What is Cancer

There are more than 100 kinds of cancer. Most cancers are named for the type of cell or the organ in which they begin.

Scientists continue to investigate what causes cancer. They study patterns of cancer in the population, looking for factors that affect people’s risk for getting cancer. In laboratories, scientists explore possible causes of cancer and examine what happens when it develops. Many questions remain, but scientists have discovered that cancer develops gradually. Heredity, environment, and lifestyle choices all seem to play a role. We also know that cancer is not spread from person to person. You cannot “catch” cancer by sharing food or drinks or through touching, kissing, or sexual contact.

How Cancer Cells Grow

Your body is a complex structure. It is made of billions of cells that act as building blocks in your body. You cannot see single cells with your eyes. Cells organize together to form glands, muscles, bones, and other body parts just like the brick, wires, and pipes in a building. Just as the material in bricks and pipes varies, so do the cells in your body.

Cells look and function differently based on where they are found in your body. However, all cells have the same basic parts and follow the same life cycle. All cells grow, divide, and die. Some go through the cycle faster than others. Every day your body makes new cells to replace those that wear out.
Normal cells are orderly in your body. They follow a pattern when they grow, multiply, and divide. When normal cells in your body become disorderly and grow out of control, this is called cancer. The cell no longer does the job it should do for the body. When a cancer cell divides, it makes more cells like itself. These cancer cells keep dividing into more cells. Eventually they crowd out and destroy the normal healthy cells and tissues the body needs.

Cancer cells can remain microscopic (too little to see with your eyes) or they may grow into a lump inside or outside your body. When the body makes too many cells that do not function properly, they form a lump called a tumor. There are two types of tumors: benign and malignant. A benign tumor is not cancer, although it can grow large and press on other parts of the body. It stays in one place and does not travel to other parts of the body. A malignant tumor is cancerous. It can grow very large and press on other parts of the body. Malignant tumors can travel to other parts of the body. Cancer cells break away and move throughout the body. When cancer cells travel from one area of your body to another, it is called a metastasis.

Cancer cells become a problem because they:

• Do not function properly like normal cells do
• Do not obey the rules of the cell life and death cycle
• Push out normal cells
• Grow and divide quicker than normal cells
• Travel to other parts of the body

Diagnostic Tests

Your doctor will need to perform tests to determine if the cancer is in more than one spot of your body and to help determine what treatment is best for you. At the time your test is scheduled, you will receive complete information about the test and how to prepare for it. The following are some tests you may have.

• Biopsy. Removes a tissue sample to see if cancer cells are present. This can be done surgically or with a needle.
• X-ray. Uses a form of radiation that can show an image of cancer in your body or bones.
• Ultrasound. Uses high-frequency sound waves to outline a part of the body. Ultrasound is a way to find out if a structure is solid or liquid.
• Computerized Tomography (CT) Scan. Produces detailed pictures of the inside of your body. It is a painless test commonly used for imaging the many parts of your body.
• Magnetic Resonance Imagery (MRI). Diagnoses abnormalities and diseases not seen on conventional X-rays. MRIs produce high-quality images without using radiation.
• Bone Scan. Evaluates the structure of your bones. A low-dose radioactive dye is injected into a vein and images are taken. Dye that  gathers in a specific area suggests an abnormality.

Blood Tests

Blood tests help determine what is happening to your body. They also help your doctor choose the best way to treat you. Blood can be drawn from your arm or your finger.

Certain types of cancer treatment change your blood. You may need to change your treatment plan if your blood cells are not in balance. Some people require blood transfusions to bring up blood counts that are too low. Common types of blood tests your doctor will check include the following:

• White blood cell count. White blood cells work to combat infections. They can kill germs and disease.
• Red blood cell count. Red blood cells carry oxygen to all parts of the body. They are made in the bone marrow.
• Platelet count. Platelets help stop bleeding. Platelets and other parts of the blood form clots or scabs that stop bleeding.
• Tumor markers. These are certain substances that are produced by a cancerous tumor. These tumor markers can be used to determine if the treatment is working.

Cancer Treatments

A cancer diagnosis does not always mean a hospital stay is required. In fact, many procedures and treatments can be done in outpatient clinics. These clinics are staffed with experts in cancer treatment and can provide you with the best care during clinic hours so you can sleep in your own bed at night.

