lid down before flushing to avoid
splashing. If possible, you may want to use a separate toilet during this time.
• Both men and women should sit on the toilet to use it. This cuts down on splashing.
(9 of 39)
• Always wash your hands with warm water and soap after using the toilet. Use paper
towels to dry your hands and throw them away.
• If you vomit into the toilet, clean off all splashes and flush twice. If you vomit into a
bucket or basin, carefully empty it into the toilet without splashing the contents and
flush twice. Wash out the bucket with hot soapy water and rinse it, emptying the wash
and rinse water into the toilet, then flushing it. Dry the bucket with paper towels and
throw them away.
• Caregivers should wear throw-away gloves if they need to touch any of your body
fluids. (These can be bought in most drug stores.) They should always wash their
hands with warm water and soap afterward--even if they had gloves on.
• If a caregiver does come in contact with any of your body fluids they should wash the
area very well with warm soap and water. Although this is not likely to cause any
harm, try to take extra care to avoid this. At your next visit, let your doctor know this
happened. Being exposed frequently may lead to problems and extra care should be
taken to avoid this.
• Any clothes or sheets that have body fluids on them should be washed in your
washing machine--not by hand. Wash them twice in hot water with regular laundry
detergent. Do not wash them with other clothes. If they cannot be washed right away
seal them in a plastic bag.
• If using throw-away adult diapers, underwear, or sanitary pads, seal them in plastic
and throw them away with your regular trash.
Adapted from The Cleveland Clinic Foundation. Chemotherapy Precautions During and After Treatment. 2008.
Available at www.cchs.net/health/health-info/docs/4300/4350.asp?index=13586&pflag=1
Will I be able to work during treatment?
Whether you can continue work, school, and other activities depends on your treatment and
how it affects you. For some treatments, you may need to stay in a hospital for a week or
more, but most people are able to keep working during treatment. You might be able to
schedule your treatments late in the day or right before the weekend so that they interfere
with work as little as possible.
If chemo makes you tired, try to adjust your work schedule for a while. You may be able to
arrange a part-time schedule or work from home. Federal and state laws may require some
employers to allow you to work a flexible schedule during your treatment.
(10 of 39)
To find out more about your rights as an employee, call your local American Cancer Society
office or our toll-free number, or email us by clicking on the "contact us" button at
www.cancer.org. You may also find out about employment-related rights by contacting your
congressional or state representatives.
How will I know if the chemo is working?
Your cancer care team will measure how well your treatments are working by doing certain
tests. This will include physical exams, blood tests, bone marrow biopsies, scans, and x-rays.
Ask your doctor about the test results and what they show about your progress. Although you
may have side effects, these side effects do not tell you whether or not treatment is working.
How do I give my permission for this treatment?
You will be asked to give your written permission to get chemo based on your understanding
of the drugs your doctor recommends. Know the answers to all of these questions before you
sign the consent form.
• Which chemo drugs will I be given for my cancer?
• How will the drugs be given to me?
• How often will I need to get chemo?
• How long will my treatments last?
• What side effects could I have from these drugs?
• How likely is this treatment to be successful?
Although the specifics of the consent form may vary from state to state, the form usually
states that your doctor has explained your condition to you, how the chemo will benefit you,
the risks, and the other options available to you. Your signature on the form means that you
have gotten this information and that you are willing to be treated with chemo. This process
is called giving informed consent.
What causes side effects?
(11 of 39)
Chemo drugs are made to kill fast-growing cells. Because these drugs travel throughout the
body, they can affect normal, healthy cells as well as cancer cells. Damage to healthy tissue
causes side effects. Although side effects are not always as bad as you might expect, many
people worry about this part of their cancer treatment.
The normal cells most likely to be affected are blood forming cells in the bone marrow; hair
follicles; and cells in the mouth, digestive tract, and reproductive system. Some chemo drugs
can damage cells in the heart, kidneys, bladder, lungs, and nervous system. In some cases,
medicines called cytoprotective drugs may be given with the chemo to protect the body’s
normal cells.
What are common side effects?
You are not alone if you have questions about side effects. Before chemo starts, most people
worry about whether they will have side effects and, if so, what they will be like. The most
common side effects of chemo include:
• nausea and vomiting
• hair loss
• fatigue (tiredness)
• increased chance of bruising and bleeding
• anemia (low red blood cell count)
• infection
Chemo may affect parts of your body in the following ways:
• intestinal and stomach problems
• appetite and weight changes
• sore mouth, gums, and throat
• nerve and muscle problems
• dry and/or discolored skin
• kidney and bladder irritation
• sexual and fertility issues because of effects on reproductive organs
What you should remember about side effects
• Every person doesn't get every side effect, and some people get few, if any.
(12 of 39)
• The severity of side effects varies greatly from person to person. Be sure to talk to
your doctor and nurse about which side effects are most likely with your chemo, how
long they might last, how bad they might be, and when you should seek medical care
for them. For more information see the section, "When to call your doctor."
• Your doctor may give you medicines to prevent some side effects before they happen.
• Many people have no long-term problems from chemo. And although side effects can
be unpleasant, they must be measured against the need to kill the cancer.
How long do side effects last?
Most side effects slowly go away after treatment ends because the healthy cells recover over
time. The time it takes to get over some side effects and regain energy varies from person to
person and depends on many factors, including your overall health and the drugs you were
given.
Although many side effects go away fairly quickly, some may take months or years to
completely go away. Sometimes the side effects can last a lifetime, such as when chemo
causes long-term damage to the heart, lungs, kidneys, or reproductive organs. Certain types
of chemo sometimes cause delayed effects, such as a second cancer that may show up many
years later.
Patients often become discouraged about how long their treatment lasts or the side effects
they have. If you feel as if you are becoming discouraged, talk to your doctor. You may be
able to change your medicine or treatment schedule. If needed, your doctor should be able to
suggest ways to reduce any pain and discomfort you have.
What can I do about nausea and vomiting?
Nausea and vomiting are 2 of the most common and most dreaded side effects of chemo.
How often you feel these side effects and how bad they are depend on the drugs you are
getting and how they affect you.
Nausea and vomiting may start during treatment and last a few hours. Sometimes, but less
often, severe nausea and vomiting can last for a few days. Be sure to tell your doctor or nurse
if you are very nauseated, if you have been vomiting for more than a day, or if your nausea is
so bad that you cannot keep liquids down.
The good news is that nausea and vomiting can almost always be lessened by a change in the
way you eat and with drugs that help relieve both symptoms (these drugs are called anti(
13 of 39)
emetics). Different anti-emetics work for different people. You may need to try more than
one before you get relief. Don’t give up! Keep working with your doctor and nurse to find
the one that works best for you.
About half of the people getting chemo feel queasy even before treatment begins. This is
called anticipatory nausea, and it is very real. The best way to handle anticipatory nausea is
by taking effective anti-emetics to prevent vomiting, and by using relaxation techniques.
Things that may help you with nausea and vomiting:
• Avoid big meals so your stomach won’t feel too full. Eat frequent, small meals
throughout the day instead of 1, 2, or 3 large meals.
• Drink liquids at least an hour before or after mealtime instead of with your meals.
• Eat and drink slowly.
• Stay away from sweet, fried, or fatty foods.
• Eat foods cold or at room temperature so you won’t be bothered by strong smells.
• Chew your food well for better digestion.
• If nausea is a problem in the morning, try eating dry foods, such as cereal, toast, or
crackers, before getting up. (Don’t try this if you have mouth or throat sores or are
troubled by a dry mouth.)
• Drink cool, clear liquids, such as apple juice, tea, or ginger ale that has lost its fizz.
• Suck on ice cubes, mints, or tart candies. (Don’t eat tart candies if you have mouth or
throat sores.)
• Try to avoid odors that bother you, such as cooking smells, smoke, or perfume.
• Rest in a chair after eating, but don’t lie flat for at least 2 hours after you’ve finished
your meal.
• Wear loose-fitting clothes.
• Breathe deeply and slowly when you feel nauseated.
• Distract yourself by talking with friends or family members, listening to music, or
watching a movie or TV show.
(14 of 39)
• Use relaxation techniques.
How do I deal with losing my hair?
Hair loss (alopecia) can be devastating. Not all chemo drugs will make you lose your hair.
Some people have mild thinning that they only notice. Your doctor will be able to tell you if
your medicines are likely to make you lose your hair.
If you do lose your hair, it will almost always grow back after the treatments are over. But it
might be a different color or texture.
You can lose your hair on all parts of your body, not just your head. Facial hair, including
eyelashes and eyebrows; arm and leg hair; underarm hair; and pubic hair all may be affected.
It usually doesn’t happen right away. More often, hair loss begins after a few treatments. At
that point, your hair may fall out slowly or in clumps. Any hair that remains may become
dull and dry.
Things that may help you with hair loss:
• Use mild shampoos.
• Use soft hair brushes.
• Use low heat if you must use a hair dryer.
• Don't use brush rollers to set your hair.
• Don't dye your hair or get a perm.
• Have your hair cut short. A shorter style will make your hair look thicker and fuller. It
also will make hair loss easier to deal with if it does happen.
• Use a sunscreen, hat, scarf, or wig to protect your scalp from the sun.
• Use a satin pillowcase.
Sometimes, either during the regrowth of your hair or when you are bald, your scalp may feel
extra tender, dry, and itchy. Keeping your scalp clean by using a moisturizing shampoo and
conditioner may help. Use gentle creams or lotions on your scalp as needed. Even a gentle
scalp massage may make your scalp feel better.
(15 of 39)
After chemo, your hair's texture and fullness may change. Hair dyes contain chemicals like
peroxide that can damage hair. Although there is no research that supports hair dye doing
more damage to hair after chemo, most doctors recommend patients do not use hair dyes
until hair returns to normal. This may be as long as 6 months after treatment.
Should I cover my head if I lose my hair?
Some people who lose all or most of their hair choose to wear turbans, scarves, caps, wigs, or
hair pieces. Others leave their heads uncovered. Still others switch back and forth, depending
on whether they are in public or at home with family and friends.
Here are tips to follow if you choose to cover your head with a wig or
hairpiece:
• Shop for your wig or hairpiece before you lose a lot of hair so you can match your
natural color, texture, and style.
• You may be able to buy a wig or hairpiece at a specialty shop just for cancer patients.
• A sales person may be able to come to your home to help you.
• You can get more tips or even buy a wig or hairpiece through our "tlc" Tender Loving
Care® catalog. Call us for a copy or visit the "tlc"TM Web site at www.tlcdirect.org.
• If you would prefer to borrow rather than buy a wig or hairpiece, call us or check with
the social work department at your hospital.
If you need a hairpiece because of cancer treatment, it is a tax-deductible expense. It may
also be at least partly covered by your health insurance. Be sure to check your policy, and ask
your doctor to write a prescription for a "hair prosthesis."
What about fatigue?
Fatigue is one of the most common side effects of cancer treatment. It can range from mild
lethargy to feeling completely wiped out. It is different from feeling tired and does not get
better with rest or sleep. Fatigue tends to be the worst at the beginning and at the end of a
treatment cycle. Like most other side effects, it will go away once chemo is complete.
(16 of 39)
Things that may help you with fatigue:
• Get plenty of rest and allow time during the day for rest periods.
• Talk with your doctor or nurse about a regular exercise program.
• Eat a well-balanced diet and drink plenty of liquids.
• Limit your activities. Do only the things that are most important to you.
• Get help when you need it. Ask family, friends, and neighbors to pitch in with
activities, such as child care, shopping, housework, or driving. For example, you
might ask neighbors to pick up some items for you at the grocery store while doing
their own shopping.
• Get up slowly to help prevent dizziness after sitting or lying down.
• Let your doctor know if you are having a hard time sleeping at night.
How will chemo affect my blood cell count?
The bone marrow produces 3 important parts of your blood:
• red blood cells, which carry oxygen to cells throughout the body
• white blood cells, which fight infection
• platelets, which help blood to clot and stop bleeding
Chemo destroys some of the bone marrow cells so fewer blood cells are produced. A drop in
the levels of any of these cells leads to specific side effects.
Your doctor will check your blood cell count by doing a test called a complete blood count or
CBC. This will be done often during your treatment.
Anemia
When you have too few red blood cells, your body tissues don't get enough oxygen to do
their work. This condition is called anemia. You may have these symptoms:
• fatigue
(17 of 39)
• dizziness
• paleness
• a tendency to feel cold
• shortness of breath
• weakness
• a racing heart rate
Try the suggestions listed in the previous section if your anemia is causing fatigue. Report
any symptoms to your doctor or nurse. Your doctor will check your blood cell count (also
called a complete blood count) often during your treatment. If your red blood cell count falls
too low, you may need a blood transfusion or treatment with a growth factor to boost the
number of red blood cells your bone marrow makes.
Infection
Having a low white blood cell count decreases your body's ability to fight infections. One
type of white blood cell, the neutrophil, is especially important in fighting infections. A
shortage of neutrophils is called neutropenia.
Infections can begin in almost any part of your body and most often start in your mouth, skin,
lungs, urinary tract, and rectum.
If your white blood cell count drops too much, your doctor may put off treatment, give you a
lower dose of chemo, or give you a growth factor shot that makes your bone marrow put out
more white blood cells.
Things that may help you prevent infections:
• Wash your hands often during the day, especially before you eat and after you use the
bathroom.
• Avoid crowds.
• Stay away from people who have diseases you can catch, such as colds, flu, measles,
or chickenpox.
• Do not get any immunization shots (vaccines) without first checking with your
oncologist (cancer doctor).
(18 of 39)
• Stay away from people who have recently had an immunization, such as a vaccine for
chicken pox, small pox, or the flu. Check with your doctor about which vaccines are
important and how long you should stay away from people who have had them.
