Symptoms and Management

Changes that occur to your body as a result of cancer treatment can affect how you feel about yourself. There may have been hair loss or surgical scars, physical limitations, an amputation or loss of a body part, sexual dysfunction, or weight gain or loss. The way you view or value your body influences the emotions that accompany any physical changes.

First, know that it’s okay to feel sad, upset, worried, or even angry about cancer’s lingering impact upon your body. Second, know that you are not alone. The key is to recognize your feelings as normal and to seek medical advice to help you cope and move forward.

• Cancer treatments, whether surgery, radiation, chemotherapy or medical therapy, all impact people differently. Discuss your evolving or lingering thoughts about body image with your doctor or nurse.
• Be kind to yourself. Recognize your thought patterns and consciously try to take control and turn them toward positive goals and thoughts.
• Seek out a support group so that you can address questions and concerns with those who also have been in your footsteps.

We offer free counseling services at the Barnard Health and Cancer Information Center, if needed. Call (314) 362-7844 to make an appointment.

Hot flashes are common side effects in cancer survivors.  Hot flashes are sudden feelings of warmth that usually begin on the face and chest and then spread through the body. Often lasting a few minutes, hot flashes can be accompanied by sweats, chills and anxiety.  Though most common in women, some men can experience hot flashes as well.

In women, hot flashes can be caused by low levels of the hormone estrogen. This can be due to natural menopause or early menopause brought on by certain cancer treatments, such as radiation therapy to the pelvis, removal of the ovaries, and certain chemotherapies and hormone therapies.

In men, hot flashes can be caused by low levels of the hormone testosterone, most often due to prostate cancer treatment, such as surgery to remove one or both testicles, or hormone therapy.

There are many simple changes that may help manage your hot flashes, including:

• Dress in layers so you can peel one off when you get warmer.
• Take a cool shower before bed.
• When possible, lower the thermostat, use air conditioning, ceiling fans or handheld fans.
• Use an ice pack or frozen water bottle on the back of your neck.

Other simple lifestyle changes the have proven effective to treat hot flashes include:

• Exercise
• Relaxation and stress reduction – such as meditation, breathing and visual exercises
• Changing diet – for some, having a low fat diet is helpful in managing hot flashes.
• Yoga
• Acupuncture

If you are having trouble with hot flashes, talk to your health care provider.  You don’t have to go through it alone.  Seeking treatment for your hot flashes could help improve your quality of life.

Fatigue is one of the most common side effects of cancer treatment. It can occur during cancer treatment or linger long after treatment has ended. When sleep and rest are not effective, it’s time to talk with your doctor. Your chronic feeling may be linked to anemia, which is when there are not enough red blood cells in your body. Poor nutrition from a loss of appetite, dehydration, abnormal hormone levels and some medications also may be causes of fatigue. Ongoing emotional anxiety, pain, or memory issues are other potential factors for chronic fatigue.

Cancer patients may experience oral or dental problems during or after cancer treatment.  According to the National Institute of Dental and Craniofacial Research, four out of 10 patients undergoing chemotherapy may develop oral complications. The risk is higher for patients who undergo hematopoietic stem cell transplants and in those who receive radiation treatments for head and neck cancers.

Oral problems seen in some cancer patients are inflammation, infections, salivary gland dysfunction, dry mouth, difficulty in swallowing or speaking, or loss of taste as well as an increased risk of dental decay.  If you’re experiencing these side effects:

• Maintain a daily oral hygiene routine of brushing your teeth with an extra-soft toothbrush after every meal and before bedtime. Floss daily and gently.
• Keep to a regular schedule of professional teeth cleanings and dental visits so that any issues can be identified and addressed as soon as possible.
• Inform your dentist of your cancer diagnosis so that he or she can monitor for infections, abnormal growth, or periodontal disease.
• Avoid mouthwashes containing alcohol.
• Sip water or suck on ice chips to relieve a dry mouth. Your dentist may also recommend a saliva spray, an oral care product for dry mouth such as Biotene, or other medication.

Your dentist may recommend supplemental high-potency fluoride gels or daily fluoride applications, especially if you have salivary gland dysfunction.

We get it. Incontinence is an embarrassing issue that most people would rather not talk about, let alone seek treatment.

The reality, though, is that urinary incontinence impacts more than 25 million people in the United States, including cancer survivors. More importantly, there are many treatment options available to men and women so that you can improve the quality of your life.