Surgery and some procedures require hospitalization. It is also possible to receive some care in your home, if necessary. Your health care team will work with you to determine the setting for you to receive care, be that in the home, hospital, clinic, or other facilities.

Depending on the type of cancer you have, you may receive different types of treatment. Treatments are aimed at either curing the cancer, controlling it, or making you more comfortable. Your doctor will give you more specific information about your treatment plan.

• Chemotherapy. Chemotherapy is the use of special medications to fight cancer. There are more than 40 different types of chemotherapy. One or more chemotherapy agents can be used to treat your cancer. Chemotherapy is most often injected into a vein, and is usually given in more than one treatment. Usually a treatment period is followed by a recovery period, then another treatment and so on. This is called a treatment cycle. The number of treatments depends on the type of cancer you have.
• Radiation Therapy. Radiation therapy is the use of high energy X-rays to kill cancer cells. It is a local treatment because it is used to treat cancer in one part of your body. The radiation may come from a machine outside your body. This is called external radiation. It also can come from radioactive materials placed in your body. This is called implant radiation.
• Surgery. Two main types of surgery are used when treating cancer:
  • Excisional—a local therapy to remove the cancer from your body. Tissues around the tumor and nearby lymph nodes may also be removed during the operation.
  • Reconstructive—rebuilds an area which has been disrupted by cancer and surgery.
• Hormone Therapy. Hormone therapy is used to treat cancers that depend on hormones to grow. Hormone therapy can be used to prevent cancer cells from getting or using the hormones they need to grow. Surgery may be used to remove the part of the body that makes the hormone. Drugs may be used to stop hormone production or change the way hormones work. Hormonal therapy affects all parts of the body.
• Biological Therapy. Biological therapy uses the body’s natural defenses (immune system) to fight cancer or lessen the side effects. It is also known as immunotherapy or biotherapy. It affects all parts of your body.
• Bone Marrow Transplant. This procedure replaces your bone marrow with healthy bone transplant marrow. A bone marrow transplant is a very complex treatment. It includes chemotherapy with or without radiation therapy.

Managing Side Effects of Cancer Treatments

Caring for Your Mouth During Chemotherapy

Chemotherapy destroys cancer cells. In addition, it may damage normal cells, including those that line your mouth. Mouth soreness or dryness may develop as early as three days after chemotherapy, but usually occurs between seven and 14 days. These side effects are not permanent. The cells or tissue in your mouth regrow as blood counts return to normal following chemotherapy. Good care of your mouth, teeth, and gums can help prevent mouth sores from becoming infected. Use the following suggestions to keep your mouth healthy:

• Check your mouth daily for changes.
• Report any mouth or lip sores to your doctor.
• Use a soft bristle toothbrush softened under warm water when you brush your teeth.
• Use a slow, gentle action to brush your teeth so you do not damage the soft tissue in your mouth.
• Use dental floss carefully to prevent hurting your gums.
• Rinse your mouth frequently during the day to keep it clean.
• Use a saline mouth rinse (one teaspoon salt in one quart water) after meals and at bedtime.
• Avoid foods or substances that are irritating to the lining of your mouth, such as:
  • Hot foods
  • Highly seasoned or spicy foods
  • Citrus juices or acidic foods
  • Coarse or abrasive foods such as chips, popcorn, or dry toast
  • Alcoholic drinks
  • Cigarettes
  • Commercial mouthwashes
• Keep your lips moist by using lip balm.
• Avoid licking your lips.
• Talk to your doctor before you schedule a dental cleaning.

If you develop mouth sores, the following suggestions may help ease discomfort.

• Rinse your mouth with saline solution every one to two hours.
• Eat soft or liquid foods that are easy to chew and swallow such as poached eggs, oatmeal, milkshakes, pudding, or blenderized foods.
• Try foods at different temperatures. Chilled or room temperature foods usually are tolerated the best.

If you experience mouth dryness, the following suggestions may help ease dryness.