• Clean your rectal area very well but gently after each bowel movement. Ask your
doctor or nurse for advice if the area becomes sore or if you have hemorrhoids. Also,
check with your doctor before using enemas or suppositories.
• Don’t cut, bite, or tear the cuticles of your nails.
• Be careful not to cut or nick yourself when using scissors, needles, or knives.
• Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.
• Use an extra soft toothbrush that won’t hurt your gums and talk to your doctor before
using dental floss.
• Don’t squeeze or scratch pimples.
• Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry
using a light touch. Don’t rub.
• Use lotion or oil to soften and heal your skin if it becomes dry and cracked.
• Clean cuts and scrapes right away with warm water and soap. Use an antibiotic cream
and cover with a bandage.
• Wear waterproof gloves when gardening or cleaning up after animals and others,
especially small children.
Even if you are being extra careful, your body may not be able to fight infections when your
white blood cell count is low. Look out for and check your body regularly for signs and
symptoms that you might have an infection. Pay special attention to your eyes, nose, mouth,
and genital and rectal areas. The symptoms of infection could be:
• fever of 100.5°F or greater when your temperature is taken by mouth
• chills
• sweating
• loose stools (This can also be a side effect of chemo.)
• a burning feeling when you urinate
• a severe cough or sore throat
• unusual vaginal discharge or itching
• redness, swelling, or tenderness, especially around a wound, sore, pimple, IV site, or
vascular access device
(19 of 39)
• abdominal (belly) pain
Report any signs of infection to your doctor right away. If you have a fever, don't use aspirin,
acetaminophen (Tylenol®), or any other medicine to bring your temperature down without
first checking with your doctor.
Bleeding or clotting problems
Chemo drugs can affect the bone marrow's ability to make platelets. These are the blood cells
that help stop bleeding by plugging up damaged blood vessels and by helping your blood to
clot. If your blood does not have enough platelets, you may bleed or bruise more easily than
usual, even from a minor injury. A shortage of platelets is called thrombocytopenia.
Report these signs of thrombocytopenia to your doctor:
• unexpected bruising
• small red spots under the skin
• red or pink urine
• black or bloody bowel movements
• any bleeding from your gums or nose
• bad headaches
• dizziness
• an increase in weakness
• pain in joints and muscles
Your doctor will check your platelet count often during your treatment. If it falls too low, you
may need a platelet transfusion.
Things that may help you avoid problems if your platelet count is low:
• Don't take any medicine without first checking with your doctor or nurse. This
includes aspirin and aspirin-free pain relievers, like acetaminophen (Tylenol®),
ibuprofen, and any other medicines you can buy without a prescription. Some of these
medicines can weaken the platelets and make bleeding problems worse.
• Don't drink any alcohol (beer, wine, or liquor) unless your doctor says it's all right.
• Use an extra soft toothbrush to clean your teeth and talk to your doctor before using
dental floss.
• If you have a runny nose, blow gently into a soft tissue.
(20 of 39)
• Take care not to cut or nick yourself when using scissors, needles, knives, or tools.
• Be careful not to burn yourself when ironing or cooking. Use a padded glove when
you reach into the oven.
• Avoid contact sports and other activities that might cause an injury.
• Avoid becoming constipated.
• Use an electric shaver instead of a razor.
• When bending over, keep your head above your heart.
What if I get diarrhea?
When chemo affects the cells lining the intestine, it can cause diarrhea. Diarrhea is most
often defined as 2 or more loose stools in a 4-hour time period. If you have diarrhea that lasts
for more than 24 hours, or if you have pain and cramping along with it, call your doctor. In
severe cases, the doctor may have you take an anti-diarrheal medicine, but don't take any
over-the-counter anti-diarrheal medicines without asking your doctor first.
Things that may help you control diarrhea:
• Eat smaller amounts of food, but eat more often.
• Avoid coffee, tea, alcohol, and sweets.
• Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber foods
include whole grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn,
and fresh and dried fruit. Eat low-fiber foods instead, such as white bread, white rice
or noodles, creamed cereals, ripe bananas, canned or cooked fruit without skins,
cottage cheese, yogurt, eggs, mashed or baked potatoes without the skin, pureed
vegetables, chicken or turkey without the skin, and fish.
• Stay away from fried, greasy, or spicy foods.
• Avoid milk and milk products if they make your diarrhea worse.
• Eat more potassium-rich foods, such as bananas, oranges, potatoes, and peach and
apricot nectars, unless your doctor has told you otherwise.
(21 of 39)
• Drink plenty of fluids to replace those you have lost through diarrhea. Mild, clear
liquids, such as apple juice, water, weak tea, clear broth, or ginger ale are best. Make
sure they are at room temperature and drink them slowly. Let carbonated drinks lose
their fizz before you drink them.
If your diarrhea is severe (meaning that you have had 7 or 8 loose movements in 24 hours),
tell your doctor right away. Ask if you should try a clear liquid diet to give your bowels time
to rest.
As you feel better, slowly add the low-fiber foods. A clear liquid diet doesn't have all the
nutrients you need, so don't follow it for more than 3 or 4 days. If your diarrhea doesn’t get
better, you may need to get IV fluids to replace the water and nutrients you have lost.
Is constipation common?
Some people become constipated from chemo. Others may become constipated because they
are less active, eat less than usual, have diet changes, or because they are taking certain pain
medicines. Tell your doctor if you have not had a bowel movement in 2 or more days. You
may need to take a laxative or stool softener, but don’t use these unless you have checked
with your doctor, especially if your white blood cell count or platelet count is low.
Things that may help you deal with constipation:
• Drink plenty of fluids to help keep your stool soft. Warm and hot fluids work
especially well.
• Eat a lot of high-fiber foods. High-fiber foods include bran, whole wheat breads and
cereals, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn.
• Get some exercise. Just getting out for a walk can help, as can a planned exercise
program. Be sure to check with your doctor before increasing your physical activity.
What about eating and gaining weight?
Some people, usually women, put on weight during chemo. We are not sure why this
happens, but it may have to do with intense food cravings that develop despite the nausea.
The average weight gain for women is about 7 pounds.
(22 of 39)
Whether you gain weight or not, good nutrition is very important during treatment. People
who eat well cope with side effects better and are better able to fight infection. Their bodies
can also rebuild healthy tissues faster.
Eating well during chemo means choosing a balanced diet that contains all the nutrients your
body needs. You should include foods from each of the following food groups: fruits and
vegetables; poultry, fish, and meat; cereals and breads; and dairy products. You also should
take in enough calories to keep your weight up and, most importantly, enough protein to
build and repair skin, hair, muscles, and organs.
You also may need to drink extra fluid to protect your bladder and kidneys during your
treatment.
What if I don’t feel like eating?
There may be days when you just can’t eat because of things like nausea or mouth and throat
problems. You also can lose your appetite if you feel depressed or tired.
When you have a poor appetite, try these tips:
• Eat small meals or snacks whenever you want. You don’t have to eat 3 regular meals
each day.
• Vary your diet and try new foods and recipes.
• Take a walk before meals whenever you can. This may make you feel hungrier.
• Change your mealtime routine. For example, eat by candlelight or in a different place.
• Eat with friends or family members. When eating alone, listen to the radio or watch
TV.
• If you live alone you might want to arrange for Meals on Wheels or program like this
to bring food to you. Ask your doctor, nurse, or local American Cancer Society office
about services in your area.
For more information, please see our booklet, Nutrition for the Person with Cancer During
Treatment: A Guide for Patients and Families.
(23 of 39)
Can I drink alcohol?
Small amounts of alcohol can help you relax and increase your appetite. But alcohol may
interact with some drugs to reduce their effectiveness or worsen their side effects. Be sure to
ask your doctor if you can drink beer, wine, or other alcoholic beverages.
Should I take vitamin or mineral supplements?
There is no single answer to this question, but one thing is clear: No diet or nutritional plan
can "cure" cancer. Taking vitamin and mineral supplements or any other complementary and
alternative medicine should never be done in place of medical care. You should not take any
supplements without telling your doctor first.
For more information, please call us or visit our Web site to get Guidelines for Using
Complementary and Alternative Methods and Complementary and Alternative Methods for
Cancer Management.
What about sore mouth, gums, and throat problems?
Good oral care is important during cancer treatment. Chemo can cause sores in the mouth
and throat. It can make these areas dry and irritated or cause them to bleed. Mouth sores are
not only painful, they can become infected by the many germs that normally live in your
mouth. Infections can be hard to fight during chemo and can lead to serious problems. It's
important to take every possible step to prevent them.
Ways to keep your mouth, gums, and throat healthy:
• Have your teeth cleaned and to take care of any cavities, abscesses, gum disease, or
poorly fitting dentures before you start chemo.
• Ask your dentist to show you the best ways to brush and floss your teeth during
chemo.
• Ask about a daily fluoride rinse or gel to help prevent decay because chemo can make
you more likely to get cavities.
• Brush your teeth and gums after every meal. Use an extra soft toothbrush and a gentle
touch; brushing too hard can damage soft mouth tissues.
(24 of 39)
• Ask your dentist to suggest a special type of toothbrush, floss or dental ribbon, and
toothpaste if your gums are very sensitive.
• Rinse your toothbrush well after each use and store it in a dry place.
• Avoid commercial mouthwashes. They often contain large amounts of irritating salt
or alcohol. Instead, ask your doctor or nurse about a mild mouthwash or a mouthwash
with antibiotics to help prevent mouth infections.
If you develop sores in your mouth (this is called stomatitis), contact your doctor or nurse
because you may need medical treatment.
If the sores are painful or keep you from eating, try these ideas:
• Ask your doctor if there is anything you can put right on the sores and if there is
medicine you can take to ease the pain.
• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender
mouth and throat.
• Choose soft, soothing foods, such as ice cream, milkshakes, baby food, soft fruits
(like bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or
scrambled eggs, cottage cheese, macaroni and cheese, custards, puddings, and gelatin.
You also can puree cooked foods in the blender to make them smoother and easier to
eat.
• Avoid irritating, acidic foods, such as tomatoes, citrus fruit, and fruit juice (orange,
grapefruit, and lemon); spicy or salty foods; and rough, coarse, or dry foods such as
raw vegetables, granola, and toast.
If your mouth is dry and it bothers you or makes it hard for you to eat, try
these tips:
• Ask your doctor if you should use an artificial saliva product to moisten your mouth.
• Drink plenty of liquids.
• Suck on ice chips, popsicles, or sugarless hard candy.
• Chew sugarless gum.
• Moisten dry foods with butter, margarine, gravy, sauces, or broth.
(25 of 39)
• Dunk crisp, dry foods in mild liquids.
• Eat soft and pureed foods.
• Use lip balm if your lips become dry.
Will chemo affect my nerves and muscles?
Certain chemo drugs can cause peripheral neuropathy, a nerve problem that causes tingling,
pins and needles, burning sensations, weakness, and/or numbness in your hands and feet.
You may feel any of these nerve-related symptoms:
• loss of balance
• clumsiness
• trouble picking up objects and buttoning clothing
• problems walking
• jaw pain
• hearing loss
• vision changes
• stomach pain
• constipation
Along with affecting the nerves, certain chemo drugs can affect the muscles and make them
weak, tired, or sore.
Nerve and muscle effects are frustrating, yet in most cases they are not serious if caught
early. They are usually short-term and will get better after treatment is done. Still, it is
important to tell your doctor about any nerve or muscle symptoms right away. They can
worsen and become quite painful if left untreated. Your doctor might want to stop the chemo
for awhile or offer you treatment to ease these symptoms.
Caution and common sense can help you deal with nerve and muscle
problems.
Follow these tips:
• If your fingers become numb, for example, be very careful when handling objects that
are sharp, hot, or otherwise dangerous.
(26 of 39)
• If your sense of balance is affected, move carefully, use handrails on stairs, and use a
bath mat in the tub or shower.
Will my skin and nails be affected?
You may have minor skin problems during treatment, including color changes, redness,
itching, peeling, dryness, rashes, and acne.
You can take care of most of these problems yourself using these tips:
• If you develop acne, try to keep your face clean and dry.
• For itching, use cornstarch.
• To help avoid dryness, take quick, warm showers rather than long, hot baths.
• Apply creams or lotions after bathing, while your skin is still moist.
• Do not use perfume, cologne, or aftershave lotion. These products often contain
alcohol, which can make your skin dry.
When given through an IV, certain chemo drugs, may darken your skin along the vein. This
discoloration will usually fade a few months after treatment ends.
Most skin problems are not serious, but a few need to be taken care of right away. For
example, certain drugs given through an IV can cause serious, long-term tissue damage if
they leak out of the vein. Tell your doctor or nurse right away if you feel any burning or pain
when you are getting IV drugs. These symptoms don’t always mean there’s a problem, but
they should always be checked out right away.
Let your doctor or nurse know right away if you develop sudden or severe itching, if your
skin breaks out in a rash or hives, or if you are wheezing or have any other trouble breathing.
These symptoms may mean you are having an allergic reaction that needs immediate
attention.
Some chemo drugs may make you more sensitive to the sun. Check with your doctor or nurse
about using sunblock. You may need to completely avoid direct sunlight. Wear long-sleeved
cotton shirts, hats, and pants to block the sun.
(27 of 39)
Your nails may become darkened, brittle, or cracked, or they may develop vertical lines or
bands. Protect your nails by wearing gloves when washing dishes, gardening, or doing other
work around the house. Some over-the-counter products might strengthen your nails, but
these products may also cause irritation.
Get advice from your doctor if any skin and nail problems don't respond to your efforts. Be
sure to let your doctor know if you have redness, pain, or changes around your cuticles or
any other skin problems that you are worried about.
