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Side Effects of
Treatment
It is hard to limit the
effects of cancer treatment so that only cancer cells are
removed or destroyed. Because healthy cells and tissues may
also be damaged, treatment often causes unwanted side effects.
The side effects of cancer
treatment are different for each person, and they may even be
different from one treatment to the next. Doctors try to plan
treatment to keep problems to a minimum. They also watch
patients carefully so that they can help with any problems
that occur. The National Cancer Institute booklets Radiation
Therapy and You, Chemotherapy
and You, and Understanding
Breast Cancer Treatment: A Guide for Patients have
helpful information about these cancer treatments and coping
with their side effects.
Surgery
Surgery causes short-term
pain and tenderness in the area of the operation, so women may
need to talk with their doctor about which method of pain
control would be appropriate. Any kind of surgery also carries
a risk of infection, poor wound healing, bleeding, or a
reaction to the anesthesia used in surgery. Women who
experience any of these problems should tell their doctor or
nurse right away.
Removal of a breast can
cause a woman's weight to shift and be out of
balance--especially if she has large breasts. This imbalance
can cause discomfort in a woman's neck and back. Also, the
skin in the breast area may be tight, and the muscles of the
arm and shoulder may feel stiff. After a mastectomy, some
women have some permanent loss of strength in these muscles,
but for most women, reduced strength and limited movement are
temporary. The doctor, nurse, or physical therapist can
recommend exercises to help a woman regain movement and
strength in her arm and shoulder.
Because nerves may be
injured or cut during surgery, a woman may have numbness and
tingling in the chest, underarm, shoulder, and arm. These
feelings usually go away within a few weeks or months, but
some women may have permanent numbness.
Removing the lymph nodes
under the arm slows the flow of lymph. In some women, this
fluid builds up in the arm and hand and causes swelling (lymphedema).
Women need to protect the arm and hand on the treated side
from injury, even long after surgery. They should ask the
doctor how to handle any cuts, scratches, insect bites, or
other injuries that may occur. Also, they should contact the
doctor if an infection develops in the arm or hand.
Radiation Therapy
The radiation oncologist
will explain the possible side effects of radiation therapy
for breast cancer--including uncommon side effects that may
involve the heart, lungs, and ribs. One of the common side
effects is fatigue, especially in the later weeks of treatment
and for sometime afterward. Resting is important, but doctors
usually advise their patients to try to stay reasonably
active, matching their activities to their energy level. It is
also common for the skin in the treated area to become red,
dry, tender, and itchy. Toward the end of treatment, the skin
may become moist and "weepy." Exposing this area to
air as much as possible will help the skin heal. Because bras
and some types of clothing may rub the skin and cause
irritation, patients may want to wear loose-fitting cotton
clothes. Good skin care is important at this time, and
patients should check with their doctor before using any
deodorants, lotions, or creams on the treated area. These
effects of radiation therapy on the skin are temporary, and
the area gradually heals once treatment is over. However,
there may be a permanent change in the color of the skin.
For most women, the breast
will look and feel about the same after radiation therapy.
Occasionally, the treated breast may be firmer. Also, it may
be larger (due to fluid buildup) or smaller (because of tissue
changes) than it was before. For some women, the breast skin
is more sensitive after radiation treatment; for others, it is
less sensitive.
Chemotherapy
The side effects of
chemotherapy depend mainly on the drugs the patient receives.
As with other types of treatment, side effects vary from
person to person. In general, anticancer drugs affect rapidly
dividing cells. These include blood cells, which fight
infection, cause the blood to clot, and carry oxygen to all
parts of the body. When blood cells are affected by anticancer
drugs, patients are more likely to get infections, bruise or
bleed easily, and may have less energy during treatment and
for some time afterward. Cells in hair
follicles and cells that line the digestive tract also
divide rapidly. As a result of chemotherapy, patients may lose
their hair and may have other side effects, such as loss of
appetite, nausea, vomiting, diarrhea, or mouth sores. Many of
these side effects can now be controlled, thanks to
improvements in antiemetics (drugs that reduce or prevent
vomiting) and other medications. Side effects generally are
short-term problems. They gradually go away during the
recovery part of the chemotherapy cycle or after the treatment
is over.
With modern chemotherapy,
long-term side effects are quite rare, but there have been
cases in which the heart is weakened, and second cancers such
as leukemia (cancer of the blood cells) have occurred. Also,
some anticancer drugs can damage the ovaries. If the ovaries
fail to produce hormones, the woman may have symptoms of
menopause, such as hot flashes and vaginal dryness. Her
periods may become irregular or may stop, and she may not be
able to become pregnant. However, some women may still be able
to get pregnant during treatment. Because the effects of
chemotherapy on an unborn child are not known, it is important
for a woman to talk to her doctor about birth control before
treatment begins. After treatment, some women regain their
ability to become pregnant, but in women over the age of 35 or
40, infertility
is likely to be permanent.
Hormonal Therapy
Hormonal therapy can cause
a number of side effects. They depend largely on the specific
drug or type of treatment, and they vary from patient to
patient. Tamoxifen is the most common hormonal treatment. This
drug blocks the body's use of estrogen but does not stop
estrogen production. Tamoxifen may cause hot flashes, vaginal
discharge or irritation, and irregular periods. Any unusual
bleeding should be reported to the doctor. Younger women
taking tamoxifen may become pregnant more easily and should
discuss birth control methods with their doctor.
Serious side effects of
tamoxifen are rare, but this drug can cause blood clots in the
veins, especially in the legs. In a very small number of
women, tamoxifen has caused cancer of the lining of the
uterus. The doctor may do a pelvic exam, as well as biopsies
or other tests of the lining of the uterus, to monitor for
this condition. (This does not apply to women who have had a
hysterectomy, surgery to remove the uterus.)
Young women whose ovaries
are removed to deprive the cancer cells of estrogen experience
menopause immediately. The side effects they have are likely
to be more severe than the effects of natural menopause.
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