One of the biggest misconceptions is that urinary incontinence affects only those diagnosed with prostate cancer or cancers of the pelvis, such as the bladder or rectum.  But other cancers also can trigger incontinence:

• Breast cancer — hormonal therapies can dry out vaginal or urethral tissues and trigger incontinence
• Lung/Esophageal cancer — a chronic cough can strain or stretch the muscles involved in urination
• Brain or Spinal Cord Tumors — these can impact the nerves that control bladder or pelvic muscles

Nausea or vomiting that sometimes occurs during any cancer treatment also can lead to stress incontinence.

Talk frankly with your doctor if you have incontinence issues because these symptoms can be managed. Behavioral therapy, dietary changes, medications, electrical stimulation devices and surgical procedures are all effective options to deal with either stress or urge incontinence.

At Washington University School of Medicine, we also have a dedicated interdisciplinary group of urologic specialists who treat urinary and bowel incontinence as well as other pelvic floor disorders in the Center for Colorectal and Pelvic Floor Disorders (COPE).

Learn more about living with bowel or bladder incontinence here:

• Download Patient Education Handout on Bladder Incontinence
• Download Patient Education Handout on Bowel Incontinence

Chemotherapy, radiation, and surgery all can impact reproductive organs in men and women. For example, chemotherapy can lower sperm counts or decrease their movement, leading to the inability to conceive on your own. While sperm counts may rebound in men, it may take months or years.

In women, chemotherapy can lead to premature ovarian failure. In some cases, reproductive organs are permanently affected.

If you are concerned about future fertility following treatment for cancer, ask for a referral to a reproductive endocrinologist who is knowledgeable about fertility preservation and the impact of cancer regimens.

At the WashU Medicine Fertility and Reproductive Medicine Center at Barnes-Jewish Hospital, our reproductive endocrinologists have long-standing expertise in fertility preservation (both egg and sperm cryopreservation) as well as in diagnosing and treating infertility issues. The team is the largest board-certified infertility specialty team in the region and is the only in-vitro fertilization clinic in the St. Louis area that is a member of the Society for Assisted Reproduction Technology (SART).

These board-certified specialists can extract and evaluate a woman’s eggs before or after cancer treatment, as well as do pre-implantation testing. They also can monitor ovarian function as a woman ages and suggest when egg preservation is necessary due to a decline in ovarian function.

Men can contact the clinic to discuss sperm banking before or after treatment. They also can obtain a complete semen analysis and viability test in the Center.

For more information about the services available in the Center, call (314) 286-2400 or visit fertility.wustl.edu.

As many as three out of every four cancer patients experience some form of memory or thinking problems during treatment. Of those, The American Society of Clinical Oncology notes that more than one-third of them will continue to have cognitive problems after finishing treatment.

What causes this? It can be due to:

• The type of cancer treatment you received. It’s well documented that chemotherapy can result in memory loss and trouble in concentrating. Doctors and patients even have coined a name for it — “chemo-brain.” In addition to chemotherapy, radiation and some types of hormone therapy also can produce similar problems with memory and organization.
• Medications you are prescribed. Some have side effects that include impaired concentration and memory loss.
• A medical condition such as anemia or an electrolyte imbalance.
• Lack of sleep or emotional distress. Both can negatively impact memory and concentration.

Cognitive problems can be managed in a wide variety of ways, including medications, occupational therapy and cognitive rehabilitation. You also may find these simple coping and brain-strengthening strategies effective:

• Carry a notepad to jot down reminders and to-do lists.
• Place commonly used items in the same location so you can easily find them again. For example, hang your car keys in the same place every day.
• Play brain games, such as crossword or Sudoku puzzles.
• Try a new hobby — such as painting, knitting or playing a musical instrument — to spark memory retention with something you enjoy.
• Be physically active every day. Walking, swimming, yoga, even gardening can be beneficial to increasing mental alertness.

Talk with your doctor about any lingering memory or other cognitive problems you may have and learn more about effective treatment options. Through WashU Medicine Occupational Therapy, we have specialists who can help you cope with cognitive changes such as short-term memory loss, trouble concentrating (sometimes called “chemo brain”), and difficulty in decision-making.

Talk with your care provider for a referral for these services. For more information call 314-286-1669, option 3 or email [email protected].

Lymphedema is a type of abnormal swelling that occurs when protein-rich lymph fluid builds up in the body’s soft tissues. Typically, the swelling is in the arms or legs, but it can occur in other parts of the body, including the chest, back or genital area.