What is "radiation recall"?
If you have had radiation treatments before, you could develop radiation recall. During or
shortly after you get certain chemo drugs, the skin over the area that had been treated with
radiation may turn red -- a shade anywhere from light to very bright -- and may itch or burn.
This is radiation recall and the reaction may last hours or even days. You can soothe the
itching and burning by putting a cool, wet compress over the affected area. Report any skin
irritation or changes to your doctor or nurse. Skin that has had radiation always should
always be protected from the sun.
Will my kidneys or bladder be affected?
Some chemo drugs can irritate your bladder or cause short- or long-term kidney damage.
They may also cause your urine to change color (orange, red, or yellow) or to take on a
strong or medicine-like odor. For a short time, the color and odor of semen may be changed,
too.
Ask your doctor if your chemo may have these effects. And let your doctor know if you have
any symptoms that might be a sign of a problem. Watch for these signs and symptoms:
• pain or burning when you urinate
• urinating a lot
• a feeling that you must urinate right away
• reddish or bloody urine (Some chemo drugs will change the color of your urine. Tell
your doctor or nurse if this happens.)
• fever
• chills
Drink plenty of fluids to ensure good urine flow and help prevent problems. Water, juice,
coffee, tea, soup, soft drinks, broth, ice cream, popsicles, and gelatin also count as fluids.
(28 of 39)
When to call your doctor
At this time, you are likely more in tune with your body than you ever have been in your life.
You notice every physical change and imbalance. Do not make light of any physical
symptoms you may have.
Some side effects are fleeting and minor, but others may be a sign of serious problems. You
should not be the judge. Tell your doctor right away if you suffer from any of the following
symptoms during your chemo treatment:
• a fever of 100.5°F or greater
• bleeding or unexplained bruising
• a rash or allergic reaction, such as swelling or severe itching or wheezing
• intense chills
• pain or soreness at the chemo injection site or catheter site
• unusual pain, including intense headaches
• shortness of breath
• long-lasting diarrhea or vomiting
• bloody stool or blood in your urine
Will my sexual function and fertility be affected?
Chemo can but does not always affect sexual organs and functioning. The possible side
effects depend on the drugs used, age, and general health.
Men
Chemo may lower the number of sperm cells, reduce their ability to move, or cause other
changes. These changes can result in short- or long-term infertility. Infertility affects a man’s
ability to father a child, but does not affect his ability to have sex.
Because permanent sterility (infertility) may occur, it's important to discuss this issue with
your doctor BEFORE you begin chemo. You might want to think about banking your sperm
for future use.
Men who are getting chemo should use birth control with their partners during treatment
because chemo may have harmful effects on chromosomes of sperm cells. Ask your doctor
when you can stop using birth control for this reason.
(29 of 39)
Women
Chemo can damage the ovaries and reduce the amount of hormones they produce. As a
result, you may have these side effects:
• Your menstrual periods may become irregular or stop completely during treatment.
• You may have menopause-like symptoms, such as hot flashes and itching, burning, or
dryness of vaginal tissues. These tissue changes can make intercourse uncomfortable,
but the symptoms often can be relieved by using a water-based vaginal lubricant.
• You may be more likely to get vaginal infections. To help prevent infection, avoid
oil-based lubricants such as petroleum jelly, always use a condom for sexual
intercourse, wear cotton underwear and pantyhose with a ventilated cotton lining, and
don’t wear tight slacks or shorts. Your doctor also may prescribe a vaginal cream or
suppository to reduce the chances of infection. If you do get an infection, it should be
treated right away.
• You may become infertile (unable to become pregnant). Whether this happens and
how long it lasts depends on many factors, including the type of drug, the doses
given, and your age. It is important to discuss this possibility BEFORE you start
treatment.
Pregnancy and chemo
Although pregnancy may be possible during chemo, it should be avoided because some
chemo may cause birth defects. Doctors advise women of childbearing age -- from the teens
through the end of menopause -- to use birth control throughout their treatment. If a woman
is pregnant when her cancer is discovered, it may be possible to delay chemo until after the
baby is born. For a woman who needs treatment sooner, the doctor may suggest starting
chemo after the 12th week of pregnancy, when the fetus is beyond the stage of greatest risk.
In some cases, termination of the pregnancy may be considered.
Talk to your doctor if you and your partner are considering pregnancy after completing
chemo.
How about my sexuality?
(30 of 39)
Some people feel closer than ever to their partners and have an increased desire for sexual
activity during treatment. Others experience little or no change in their sexual desire and
energy level. Still others find that their sexual interest declines because of the physical and
emotional stresses of having cancer and getting chemo. These stresses may include:
• worries about changes in how you look
• anxiety about health, family, or finances
• side effects, including fatigue and hormonal changes
A partner's concerns or fears also can affect the sexual relationship. Some may worry that
physical intimacy will harm the person who has cancer. Others may fear that they might
“catch†the cancer or be affected by the drugs.
You and your partner can clear up many of these misunderstandings by talking about sexual
concerns with your doctor, nurse, or a counselor who can give you the information and the
reassurance you need.
You and your partner also should try to share your feelings with one another. If it’s hard for
you to talk to each other about sex or cancer, or both, you may want to talk to a counselor
who can help you communicate more openly.
If you were comfortable with and enjoyed sexual relations before starting treatment, chances
are you will still find pleasure in physical intimacy during treatment. But you may find that
intimacy takes on new meaning. Hugging, touching, holding, and cuddling may become
more important, while sexual intercourse may become less important.
For more information, please see our booklets Sexuality and Cancer: For the Woman Who
Has Cancer and Her Partner and Sexuality and Cancer: For the Man Who Has Cancer and
His Partner.
What about my memory and thinking?
Recent research has shown that chemo can also impact the thinking functions of the brain,
known as cognitive functioning, for up to 10 years after treatment. This happens in a small
number of patients and is often worse with larger doses of chemo. Some of the brain’s
activities that are affected are concentration, memory, comprehension (understanding), and
reasoning. The changes that were found in patients were subtle, but the people who have
problems notice the differences in their thinking.
Patients who have had chemo and have cognitive impairment often call this experience
chemo brain or chemo-fog. Researchers are not sure exactly why chemo affects the brain in
this way or exactly how much chemo (or in what combinations) it takes to cause a problem.
(31 of 39)
Researchers are currently studying the problem. They are looking for more information to
help prevent and treat cognitive impairment for chemotherapy patients. Just being aware that
problems with thinking can happen may help patients and their family members feel less
isolated and alone.
If you have problems with thinking that interfere with your daily life, there are memory
retraining exercises and programs, as well as other treatments, that may help you retain or
improve your memory and problem-solving abilities. You can also learn strategies that may
help you cope with the loss of cognitive function. Ask your doctor if he or she can
recommend a health professional who can help. You can get more information in our
document Chemo Brain.
What emotional effects can I expect?
Chemo can bring major changes to your life. It can affect your overall health, threaten your
sense of well-being, disrupt your daily routines, and put a strain on your relationships. It is
normal and understandable for you and your family to feel sad, anxious, angry, or depressed.
There are ways to cope with these emotional side effects, just as there are ways to cope with
the physical side effects.
You can draw support from many sources. Here are some of the most important:
Doctors and nurses
If you have questions or worries about your cancer treatment, talk with members of your
health care team.
Counseling professionals
Counselors can help you express, understand, and cope with the emotions cancer treatment
can cause. Depending on what you want and need, you might want to talk with a psychiatrist,
psychologist, social worker, sex therapist, or member of the clergy.
Friends and family
Talking with friends or family members can help you feel a lot better. Often, they can
comfort and reassure you in ways that no one else can. But you may find that you have to
make the first move. Many people do not understand cancer and may withdraw from you
because they’re afraid of your illness. Others may worry that they will upset you by saying
the wrong thing.
(32 of 39)
You can help relieve these fears by talking openly with others about your illness, your
treatment, your needs, and your feelings. You can correct mistaken ideas and let people know
that there’s no one "right" thing to say. Once people know they can talk with you honestly,
they may be more willing and able to open up.
Support groups
Support groups are made up of people who are going through the same kinds of experiences
you are. Many people with cancer find they can share thoughts and feelings with group
members more easily than with anyone else. Support groups can also be an important source
of practical information about living with cancer.
You can also find support in one-to-one programs that match you with a person like you in
age, gender, type of cancer, and so forth. You might talk with this person on the phone or
arrange visits.
Where to find information about support programs:
• your hospital's social work department
• your local American Cancer Society office or by calling us at 1-800-ACS-2345 (1-
800-227-2345)
Coping techniques for daily life
Here are some tips to help you during chemo:
• Try to keep your treatment goals in mind. This will help you keep a positive attitude
on days when the going gets rough.
• Eating well is very important. Your body needs food to rebuild tissues and regain
strength.
• Learn as much as you want to know about your disease and its treatment. This can
lessen your fear of the unknown and increase your feeling of control.
• Keep a journal or diary while you're being treated. A record of your activities and
thoughts can help you understand the feelings you have as you go through treatment.
It can also help you highlight questions you need to ask your doctor or nurse. You
also can use your journal to record the side effects. This will help you when you talk
about them with your doctor and nurse. You can write down the steps you take to
cope with side effects and how well those steps work, too. That way, you’ll know
which methods worked best for you in case you have the same side effects again.
(33 of 39)
• Take it easy. You may not have as much energy as usual, so try to get as much rest as
you can. Let the small stuff slide and only do the things that are most important to
you.
• Try new hobbies and learn new skills.
• Exercise if you can and if your doctor says it's OK. Using your body can make you
feel better about yourself, help you get rid of tension or anger, and build your
appetite.
How can I relieve stress and relax?
Simple techniques can help you cope with stress and help you relax. Try some of these
methods to find the ones that work best for you. You may want to check with your doctor
before using these techniques, especially if you have lung problems.
Muscle tension and release
• Lie down in a quiet room.
• Take a slow, deep breath.
• As you breathe in, tense a muscle or group of muscles. For example, clench your
teeth or stiffen your arms or legs.
• Keep your muscles tense for a second or 2 while holding your breath.
• Then breathe out, release the tension, and let your body relax completely.
• Repeat the process with another muscle or muscle group.
Another way to do this is called progressive relaxation. You work your way up your body
starting with the toes of one foot. Contract then relax all the muscles of one leg. Do the same
with the other leg. Work your way up your body, contracting then relaxing each of the
muscle groups in your body, including those in your neck and face. Remember to hold your
breath while briefly contracting your muscles and to breathe out when releasing the tension.
Rhythmic breathing
(34 of 39)
• Get into a comfortable position and relax all your muscles.
• Close your eyes or focus on a distant object if you prefer to keep them open.
• Breathe in and out slowly and comfortably through your nose. If you like, keep the
rhythm steady by saying to yourself, "In, 1, 2. Out, 1, 2."
• Feel yourself relax and go limp each time you breathe out.
• You can continue this for just a few seconds or for up to 10 minutes.
Biofeedback
With biofeedback training you can control body functions such as heart rate, blood pressure,
and muscle tension. A machine will sense and alert you when your body shows signs of
tension. The machine will also give you feedback when you relax your body. With time and
practice you will be able to control your relaxation responses without having to depend on
feedback from the machine. Your doctor or nurse can refer you to someone trained in
teaching biofeedback.
Mental imagery
• Close your eyes, breathe slowly, and feel yourself relax.
• Imagine a ball of healing energy -- perhaps a white light -- forming somewhere in
your body.
• When you see the ball of energy, slowly breathe in and blow the ball to any part of
the body where you feel pain, tension, or discomfort, such as nausea. When you
breathe out, picture the air moving the ball away from your body, taking with it any
painful or uncomfortable feelings. (Be sure to breathe naturally; don't blow.)
• Continue to picture the ball moving toward you and away from you each time you
breathe in and out. You may see the ball getting bigger and bigger as it takes away
more and more tension and discomfort.
Visualization
Visualization is much like imagery. With visualization you create an inner picture that
represents your fight against cancer. You might visualize rockets blasting away the cancer
cells in your body or knights in armor battling the cells.
(35 of 39)
Hypnosis
Hypnosis puts you in a trance-like state that can help reduce discomfort and anxiety. You can
be hypnotized by a qualified person, or you can learn how to hypnotize yourself. If you are
interested in learning more, ask your doctor or nurse to refer you to someone trained in the
technique.
Distraction
Distract yourself from your worries or discomforts by watching TV, listening to the radio,
reading, going to the movies, or working with your hands by doing needlework or puzzles,
building models, or painting. You may be surprised how comfortably the time passes.
How do I pay for my chemo?
The cost of chemotherapy varies with the kinds of drugs used, how long and how often they
are given, and whether you get them at home, in a clinic, office, or hospital. Most health
insurance policies, including Medicare Part B, cover at least part of the cost of most kinds of
chemo.
To reduce their costs, private insurance companies are more often deciding to not pay for the
use of some chemo drugs. They may do this even if those drugs are proven cancer therapies.
Before you begin treatment, find out whether your insurance company or Medicare will pay
for your care.
For more information on how to maintain control of your finances so you can better focus
your energies on treatment and recovery, see our booklet, Financial Guidance for Cancer
Survivors and Their Families: In Treatment.
What you need to know about insurance coverage
Insurance companies may deny payment for chemo for these reasons:
• They may not be aware of new treatments.
• They may limit the selection of drugs that doctors can use for chemo.
(36 of 39)
• They may restrict payment to the uses first approved by the Food and Drug
Administration (FDA).
If you are going to take part in a clinical trial, find out if your insurance will cover the cost of
patient care. In some cases, insurers may deny payment. Coverage may vary by state.
If your insurer denies payment for your treatment, don’t give up. Most people do get
payment.
