• Your Body after Treatment

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    Although your treatment has ended, you are still coping with how it affects your body. It can take time to get over the effects of cancer treatment. Each person's schedule is different. You may wonder how your body should feel during this time and what may be a sign that cancer is coming back. This section talks about some of the problems that can occur when treatment is over.

    What you experience may be related to the type of cancer you had and the treatment you received. It is also very important to remember that no two people are alike, so you may experience changes that are very different from someone else's, even if they had the same type of cancer and received the same treatment.

    Fatigue

    "I can walk and keep busy," said one testicular cancer survivor, "but it gets very tiring. If I sit in a chair and really want to read or watch something, I'm gone in about 30 seconds, and it is a deep sleep."

    Some cancer survivors report that they still feel tired or worn out after treatment is over. In fact, fatigue is one of the most common complaints during the first year after treatment.

    Rest or sleep does not "cure" the type of fatigue you may have after cancer treatment, and doctors do not know its exact cause(s). The causes of fatigue are different for people who are receiving treatment than they are for those who have completed treatment:

    • Fatigue during treatment can be caused by cancer therapy. Other problems can also play a part in fatigue, like anemia (having too few red blood cells), poor nutrition, not drinking enough liquids, and depression. Pain can also make fatigue worse.
    • Researchers are still learning about what may cause fatigue after treatment.

    holdingfaceHow long will fatigue last? There is no "normal" pattern. For some, fatigue gets better over time. Others, such as those who have had bone marrow transplants, may have less energy for years after their final treatment.

    Some people feel very frustrated when fatigue lasts longer than they think it should and gets in the way of their normal routine. They also may worry that their friends, family, and coworkers will get upset with them if they complain of fatigue often.

    Getting help with fatigue from your doctor or nurse

    Talk to your doctor about what may be causing your fatigue and what can be done about it. Ask about:

    • How any medicines you are taking or other medical problems you have might affect your energy level
    • How you can control your pain, if pain is a problem for you
    • Exercise programs that might help, such as walking
    • Relaxation skills
    • Changing your diet or drinking more fluids
    • Medicines or nutritional supplements that can help
    • Specialists who might help you, such as physical therapists, occupational therapists, nutritionists, or mental health care providers
    Tips: fighting fatigue

    How do you fight fatigue? Here are some ideas that have helped others:

    • Plan your day. Be active at the time of day when you feel most alert and energetic.
    • Save your energy by changing how you do things. For example, sit on a stool while you cook or wash dishes.
    • Take short naps or rest breaks between activities.
    • Try to go to sleep and wake up at the same time every day.
    • Do what you enjoy, but do less of it. Focus on old or new interests that do not tire you out. Try to read something brief or listen to music.
    • Let others help you. They might cook a meal, pick up something at the store, or do the laundry. If no one offers, ask for what you need. Friends and family might be willing to help but may not know what to do.
    • Just say "no" to things that do not matter as much to you now. This may include housework and other chores. By using the energy you have in rewarding ways, you can live a fuller life.
    • Think about joining a support/education group for people with cancer. Talking about your fatigue with others who have had the same problem can help you learn new ways to cope.

    Pain

    neckpainYou may have pain after treatment. In some cases, it is caused by the treatment itself.

    Types of pain you may feel following cancer treatment include:

    • Skin sensitivity where you received radiation.
      This type of pain is quite common and can last for many months. "I am so sensitive [there] that I cannot put on anything tight," one breast cancer survivor noted.
    • Pain or numbness in the hands and feet due to injured nerves.
      Chemotherapy or surgery can damage nerves, which can cause severe pain. (This is called neuropathy.)
    • Painful scars from cancer surgery.  
    • Pain in a missing limb or breast.
      While doctors do not know why this pain occurs, it is real. It is not just "in your mind."
    Getting help with pain from your doctor or nurse

    You deserve to get relief from your pain, and your doctor or nurse can help you. Wanting to control pain is not a sign of weakness. It is a way to help you feel better and stay active.

    If you are older, you may not know whether your pain is because of cancer or because of other health problems, such as arthritis. You might not think to mention it to either your oncologist or your other doctors, but you should do so. If you are in pain, tell your oncologist or another doctor.

    With your help, your doctor can assess how severe your pain is. Then, he or she might suggest one or more of the following approaches. These approaches have helped others recovering from cancer and may help you.