In cancer patients, lymphedema can occur when lymph nodes are removed or damaged. You should contact your doctor if you experience any of the following:

• Swelling of an arm or leg (or fingers or toes)
• Decreased flexibility
• Tightness or thickness of the skin in a particular area
• A heavy feeling in the arms or legs
• A feeling of discomfort or tightness when wearing either clothing, shoes or jewelry
• Pain, redness, itching, increased skin temperature in a particular area or a rash, which may be a sign of an infection and warrants immediate medical attention.
• Purple lesions that are flat or raised on the skin. These could be a sign of lymphangiosarcoma, a rare but fast-growing cancer of the lymph vessels.

Damage to the lymph system is not repairable. Early recognition and treatment of lymphedema, however, can minimize discomfort, pain and long-term effects. Good hygiene also can help prevent infection. Once lymphedema is diagnosed, treatment focuses on controlling the swelling and minimizing the build-up of fluid through

• Compression devices
• Pressure garments
• Exercise
• Massage Therapy
• Laser Therapy
• Weight Loss

Lymphedema requires careful evaluation and treatment. Don’t delay in talking with your doctor if you have any of the above symptoms.

Download our patient resource about lymphedema here.

While many cancer patients complete their treatment regimen with no lasting after-effects, some patients may have lingering side effects, including pain, tingling or numbness in the arms and legs. Medications, steroids or physical and occupational therapy may ease the problems. You should talk with your doctor if you are experiencing or continue to experience these side effects after treatment.

Chemotherapy-induced peripheral neuropathy, or CIPN, can cause severe pain and make it difficult to use your fingers to pick up objects or even walk. While a strong tingling feeling or shock-like pain is the most often recognized symptom, other signs include

• Pain that comes and goes
• Burning sensation
• Numbness
• Balance problems
• Sensitivity to touch
• Muscle weakness
• Constipation or urinating problems

A telltale sign is when symptoms move from the feet to the hands, or from the fingers to the arms — in other words, starting from a farther point in the hands or legs and then moving up toward the torso and head.

Lifestyles changes may be beneficial.  The American Cancer Society recommends that if you are experiencing neuropathy and/or pain:

• Avoid things that seem to make your symptoms worse, such as hot or cold temperatures, or snug clothes or shoes.
• Don’t drink alcohol. It can cause nerve damage on its own, and might make CIPN worse.
• If you have diabetes, control your blood sugar. High blood sugar levels can damage nerves.
• If you have neuropathy in your hands, be very careful when using knives and other sharp objects.
• Examine your feet daily to see if you have any injuries or open sores. Always wear shoes that cover your whole foot when walking, even at home.
• If you have trouble walking and balancing, try to support yourself as much as possible by holding onto walls or using a walker or cane. If possible, install handrails in the hallways and bathrooms to help you keep your balance. Remove throw rugs from walkways in your home to prevent falls.
• Avoid extreme temperatures. Keep hands and feet warm and well covered in cold weather. Protect yourself from heat injuries and turn down your hot water heater temperature so that is less than 120 degrees. Use gloves when using hot water to wash dishes or to handle items being removed from the freezer.

Lingering pain and neuropathy can impact quality of life and lead to depression or anxiety if not addressed. Talk with your cancer team as soon as possible if you notice ongoing symptoms that need to be addressed. You may also benefit from a referral to the Pain Management Center, a multidisciplinary team of specialists who focus solely on pain management during and after cancer treatment. For more information, call (314) 362-8820.

Cancer treatments may increase the risk for osteoporosis, or bone loss. The two most vulnerable populations for developing low bone density or osteoporosis are women who have been treated for breast cancer and men who have been treated for prostate cancer.

Radiation negatively impacts bone-building cells, increasing the potential for bone fractures. Other treatments may stimulate specific cells in the body called osteoclasts that then target and destroy bone tissue.

In breast cancer patients, chemotherapy treatments may induce early menopause and trigger rapid bone loss. Similarly, in men with prostate cancer, the surgical removal of the testicles results in a drop in testosterone levels, which also can lead to osteoporosis.

Doctors can talk to you about calcium and vitamin D supplements as well as more potent prescription medications that can stop or slow the progression of bone loss.

Learn more about bone loss symptoms and treatment/prevention here:

• Download Patient Education Handout on Bone Loss

Do not be afraid to discuss any sexual dysfunction concerns or problems with your doctor either during or after cancer treatment. Sexuality is an important aspect in your quality of life and it shouldn’t be ignored.