What to do if your claim is not paid
• Tell your health care team if you have been denied payment so that they can contact
your insurer and help answer any questions.
• Ask your doctor's office staff to provide insurance companies with the results of
scientific studies showing that a certain drug works for your type of cancer.
• Ask hospitals and cancer centers to provide information like this too. These actions
are often enough to get your claim paid.
• Contact reimbursement specialist hotlines at pharmaceutical companies.
In some states, Medicaid (which makes health care services available for people with
financial need) may help pay for certain treatments. Contact the office that handles social
services in your city or county to find out if you are eligible for Medicaid and whether your
chemo is a covered expense. Medicaid approval can take a long time, so begin the process as
early as possible.
You can also contact your hospital’s social service office which may be able to direct you to
other sources of help.
A last alternative may be to sue the insurance company to get payment for your cancer
treatment. In many cases, courts have sided with patients and ordered insurance companies to
pay for a patient’s treatment.
Always ask your doctor and nurse any questions you have about your chemo. Open and
honest talks between you, your family, and your cancer care team is the best way to
understand what is happening to you, your body, and your cancer.
No matter who you are, we can help. Contact us anytime, day or night, for cancer-related
information and support. Call us at 1-800-ACS-2345 (1-800-227-2345) or visit
www.cancer.org.
(37 of 39)
Glossary
These are some words that you may hear your health care team use.
Adjuvant therapy: Treatment used in addition to main treatment. It usually refers to
hormone therapy, chemotherapy, radiation therapy, or immunotherapy given after surgery to
increase the chances of curing the disease or keeping it in check.
Alopecia: Hair loss. It is usually short term and is caused by the use of chemo drugs.
Anemia: Having too few red blood cells. Symptoms of anemia include feeling tired, weak,
and short of breath.
Anti-emetic: A medicine to prevent or control nausea and vomiting.
Benign: Non-cancerous, or not cancer.
Blood cell count: The number of red blood cells, white blood cells, and platelets in a sample
of blood. This is also called complete blood count (CBC).
Bone marrow: The inner, spongy tissue of bones where blood cells are made.
Cancer: A general term for more than 100 diseases in which abnormal cells grow out of
control. Also used to refer to a malignant tumor or cancerous tumor.
Catheter: A thin, flexible tube. Doctors use these to place fluids in your body or as a way for
fluids to leave your body.
Central venous catheter (CVC): A special thin, flexible tube placed in a large vein, usually
in the chest, neck, or upper arm. It can remain there for as long as it is needed to deliver and
withdraw fluids.
Chemotherapy: The use of drugs to treat disease. The term most often refers to drugs used
to treat cancer. Often called chemo.
Chromosomes: Threadlike bodies that carry genetic information. They are found in the
nucleus, or center part, of a cell.
Clinical trials: Medical research studies done in patient volunteers. Each study is designed
to answer scientific questions and to find better ways to detect, prevent, or treat cancer or its
side effects.
(38 of 39)
Combination chemotherapy: The use of more than one chemo drug to treat cancer.
Complementary and alternative medicine (CAM): Non-conventional ways of dealing with
disease. This term covers a broad range, such as herbs/vitamins/minerals, mind/body/spirit,
diet and nutrition, physical touch, and biological methods.
Fatigue: The feeling of being tired physically, mentally, and emotionally. Cancer-related
fatigue persists over time and can interfere with usual activities. This fatigue is different from
the fatigue of everyday life, which is usually short term and relieved by rest.
Growth factors: Also known as colony-stimulating factors, growth factors are substances
that stimulate the production of blood cells in the bone marrow. They can help the bloodforming
tissue recover from the effects of chemotherapy and radiation therapy.
Hormones: Natural substances released by an organ that can influence the function of other
organs in the body and the growth of some types of cancer.
Infusion: Slow and/or prolonged intravenous (IV) delivery of a drug or fluids.
Injection: Using a syringe and needle to push fluids or drugs into the body; often called a
shot.
Intra-arterial: Into an artery.
Intracavitary: Into a cavity or space; most often the abdomen, pelvis, or the chest.
Intralesional: Into a tumor.
Intramuscular (IM): Into a muscle.
Intrathecal (IT): Into the spinal fluid (also called cerebrospinal fluid or CSF).
Intravenous (IV): Into a vein.
Malignant: Cancerous.
Metastasis/Metastasized: The spread of cancer cells to other areas of the body through the
lymph system or bloodstream.
Neoadjuvant therapy: Systemic therapy, such as chemotherapy, hormone therapy, or
radiation therapy, given to shrink a tumor before surgery is done.
Orally (PO): taken by mouth
(39 of 39)
Peripheral neuropathy: A condition of the nervous system that usually begins in the hands
and/or feet with symptoms of numbness, tingling, burning, and/or weakness. It can be caused
by some chemo drugs.
Platelets (Plts): Special blood cells that plug up damaged blood vessels and help blood clot
to stop bleeding.
Radiation therapy: The use of high-energy rays or subatomic particles to treat disease.
Types of radiation include x-ray, electron beam, alpha and beta particles, and gamma ray.
Red blood cells (RBCs): Cells that carry oxygen from the lungs to tissues throughout the
body.
Remission: The partial or complete disappearance of signs and symptoms of disease.
Stomatitis: Sores on the lining of the mouth.
Topical: Put directly to the skin.
Tumor: An abnormal growth of cells or tissues. Tumors are either benign (non-cancerous) or
malignant (cancerous).
White blood cells (WBCs): The blood cells that fight infection.
Last Medical Review: 3/8/2008
Last Revised: 5/15/2008
2008 Copyright American Cancer Society
(1 of 36)
UNDERSTANDING RADIATION THERAPY: A GUIDE FOR
PATIENTS AND FAMILIES
You've been told you have cancer. You've looked at your treatment options and you and your
doctor have agreed that radiation therapy is your best choice. Now you may have many
questions about your treatment:
• What will radiation treatment be like?
• Will it hurt?
• How long will treatment take?
• Will I have to stay in a hospital?
• How much will it cost?
The American Cancer Society knows you may have concerns about radiation therapy, and we
have answers to some of your questions. Remember that, along with reading about your
treatment, you can also count on your doctor and nurse to answer your questions.
At the end of this document you will find a glossary that defines words and terms used by
your health care team. The words that are in italics the first time they are used are also in the
glossary. You can use the glossary to help you better understand the talks you have with your
health care team. Open and honest talks with your cancer care team are the best way to
understand what is happening during your treatment.
What is radiation therapy? When is it used?
Radiation therapy uses high-energy particles or waves, such as x-rays, gamma rays, electron
beams, or protons to destroy or damage cancer cells. Other names for radiation therapy are
radiotherapy, irradiation, or x-ray therapy.
(2 of 36)
Radiation therapy is one of the most common treatments for cancer. It is often part of the
main treatment for certain types of cancer, such as cancers of the head and neck, bladder,
lung, and Hodgkin disease. Many other cancers are also treated with radiation therapy.
Thousands of people become free of cancer after getting radiation treatments. Radiation can
be given alone or combined with other treatments, such as surgery or chemotherapy. And
sometimes patients get more than one type of radiation therapy.
How does radiation therapy work?
All cells grow and divide to form new cells. But cancer cells grow and divide faster than
many of the normal cells around them.
Radiation therapy uses special equipment to deliver high doses of radiation to the cancer
cells. This kills or damages them so they cannot grow, divide, or spread. Radiation works by
breaking a piece of the DNA molecule inside the cancer cell, which keeps the cell from
growing and dividing. Some nearby normal cells may be affected by radiation, but most fully
recover from the effects of the treatment and go back to working the way they are supposed
to.
Unlike chemotherapy, which exposes the entire body to cancer-fighting drugs, radiation
therapy is usually a local treatment. It affects only the part of the body being treated. The
goal of radiation treatment is to damage as many cancer cells as possible, with little harm to
nearby healthy tissue.
In some cases radioactive substances may be given in a vein or by mouth, then the radiation
does travel throughout the body. But for the most part, the radioactive substance collects in
the area of the tumor so that there is little effect on the rest of the body.
Do the benefits outweigh the risks and side effects?
Radiation therapy may be more helpful in some cases than in others. For example, some
types of cancer are more sensitive to radiation than others. And some cancers are in areas that
are more easily treated with radiation without causing major side effects.
If your doctor recommends radiation treatment, it is because he or she feels that the benefits
you may get from it will outweigh the possible side effects. Still, this is something you must
be comfortable with. Knowing as much as you can about the possible benefits and risks can
help you decide whether radiation therapy is best for you. Questions to ask your doctor might
include the following:
• What is the purpose of radiation treatment for my type of cancer?
(3 of 36)
- To destroy or shrink the tumor?
- To prevent or stop the spread of the cancer?
- To lessen the chance the cancer may come back?
• If radiation therapy is to be done after surgery, what are the chances it will destroy
any cancer cells that were left behind? Could radiation be used instead of surgery?
• What are the chances that radiation therapy will work?
• What is the chance that the cancer will spread or come back if I do, or do not, have
radiation therapy?
• Are there other treatment options?
• If I decide on radiation therapy, what can I do to be ready for treatment?
• What will treatment involve? How often is it given? How long will it last?
• How will the radiation affect the area around the cancer?
• What side effects am I likely to have?
• Will any of these side effects affect how I do things, such as eat or drink, exercise,
work, etc.?
• Will side effects change how I look?
• How long will the side effects last?
• Will I be at higher risk for any other health problems in the future?
How much does radiation treatment cost?
Treating cancer with radiation can cost a lot. It requires complex equipment and the services
of many health care professionals. The exact cost of your radiation therapy will depend on
the type and number of treatments you need.
Most health insurance plans, including Medicare Part B, cover the charges for radiation
therapy. Talk with your doctor's office staff or the hospital business office about your health
plan and how your bills for treatment will be paid.
(4 of 36)
In some states, Medicaid (which makes health care services available to people with financial
need) may help pay for treatments. Call your city or county social services office to find out
if you qualify for Medicaid and if radiation therapy is a covered expense. If you need
financial help, contact your hospital's social service office or the American Cancer Society at
1-800-ACS-2345 (1-800-227-2345) to learn where you might get more help.
Who gives radiation treatments?
During your radiation therapy, you will have a team of medical professionals caring for you.
Your team may include the following people:
• Radiation oncologist: A doctor specially trained to treat cancer patients with
radiation. He or she is in charge of your radiation treatment plan.
• Radiation physicist: The person who makes sure the radiation equipment is working
as it should and gives you the dose prescribed by your radiation oncologist.
• Dosimetrist: Supervised by the radiation physicist, this person helps the radiation
oncologist plan the treatment.
• Radiation therapist or radiation therapy technologist: This person operates the
radiation equipment and positions you for treatment.
• Radiation therapy nurse: A nurse with special training in cancer treatment who can
give you information about radiation treatment and side effects.
You may also need the services of a dietitian, physical therapist, social worker, dentist or
dental oncologist, or other health care professionals.
Informed consent
Before treatment, you will be asked to sign a consent form. This form gives the doctor
permission to treat you with radiation and do the tests that are needed to plan your treatment.
The details of the consent form may vary, but it usually says that your doctor has explained
to you how radiation therapy may benefit you, the possible risks, and your other treatment
options. By signing the form, you are saying that you have gotten this information, that you
understand it, and that you are willing to be treated with radiation. It also means that you
understand there is no guarantee that the treatment will work.
Before signing the consent form, be sure that you understand these things:
(5 of 36)
• the potential benefits of the treatment
• how the treatment will be given, including how long it will last
• the possible side effects, including when they usually show up and how long they last
• when to call your doctor
• what other treatment options are available for you
How is radiation therapy given?
Radiation therapy can be given in 3 ways: as external radiation, as internal radiation, or as
systemic radiation. In some cases more than one type of therapy is used.
External radiation (or external beam radiation) uses a machine that directs high-energy rays
from outside the body into the tumor and some normal nearby tissue. Most people get
external radiation therapy over many weeks. It is done during outpatient visits to a hospital or
treatment center.
Internal radiation therapy (also called brachytherapy) uses a radioactive source in the form
of a wire, seed, or pellet that is called an implant. The implant is put inside the body in or
near the tumor. The radiation from the implant travels only a short distance, so it has very
little effect on normal body tissues. In some cases, patients may need to stay in the hospital
while getting internal radiation.
Sometimes, after a tumor has been removed by surgery, radioactive implants are put into the
area where the tumor was to kill any tumor cells that may still be there.
Implants may either be left in the patient as a permanent implant or they may be removed
after a certain amount of time.
Systemic radiation is another type of internal radiation therapy. Radiopharmaceuticals are
used for this treatment. Radiopharmaceuticals are radioactive drugs used to treat certain types
of cancer, such as thyroid cancer or cancer that has spread to the bone (bone metastases).
These drugs are unsealed radioactive sources that can be given by mouth or by injection,
which then travel throughout the body. Treatment with radiopharmaceuticals often requires a
brief time in the hospital.
The different types of radiation therapy are described in more detail in the next sections.
External radiation therapy
(6 of 36)
How does your doctor plan your treatment?
Choosing the type of radiation to use depends on the type of cancer you have and where it is
in your body.
After a physical exam and a review of your medical history and test results, the doctor will
pinpoint the area to be treated. This is done a few days before starting radiation therapy in a
process called simulation. You will be asked to lie still on a table while the radiation therapist
uses a special x-ray machine to define your treatment field (also called treatment port). These
are the exact places on your body where the radiation beams will be aimed.
