Advanced Colorectal Cancer

Side Effects

It is now possible to manage many common side effects of advanced colorectal cancer treatment, which can help you feel better, stick with your treatment plan and achieve the best possible outcome. Not all people treated for advanced colorectal cancer will have the same side effects, and whether or not you experience a side effect depends on many factors, including your age, overall health and specific treatment plan. Side effects also differ in severity and vary according to the type of treatment you receive. It’s extremely important to keep an open dialogue with your doctor about any side effects you experience and to never keep side effects to yourself.

Recovering from surgery

The short-term side effects of surgery for colorectal cancer generally include pain and tenderness in the abdominal area where the operation occurred, as well as constipation (or diarrhea) and fatigue. The need to retrain the bowel after surgery is also common, so talk to your doctor if you cannot regain control of your normal bowel function. In addition, if you had a colostomy (see Treatment) you will need to adapt to life with an ostomy (see Adapting to life… near the bottom) and you may experience some irritation around the stoma (the surgically created opening through which your waste will pass). Your doctor or nurse can help you learn how to properly clean the area to prevent infection.

Managing the side effects of cancer drugs

While the side effects from targeted therapy drugs and chemotherapy drugs used to treat advanced colorectal cancer have some differences, several of their most common side effects are the same.

Fatigue

Treatment-related fatigue occurs primarily because the body needs extra energy to repair the healthy tissue damaged by cancer treatment. Increasing activity and performing regular exercise (such as walking or bike riding) are the best ways to help manage and reduce symptoms of fatigue. If your fatigue is severe, your doctor may recommend that you take a psychostimulant drug for a short period of time.

Nausea and vomiting

Many cancer drugs affect the lining of the stomach, which causes nausea and vomiting. Nausea is feeling the need to vomit, and vomiting occurs when the stomach muscles contract and push the stomach contents up through the mouth. Recent advances have led to the development of antiemetic drugs to prevent and control nausea and vomiting, which your doctor will prescribe as necessary. To further protect yourself, you may want to try some nondrug approaches, including progressive muscle relaxation, biofeedback, guided imagery, self-hypnosis and acupuncture. Eating several small meals (rather than a few big meals), staying hydrated and avoiding unpleasant odors can also help.

Diarrhea

Diarrhea is the passing of loose or watery stools three or more times a day, which may cause cramps in the abdomen and pain or discomfort in the rectum. Left untreated, diarrhea can lead to serious problems, such as dehydration, loss of important nutrients, weight loss and fatigue. Once diarrhea occurs, following a clear-liquid diet may help the lining of your intestines heal. And as diarrhea begins to improve, you can slowly add solid foods back into your diet, starting with low-fiber foods like white rice or boiled potatoes. Some foods can worsen diarrhea, including dairy products; spicy, greasy or fried foods; raw fruits or vegetables; and foods high in fiber. Over-the-counter medicines and fiber supplements are also available to control diarrhea, but ask your doctor before taking anything. If diarrhea is severe, your doctor may prescribe other medications or choose to stop treatment temporarily and restart it when your diarrhea is controlled.

Mouth sores

Mouth sores, known as oral mucositis, are small cuts or ulcers that form in the lining of the inside of the mouth and can affect the gums, tongue, roof of the mouth or lips. Taking good care of your teeth and gums is essential to managing mouth sores, and you should brush and floss several times a day. Your doctor may also suggest rinsing your mouth with special solutions or prescribe a medication that coats the lining of your mouth or pain medications that you can apply topically. To manage mouth sores, keep your mouth and lips moist by using lip balm, sipping on water, sucking on ice chips and drinking through a straw. Choose soft, moist foods that are easy to swallow, like mashed potatoes and scrambled eggs, and always let your food cool down to room temperature before you eat. It is also a good idea to avoid alcoholic beverages and tobacco products as well as hot, spicy, citric, greasy, fried, coarse or rough-textured foods because they might irritate your mouth even further.

Skin reactions

Skin reactions to cancer treatments are common among patients and include reactions such as redness and irritation (similar to sunburn), skin rash or dry, flaky skin. These reactions often cause itchiness and discomfort, and while most are mild to moderate, some can become severe if not treated early. If you develop a rash that causes itchiness or pain, your doctor may prescribe a mild corticosteroid cream or an antibiotic gel. In addition, severe rashes are usually treated with an oral antibiotic and perhaps an oral corticosteroid. When a rash is severe, the dose of the cancer drug(s) is often reduced or temporarily stopped and then restarted if the rash gets better within two weeks. Some nondrug remedies you may want to try include taking baths rather than showers, moisturizing your skin at least twice a day with a thick cream made for sensitive skin, wearing loose-fitting clothing, avoiding contact with hot water (opt for lukewarm instead) and protecting your skin from the sun.