• Drink at least six to eight glasses of liquids (eight ounces each) a day.
• Eat moist foods like ice cream, pudding, and popsicles to keep your mouth moist and ease soreness.
• Use gravies and sauces to moisten dry foods.
• Use a lip balm or Vaseline® to keep lips moist.
• Talk to your doctor if mouth sores or dryness are severe. He or she may be able to prescribe a medication to help you.

Managing Constipation

Constipation is the passage of hard, dry, or infrequent stools. Each person has his or her own natural schedule. Some people may move their bowels two to three times a day. Other people may have a bowel movement once every three to five days. You do not need to worry about how often you move your bowels. You should be concerned only when bowel habits change a lot from how they usually are.

Constipation can be caused by a number of factors including inactivity, a low fiber diet, and changes in bowel habits. The opioids used for pain control and some chemotherapy agents also can cause constipation. The growth and spread of the cancer may also contribute to it.

Factors such as being in an unfamiliar place, needing assistance when going to the bathroom, or having to use a bedpan can also contribute to constipation. Stress and depression can also affect normal bowel habits.

How to Prevent and Treat Constipation

You can often keep your bowels moving regularly by following these tips.

Eat more fiber. Fiber relieves constipation and keeps your bowels moving. Fiber is the part of the food your body does not break down during digestion. It works as a natural laxative, adds bulk, and draws water to the stool. This makes the stool easier to pass. You can add fiber to your diet by eating a variety of fruits, vegetables, and whole grain breads and cereals.

There are over-the-counter fiber supplements that may also be helpful. If you use an over-the-counter fiber supplement read and follow the directions. If you are using an opioid to manage pain and are experiencing constipation, a fiber-supplement is not recommended, as it will cause an increase in gas and bloating.

Drink plenty of fluids. In addition to increasing your dietary fiber intake it is important to drink at least six to eight cups of decaffeinated fluids. Water and juice are good choices, but soup, Jell-O, and milk may also help keep your fluid intake up. Try drinking a warm beverage about one half hour before your usual time for a bowel movement.

Stay active. If possible, stay active. Activity helps your bowels move more freely and can also help relieve stress that may make you more constipated.

Use a stool softener or mild laxative. A mild laxative, or a stool softener, can be used for relief of temporary symptoms. If you are using an around-the-clock opioid to manage pain you will need to take a stool softener on a daily basis. Use stool softeners and laxatives as directed. Do not use suppositories or enemas without consulting with your doctor or nurse. You will work with your doctor to determine the most effective way to treat constipation. Once you find a bowel routine that works, it is important to keep it up as long as diarrhea is not a problem. 

When to Call Your Doctor

Call your doctor if you experience any of the following conditions:

• Abdominal pain and cramping that is not relieved by a bowel        movement.
• Constipation that does not resolve with use of a high fiber diet,          increase of fluids, and use of medications as recommended.
• Blood in stools (bright red blood coloring the water in the toilet) or stools that look like tar or coffee grinds.

Managing Diarrhea

Radiation and chemotherapy treatments used to prevent cancer cells from dividing and multiplying can also affect the normal cells lining your intestines. This can result in diarrhea. Diarrhea is the passage of frequent, loose, or watery stools often occurring with abdominal cramping. Stools move so quickly through the intestines that the body is unable to absorb the fluid in them.

Diarrhea can lead to loss of fluids or dehydration.

What You Can do to Manage Diarrhea

• If your doctor prescribes a medication for diarrhea take it as directed. Do not take any medication without consulting your doctor.
• Replace fluids that have been lost, and to prevent dehydration:
  • Drink a variety of fluids like clear fruit juices or tea. Try for eight large glasses a day.
  • Sip fluids slowly.
  • Use a beverage that replaces lost salt and potassium like Gatorade
  • Use soup or broth to replace lost salt
  • Let carbonated beverages stand before you drink them. This will help prevent gas and bloating.
• As diarrhea improves add bland foods like chicken without the
  skin, crackers, white bread, pasta noodles, canned fruits
  without the skin, poached eggs, toast, or rice.