To be sure the radiation beams are aimed correctly, special molds or casts of parts of your
body may be made to help you be still during your treatment. They will also help get you in
the same position for future treatments. The radiation therapist may mark the treatment field
with freckle-sized dots of semi-permanent ink. The marks will likely fade away over time,
but they are needed until your treatment is finished. Don’t use soap on or scrub these marks.
Sometimes the area may be marked with permanent dots like a tattoo. (These can later be
removed with a laser if you like.)
Based on the simulation, other tests, and your medical diagnosis, the doctor will decide how
much radiation is needed, how it will be given, and how many treatments you should have.
External radiation therapy is usually given with a machine called a linear accelerator (called
linac for short), which is described below.
How long does the treatment take?
In most cases the total dose of radiation needed to kill a tumor can’t be given all at once. This
is because it is very hard to give radiation therapy without harming some normal cells
nearby. A dose of radiation given all at once can cause more damage to normal tissues, and
as a result more side effects, than giving the same dose over many treatments.
This is why the total dose of external radiation therapy is usually divided into smaller doses
called fractions. The most common way to give it is daily, 5 days a week (Monday through
Friday) for 5 to 8 weeks. Weekend rest breaks allow time for normal cells to recover. The
total dose of radiation and the number of treatments can vary, based on:
• the size and location of your cancer
• the type of cancer
• the reason for the treatment
• your general health
• any other treatments you are getting
(7 of 36)
Other radiation schedules may be used in certain cases. For example, radiation therapy may
last only a few weeks (or less) when it’s being given to relieve symptoms, because the
overall dose of radiation is lower. In some cases, radiation might be given as 2 or more
treatments each day (called hyperfractionated radiation therapy). Or it might be given as
split-course therapy, which allows for several weeks off in the middle of treatments to allow
the body time to recover while the cancer shrinks.
What happens during each treatment visit?
External radiation treatment is painless. It is much like having a regular x-ray. The treatment
itself takes only a few minutes. But each session can last 15 to 30 minutes because of the
time it takes to set up the equipment and place you in the correct position.
Depending on the area being treated, you may need to undress, so wear clothes that are easy
to take on and off. You will be asked to lie on a treatment table next to the radiation machine
(called a linear accelerator or linac). The machine has an arm that extends over the table. The
radiation comes out of this arm. The machine can move around the table to change the angle
of the radiation, if needed.
The radiation therapist may put special heavy shields between the machine and parts of your
body that are not being treated to help protect normal tissues and organs.
Once you are in the correct position, the radiation therapist will go into a nearby room to
operate the machine and watch you on a TV monitor. You will be able to talk with the
therapist over an intercom. You will be asked to lie still during the treatment. You do not
have to hold your breath -- just breathe normally.
The radiation therapy machine will make clicking and whirring noises and may sometimes
sound like a vacuum cleaner as it moves to aim the radiation beam from different angles. The
radiation therapist controls the movement and checks to be sure it is working properly. If you
are concerned about anything that happens in the treatment room, ask the therapist to explain.
If you feel ill or uncomfortable during the treatment, tell the therapist right away. The
machine can be stopped at any time.
Will I be radioactive during or after external radiation treatment?
External radiation therapy affects cells in your body only for a moment. Because there is no
radiation source in your body, you are not radioactive at any time during or after treatment.
(8 of 36)
Newer forms of external radiation therapy
Today, scientists have developed newer, more precise ways of giving external radiation
therapy. These approaches allow doctors to focus the radiation more directly on the tumors.
These newer forms of radiation do less damage to normal tissues, and this allows doctors to
use higher doses directed only at the tumors. These methods though are still fairly new, and
their long-term effects are still being studied.
Newer machines allow doctors to shape (conform) the radiation beam to match the shape of
the tumor. With conformal radiation, a special computer uses imaging scans (such as CT
scans) to map the location of the cancer in the body in 3 dimensions (3 dimensional or 3-D).
Radiation beams can then be shaped (or conformed) to match the shape of the cancer. This
helps to better protect nearby tissues and the parts of the body in between the radiation beam
and the cancer.
Three-dimensional conformal radiation therapy (3D-CRT) delivers shaped beams at the
cancer from different directions. Patients are fitted with a mold or cast to keep the body part
still so the radiation can be aimed more accurately. By aiming the radiation more precisely, it
may be possible to reduce radiation damage to normal tissues and better fight the cancer by
increasing the radiation dose to the tumor.
Intensity modulated radiation therapy (IMRT) is a newer method much like 3D-CRT. It
conforms to the tumor shape like 3D-CRT, but also allows the strength of the beams to be
changed in some areas to lessen damage to normal body tissues. This provides even more
control in reducing the radiation reaching normal tissue while getting a higher dose to the
tumor. It may result in even fewer side effects.
A newer form of IMRT, called helical tomotherapy, uses a linear accelerator inside a large
"donut" that spirals around the body while you lie on the treatment table. It can deliver
radiation from many different angles around the body. This may allow for even more
precisely focused radiation.
Conformal proton beam radiation therapy is much like conformal therapy but it uses
proton beams instead of x-rays. Protons are parts of atoms that cause little damage to tissues
they pass through but are very good at killing cells at the end of their path. This means that
proton beam radiation may be able to deliver more radiation to the tumor while reducing side
effects on nearby normal tissues. Protons can only be put out by a special machine called a
cyclotron or synchrotron. This machine costs millions of dollars and requires expert staff.
This is why proton beam therapy can be expensive and it is not yet found in many radiation
treatment centers. More studies are needed to determine whether proton radiation produces
better results in specific cancers than the usual photon radiation treatment.
(9 of 36)
Intraoperative radiation therapy (IORT) is external radiation given directly to the tumor or
tumors during surgery. It may be used if the tumors cannot be totally removed or if there is a
high chance of the tumor coming back in the same area. While the patient is under anesthesia
(asleep), the surgeon finds the cancer. Normal tissues can be moved out of the way and
protected with special shields, so IORT can allow the doctor to give one large dose of
radiation to the cancer and not affect nearby tissues. IORT is usually given in a special
operating room lined with radiation-shielding walls.
Stereotactic radiosurgery is not really surgery but a type of radiation treatment that gives a
large dose of radiation to a small tumor area in a single session. It is mostly used for brain
tumors and other tumors inside the head. First, a head frame is attached to the skull to help
precisely aim the radiation beams. Once the exact location of the tumor is known from the
CT or MRI scans, radiation is sent to the area from a machine. The radiation is very precise
and nearby tissues are affected as little as possible.
There are 3 different ways stereotactic radiosurgery can be given:
• The most common type uses a movable linear accelerator that is controlled by a
computer. Instead of delivering many beams at once, the machine moves around to
deliver radiation to the tumor from different angles. Several machines do stereotactic
radiosurgery in this way, with names such as X-Knife™, CyberKnife®, and Clinac®.
• The Gamma Knife® uses high-energy radiation that is precisely focused at the tumor
from many different angles for a short period of time. This large dose of radiation is
given exactly to the tumor in one treatment session. It does not use a knife and it is
not surgery.
• A third type uses heavy charged particle beams (such as protons and helium ions) to
deliver stereotactic radiation to the tumor.
Stereotactic radiosurgery typically uses one session to deliver the whole radiation dose,
though it may be repeated if needed. Sometimes doctors give the radiation in many smaller
treatments to deliver the same or slightly higher dose (fractionation). This is sometimes
called fractionated radiosurgery or stereotactic radiotherapy.
Clinical trials are being done to look at how well stereotactic radiosurgery and stereotactic
radiotherapy work alone and when used along with other types of radiation therapy.
Internal radiation therapy (brachytherapy)
What is internal radiation therapy?
(10 of 36)
Your doctor may recommend internal radiation therapy (also called brachytherapy) as the
best way to treat your cancer. Instead of using radiation beams aimed from a large machine,
the radiation source is usually sealed in a small holder (called an implant). The implant is
placed very close to or inside the tumor. The material is placed so that it harms as few of the
normal cells as possible. The material itself may be left in the body for only a short time, or it
may be left there permanently. This allows the doctor to give a high dose of radiation to a
smaller area than is possible with external radiation treatment.
The main types of brachytherapy are intracavitary radiation and interstitial radiation. Both of
these methods involve using radioactive implants, such as metal pellets, seeds, ribbons,
wires, needles, capsules, or tubes. During intracavitary radiation, the material is placed in a
cavity (space) in the body, such as the uterus. With interstitial radiation, the implants are
placed in or near the cancer, but not in a body cavity.
How are implants placed in the body?
Sealed radioactive substances are placed in body cavities or body tissue with applicators,
which are often metal tubes or plastic tubes called catheters. This is done in a hospital
operating room. You will get anesthesia, which may be either general (where you are given
drugs to put you into a deep sleep) or local (where part of your body is numbed). The
applicators are put in by a doctor using an imaging test (such as an x-ray or MRI) to look at
the exact area where the radiation needs to go. If the applicators need to stay in, stitches may
be used to keep them in place until treatment is over.
During the actual radiation treatment, the implants are put into the body through the
applicator(s). Some implants are permanent. They are put in through the applicator and then
the applicator is removed. Other implants are left in only for a certain amount of time. For
the implants that will be removed after a certain number of minutes, hours, or days, the
applicator is usually left in until the treatment is finished. The applicator is then removed
when the implants are taken out for the last time.
How long do implants stay in place?
The type of implant you receive and your treatment schedule will depend on the type of
cancer, where it is in your body, your general health, and other treatments you have had.
Some implants deliver low doses of radiation. They are left in place for many days or may
even be permanent. Others deliver high doses of radiation and are taken out after only a few
minutes.
(11 of 36)
Some low-dose implants are left in place from 1 to 7 days. For larger implants, depending on
where the implant is placed, you may have to stay in a hospital bed and lie fairly still to keep
it from moving.
Some smaller implants (such as the seeds or pellets used to treat prostate cancer, and some
lung cancers) may be left in permanently. Over the course of several weeks they stop giving
off radiation. The seeds are about the size of rice grains and rarely cause problems. If your
implants are to be left in, you may be able to go home the same day they are put in (or the
day after). But you will need to stay in the treatment center until the anesthesia wears off.
Sometimes special precautions are needed to protect family and friends from the radiation
given off by the implants. Ask your health care team about this.
High-dose-rate (HDR) brachytherapy allows a person to be treated for only a few minutes at
a time with a powerful radioactive source that is put in the applicator. The source is removed
after only a few minutes. This may be repeated over the course of a few days to weeks. The
radioactive material is not left in your body. Sometimes the applicator is left in place between
treatments, or it may be put in place before each treatment.
How will I feel during implant therapy?
You are not likely to have a lot of pain or feel sick while implants are being put in. The
anesthesia used while they are being placed might make you feel drowsy, weak, or
nauseated, but these side effects do not last long. If your implant is held in place by an
applicator, you may have some discomfort in that area. Ask for medicine to help you relax or
to relieve pain if needed. Be sure to tell the nurse if you have any burning, sweating, or other
symptoms.
What happens after a temporary implant is removed?
In most cases, anesthesia is not needed when the applicator and/or implant is removed. It is
usually done right in your hospital room. The treated area may be sore or tender for some
time after treatment, but most patients can return to normal activities quickly. Keep in mind
that your body is recovering, and you may need extra sleep or rest breaks over the next few
days.
What happens to permanent implants?
Radioactive material will stop giving off radiation over time. This may take weeks or
months. Talk to the doctor or nurse about how long this may take in your case. Once the
(12 of 36)
radiation is gone, the implant(s) are no longer active. Usually they stay in place and cause no
harm, and they do not need to be removed.
Will I be radioactive during or after internal radiation treatment?
With internal radiation therapy, your body may give off a small amount of radiation for a
short time. If the radiation is contained in a temporary implant, you will be asked to stay in
the hospital and may have to limit visitors during treatment. You also may be asked to stay a
certain distance away from them. Pregnant women and children may not be allowed to visit
you. With sealed implants, body fluids and materials used by the patient are not radioactive.
Permanent implants give off small doses of radiation over a few weeks to months as they
slowly stop giving off radiation. The radiation usually doesn’t travel much farther than the
area being treated, so the chances that others could be exposed to radiation is very small.
Still, your health care team may ask you to take certain precautions such as staying away
from small children and pregnant women, especially just after you get the implants.
Systemic radiation
What is systemic radiation therapy?
Systemic radiation uses radioactive drugs called radiopharmaceuticals. These unsealed
radiation sources are usually in the form of a liquid. Examples are strontium 89 and iodine
131. The radiopharmaceuticals may be injected into the body, given in a vein (IV), or taken
by mouth. They travel throughout the body and are designed to collect in the area of the body
where the cancer is. That is where they give off their radiation to kill the cancer cells.
Will I be radioactive during or after systemic radiation treatment?
After systemic radiation with an unsealed radioactive substance such as iodine, phosphorus,
or strontium by mouth or into a vein, some radiation will stay in your body for a few days,
until your body has had a chance to get rid of it. You may need to stay in the hospital for 1 or
2 days, and your health care team will tell you what precautions to take until your body no
longer contains radiation that might affect others. These precautions vary depending on the
substance used.
(13 of 36)
Patient and family safety
Sometimes doctors recommend certain safety measures to protect the people around you
from the systemic radiation in your body. This is because the radioactive materials can leave
your body through saliva, sweat, blood, and urine, making these fluids radioactive. In most
cases, the safety precautions must be followed only the first few days after treatment. Over
time the radiation becomes weaker and your body gets rid of it. Talk to the doctor or nurse
about how long this may take in your case, and if there are special precautions you will need
to take.
You might be told to follow these precautions for a certain amount of time:
• follow personal hygiene after using the toilet
• use separate utensils and towels
• drink extra fluids to flush the radioactive material out of your body
• avoid sexual contact
• limit your contact with infants, children, and women who are pregnant
Ask your health care team about the precautions you need to take. Be sure you understand
what you need to do to protect the people around you.
