13 Facts Everyone Should Know about Metastatic Breast Cancer
My feet and hands have gotten tingly. What is this, and how can I make it go away?
Neurological problems, such as peripheral neuropathy, are possible side effects of some chemotherapy drugs. Peripheral neuropathy is damage to peripheral nerves. There are three types of peripheral nerves: sensory, motor, and autonomic. Sensory nerves allow us to feel temperature, pain, vibration, and touch. Motor nerves are responsible for voluntary movement and allow us to walk and open doors, for example. Autonomic nerves control involuntary or automatic functions such as breathing, digestion of food, and bowel and bladder activities. When there is damage to the peripheral nerves, the symptoms depend on the types of peripheral nerves affected. Though chemotherapy drugs can affect any of the peripheral nerves, the most common ones affected are the sensory nerves causing numbness and tingling in the hands and feet. For patients who already have peripheral neuropathy from other causes, diabetes, for example, the chemotherapy can sometimes make it worse.
Symptoms of peripheral neuropathy include:
Numbness and tingling, which may feel like pins and needles in your hands and/or feet
Burning pain in hands and feet
Difficulty writing or buttoning a shirt
Difficulty holding a cup or glass
Constipation
Decreased sensation of hot or cold
Muscle weakness
Decreased hearing or ringing in the ears (known as tinnitus)
If you develop any of these symptoms, it’s important to tell your doctor right away. Describe the symptoms you are experiencing. If you already have any of these symptoms before starting chemotherapy, tell your doctor. Your doctor may decide to prescribe medication for you to reduce these symptoms. The medicines most commonly used are drugs that are given to neurology patients for treatment of seizures and depression. Some examples are gabapentin (Neurontin), carbamazepine (Tegretol), and amitriptyline (Elavil). Additional measures you should consider taking at home include paying close attention when you walk and avoid having scatter rugs in your house. Keep your home well-lit so you can see where you are walking. If you are still driving a car, be sure you can feel the foot pedals. If temperatures are hard to decipher, then ask for help in checking the temperature of the bathwater as well as any hot beverages you are drinking. Take extra precaution to guard against frostbite in the water.
I am feeling more joint pain and backaches that make it difficult to walk around. What can I do to manage my pain?
For some patients, pain may be the most difficult symptom to overcome and cope with. Metastatic breast cancer that has spread to the bones, for example, can cause bone pain that is very uncomfortable. It can reach a point of making it difficult to walk around and function well because the pain is so intense. A primary goal for you and your doctor is to prevent pain from being debilitating if it happens. Your doctor will prescribe pain medications for you. Sometimes it takes several different types of medications to get pain under control. This is usually more of an issue for patients toward the end of life. If taking narcotics for pain management, avoid driving as your alertness may be impaired and you may be more prone to accidents. Some pain medications can be constipating so talk with your doctor about taking stool softeners to prevent bowel problems. The goal is for pain to be manageable and not so uncomfortable that your quality of life is negatively affected. Tell your doctor if the pain medications are no longer working as well as they did when first prescribed. Adjusting medications is a continuous and expected process.
I am so worried about pain. Will I suffer a lot?
Not everyone with metastatic cancer has pain. However, if you do have pain, rest assured that your doctor will be able to control it. The cancer itself does not cause pain. People with metastatic cancer experience pain if the tumor presses on surrounding organs or nerves. One of the major goals of systemic anti-cancer treatment is to control pain, but it may take a couple of months for it to be effective. While you are waiting for this, you will need specific anti-pain treatment. Sometimes the treatment does not kill enough cancer cells to make the pain go away completely, and you will have to continue to take pain medication.
Doctors use medicines and radiation therapy to control pain. The medicines are usually given by mouth, but they are sometimes administered in the veins or by placing medicated patches on the skin. Nerve blocks are often useful in controlling pain that is in a localized area. Relaxation techniques, massage, and acupuncture also have roles in managing some types of cancer pain.
How will my doctor control my bone pain?
Bone metastases are the most common cause of pain in patients with metastatic breast cancer. Not everyone with cancer in the bones has pain. Radiation therapy is particularly effective in treating bone pain. You may not experience its full effect until a few weeks after the last treatment, so be patient. In the meantime, you should not hesitate to take the pain medicine (analgesics) that your doctor prescribes. If you need narcotic medications to control your pain, your doctor may also want you to take an NSAID (nonsteroidal anti-inflammatory drug) to make it work better. Of course, the best way to ultimately control and prevent bone pain is for your cancer to go into remission from systemic therapy. Since radiation can make the side effects of chemotherapy worse (especially bone marrow suppression, mucositis, and diarrhea), your oncologist often holds off giving you chemotherapy during the radiation treatments. Your doctor may also recommend radiation therapy to prevent you from breaking a bone, even if the cancer in your bones is not causing pain. Intravenous bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), also help control bone pain and speed bone healing.
Terms:
Peripheral neuropathy – Numbness and pain of the hands and feet, which can be caused by infection, very strong drugs (such as chemotherapy), or disease.
Analgesic – Drugs that reduce pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) – A class of pain medications, often sold over-the-counter, that includes ibuprofen and similar common painkillers.