When to Call Your Doctor

• Any change in normal bowel habits
• More stools per day than before treatment started
• Softer or looser stools
• Increased gas, cramping, abdominal pain
• Signs of dehydration including dry mouth, decreased urination, or darker yellow urine
• Fever with or without chills
• Dizziness and confusion
• Leg cramps
• Weakness

Managing Hair Loss During Chemotherapy

Hair loss, or alopecia, may be a side effect of chemotherapy and radiation. It is reassuring to know hair usually grows back after treatments are over. Many people like their new hair better than their old hair.

Chemotherapy and Hair Loss
What You Can Expect

Hair loss is not painful. You may experience tingling of the scalp or a mild headache prior to the loss of hair. The extent of hair loss varies from thinning of the scalp to total loss of body hair. How much hair you lose depends on the following:

• The drug or combination of drugs being used
• The way the drug works
• The dose of the drug
• The method of administration
• The number of actively growing hair follicles at the time of chemotherapy treatment (Individuals who have few hairs growing at the time of chemotherapy will be less sensitive to hair loss.)

How Chemotherapy Affects Your Hair

Hair follicles are susceptible to the effects of chemotherapy because of their fast rate of growth. At any given time, about 85 percent of your hair follicles are in an active phase of cell growth, while other body hair like eyebrows, pubic hair, and underarm hair are in a resting phase. This explains why scalp hair loss is more common and severe than loss of other body hair.

Chemotherapy-induced hair loss occurs in two ways. It can affect the hair root or the hair shaft. Higher doses or more potent types of chemotherapy destroy enough cells to cause complete destruction of the root and loss of the hair root bulb. Hair may be lost spontaneously when combed or washed.

Some types of chemotherapy slow the cellular growth rate. This causes partial damage of the hair rod and narrowing of the hair shaft. Narrow, weakened hair shafts break off easily. The root remains in the scalp. It is still able to grow but leaves a thinning pattern of hair.

When Hair Loss Occurs

Hair loss may not happen right away. It usually occurs anywhere from two to three weeks after treatment. There are some chemotherapy drugs that cause hair loss immediately. The loss is sudden, occurring within 24 to 48 hours of treatment. Hair growth begins again one to two months after treatment is completed. Some hair growth may even occur during active treatment, but this is usually minimal because the chemotherapy continues to have an effect on your hair.

Drugs That Cause Hair Loss

Specific drugs with high potential of causing hair loss include: Adriamycin™ (doxorubicin), Cytoxan™ (cyclophosphamide), IFEX™ (ifosfamide), Oncovin™ (vincristine) and Taxol™ (paclitaxel). There are other drugs that when given alone or in combination with each other may cause hair loss. Ask your health care provider if hair loss is a side effect of the medications you are using.

Radiation and Hair Loss

Radiation therapy can cause hair loss but only in the area being treated. For example, if you are receiving radiation treatment to your hip, you will not lose hair from your head. Radiation to your head may cause you to lose some of the hair from your scalp. Hair loss usually occurs two to three weeks after treatment begins. It may take a long time for hair to grow back after radiation treatment.

Caring For Your Hair and Scalp

It is important to care for your hair and scalp to protect and keep it as healthy as possible during cancer treatments. Follow the suggestions below to protect your hair:

• Use mild shampoo.
• Use soft hairbrushes.
• Use low heat when drying your hair with a blow dryer.
• Do not dye your hair or get a permanent.
• Use a sunscreen/sunblock if you lose a lot of hair on your head.
• Consider using a turban, scarf, cap, wig, or hairpiece. These can help protect your scalp from the sun and may help you feel more comfortable with your hair loss.
• Talk to your health care provider, family members or friends if you are feeling down or angry about your hair loss.
• Some insurance companies may provide coverage for wigs and hairpieces. Ask your health care provider for a “wig prescription” if required by your insurance company.

Managing Nausea and Vomiting During Chemotherapy

Nausea and vomiting may be a side effect of chemotherapy. There are three types of nausea and vomiting that can occur. These include:

• Chemotherapy-induced nausea and vomiting. This occurs from the time chemotherapy is given until 24 to 48 hours after treatment.
• Delayed nausea and vomiting. This occurs more than 48 hours after chemotherapy is given.
• Anticipatory nausea and vomiting. This occurs as a result of just thinking about chemotherapy.

The medications that are used to relieve or prevent nausea during chemotherapy are called antiemetics. Your doctor will work with you to find a medication that works best for you.

