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Possible Side Effects of Cancer Treatment

You are finished with your active cancer treatment and moving to the next phase of your life. You may find your life returns to what you knew before you had cancer. On the other hand, you may find that physical, psychosocial or financial concerns continue because of earlier treatments. Patients often call this the "new" normal.

Many cancer survivors face some of the following late or long-term side effects:

Physical Side Effects

Fatigue

Fatigue is the most common complaint of cancer survivors. Cancer-related fatigue results from the cancer, its treatment, and treatment side effects. Survivors often complain that they can't get over feeling tired, regardless of how much sleep they get. If you are experiencing fatigue, talk to your physician about coping strategies such as exercise, relaxation skills and energy conservation.

Cancer Recurrence or Secondary Cancers

All cancer patients live with the possibility that their cancer will recur or spread (metastasize). Some patients also may develop secondary cancers, some of which may be a result of treatments used for their original cancer.

Dental Problems

Chemotherapy may affect tooth enamel and increase the risk of long-term dental problems. High-dose radiation to the head and neck area can change tooth development and cause gum disease. It may also cause tooth decay or loss.

Soreness or ulcers in the mouth or throat may result from cancer treatment. These side effects can be painful and make it difficult for you to eat, talk and swallow. MD Anderson patients may be referred to a specialist in our dental clinic in the Department of Head and Neck Surgery if you have problems with your teeth, gums or mouth.

Xerostomia (dry mouth) is common in head and neck cancer survivors because salivary glands are susceptible to radiation damage. Xerostomia makes it harder to swallow, sleep, and speak, and is associated with loss of appetite due to altered taste.

Diabetes

Steroid drugs used to treat certain cancers may increase blood glucose levels (hyperglycemia) in some patients who do not have diabetes. Although it's unclear if these patients will develop diabetes, they are at higher risk because their glucose levels may remain elevated after treatment stops.

Endocrine Changes

Men and women whose cancer treatments are designed to eliminate the sex hormones that many cancers need to grow may experience the following side effects:

  • Decreased sex drive
  • Memory loss
  • Anemia
  • Decreased muscle mass
  • Depression
  • Weight gain
  • Loss of body hair

Hypothyroidism

Survivors of cancer to the head,  neck and Hodgkin's lymphoma who were treated with radiation therapy often suffer from hypothyroidism, a condition in which there is too little thyroid hormone. Symptoms include weight gain, constipation, dry skin and sensitivity to cold. Hypothyroidism can be treated with medication.

Incontinence

Removal of the prostate or bladder increases the possibility of incontinence or urine leakage depending on the type of surgery performed.  Survivors with continent urinary diversion after the removal of the bladder can gain an element of bladder control through special exercises, but incontinence while sleeping is inevitable.

Infertility

Either chemotherapy or radiation may cause infertility in both sexes. In women, chemotherapies with alkylating agents such as cyclophosphamide can damage the ovaries, resulting in irregular or absent menstrual periods.

Men with colorectal or genitourinary cancers who have had chemotherapy and radiation therapy are at increased risk of infertility. Chemotherapies that affect male fertility include alkylating and methylating agents, vinca alkaloid, antimetabolite, and platinum.

Learning & Memory Problems

Many cancer patients have problems with learning and memory during and immediately after treatment. Researchers have also discovered that the cancer itself may affect verbal learning and memory functions. The good news is that memory loss is one side effect that improves in long-term survivors. Cognitive problems resulting from chemotherapy is called "chemobrain."

Lymphedema

Lymphedema occurs when lymph nodes under the arm are damaged by radiation or surgically removed as part of breast cancer treatment. Lymphatic fluid accumulates in the tissue, causing painful inflammation and limited arm function. It's estimated that 12-25% of breast cancer patients develop lymphedema, mostly in the first year after treatment. However, lymphedema can occur many years later.

Neuropathy

One of the most difficult treatment side effects is neuropathy, a tingling or burning sensation in the hands and feet due to nerve damage. Neuropathy can be caused by radiation, surgery and chemotherapies such as taxanes, platinum, vincristine, and thalidomide. Neuropathy is generally thought to be irreversible and can progress.

Organ Damage

Certain types of cancer treatment can age or damage the heart, lungs, liver or kidneys. This damage may cause long-term health problems. These problems may appear as you age or have other health problems.

Some cancer treatments cause heart failure. Certain types of chemotherapy medicine are harmful to the heart. Heart failure symptoms include shortness of breath, feeling weak and tired after regular activity or while at rest, chest discomfort or feeling the heart beat fast.

Certain drugs damage the lungs and airways. These drugs include some antibiotics, chemotherapy medicines or some types of biotherapies. Common symptoms of lung damage include problems breathing, coughing or pneumonia. It is important that you tell your doctor if you experience any of these symptoms.

Some chemotherapy medicines damage the liver. Symptoms of liver damage may include dark urine, pale stools, yellowing of your eyes or skin, swelling or pain in your abdomen (stomach area), flu-like symptoms or severe fatigue. When taking some chemotherapy drugs, you will have regular blood tests to check how your liver is working.

Other chemotherapy medicines damage the kidneys. Symptoms of kidney damage include decreased urine flow or bladder irritation and bleeding. You may also have a change in urine color or a burning feeling while you urinate. Your doctor will check your kidney function closely.

Osteoporosis

Bone loss is a common side effect for survivors of lymphoma, leukemia, breast and prostate cancers. Osteoporosis can be caused by the cancer itself, cortisone-type drugs, treatment-induced menopause, cancer cells in the bone marrow and treatments that affect testosterone, which is crucial to bone health.

Pain

Pain can be a side effect of treatment or from the cancer itself. While pain management in patients undergoing active cancer treatment has improved significantly in recent years, little is known about long-term pain among disease-free survivors, which can be severe and affect quality of life.

Premature Aging

Cancer patients treated with certain chemotherapies and radiation may experience health conditions normally seen in older people. One of the most common long-term side effects for women is early menopause, which also increases the risk for osteoporosis. The effects of cancer treatment on men include osteoporosis, incontinence, infertility, and erectile dysfunction or impotence.

Sexual Dysfunction

Many men and women treated for cancer experience sexual side effects. Problems getting or keeping erections can occur in men, especially when the cancer begins in the pelvic organs. In women, cancer treatment can lead to sudden menopause or can worsen the vaginal dryness that occurs gradually after natural menopause. If sex becomes painful, speak to your doctor.

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© 2014 The University of Texas MD Anderson Cancer Center