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(11) Cancer Symptoms & Treatment

 Breast cancer symptoms

Signs and Symptoms of Cancer

CST11

What can I do for flu-like symptoms?

 Flu-like symptoms may be caused by infection, cancer, or treatment for cancer. These symptoms are most commonly fever, chills, aches and pains in the muscles (myalgias), and fatigue. You might also experience decreased appetite, headache, nausea, vomiting, or diarrhea.

If you develop these symptoms, call your doctor or nurse. Always immediately report fever of 100.5ºF or greater, with or without chills, to your doctor’s office unless the fever is a known chronic problem. If these symptoms are new, you need to make sure you don’t have an infection. The doctor will ask you questions, perform a physical examination, take blood samples, and perhaps perform other tests. If you have an infection, treatment will be prescribed.

When a cancer causes flu-like symptoms, they are commonly referred to as tumor fever. Many people with tumor fever experience symptoms on a daily basis and usually at the same time (or times) each day. Very often, when treatment of the cancer results in remission or cure, tumor fever goes away.

Certain treatments for cancer can cause flu-like symptoms. If these symptoms are likely to occur from your treatment or from other medications, your doctor or nurse will tell you. The reaction can occur while you are receiving the medication, within a few hours, or even several days after the treatment.

Flu-like symptoms can be caused by:

• Chemotherapy, such as gemcitabine, dacarbazine, and bleomycin.

• Biologic therapy (therapy that boosts your immune system to fight the cancer), such as interferon or interleukin, and monoclonal antibodies, such as rituximab and trastuzumab.

• Medicines to strengthen bone, such as pamidronate and zoledronic acid.

If you are likely to experience these symptoms while you are receiving the medication, the doctor or nurse will give you premedication (before the treatment) to prevent the reaction: acetaminophen, diphenhydramine, nonsteroidal anti-inflammatory medication (ibuprofen, naproxen), or even meperidine or morphine.

If you experience flu-like symptoms at home, regardless of the reason, the following measures may help:

• Your doctor may prescribe acetaminophen or nonsteroidal anti-inflammatory medicines (e.g., naproxen) for you to take around the clock (on a regular basis).

• Drink plenty of fluids to prevent dehydration from fever.

• Take cool to tepid sponge baths to keep your fever down.

• Take regular uninterrupted rest periods if you are tired.

• Ask your doctor to prescribe medicine for nausea, vomiting, and diarrhea if you develop these.

What can I do to treat itching?

Itching is a sensation that makes people want to scratch. The medical term for this is pruritus. Itchiness can occur on one area of the body (localized), or it can affect the entire body (generalized). It may also be accompanied by a rash or other skin changes. In patients with cancer, itching can have a number of causes:

• Some cancers, including leukemia, lymphoma, and cancers of the stomach, lung, or breast, may be associated with itching.

• Some chemotherapy medicines may cause itching, such as doxorubicin and erlotinib.

• Radiation therapy may cause skin changes, including itching. If you are being treated with radiation, contact your doctor or nurse before applying anything new to your skin to soothe irritation.

• Some medicines, including pain medicine (narcotic analgesics like morphine) and antibiotics can cause itching.

• An allergic reaction to medicine can cause itching.

• Other diseases, such as liver disease and kidney failure, may be associated with itching. ( Jaundice is characterized by a yellowing of the skin and the whites of the eyes resulting from a buildup of bilirubin in the tissues; it can occur if the bile ducts are blocked or if the liver is not functioning, and is accompanied by a darkening of the urine and a lightening of stool color.)

• Other causes are dry skin, insect bites, and changes in the soap or laundry detergent.

Constant scratching can cause more irritation to the skin and, in some people, a break in the skin that can bring about additional discomfort and even infection.

Itching can interfere with your sleep and overall quality of life. If you have itching, a rash, redness, or breakdown of your skin, contact your doctor or nurse before applying anything to your body. The doctor will ask you many questions, inspect your skin, and possibly take a blood sample. Be prepared to give them the following information:

• The area that is affected, when it started, and what makes it better or worse

• Medicines that you are taking, including prescription and over-the-counter medicine (Be sure to tell them about any new medicines.)

• Changes in your skin, such as rash, hives, or dryness, and changes in the color of your skin, such as redness or yellow skin (jaundice)

If the cancer is causing the itching, treatment resulting in remission or cure often stops it. If the itching is caused by a medicine, your doctor may stop the medicine or switch to another one that won’t cause itching. If you have itchiness or a skin reaction from radiation treatments, speak to your nurse about specific skin recommendations for people receiving radiation therapy.

There are many treatments for itching. Here are some general measures that almost anyone can try:

• Bath or shower using tepid water and a super fatted unscented soap (e.g., Dove). Aveeno oatmeal baths may also be soothing.

• Use emollient lotions, such as Curél or Lubriderm.

• Keep your fingernails trimmed.

• Keep the air humidified.

• Drink plenty of fluids.

• Wear loose-fitting cotton clothing; use cotton sheets.

• Apply cool compresses for localized itching.

• Use distraction measures, relaxation techniques, or guided visual imagery.

Your doctor or nurse might suggest other treatments:

• Steroid creams, either by prescription or over-the counter;

• Topical or oral antihistamines (e.g., diphenhydramine);

• Sedatives for those who are unable to sleep;

• Referral to a dermatologist for a consultation.