How Antiemetic Medications Are Given

• Oral tablets. These usually take effect in 30 to 60 minutes.
• Rectal suppositories. These may be used when you cannot take anything by mouth. They usually take effect in 30 to 60 minutes.
• Intravenous infusions (IV). These are used when nausea is severe. They become effective in five to 30 minutes.

Taking Your Antiemetic Medications

Your doctor will give you specific instructions on how to take your medications. You can also try the following:

• Take your medication one-half to one hour before a meal to help prevent nausea associated with eating.
• Take your prescribed medication one to two hours before chemotherapy if you have problems with nausea before you receive chemotherapy. Your doctor will advise you on how to continue your medication during your treatment. If the medication causes drowsiness, arrange to have someone drive you to your treatment or anywhere you need to go.
• Take your medication and rest one-half to one hour prior to getting out of bed if you are nauseated when you wake up.

Side Effects of Antiemetic Medications

Antiemetic medications may have side effects and these may be different for each person. (Do not despair if a medication does not work. There are several medications that can be used to prevent nausea.) The following are the most common side effects for frequently used antiemetics:

Thiethylperazine (Torecan™), Prochlorperazine (Compazine™), Metoclopramide (Reglan™) and Haloperidol (Haldol™)

• Drowsiness or dizziness. If you experience drowsiness or dizziness, be careful about doing activities that require alertness such as driving a car or operating dangerous equipment like lawnmowers or electric saws. Talk with your doctor if these symptoms continue or are disturbing.
• Headache. Talk to your doctor about a pain reliever to ease your headache.
• Restlessness and jitteriness.
• Difficulty swallowing or speaking, spasms in the neck and face muscles, tightness in the neck or back muscles, and difficulty walking. If any of these symptoms occur, stop taking your antiemetic medication and call your doctor. He or she can give you a medication to stop these symptoms. You will be prescribed a different antiemetic medication if this side effect occurs.

Lorazepam (Ativan™)

• Drowsiness
• Restlessness and jitteriness

Dexamethasone (Decadron™)

• Increased appetite
• Insomnia
• Restlessness

Self-Care For Easing Nausea

In addition to taking the medication your doctor prescribes, use the following tips to help manage nausea.

• Experiment with various eating patterns.
  • Eat a regular meal three to four hours prior to therapy, and then eat very light meals for the rest of the day, or eat frequent light meals throughout the day.
  • Keep something in your stomach. Eat small frequent meals instead of one, two, or three large meals. Keeping something in your stomach helps to absorb excess acid and helps manage nausea.
  • Avoid eating or drinking one to two hours before and after chemotherapy.
• Drink small, frequent amounts of cool liquids such as decaffeinated soft drinks or ice tea, or try Popsicles®, broth, or sherbet.
• Eat soft, bland foods like applesauce, toast, rice, oatmeal, canned fruit, or soda crackers.
• Limit fatty, greasy, fried, spicy, and hot foods with strong odors.
• Limit sweets such as candy, cookies, and cake if they make nausea worse.
• Avoid unpleasant odors, sights, and sounds.
• Experiment with different relaxation techniques.
  • Rest in a comfortable position in a quiet environment and take slow, deep breaths.
  • Use distraction to minimize the feeling of nausea. For example, listen to music, watch your favorite TV program or read. Visit with a friend.
  • Concentrate on a visual image of a pleasant place or person.
• Change positions. For example, sit instead of lay, or move from side to side.
• Lay on left side.
• Try dry or salty foods. Eat dry soda crackers when you first get up.
• Sip cool liquids between meals.
• Chew food thoroughly and slowly.
• Try tart foods like lemons, pickles, or sour candy.

Talking With Your Doctor or Nurse

At the time of your diagnosis, you may have many questions or concerns. It is important that you have confidence and trust in your medical team. The first doctor you see doesn’t have to be the doctor who follows you throughout the course of your treatment. This is especially true if you do not feel comfortable with the relationship you have with your doctor. It is okay to ask for a new doctor if you feel uncomfortable with your current doctor.