    • Pain relief medicines.
      In most cases, doctors will try the mildest medicines first. Then they will work up to stronger medicines if you need them. The key to getting relief is to take all medicines just as your doctor prescribes. To keep pain under control, do not skip doses or wait until you hurt to take these medicines. You may be afraid that if you use medicines you'll become a "drug addict," but this almost never happens if you take the correct dose and see your doctor regularly.
    • Antidepressant medicines.
      Some of these have been prescribed to reduce pain or numbness from injured nerves.
    • Physical therapy.
      Going to a physical therapist may help relieve your pain. The therapist may use heat, cold, massage, pressure, and/or exercise to help you feel better.
    • Braces.
      These limit movement of a painful limb or joint.
    • Acupuncture.
      This is a proven method that uses needles at pressure points to reduce pain.
    • Hypnosis, meditation, or yoga.
      Any of these may help your pain. A trained specialist can teach you these approaches.
    • Relaxation skills.
      Many people with cancer have found that practicing deep relaxation helped relieve their pain or reduced their stress.
    • Nerve blocks or surgery.
      If you do not get relief from the other approaches in this section, you may want to ask the doctor about these. Nerve blocks or surgery often help if you have persistent, limiting pain, but they may put you at risk for other problems. They may also require you to stay in the hospital.

    Note: Health insurance does not always cover these approaches. Find out whether your policy covers the approaches your doctor recommends.

    Tips: Talking to your doctor about pain

    Here are some tips to help you describe your pain to your doctor:

    • Use numbers. Talk about how strong the pain feels on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you could have.
    • Describe what the pain feels like. Is it sharp, dull, throbbing, steady?
    • Point out the exact places it hurts, either on your body or on a drawing. Note whether the pain stays in one place or whether it moves outward from the spot.
    • Explain when you feel pain. Note when it starts, how long it lasts, if it gets better or worse at certain times of day or night, and if anything you do makes it better or worse.
    • Describe how your pain affects your daily life. Does it stop you from working? Doing household chores? Seeing your friends and family? Going out and having fun?
    • Make a list of all the medicines you are taking (for any reason). If you are taking any for pain relief, how much do they help?
    • Talk about any side effects from your pain control medicine, such as constipation or other changes in bowel habits, or feeling groggy or "out of it." Many of these problems can be solved.
    • Talk about your goals for pain relief. Do you want no pain at all (which can sometimes be hard to achieve), or is your goal to feel well enough to do specific activities?
    • Keep a pain diary. A diary can help you track changes over time. It can also show how you respond to any pain control medicine or other treatment you receive.

    Lymphedema: Arm or leg swelling

    Lymphedema is a swelling of a part of the body, usually an arm or leg, that is caused by the buildup of lymph fluid. It can be caused by cancer or the treatment of cancer. There are many different types of lymphedema. Some types happen right after surgery, are mild, and don't last long. Other types can occur months or years after cancer treatment and can be quite painful. Lymphedema can also develop after an insect bite, minor injury, or burn.

    People who are at risk for lymphedema are those who have had:

    • Breast cancer
      if you had radiation therapy or had your underarm lymph nodes removed. Your risk is even higher if you had radiation in the underarm area after your lymph nodes were removed.
    • Melanoma of the arms or legs
      if you had lymph nodes removed and/or had radiation therapy.
    • Prostate cancer
      if you had surgery or radiation therapy to the whole pelvis.
    • Cancer of the female or male reproductive organs
      if you were treated with surgery to remove lymph nodes or had radiation therapy.
    • Other cancers that have spread to the lower abdominal area.
      The pressure from the growing tumor can make it hard for your body to drain fluid.
    Getting help with lymphedema from your doctor or nurse

    Your doctor or nurse may be able to help you find ways to prevent and relieve lymphedema. Ask about:

    • Ways to keep your skin healthy.
      It is important to keep your skin clean. You should also keep it moist with lotion.
    • Exercising
      to help the body drain the lymph fluid, and what types of exercise you should not do.
    • Treating lymphedema.
      He or she may suggest:
      • Keeping the arm or leg raised above your chest.
      • Special massage that can help by moving the lymph fluid from where it has settled.
      • Special bandages and clothing that can help lymph fluid drain.
      • Losing weight.
       