Lisa’s comment:

Pruritis associated with the radiation field drove me crazy. Even though I used all recommended creams (Biafine, Bactroban Ointment, Betamethasone Dipropionate Ointment),

I still found myself scratching absentmindedly. I felt that I needed to put myself in mittens, in addition to keeping my fingernails short, in order to prevent significant skin breakdown.

ACTIVITY AND SLEEP

I feel tired much of the time. What can I do to increase my energy?

Lisa’s comment:

I am a single professional woman. I have elderly parents who live across town, a brother who lives 15 miles away, and numerous friends who live both near and far. I am an independent individual. I insisted on getting myself to and from my treatments (chemotherapy) via mass transportation, alone-I live about 30 miles from the Cancer Center.

My fatigue was significant, but generally occurred a few days after treatment. My parents and friends wanted to drive me to my treatments, but I wouldn’t allow them. My mother, therefore, took on the added chore of doing my laundry and food shopping every week. My parents’ help significantly contributed to my increased energy levels. It allowed me to save my energy for long workdays.

Mary Ann’s comment:

I wish I had the magic answer as to what to do about the fatigue that accompanies my treatment. I, too, am tired all the time. I was doing a whole lot of napping but have now tried pushing through that 3 o’clock (or 10 a.m., 11 a.m., 2 p.m., 4 p.m., 6 p.m.-anytime) exhaustion. Sometimes it works, sometimes it doesn’t. Caffeine is not the answer and I find myself drinking Gatorade of all things! I always thought of it as some fancy Kool-Aid but have discovered, thanks to the advice of my oncologist, that it does add something back to your system. It really has helped me (and it comes in a low-calorie variety but good luck finding it!)

Fatigue is a common problem for people with cancer.

You may feel tired, weak, or weary; lack energy; be unable to concentrate; or feel irritable or depressed.

Many things may cause fatigue:

• The disease itself

• The treatment you are receiving

• The side effects of certain medications (e.g., medications to treat pain or nausea)

• Anemia (a low red blood cell count)

• A decrease in the amount of food you eat

• A decrease in the amount of liquids you drink

• Difficulty sleeping

• Emotional distress

• Chronic pain

However, many people with cancer develop fatigue without any clear single cause.

Sleeping extra hours at night, by going to bed earlier or staying in bed a bit later in the morning, will improve your energy. Resting during the day is also important: napping for short periods or just lying down and relaxing. Plan these rest periods for times when you know you will be more likely to feel tired.

Even bathing, dressing, or eating may cause some people to feel tired, and they should plan time for a short rest after these activities. However, at the same time, you want to push yourself to be as active as possible.

Lying in bed all day generally makes you weaker. In fact, there is evidence that exercising will actually increase your energy level as long as you don’t push yourself to the point of exhaustion. If you are currently exercising on a regular basis, try to maintain your schedule, adjusting the intensity and frequency of your exercise regimen according to how you feel. If you are not currently exercising, take a daily walk. Start with 5 to 15 minutes a day. Adjust the distance and pace based on how you feel. The key thing is to find a balance between rest and activity.

Anemia, one cause of fatigue, may be treated with a medication called epoetin (Procrit, Epogen) or darbepoetin (Aranesp). This medication stimulates your bone marrow to make more red blood cells, raising your blood cell count and increasing your energy. It is given by injection under the skin using a very small thin needle. It comes in different doses and is commonly given once a week. You may be instructed to take an iron supplement by mouth while getting these injections. If you are anemic and feel fatigued, ask your doctor if this medication could help you.

If you have other specific problems that you think may be contributing to your fatigue, speak with your doctor or nurse about them. Ask them about taking a sleeping medication if you are having difficulty sleeping at night. Ask them about how to manage your pain better if you are not comfortable. Ask about how you can cope with emotional distress better. Ask them for advice on how to increase your food and fluid intake if you feel you are not eating and drinking enough.

Unfortunately, fatigue cannot always be effectively treated. It is often necessary to adjust your activity to accommodate to changes in your energy level.

Conserve your energy for the most important activities. Think about all the things you do during the day: working, shopping, cooking, cleaning, household chores, errands, taking care of children or dependent relatives, being with family and friends, and recreational or leisure activities.

Which of these activities are the most important?   Which give you the most pleasure? Which make you feel good about yourself? Save your energy for them. You’ll probably notice that your energy is greater at certain times of the day. Plan your favorite activities for those times. For the other things that must get done, ask family and friends to help. People often want to be helpful but don’t know how. Tell them specifically what you need help with; they will probably be grateful for the direction.

Finally, let go of the things you don’t need to do and don’t want to do.

To learn more about fatigue, search on the following Internet sites:

• American Society of Clinical Oncology: www.cancer.net

• National Cancer Institute: www.cancer.gov

• American Cancer Society: www.cancer.org

Terms:

Myalgias - Aches and pains in the muscles.

Pruritus - A sensation that makes people want to scratch.

Jaundice - Yellowing of the skin and the whites of the eyes resulting from a buildup of bilirubin in the tissues; it can occur if the bile ducts are blocked or if the  liver is not functioning, and is accompanied by a darkening of the urine and a lightening of stool color.

Anemia - A low red blood cell count. If you are being treated with radiation, contact your doctor or nurse before applying anything new to your skin to soothe irritation.

If you are being treated with radiation, contact your doctor or nurse before applying anything new to your skin to soothe irritation.

The key thing is to find a balance between rest and activity.

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