Feel free to talk with your doctor or nurse and get your questions answered. You will be less afraid if you know what the doctor is doing for you. It is often difficult to think of questions when cancer is new to you. If you do not know what to ask, start by asking your doctor these questions:

1. What kind of cancer do I have?
2. What treatment will be best for me?
3. What are the benefits of this treatment?
4. What are the risks of this treatment?
5. What other treatment methods are available?
6. How will I feel?
7. How often will I need to see the doctor or nurse?
8. Will I come to the office or to the hospital?
9. How long will I stay?
10. How many times will I need to come for treatments?
11. When will I feel okay again?
12. How will cancer change my life?
13. Will my insurance cover the costs of treatment and medical care?
14. What are the side effects of my treatment? How can I prepare for these?

Medications

Your doctor may prescribe medications during the course of treatment. Make sure all the medications you take are working for you, instead of against you, by doing the following:

• Telling your doctor or pharmacist about each medication you are taking. This includes prescriptions, over-the-counter medications, vitamins, minerals, and herbal preparations.
• Telling your doctor or pharmacist about any past reactions to specific drugs.
• Taking your medication exactly as prescribed. It is important that you take all the medication, even if you feel fine.
• Talking to your doctor or pharmacist before starting any over-the-counter medications, including herbal supplements, vitamins, and minerals.

Keep a list of all your medications in the medication record worksheet and in your wallet or purse. Record the name of the medication, the strength, how often you take it, and why. Consider the following when you need your prescription refilled.

• Many prescriptions can be filled over the phone. Some medications used to relieve pain may require a written prescription. Discuss what you will need to refill your prescription with your doctor.
• Call for your prescription when you still have a three- to four-day supply of medication.
• Call your pharmacy for refills, even if your pill bottle states “no refills.” The pharmacist will call your doctor.
• Ask your pharmacy when you will be able to pick up your prescription(s). Some pharmacies may need one to two business days to fill your prescription.

When you have been told that you or your loved one has cancer, it is normal to feel stressed and upset. Cancer affects a person’s physical well-being, self-esteem, and daily activities. Changes and loss can create strong feelings of grief and sadness. It is important to learn how to deal with the feelings you have about cancer. Give yourself time to make the adjustment. Remember that many people with cancer will be treated successfully and live many years—with a high quality of life—after their diagnosis.

What to Expect

It is normal to be fearful, anxious, and frustrated after a cancer diagnosis. You may feel a mixture of hope and despair. Sometimes you will be courageous. You will still be able to laugh. Sometimes you will be very angry or afraid.

Some patients have compared the experience to a roller coaster. Finding ways to cope with the ups and downs of your emotions will help. As a starting point, think about how you have dealt with difficult situations in the past. Knowing what works best for you and what doesn’t work can help you deal with the emotions ahead.

Sharing your Feelings

You may not be ready to share all your feelings. Give yourself time to let your feelings out, and make sure the people who are supporting you know when you are ready. You may need to rely on family and friends more than you did before. Share your feelings honestly. Talking may include expressing anger, fear, and inner confusion. Even these exchanges can be valuable if everyone learns to share feelings. Although you really do not want to hurt anyone, you may lash out at the people you love the most because you are afraid and angry. Express your feelings to them. Give them the opportunity to listen and understand. It is important to realize that they, too, may be having some of the same feelings and also may need to release them.

Your family may need some time to adjust to your diagnosis. If your family is unable to be supportive, find others who will be.

Finding Support

Do not be afraid to ask for help. Take time to ask your health care team the questions that come to mind. The more you know, the more certain you can become. Emotional assistance takes many forms. You may find comfort in discussing your feelings with a family member or a close friend. Some people find support groups helpful.

Sexuality and Cancer

Sexuality is an important part of the quality of everyday life. It is important to remember that pleasurable, sexual touching is always possible, regardless of your physical health or medical history.

Chemotherapy, surgery, and radiation can affect you in different ways. You may experience:

• Decreased energy
• Decreased sexual desire
• Difficulty in gaining or maintaining an erection (impotence)
• Inability to ejaculate
• Inability to lubricate
• Inability to achieve orgasm
• Alterations in body image
• Infertility
• Premature menopause

Chemotherapy, radiation, and surgery can affect you in different ways. Before you or your partner begin any form of cancer treatment, discuss potential sexual and reproductive problems with your doctor. Following are some ways these treatments may affect you.