    • Finding sources of emotional support
      to help you cope.
    Tips: Preventing or relieving lymphedema

    Other cancer survivors have found these tips helpful:

    • Watch for signs of swelling or infection (redness, pain, heat, fever). Tell your doctor or nurse if your arm or leg is painful or swollen.
    • Keep your arm or leg free of cuts, insect bites, or sunburn. Try not to have shots or blood tests done in that area.
    • Eat a well-balanced, protein-rich, low-salt diet.
    • Keep regular follow-up appointments with your doctor.
    • Wear loose-fitting clothing on your arm or leg.
    • Try not to use that arm or leg to figure out how hot or cold something is-such as bathwater or cooked food. You may be less able to feel hot and cold now.

    Problems with your mouth or teeth

    Research shows that many people who have been treated for cancer develop problems with their mouth and teeth.

    Radiation to the head and neck can cause problems with your teeth and gums; the soft, moist lining of your mouth; glands that make saliva (spit); and jawbones.

    This can cause:

    • Dry mouth
    • Cavities and other kinds of tooth problems
    • Loss or change in sense of taste
    • Painful mouth and gums
    • Infections in your mouth
    • Jaw stiffness or jawbone changes

    If you were treated with certain types of chemotherapy, you can also have many of the same problems.

    Some problems go away after treatment. Others last a long time, while some may never go away. Some problems may develop months or years after your treatment has ended.

    Who has these problems?
    • Almost all people who have had radiation therapy to the head and neck
    • Most people who have had bone marrow transplants
    • About 2 of every 5 people treated with chemotherapy
    Getting help with your mouth or teeth problems

    If you find that these problems persist after cancer treatment ends, talk to your doctor about:

    • What may be causing these problems
    • Ways to control mouth pain

    See your dentist soon after you are done with treatment. Ask about:

    • How often you should have checkups
    • Ways to take care of your mouth and teeth
    Tips: Preventing or relieving mouth or teeth problems

    Keep your mouth moist.

    • Drink a lot of water.
    • Suck ice chips.
    • Chew sugarless gum or suck on sugar-free hard candy.
    • Use a saliva substitute to help moisten your mouth.

    Keep your mouth clean.

    • Brush your teeth, gums, and tongue with an extra-soft toothbrush after every meal and at bedtime. If it hurts, soften the bristles in warm water.
    • Use a mild fluoride toothpaste (like a children's toothpaste) and a mouthwash without alcohol.
    • Floss your teeth gently every day. If your gums bleed or hurt, stay away from the areas that are bleeding or sore, but keep flossing your other teeth.
    • Rinse your mouth several times a day with a solution of 1/4 teaspoon baking soda and 1/8 teaspoon salt in one cup of warm water. Follow with a plain water rinse.
    • If you have dentures, clean, brush, and rinse them after meals. Have your dentist check them to make sure they still fit you well.

    If your mouth is sore, remember to stay away from:

    • Sharp, crunchy foods, like taco chips, that could scrape or cut your mouth
    • Foods that are hot, spicy, or high in acid, like citrus fruits and juices, which can irritate your mouth
    • Sugary foods, like candy or soda, that could cause cavities
    • Toothpicks (they can cut your mouth)
    • All tobacco products
    • Alcoholic drinks

    If you have stiffness in your jaw:

    • Three times a day, open your mouth as far as you can without pain, then close it. Repeat 20 times.

    Weight changes

    Research shows that some cancer survivors who have had certain kinds of chemotherapy or who have taken certain medicines have problems with weight gain, and the added pounds stay on even when treatment ends. Breast cancer survivors who have had certain types of chemotherapy gain weight in a different way: they may lose muscle and gain fat tissue. Unfortunately, the usual ways people try to lose weight may not work for them.

    Some cancer survivors have the opposite problem: they have no desire to eat, and they lose weight. Some men say that weight loss is a bigger concern for them than weight gain. It makes them feel less strong and like "less of a man."