Preventing and managing common side effects
What can I do to take care of myself during therapy?
You need to take special care of yourself to protect your health during radiation treatment.
Your doctor or nurse will give you advice about your treatment and the side effects you
might have. Here are some other tips:
• Be sure to get plenty of rest. You may feel more tired than normal. Try to get good,
restful sleep at night. This tiredness, often called fatigue, may last for several weeks
after your treatment ends. See the section "Dealing with fatigue" for more
information.
• Eat a balanced, nutritious diet. Depending on the area of the body that will get
radiation (for example, the abdomen or pelvic area), your doctor or nurse may suggest
changes in your diet. You can get more information in our booklet, Nutrition for the
Person with Cancer During Treatment: A Guide for Patients and Families.
• Take care of the skin in the treatment area. If you get external radiation therapy,
the skin in the treatment area may become more sensitive or look sunburned. Ask
(14 of 36)
your doctor or nurse before using any soaps, lotions, deodorants, medicines,
perfumes, cosmetics, talcum powder, or other substances on the treated area. Some of
these products may irritate sensitive skin. See the section "Dealing with skin
problems" for more information.
• Avoid wearing tight clothes. This includes girdles, pantyhose, or close-fitting collars
over the treatment area. Instead, wear loose, soft cotton clothing. Do not starch your
clothes.
• Do not rub, scrub, or use adhesive tape on treated skin. If you skin must be
covered or bandaged, use paper tape or other tape for sensitive skin. Try to put the
tape outside the treatment area, and do not put the tape in the same place each time.
• Do not put heat or cold (such as a heating pad, heat lamp, or ice pack) on the
treatment area. Talk with your doctor first. Even hot water may hurt your skin, so
use only lukewarm water for washing the treated area.
• Protect the treated area from the sun. Your skin may be extra sensitive to sunlight.
If possible, cover the treated skin with dark-colored clothing before going outside.
Ask your doctor if you should use a lotion that contains a sunscreen. If so, use a
sunscreen product with a sun protection factor (SPF) of at least 15. Reapply the
sunscreen often, even after your skin has healed. Continue to give your skin extra
protection from sunlight for at least 1 year after radiation therapy.
• Tell your doctor about medicines you are taking before treatment. Let your
doctor know if you take any medicines, even things like aspirin, vitamins, or herbs.
Side effects can vary
Your doctor and nurse are the best people to talk to you about your treatment, side effects,
home care, and any other medical concerns you may have. Tell them about any side effects
you are having, including skin changes, tiredness (fatigue), diarrhea, or trouble eating. Be
sure that you understand any home care instructions and know who to contact if you have
more questions.
Side effects vary from patient to patient and will depend on the radiation dose and the part of
your body treated. Some patients have no side effects at all, while others have quite a few.
There is no way to know who might or might not have side effects. Your overall health can
sometimes affect how your body reacts to radiation treatment and whether you have side
effects.
Radiation therapy can cause early and late side effects. Early side effects are those that
happen during or shortly after treatment. They usually are gone within a few weeks after
(15 of 36)
treatment. Late side effects are those that take months or years to develop. They are often
permanent.
The most common early side effects are:
• fatigue (feeling tired)
• skin changes
Other early side effects usually are related to the area being treated, such as hair loss and
mouth problems following radiation treatment to the head.
Most side effects go away in time. In the meantime, there are ways to reduce the discomfort
they may cause. If you have bad side effects, the doctor may stop your treatments for a while,
change the schedule, or change the type of treatment you are getting. Tell your doctor, nurse,
or radiation therapist about any side effects you notice so they can help you manage them.
The information here can serve as a guide to handling some side effects, but it cannot replace
talking with your doctor or nurse about what is happening to you.
Dealing with fatigue
Fatigue is the feeling of being tired physically, mentally, and emotionally. It is very common
with cancer and its treatment, and often happens with radiation therapy. Managing fatigue is
an important part of care for you and your loved ones.
Fatigue means having less energy to do the things you normally do or want to do. It can last a
long time and can interfere with your usual activities. It is different from the fatigue of
everyday life, which is usually short-term and relieved by rest. Cancer-related fatigue is more
severe and more distressing. Rest does not always relieve it. Cancer-related fatigue can:
• differ from one day to the next in how bad it is and how much it bothers you
• be overwhelming and make it hard for you to feel well
• make it hard to be with your friends and family
• make you less able to keep up your normal activities, including going to work
• make it hard to follow your cancer treatment plan
• last different lengths of time, which makes it hard to guess how long you will have it
Only you know if you have fatigue and how bad it is. No lab tests or x-rays can diagnose or
describe your level of fatigue. The best measure of fatigue comes from your own report to
your doctor or nurse. You can describe your level of fatigue as none, mild, moderate, or
severe. Or you can use a scale of 0 to 10, where a 0 means no fatigue, and a 10 is the worst
fatigue you could imagine. Either way you choose, it is important to describe your fatigue to
your cancer team.
(16 of 36)
Most people begin to feel tired after a few weeks of radiation therapy. Fatigue usually gets
worse as your treatment goes on. Stress due to your illness, daily trips for treatment, and the
effects of radiation on normal cells may also worsen fatigue.
The cause of cancer-related fatigue is not always clear. But if the cause of fatigue is known,
treatment will be directed at the cause. For example, if anemia (low red blood cell counts) is
thought to be causing fatigue, the anemia can be treated. In some patients, treatment may
include correcting fluid and mineral imbalances in the blood. Increased physical activity,
treating sleep problems, and good nutrition all seem to improve fatigue. Education and
counseling are part of the treatment; they can help people learn how to conserve energy,
reduce stress, and use distraction to focus on things other than the fatigue.
By understanding fatigue, you can cope with it better and reduce your distress. Often, a
family member can help you talk to your health care team about your fatigue and how it
affects you.
Fatigue will usually go away over time after your treatment is finished. Until then, there are
some things that you can do to help you deal with it:
• Make a list of your regular activities in order of how important they are to you. Try to
do the important ones first, when you have the most energy.
• Ask for help from loved ones and friends.
• Place things that you use often within easy reach.
• Use methods to reduce stress, such as deep breathing, visual imagery, meditation,
prayer, talking with others, reading, listening to music, painting, or any other activity
that gives you pleasure.
• Keep a journal of how you feel each day. Take it with you when you see your doctor.
• Balance rest and activities. Avoid too much bed rest, which can make you feel weak.
Schedule activities so that you have time for plenty of rest. Most people find that a
few short rest periods are better than one long one.
• Discuss physical activity with your doctor before you start any exercise program.
• Unless you are given other instructions, eat a healthy diet that includes protein (meat,
milk, eggs, and beans), and drink plenty of water each day.
Let your doctor or nurse know about your fatigue and talk with them if:
• Your fatigue does not get better, keeps coming back, or gets worse.
• You are more tired than usual during or after an activity.
(17 of 36)
• You are feeling tired and it is not related to something you've done.
• You become confused or cannot focus your thoughts.
• You cannot get out of bed for more than 24 hours.
• Your fatigue disrupts your social life or daily routine.
If you need to take time off from work, talk to your employer. You may also have some
rights that will help you keep your job. Call us or visit our Web site to get more information
on fatigue, as well as information on the Americans with Disabilities Act and the Family and
the Medical Leave Act. Some of these laws can help people with cancer.
Dealing with skin problems
Your skin in the treatment area may look red, irritated, swollen, blistered, sunburned, or
tanned. After a few weeks, your skin may become dry, flaky, itchy, or peel. It is important to
let your doctor or nurse know about any skin changes. They can suggest ways to ease the
discomfort and maybe lessen further irritation.
Most skin reactions go away a few weeks after treatment ends. In some cases, though, the
treated skin will stay darker than it was before. You need to be gentle with your skin. Here
are some ways to do this:
• Use only lukewarm water and mild soap. Just let water run over the treated area. Do
not rub. Also be careful not to rub away the ink marks needed for your radiation
therapy.
• Do not wear tight clothing over the treatment area.
• Try not to rub, scrub, or scratch any sensitive spots.
• Do not put anything that is hot or cold, such as heating pads or ice packs, on your
treated skin, unless your doctor tells you to do so.
• Do not use a pre-shave or after-shave lotion or hair-removal products. Use an electric
shaver if you must shave the area, but first check with your doctor or nurse.
• Ask your doctor or nurse before using any powders, creams, perfumes, deodorants,
body oils, ointments, lotions, or home remedies in the treatment area while you are
being treated and for several weeks afterward. Many skin products can leave a
coating on the skin that can cause irritation, and may even change the dose of
radiation that enters the body.
• Avoid exposing the area to the sun during treatment and for at least 1 year after your
treatment is completed. Do not use tanning beds.
(18 of 36)
• If you expect to be in the sun for more than a few minutes, wear protective clothing
(such as a hat with a broad brim and shirt with long sleeves) and use a sunscreen. Ask
your doctor or nurse about using sunscreen lotions.
What can I do about hair loss?
Radiation therapy can cause hair loss (alopecia), but only in the area being treated. For
example, if you get treatment to your hip, you will not lose hair from your head. But
radiation to your head may cause you to lose some or all of the hair on your head.
Most patients find that their hair grows back after the treatments are finished, but dealing
with hair loss can be hard. When it does grow back, your hair may be thinner or a different
texture than it was before. Ask your doctor or nurse if you have questions or concerns about
hair loss.
If you do lose your hair, your scalp may be tender and you may want to cover your head.
You should wear a hat or scarf to protect your head when you are in the sun. If you prefer to
wear a hairpiece or wig, be sure the lining does not irritate your scalp. Your local American
Cancer Society office may be able to help you get wigs or hats. You may also want to check
to see if head coverings are a tax-deductible expense or if they are covered by your health
insurance.
Will my blood counts be affected?
Radiation therapy can cause low white blood cell counts or low levels of platelets, but this is
rare. These blood cells help your body fight infection and prevent bleeding. If your blood
tests show this side effect, treatment might be delayed for about a week to allow your blood
counts to return to normal. This side effect is more likely to happen if you are also getting
chemotherapy.
Will I have eating problems?
Radiation to the head and neck or parts of the digestive system may cause eating and
digestion problems. You may lose interest in food during your treatment. Even if you are not
hungry, you should try to eat protein and high-calorie foods. Doctors have found that patients
who eat well can better handle their cancer treatments and side effects.
(19 of 36)
Coping with short-term diet problems may be easier than you expect. There are a number of
guides and recipe booklets for patients who need help with eating problems. You can get a
copy of our free booklet, Nutrition for the Person with Cancer: A Guide for Patients and
Families, by calling our toll-free number, or you can read it on cancer.org.
The list below suggests things you can do when you don't feel like eating, and how to make
the most of it when you do feel like eating.
• Eat when you are hungry, even if it is not mealtime.
• Eat 5 or 6 small meals during the day rather than 2 or 3 large ones.
• Vary your diet and try new recipes.
• If you enjoy company while eating, try to eat with family or friends, or turn on the
radio or television.
• Keep healthful snacks close by for nibbling when you get the urge.
• If other people offer to cook for you, let them. Do not be shy about telling them what
you would like to eat.
• If you live alone, you might want to arrange for programs like Meals on Wheels to
bring food to you. Ask your doctor, nurse, or local American Cancer Society office
about Meals on Wheels in your area.
• If you drink alcohol, ask your doctor if you should avoid alcohol during your
treatment. Find out if it will interact with any medicines you are taking.
If you are able to eat only small amounts of food, you can increase the calories per serving by
trying the following:
• Add butter or olive oil.
• Mix canned cream soups with milk or half-and-half rather than water.
• Drink milkshakes, instant breakfast mixes, or liquid supplements (in cans or bottles)
between meals.
• Add cream sauce or melted cheese to your favorite vegetables.
Some people find they can handle large amounts of liquids even when they do not feel like
eating solid foods. If this is the case for you, try to get the most from each glassful by making
drinks enriched with powdered milk, yogurt, honey, or liquid nutrition drinks.
(20 of 36)
Talk to your health care team about any eating problems you may be having. They can help
you find ways to feel better and get the nutrients your body needs.
How will I feel emotionally?
Many patients feel tired due to the radiation therapy and this can affect emotions. You also
might feel depressed, afraid, angry, frustrated, alone, or helpless.
Attending a support group of other people with cancer may help you. Ask your doctor or call
the American Cancer Society for more information about ways to meet with others who share
your problems and concerns.
Will side effects limit my activity?
Side effects might limit your ability to do things. But what you can do will depend on how
you feel. Some patients are able to go to work or enjoy leisure activities while they have
radiation therapy. Others find they need more rest than usual and cannot do as much. Your
doctor may suggest you limit activities that might irritate the area being treated.
Are there long-term side effects I should be concerned about?
During and right after radiation therapy, it may be hard to think ahead to what may happen
many years in the future. But depending on the type of treatment and the location of the
cancer, there may be long-term side effects from your radiation treatment. (Some of these are
described in more detail in the next section.) Even though long-term problems are less
common than short-term side effects, they should still be taken into account when making
decisions about radiation therapy.
Damage to your body
Radiation can damage normal cells, and sometimes this damage can have long-term effects.
For example, radiation to the chest area may affect the lungs or heart. In some people this
may cause scarring, which can affect a person’s ability to do things. Radiation to the
abdomen (belly) or pelvis can lead to bladder, bowel, or sexual problems in some people.
Radiation in certain areas can also lead to fluid build-up and swelling in parts of the body, a
condition known as lymphedema.
(21 of 36)
Risk of another cancer
Another thing some people worry about is a possible increased risk of getting a second
cancer some time in the future. This increase in risk is small but real.