Chemotherapy

• Chemotherapy may affect a patient’s fertility. This depends on age, sex, and the specific drug being used.
• Chemotherapy can affect how cells grow and multiply. For this reason, the treatment may cause birth defects during pregnancy, or if either men or women are receiving treatment at the time of conception. When receiving chemotherapy, men and women should discuss reliable methods of birth control with their doctor.
• Studies suggest that most types of chemotherapy are safe after the first trimester.
• The drugs used in chemotherapy are not transferred by kissing, hugging, cuddling, or through intercourse. You will still be able to be intimate with your partner.
• Most chemotherapy agents are excreted from the body in the first 72 hours following administration. Avoid oral sex and use condoms during this period in the event that the semen or vaginal secretions contain chemotherapy by-products.

Radiation

Impotence, inability to ejaculate, inability to lubricate, and inability to achieve orgasm may result when radiation therapy is used to treat gynecological, testicular, prostate, or rectal cancer. Infertility can occur when these cancers are treated with radiation.

Surgery

Impotence, inability to ejaculate, inability to lubricate, or inability to achieve orgasm may result when surgery is used to treat cancer in the following parts of the body: colon, rectum, pituitary and male or female genital and urinary tract systems.

Body image may be altered as a result of certain types of surgery. This may be true for women who require a mastectomy. You may feel less attractive and think your partner may not want to be close to you.

Contraception and Cancer Treatments

Talk to your doctor about reliable forms of birth control while receiving cancer treatments. When selecting an appropriate method, consider the following:

• Birth control pills can be used if the cancer is not hormonally sensitive.
• Intrauterine devices are not recommended when blood counts (white blood cell or platelet) are low because they may cause an infection or bleeding.
• Diaphragms, sponges, vaginal inserts, and condoms require careful attention to the insertion technique and personal hygiene after usage to prevent infection.

Future Reproduction

The likelihood of cancer recurrence and/or congenital defects is higher during the first two years following treatment. Men and women are advised to wait at least two years before attempting parenthood. One of the most disturbing pieces of information individuals may learn is that they will be infertile as a result of the treatment they receive. This can be devastating for those who have not yet started a family or for those who wanted to expand their families. In addition to adoption, there are options for those desiring to have children post-treatment. If your chances of infertility are high, talk to your doctor about the following:

• Sperm-banking. This may need to be completed prior to beginning therapy. While sperm can be retrieved and stored, methods of preserving eggs are still being studied.
• In vitro fertilization/embryo transfer. A retrieved egg is incubated with a sperm for five to 26 hours and then transferred to the uterus and released.
• Resources. Names of experts and facilities specializing in reproduction.

Self-Help for Sexuality Concerns

• If you have a sexual concern, talk to your doctor about it. Don’t wait until the problem seems too hard to handle; talk with your partner.
• Focus on your senses. It is easy to forget how good it feels to be caressed. Relax and enjoy touching each other.
• Use a water-soluble lubricant before intercourse if vaginal dryness is experienced.
• Talk to your doctor if you and your partner continue to have concerns about sexuality and reproduction. He or she can provide you with additional helpful resources.
   

Complementary, Alternative Therapies

Complementary and alternative therapies include a wide range of therapies, philosophies, and approaches. Complementary therapies usually are used with conventional treatments, while alternative therapies generally are used to replace conventional therapies. Recent research from the fields of psychology, neurology, and immunotherapy indicates that complementary therapy, such as laughter, relaxation, imagery, emotional expression, support groups, prayer, and music, can enhance your immune system.

Your doctor or nurse can discuss using complementary medicine as a supplement to the traditional medical therapy you are receiving. Consider the following as you discuss using complementary medicine with your doctor:

• What are the benefits of the therapy?
• How much will it cost and will it be covered by my insurance?
• Does it have side effects or risks?
• Will it interfere with other conventional treatments?

Occasionally, you may hear about a treatment your doctor has not recommended. The “reported results” of most of these treatments are based on testimonials, not on controlled research studies. Because the information about these treatments is not conclusive, they may not be the best options to use in attempting to treat your cancer. Talk to your doctor before starting any new therapies.

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