Hand-foot syndrome

Hand-foot syndrome causes redness, swelling, blistering, cracking and pain on the palms of the hands and the soles of the feet. The skin in those areas may also tingle, burn or feel tight. To treat this side effect, your doctor may prescribe a topical anti-inflammatory medication, reduce your cancer drug dose or alter your treatment schedule. You can also limit exposure of your hands and feet to hot water, cool your hands and feet with ice packs, elevate your hands and feet when sitting or lying down and avoid activities that cause unnecessary force or friction on the hands and feet to alleviate symptoms of hand-foot syndrome.

Peripheral neuropathy

Peripheral neuropathy is caused by nerve damage and results in tingling or numbness in the feet or hands, which may spread upward into your legs and arms. Treatment to relieve pain can include steroids, antidepressant or anticonvulsant medications, patches or creams with a numbing medication, opioids or narcotics. Regular exercise, such as walking, and stretching and strengthening activities can also help. Conversely, alcohol, extreme temperatures and snug clothing and shoes can all worsen symptoms, so avoid them when possible. Falling can also be a problem, so keep your house well-lighted, remove throw rugs and always support yourself while walking; you may even consider using a walker or cane to give yourself extra support. If you drive, make sure you can feel the pedals with your feet.

Neutropenia

Neutropenia is a low white blood cell count, which increases the risk of infection. If the count is very low, your doctor may delay your next treatment until the count has increased or prescribe a medication to stimulate the production of more white blood cells. To reduce the risk of infection, wash your hands frequently, avoid crowds and people with infections, wash fruits and vegetables carefully, and avoid raw meat, seafood and eggs. You should also know the signs and symptoms of infection, and call your doctor if any occur.

Cognitive dysfunction

Commonly called “chemo-brain,” cognitive dysfunction involves problems with concentration, word-finding, forgetfulness and organization ability. To combat this side effect, use a calendar or daily planner to keep all of your important information in one place, exercise your brain with word games and puzzles, avoid multitasking, and tell friends and family that you are having cognitive problems so they can help.

Dealing with the effects of radiation

Like the side effects from cancer drugs, the side effects from radiation therapy may include fatigue, skin reactions, nausea and vomiting, and diarrhea. If your treatment involves radiation to the pelvis, you may also experience infertility, which is the inability to have a child, as well as sexual problems; men may have problems getting or keeping an erection, and women may enter sudden menopause or have vaginal dryness that can lead to painful sexual intercourse. Before treatment begins, talk to your doctor about the possible sexual and fertility-related side effects and your options for managing them.

While it is impossible to predict how each person will be affected by colorectal cancer and its treatment, talking with your treatment team can better prepare you for what may happen. Knowing what to expect and how to help prevent or manage side effects can help you feel in control of your body, improve your quality of life, and most importantly, ensure that you have the best chance for your treatment to be effective.

 

Adapting to life with an ostomy

Surgery for advanced colorectal cancer may result in the need for an ostomy. An ostomy creates a new path for the elimination of waste when the colon or rectum must be bypassed because of disease. If an ostomy is part of your treatment, a nurse who specializes in ostomies will talk to you before you are discharged from the hospital. The ostomy nurse will teach you how to empty and replace the pouch that will now catch your waste, care for the skin around your stoma (the surgically created opening through which your waste will pass), manage your diet and daily activities, and recognize potential problems. An ostomy nurse can follow up with you at home as well until you feel comfortable caring for the ostomy yourself.

Adapting to an ostomy may take some time. But help is available, and most studies have shown that after an initial adjustment period, the quality of life is the same with an ostomy as without. There are several different pouch styles to fit your needs and body shape, and you can still bathe, wear normal clothing, eat the foods you love, participate in sexual activities and more with an ostomy. Most often, ostomies are more of a mental obstacle than a physical hindrance; you can do anything you want with an ostomy, but you may not feel comfortable doing it. If you have an ostomy, you should consider a local or online support group to help you cope.

 

 

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