The link between radiation and cancer was noted many years ago in studies of atomic bomb
survivors, workers exposed to radiation on their jobs, and patients treated with radiation
therapy. Young women, for example, who had gotten whole body radiation for the treatment
of Hodgkin disease were found to be at increased risk for breast cancer and other cancers
later in life. (This treatment is no longer common.) And some cases of leukemia are also
related to radiation exposure. The leukemia usually develops within a few years of exposure.
The risk peaks about 5 to 9 years after the radiation exposure and then slowly declines. Other
types of cancer after radiation exposure take much longer to develop. Most do not happen
until at least 10 years after radiation exposure, and some are diagnosed 15 or more years
later.
What does this mean to me?
Radiation therapy techniques have steadily improved over the last few decades. Treatments
now target the cancers more precisely, and more is known about choosing the best radiation
doses. More precise radiation means less damage to nearby, healthy tissues. These advances
are also expected to reduce the number of second cancers that result from radiation therapy.
The overall risk of second cancers is low and must be weighed against the benefits gained
with radiation treatments.
Talk to your doctor before you start radiation treatment to make sure you are aware of the
possible long-term effects. This can help you make an informed treatment decision and help
you know what symptoms you may need to watch out for after treatment.
Managing side effects of treatment to certain parts of the body
Radiation therapy to the head and neck
Some people who get radiation to the head and neck have redness and soreness in the mouth,
a dry mouth, trouble swallowing, changes in taste, or nausea. Other possible side effects
include a loss of taste, earaches, and swelling. You may lose your hair, your skin texture
might change, and your jaw may feel stiff.
(22 of 36)
If you get radiation therapy to the head or neck, you need to take good care of your teeth,
gums, mouth, and throat.
Here are a few tips that may help you manage mouth problems:
• Avoid spices and coarse foods such as raw vegetables, dry crackers, and nuts.
• Do not eat or drink very hot or very cold foods.
• Do not smoke, chew tobacco, or drink alcohol because tobacco and alcohol can make
mouth sores worse.
• Stay away from sugary snacks.
• Ask your doctor or nurse to recommend a good mouthwash. The alcohol content in
some mouthwashes has a drying effect on mouth tissues.
• Rinse your mouth with warm salt water every 1 to 2 hours as needed. (Use 1 teaspoon
of salt in 1 quart of water.)
• Sip cool drinks often throughout the day.
• Eat sugar-free candy or chew gum to help keep your mouth moist.
• Moisten food with gravies and sauces to make eating easier.
• Ask your doctor or nurse about medicines to help treat mouth sores and control pain
while eating.
If these measures are not enough, ask your dentist about artificial saliva. Mouth dryness may
be a problem even after treatment is over.
Dental care
Radiation treatment of your head and neck can increase your chances of getting cavities.
Mouth care to prevent problems will be an important part of your treatment. Before starting
radiation therapy, get a complete check-up with your dentist. Ask your dentist to talk with
your radiation oncologist before your treatments begin. If you have problem teeth, your
dentist may suggest you have them removed before starting treatment. Radiation (and dry
mouth) may damage them to the point where they will need to be removed. This may be
harder to do after treatment has started.
If you wear dentures, they may no longer fit well because of swollen gums. If your dentures
cause gum sores, you may need to stop wearing them until your radiation therapy is over
because these sores can become infected.
Your dentist probably will want to see you during your radiation therapy to talk to you about
caring for your mouth and teeth and help you deal with any soreness. Most likely, you will be
told to do the following:
• Clean your teeth and gums with a very soft brush after meals and at least one other
time each day.
• Use fluoride toothpaste that contains no abrasives.
(23 of 36)
• Use unwaxed dental tape to gently floss between teeth once a day.
• Rinse your mouth well with cool water or a baking soda solution after you brush.
(Use 1 teaspoon of baking soda in 1 quart of water.)
Radiation therapy to the brain
Stereotactic radiosurgery is often used when cancer has only spread to a few sites in the
brain. Side effects vary depending on where the radiation is aimed, and usually become most
serious 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch
for and when to call for help.
Sometimes the whole brain is treated with radiation when cancer has spread into many sites.
This may also be done to prevent cancer from spreading to the brain. Whole brain radiation
can cause some of the following side effects:
• headaches
• swelling of the brain
• hair loss
• nausea
• vomiting
• fatigue
• hearing loss
• skin and scalp changes
• trouble with memory and speech
• seizures
Medicines are usually given to prevent brain swelling, but it is important to let your doctor
know about headaches and other symptoms. Delayed effects (usually 1 or 2 years later) of
whole brain radiation can be caused by death of brain tissue. These delayed effects can
include serious problems such as memory loss, stroke-like symptoms, and poor brain
function.
Radiation therapy to the breast and chest
Radiation treatment to the chest may cause swallowing problems, cough, or shortness of
breath. Be sure to tell your doctor or nurse if you notice any of these side effects.
If you get radiation therapy after surgery (such as a lumpectomy or mastectomy) for breast
cancer, try to go without wearing a bra whenever you can. If this is not possible, wear a soft
(24 of 36)
cotton bra without underwire so that your skin is not irritated. If your shoulders feel stiff, ask
your doctor or nurse about exercises to keep your arms moving freely.
Other side effects may include breast soreness and swelling from fluid build-up in the treated
area. These side effects most likely will go away a month or 2 after you finish radiation
therapy. If fluid build-up continues to be a problem (a condition called lymphedema), ask
your doctor what steps you can take. You can also call us or visit our Web site for more
information on lymphedema.
Skin in the treated area may turn red or get darker. This will most likely fade 1 or 2 months
after you finish radiation.
Radiation therapy after breast surgery may cause other long-term changes in the breast. Your
skin may be slightly darker, and pores may be enlarged and more noticeable. The skin may
be more or less sensitive and feel thicker and firmer than it was before your treatment.
Sometimes the size of your breast changes -- it may become larger because of fluid build-up
or smaller because of the development of fibrous tissue. Many women have little or no
change in breast size. These side effects may continue for a year or longer after treatment.
If your treatment includes internal radiation implants, you might notice breast tenderness or
tightness. After the implants are removed, you are likely to have some of the same side
effects that happen with external radiation treatment. If so, follow the advice given above and
let your doctor know about any problems that persist.
After 12 months, you should not have any new changes. If you do see changes in breast size,
shape, appearance, or texture after this time, report them to your doctor right away.
When radiation treatments include the chest area, the lungs can be affected. One early change
is a decrease in the levels of surfactant, the substance that helps keep the air passages open.
This keeps the lungs from fully expanding, and may cause shortness of breath or cough.
These symptoms are sometimes treated with steroids.
A possible late effect of radiation to the lungs is fibrosis (stiffening or scarring). When this
happens, the lungs can no longer fully inflate and take in air. If a large area of the lungs is
treated with radiation, these changes can cause shortness of breath and less tolerance for
physical activity.
Radiation therapy to the stomach and abdomen
If you are having radiation treatment to the stomach or some part of the abdomen (belly), you
may have vomiting, nausea, or diarrhea. Your doctor can give you medicines to help relieve
these problems. Check with your doctor or nurse about any home remedies you are thinking
about taking during your treatment.
(25 of 36)
Managing nausea
Some patients report feeling queasy for a few hours right after radiation therapy. If you have
this problem, do not eat for several hours before your treatment. You may be able to handle
the treatment better on an empty stomach. After treatment, you may want to wait 1 to 2 hours
before eating. If the problem persists, ask your doctor about medicines to prevent and treat
nausea. Be sure to take the medicine as prescribed.
If you notice nausea before your treatment, eat a bland snack, such as toast or crackers, and
try to relax as much as possible. Here are some tips to help an upset stomach:
• Stick to any special diet your doctor or dietitian gives you.
• Eat small meals.
• Eat often and try to eat and drink slowly.
• Avoid foods that are fried or high in fat.
• Drink cool liquids between meals.
• Eat foods that don't have strong smells and can be served cool or at room
temperature.
• For a severe upset stomach, try a clear liquid diet (broth and juices) or bland foods
that are easy to digest, such as dry toast and gelatin.
• Learn deep breathing and relaxation techniques, and try them when you feel
nauseated.
Please call us or visit our Web site for more information on how to manage nausea and
vomiting.
How to handle diarrhea
Diarrhea most often begins a few weeks after starting radiation therapy. Your doctor may
prescribe medicine or give you special instructions to help with the problem. He or she may
also recommend changes in your diet, such as:
• Try a clear liquid diet (water, weak tea, apple juice, peach nectar, clear broth,
popsicles, and plain gelatin) as soon as diarrhea starts or when you feel it is going to
start.
• Avoid foods that are high in fiber or can cause gas or cramps, such as raw fruits and
vegetables, coffee, beans, cabbage, whole grain breads and cereals, sweets, and spicy
foods.
• Eat frequent small meals.
• Avoid milk and milk products if they irritate your bowels.
• When the diarrhea starts to improve, try eating small amounts of low-fiber foods such
as rice, bananas, applesauce, yogurt, mashed potatoes, low-fat cottage cheese, and dry
toast.
(26 of 36)
• Be sure you take in enough potassium (bananas, potatoes, apricots, peaches), an
important mineral you may lose through diarrhea.
Diet planning is an important part of radiation treatment of the stomach and abdomen. Keep
in mind these problems will get better when treatment is over. In the meantime, try to pack
the highest possible food value into even small meals so you get enough calories, vitamins,
and minerals.
Radiation therapy to the pelvis
If you get radiation therapy to any part of the pelvis, you might have one or more of the
digestive problems already described. You may have some irritation of your bladder, too,
which can be uncomfortable and cause you to urinate often. You may also have effects on
your fertility and sex life.
Fertility
Women: Do not try to become pregnant during radiation therapy because radiation can harm
the fetus. Women should talk to their doctor about birth control options and how radiation
may affect their fertility. If you are pregnant, let your doctor know before beginning
treatment.
Depending on the radiation dose, women having radiation therapy in the pelvic area may stop
having their menstrual periods and have other symptoms of menopause. Treatment also can
result in vaginal itching, burning, and dryness. Report these symptoms to your doctor so you
can learn about options for relieving these side effects.
Men: For men, radiation therapy to an area that includes the testes can reduce both the
number of sperm and their ability to function. This does not mean, though, that pregnancy
cannot occur. If you want to father a child and are concerned about reduced fertility, talk to
your doctor before starting treatment. One option may be to bank your sperm ahead of time.
Other than studies that looked at survivors of atomic bomb blasts, there is little information
about radiation's effect on the children conceived by men during or after getting radiation
therapy. Because of the uncertain risk, doctors often advise men to avoid getting a woman
pregnant during and for some weeks after treatment, especially if there is radiation to or near
the genital area.
Sexual relations
With some types of radiation therapy involving the pelvis, men and women may notice some
change in their ability to enjoy sex or a decrease in their level of desire.
(27 of 36)
Women: During treatment to the pelvis, some women are advised not to have sex. Some
women may find it painful. You most likely will be able to resume having sex within a few
weeks after your treatment ends, but check with your doctor first. Some types of treatment
may have more long-term effects, such as scar tissue that could affect the ability of the
vagina to stretch during sex. Again, your doctor may be able to offer suggestions if this
happens to you. You can also get more information from our booklet, Sexuality for the
Woman with Cancer.
Men: Radiation may affect the nerves that make a man able to have an erection. If a man is
having seed implant radiation therapy, he should check with his doctor about safety
precautions, such as using condoms. If erection problems do occur, it is usually gradual over
the course of many months or years. Talk with your doctor about treatment options if this is a
concern for you. You can get more information from our booklet, Sexuality For the Man with
Cancer.
Follow-up care
What does "follow-up" mean?
No matter what type of cancer you have had, you will still need regular doctor visits to check
your progress after your radiation therapy ends. You may also need help to deal with any
problems that may come up. This phase of your treatment is called follow-up care. Your
follow-up care will include checking the results of your treatment, but it may also involve
more cancer treatment, rehabilitation, and counseling. It may include appointments with your
original doctor, surgeon, medical oncologist (a doctor specially trained to treat patients with
chemotherapy), and your radiation oncologist. Your follow-up care will depend on what type
of cancer you have and other treatments you have had or will have.
Questions you may want to ask your doctor after radiation therapy:
• When can I go back to normal activities?
• How often will I need to see you?
• Which tests will be done and why?
• What symptoms or side effects should I continue to look for and let you know about?
• When can I wear a prosthesis or have reconstructive surgery?
• Do I need to continue changes in my diet?
• When can I resume sexual activity or try to have a baby?
Care after radiation therapy
(28 of 36)
For a short time following your therapy, you will need to continue some of the special care
used during your treatment. For instance, if you have skin problems after your treatment
ends, be gentle with skin in the treatment area until all signs of irritation are gone. You may
need extra rest while your healthy tissues are rebuilding. You may need to limit your
activities to conserve your energy and not try to go back to your regular schedule right away.
Pain after therapy
A few patients need help managing pain that continues after radiation therapy. Unless
directed by your doctor, do not use a heating pad or warm compress to relieve pain in any
area treated with radiation. Talk to your doctor or nurse and describe the location and type of
pain in as much detail as possible. Keep working with your cancer team until you are able to
get this under control.
You can get more information in our booklet, Pain Control: A Guide for Those with Cancer
and Their Loved Ones.
When should I call the doctor?
After treatment, you are likely to be more aware of your body and any slight changes in how
you feel from day to day. If you have any of the problems listed below, tell your doctor at
once:
• pain that does not go away, especially if it is always in the same place
• lumps, bumps, or swelling
• nausea, vomiting, diarrhea, loss of appetite, or trouble swallowing
• unexplained weight loss
• fever or cough that doesn't go away
• unusual rashes, bruises, or bleeding
• any other signs mentioned by your doctor or nurse
Do not hesitate to let your doctor know about any new problems or concerns you have. It is
always best to find out the cause of a problem so it can be dealt with right away.