First, know that many cancer patients experience some form of sexual dysfunction following cancer treatment. This can be related to your ability to have sex or to enjoy it. Do you

• Have no desire for sex?
• Have physical problems such as erectile dysfunction, vaginal dryness or pain during sex?
• Are there concerns with ejaculation or urine leakage?

All of these should be discussed with your doctor.

In men, treatment for cancers such as prostate, bladder or colorectal cancers can increase the risk of erectile dysfunction and problems with ejaculation and urine leakage.

Nerve-sparing surgical techniques have shown success in preserving erectile function. On average, if nerves aren’t damaged during treatment and there are no other co-existing conditions such as diabetes or vascular problems, up to half of all men who undergo surgery, brachytherapy or other radiation therapy will see improvement in sexual dysfunction within 1-3 years. For those who continue to have problems, oral medications, mechanical devices or penile implants are options to improve function.

Women who have undergone treatment for ovarian and other pelvic cancers can experience vaginal dryness, reduced sensations, inability to orgasm, or pain during intercourse as a result of hormonal changes or early menopause. Psychological factors such as body image also can lead to a lack of desire. Lubricants, muscle re-training and medications can address dryness and pain. Close communication with your partner and varied positions also can help.

If depression and anxiety remain after physical concerns are addressed, you should consider talking with a trained mental health professional. Through the Barnard Health and Cancer Information Center at Barnes-Jewish Hospital/WashU Medicine, we offer free counseling services. To make an appointment, call (314) 362-7844.

For women undergoing cancer treatment, you may experience vaginal dryness or irritation. While vaginal dryness is a common problem in menopause, it also can be caused by some cancer treatment drugs, such as tamoxifen for the treatment of breast cancer.

Some women are uncomfortable talking about vaginal dryness, but it can lead to painful intercourse or tears in the vaginal tissue, which then could lead to infections or impact quality of life and self-esteem. Your doctor has several options to treat vaginal dryness:

• Over-the-counter lubricants — you may just need extra lubrication to ease any dryness and discomfort. Look for a water-based gel without any perfumes, herbal extracts, spermicide or added ingredients that can irritate your tissues. Do not use petroleum jelly or other oil-based lubricants as they can increase the risk of infection as well as deteriorate latex in some condoms. Condoms that contain nonoxynol-9, a spermicide, can irritate vaginal tissue as well.
• Vaginal moisturizers — Different from lubricants, vaginal moisturizers address both the moisture and pH balance inside the vagina and are not used during sexual activity. They typically are applied at bedtime several times a week.
• Vitamin E gel capsules — Some doctors recommend the use of Vitamin E gel capsules as a vaginal moisturizer. You can pierce the capsule with a clean needle and then insert the capsule directly into your vagina. You also could squeeze the Vitamin E onto your fingers first and then maneuver into the vagina.
• Vaginal estrogen — Prescribed by a physician, vaginal estrogen is commonly available as a cream or gel that can be applied to the vulva or just inside the vagina. A ring filled with estrogen also is available that can be placed into the vagina. Note that your primary care doctor should contact your cancer specialist before prescribing any estrogen therapy for vaginal dryness as hormone treatments may not be recommended because of your cancer history.

Learn more about vaginal dryness with our patient resources:

• Download Patient Education Handout on Vaginal Dryness
• Download Patient Education Handout on Products for Vaginal Dryness

Maintaining a healthy weight is critical for cancer survivors. While many patients lose weight during cancer treatment, others will actually gain weight. Fluctuations in weight can be due to

• Anxiety
• Lack of appetite
• Lack of exercise or physical activity
• Poor dietary choices

The reality is that any cancer treatment—whether chemotherapy, radiation, surgery or other medical therapy — can cause you to change your eating habits and activity levels. Hormonal therapies can even cause you to gain weight.

Achieving a healthy weight and body mass index (BMI) is important for your overall health. Try to keep active and eat healthy foods. Drink plenty of water. Above all, don’t go on a rapid weight loss diet, which can trigger other health concerns. Your goal is to eat healthy foods to gain or maintain weight OR start a nutrition plan that results in controlled weight loss.

At the Siteman Cancer Center, we can refer you to certified dietitians that can work with you to develop a healthy, nutritious diet plan. To contact a dietitian, call 314-454-7619.

Learn more weight management here:

• Download Patient Education Handout on Regaining and Maintaining Weight After Cancer
• Download Patient Education Handout on Getting Down to a Healthy Weight After Cancer