What about going back to work?
If you have stopped working, you can return to your job as soon as you and your doctor
believe you are up to it. Some people are even able to work during their radiation therapy. If
your job requires lifting or heavy physical activity, you may need to change your routine
until you have regained your strength.
(29 of 36)
When you are ready to return to work, learn about your rights regarding your job and health
insurance. If you have any questions about employment issues, contact us for help.
What records do I need to keep?
You will want to get copies of your treatment records to keep. It is important that you be able
to give any new doctor you might see in the future the exact details of your diagnosis and
treatment. Make sure you have the following information handy:
• a copy of your pathology report from any biopsy or surgery
• if you had surgery, a copy of your operative report
• if you had radiation therapy, a copy of your treatment summary
• if you were hospitalized, a copy of the discharge summary that every doctor must
prepare when patients are sent home from the hospital
• finally, since some drugs can have long-term side effects, a list of your drugs, drug
doses, and when you took them
Any time you see a new doctor, be sure that you make copies of these records and keep your
originals for yourself. After a certain period of time, the doctors' offices and hospitals destroy
this kind of information.
Glossary
These are words that you may hear your health care team use.
accelerated radiation: radiation schedule in which the total dose is given over a shorter
period of time. (Compare to hyperfractionated radiation.)
adjuvant therapy (add-joo-vunt): a treatment used in addition to the main (primary)
therapy. Radiation therapy often is used as an adjuvant to surgery.
alopecia (al-o-pee-shuh): hair loss
anesthesia (an-es-thee-zhuh): loss of feeling, sensation, or consciousness resulting from the
use of certain drugs or gases. Also used to describe the drug or gas used to cause this.
anti-emetic (an-tie-eh-MEH-tik): a drug to prevent or treat nausea or vomiting.
applicator: (ap-lick-ate-ur) a device used to place an implant or a medicine into the body.
benign tumor (be-nine too-mer): a tumor that is not cancer.
(30 of 36)
biologic therapy (by-uh-lah-jick): treatment that uses the immune system to fight infection
and disease. Also called immunotherapy or immune therapy.
biopsy (by-op-see): the removal of a sample of tissue that is looked at under a microscope to
see if it contains cancer or other abnormal cells.
brachytherapy (brake-ee-THER-uh-pee): internal radiation treatment done by implanting
radioactive material directly into the tumor or close to it. Also called internal radiation
therapy.
cancer: a general term for more than 100 diseases that have uncontrolled, abnormal growth
of cells that can invade and destroy healthy tissues.
catheter (cath-uh-tur): a thin, flexible tube through which fluids or other materials be put in
or taken out of the body.
centigray (cGy) (sent-uh-gray): the preferred measurement of the amount of radiation dose
absorbed by the body (1 cGy = 1 rad).
chemotherapy (key-mo-THER-uh-pee): the use of certain types of drugs to treat cancer.
conformal radiation therapy (con-for-mul ray-dee-A-shun): a newer type of radiation
treatment that uses a special computer to help shape the beam of radiation to match the shape
of the tumor and delivers the beam from different directions. This reduces the amount of
exposure to nearby healthy tissues.
dietitian (also registered dietitian): a health professional who plans well-balanced diet
programs, including special diets to meet needs of people with various medical conditions.
dosimetrist (doe-sim-uh-trist):: a person who plans and calculates the proper radiation dose
for treatment.
electron beam (ee-leck-tron): a stream of high-energy particles called electrons used to treat
cancer.
external radiation: radiation therapy that uses a machine located outside of the body to aim
high-energy rays at cancer cells.
fractionated radiosurgery: see stereotactic radiosurgery.
fractionation (frack-shun-A-shun): dividing the total dose of radiation into smaller doses in
order to reduce damage to healthy tissues.
fractions: the smaller, divided doses of radiation that are given each day.
(31 of 36)
gamma rays: high-energy rays that come from a radioactive source such as cobalt-60.
helical tomotherapy (he-lick-ul toe-mah-gruff-ee): a newer form of intensity modulated
radiation therapy (IMRT) in which the radiation is directed from a donut-shaped machine
that spirals around the body.
high-dose-rate (HDR) brachytherapy: a type of internal radiation in which the radioactive
source is in place only for a few minutes and then removed. This may be repeated several
times over a few days to weeks.
hyperfractionated radiation (hi-per-frack-shun-ate-ed): radiation schedule in which it is
given in smaller doses and more than once a day, but the overall length of treatment is the
same. (Compare to accelerated radiation.)
immune therapy: treatment that uses the immune system to fight infection and disease. Also
called biologic therapy or immunotherapy.
implant, radioactive: a small source or container of radioactive material placed in the body,
either in or near a cancer. (See also brachytherapy.)
intensity modulated radiation therapy (IMRT) (in-ten-si-tee mod-you-late-ed): an
advanced method of conformal radiation therapy in which the beams are aimed from many
directions and the intensity (strength) of the beams is controlled by computers. This allows
more radiation to reach the treatment area while reducing the radiation to healthy tissues.
(See also conformal radiation therapy.)
internal radiation: a type of therapy in which a radioactive substance is implanted into or
close to the area needing treatment. Also called brachytherapy.
interstitial radiation (in-ter-stih-shul): a type of internal radiation in which a radioactive
source (implant) is put directly into the tissue (not in a body cavity).
intracavitary radiation (in-truh-kav-it-err-ee): a type of internal radiation in which a
radioactive source (implant) is placed in a body cavity, such as the vagina, as opposed to
directly into a tumor.
intraoperative radiation (in-truh-op-ruh-tiv): a type of external radiation therapy used to
deliver a large dose of radiation to the tumor and surrounding tissue during surgery.
linear accelerator (lin-ee-er ak-sell-er-a-ter): a machine that creates high-energy radiation to
treat cancers using electricity to form a beam of fast-moving subatomic particles. Also called
mega-voltage (MeV) linear accelerator or a linac.
malignant (muh-lig-nunt): cancer
(32 of 36)
medical oncologist: a doctor who is specially trained in the diagnosis and treatment of
cancer and who specializes in the use of chemotherapy and other drugs to treat cancer.
metastasis (meh-tass-tuh-sis): the spread of cancer cells to distant areas of the body by way
of the lymph system or bloodstream. Also used to describe the area to which cancer has
spread. The plural is metastases.
oncologist (on-call-uh-jist): a doctor who specializes in caring for people who have cancer.
oncology (on-call-uh-jee): the branch of medicine devoted to the diagnosis and treatment of
cancer.
palliative care (pal-ee-uh-tiv): treatment intended to relieve symptoms caused by cancer,
rather than to cure it. Palliative care can help people live more comfortably.
physical therapist: a health professional who helps patients use exercises and other methods
to restore or maintain the body's strength, mobility, and function.
platelets (plate-uh-lets): special blood cell fragments that help stop bleeding.
port (also treatment field): the area of the body through which external beam radiation is
directed to reach a tumor.
prosthesis (pros-thee-sis): an artificial replacement for a part of the body.
proton beam therapy: a form of external radiation that uses proton beams to kill cancer
cells. Protons are parts of atoms that cause little damage to tissues they pass through but are
very good at killing cells at the end of their path.
rad: short for "radiation absorbed dose"; an older term of measurement of the amount of
radiation absorbed by the body (1 rad = 1 cGy). (See centigray.)
radiation: energy carried by waves or a stream of particles. Types of radiation used to treat
cancer include x-ray, electron beam, alpha and beta particle, and gamma ray. Radioactive
substances include forms of cobalt, radium, iridium, cesium, iodine, strontium, samarium,
phosphorus, and palladium.
radiation oncologist: a doctor who specializes in using radiation to treat cancer.
radiation physicist: a person trained to ensure that the radiation machine delivers the right
amount of radiation to the treatment area. This person works with the radiation oncologist
and dosimetrist to design, plan, and calculate the proper dose for radiation treatment. (See
dosimetrist.)
(33 of 36)
radiation therapist: a person with special training to work the equipment that delivers the
radiation.
radiation therapy or radiation treatment: the use of high-energy rays or subatomic
particles that penetrate the body to treat disease.
radiation therapy nurse: a registered nurse who has special training in oncology and
radiation therapy.
radiologist: a doctor with special training in reading and interpreting diagnostic x-rays and
scans and performing specialized x-ray procedures.
radiopharmaceuticals (ray-dee-o-farm-uh-SUIT-uh-kulls): radioactive substances that are
taken by mouth or injected into the body. They collect in the area of the tumor and help stop
its growth..
radio-resistance: the ability of cells to not be affected by radiation.
radio-sensitivity: how susceptible a cell, cancerous or healthy, is to radiation. Cells that
divide frequently are especially radiosensitive and are more affected by radiation.
simulation: a process involving special x-ray pictures that is used to plan radiation treatment
so that the area to be treated is precisely located and marked.
social worker: a mental health professional with a master's degree in social work (MSW). A
social worker can help people manage medical, psychological, social, and educational needs.
stereotactic radiosurgery: a type of radiation treatment that gives a large dose of radiation
to a small tumor area, usually in a single session. It is mostly used for brain tumors and other
tumors inside the head. Though it is not surgery, it is able to focus the radiation on small
areas. There are different types of equipment for this, such as the X-Knife™, CyberKnife®,
Clinac®, and Gamma Knife®. Sometimes doctors give the radiation in many smaller
treatments to deliver the same or slightly higher dose. This is sometimes called fractionated
radiosurgery or stereotactic radiotherapy.
systemic radiation: uses radioactive materials such as iodine 131 and strontium 89 to kill
cancer cells. The materials may be taken by mouth or injected into the body. (See
radiopharmaceuticals.)
teletherapy (tell-uh-thair-up-ee): treatment in which the radiation source is at a distance
from the body (external radiation).
treatment field (or port): the place on the body at which the radiation beam is aimed.
(34 of 36)
tumor: an abnormal lump or mass of tissue. Tumors are either benign (not cancer) or
malignant (cancer).
unsealed radiation: internal radiation therapy that is swallowed or given by injecting a
radioactive substance into the bloodstream or a body cavity. This substance is not sealed in a
container or implant.
white blood cells: the blood cells that help defend the body against infection.
x-ray: a form of radiation that can be used either at low levels to make an picture of the
inside of the body on film or at high levels to kill cancer cells.
Additional resources
More information from your American Cancer Society
The following related information may also be helpful to you. These materials may be
ordered from our toll-free number, 1-800-ACS-2345 or read on our Web site at
www.cancer.org.
Caring for the Patient with Cancer at Home: A Guide for Patients and Families (also
available in Spanish)
Fatigue in People with Cancer
Nutrition for the Person with Cancer: A Guide for Patients and Families (also available in
Spanish)
Pain Control: A Guide for Those with Cancer and Their Loved Ones (also available in
Spanish)
Radiation Exposure and Cancer (also available in Spanish)
Radiation Therapy Principles (also available in Spanish)
Sexuality For the Man With Cancer (also available in Spanish)
Sexuality for the Woman with Cancer (also available in Spanish)
Surgery (also available in Spanish)
Understanding Chemotherapy: A Guide for Patients and Families (also available in Spanish)
(35 of 36)
Understanding Your Lab Test Results
Americans with Disabilities Act: Information for People Facing Cancer
Family and Medical Leave Act (FMLA)
What Is COBRA? (also available in Spanish)
National organizations and Web sites*
Along with the American Cancer Society, other sources of patient information and support
include:
American College of Radiology (ACR)
Toll-free number: 1-800-227-5463
Web site: www.acr.org
American Society for Radiation Oncology (ASTRO)
Toll-free number: 1-800-962-7876
Web site: www.astro.org
(Online brochures on radiation therapy are available at www.rtanswers.org.)
National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
Web site: www.cancer.gov
*Inclusion on this list does not imply endorsement by the American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or night, for cancer-related
information and support. Call us at 1-800-ACS-2345 (1-800-227-2345) or visit
www.cancer.org.
References
American College of Radiology and the Radiological Society of North America. Brain
Tumors. Available at: http://www.radiologyinfo.org/en/info.cfm?pg=thera-brain&bhcp=1.
Accessed December 2, 2008.
Aoyama H, Shirato H, Tago M, et al. Stereotactic Radiosurgery Plus Whole-Brain Radiation
Therapy vs Stereotactic Radiosurgery Alone for Treatment of Brain Metastases: A
Randomized Controlled Trial. JAMA. 2006;295:2483-2491.
(36 of 36)
Brent R. Pregnancy and Radiation Exposure. Health Physics Society web site. Available at:
http://hps.org/hpspublications/articles/pregnancyandradiationexposureinfosheet.html.
Accessed December 3, 2008.
Halperin EC. Particle therapy and treatment of cancer. Lancet Oncol 2006;7:676-685.
Mundt AJ, Roeske JC, Chung TD, Weichselbaum RR. Radiation oncology. In: Kufe DW,
Bast RC, Hait WN, et al, eds. Cancer Medicine. 7th ed. Hamilton, Ontario. BC: Decker Inc;
2006: 517-536.
National Cancer Institute. Radiation Therapy for Cancer: Questions and Answers. Available
at: http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Accessed November 26,
2008.
Perez CA, Brady LW, Halperin EC, Schmidt-Ullrich RK (Eds). Principles and Practice of
Radiation Oncology, Fourth Ed. Philadelphia: Lippincott Williams & Wilkins 2004.
Last Medical Review: 12/23/2008
Last Revised: 12/23/2008
2008 Copyright American Cancer Society
COMMENTS
-