    Getting help with weight gain from your doctor or nurse

    Your doctor or nurse can help you deal with weight gain. Ask about:

    • Doing strength-building exercises for your arms and shoulders, if you have lost muscle and gained fat tissue
    • Talking to a dietitian or nutritionist who can help you plan a healthy diet that won't add extra pounds
    Tips: Regaining a lost appetite

    Here are some tips that have helped others improve their appetites:

    • Start with small meals. Five small meals a day may be easier to manage than three larger ones. Try to have a smaller breakfast than usual, then have a healthy snack in the middle of the morning.
    • Focus on favorite foods. If the thought of eating still lacks appeal, try the foods you really liked before treatment. They can help jump-start your appetite.
    • Pamper yourself. Make mealtime a special time. Even if you only have a nutritional supplement drink, serve it in a chilled glass or mug. Add some fresh fruit, juice, or other flavor boost to make it taste better.
    • Find ways to make your meals look nice. Choose foods of contrasting colors; serve the meal on a pretty plate; use a colorful napkin.

    Trouble swallowing

    Some people who have had radiation therapy or chemotherapy to the head or neck areas may find it hard to eat because they have trouble swallowing. People who have had radiation to the breast or chest or those who have had surgery involving the larynx may also have this problem. As one lung cancer survivor said, "I had a really hard time swallowing and chewing because of the chemo. I just couldn't do it. I lived on soup and soft rice for weeks and weeks."

    If you have trouble swallowing:

    • Eat soft, bland foods moistened with sauces or gravies. Puddings, ice cream, soups, applesauce, and bananas and other soft fruits are nourishing and usually easy to swallow.
    • Use a blender to process solid foods.
    • Ask for advice from your health care team, including your doctor, nurse, nutritionist, and/or speech pathologist.
    • Tilt your head back or move it forward while you are eating.
    • Have a sip of water every few minutes to help you swallow and talk more easily. Carry a water bottle with you so you always have some handy.

    Bowel and bladder control

    Bowel and bladder problems are among the most upsetting issues people face after cancer treatment. People often feel ashamed or fearful to go out in public. "Going back to work was the hardest thing," one prostate cancer survivor noted. "I felt so foolish having to go to the bathroom all the time. And it was a complete surprise. My doctor never told me I would have this problem."

    This loss of control can happen after treatment for bladder, prostate, colon, rectal, ovarian, or other cancers. Your surgery may have left you with no bowel or bladder control at all. Or perhaps you still have some control, but you make lots of sudden trips to the bathroom.

    The opposite problem can happen when a medicine you are taking for pain causes constipation.

    Getting help with bowel and bladder control from your doctor or nurse

    It is very important to tell your doctor about any changes in your bladder or bowel habits. Ask your doctor or nurse about:

    • Help in dealing with ostomies. There are services and support groups to help people deal with these changes.
    • Problems with constipation, which can be treated.
    • Doing Kegel exercises and other physical training programs.
    • Medications that may help.

    Menopause symptoms

    After chemotherapy, some women stop getting their periods every month or stop getting them altogether.

    Some cancer treatments can cause changes in women's bodies and reduce the amount of hormones the body makes. These changes can cause your periods to stop, as well as cause other symptoms of menopause.

    Over time, some women will start getting their periods again (this is more likely for younger women), but others will not.

    Some common signs of menopause are:

    • Irregular periods.
      One of the first signs is a change in your periods. They may become less regular. They could be lighter. Some women have short times of heavy bleeding. Sometimes, they stop all of a sudden.
    • Hot flashes.
      Hot flashes are often worse at night and can disrupt sleep. This can cause mood changes and make it hard for you to make decisions.
    • Problems with your vagina or bladder.
      Tissues in these areas become drier and thinner. You may be more likely to get infections in your vagina. As you get older, you may also have urinary tract problems or problems holding your urine.
    • Lack of interest in having sex.
      These changes may make it hard for you to become sexually aroused.
    • Fatigue and sleep problems.
      You may feel tired or have trouble getting to sleep, getting up early, or getting back to sleep after waking up in the middle of the night.
    • Memory problems, and other problems such as depression, mood swings, and irritability.
      Some of these, especially memory problems, may be related to growing older. There may be a connection between changes in your hormone levels and your emotions.
    • Other changes in your body.
      You may notice your waist getting bigger, less muscle and more fat around your body, or thinning and loss of elasticity in your skin.
    Getting help with menopause symptoms from your doctor or nurse

    See a gynecologist every year. Ask about:

    • Medicines or supplements or other approaches that can help you manage menopause symptoms
    • Tests you should have (such as a bone density test to see if you are at risk for osteoporosis)
    • Ways you can reduce your chance of getting:
      • Osteoporosis. Menopause can put you at risk for losing bone tissue, which can weaken your bones and make them easier to break.
      • Heart Disease. Menopause can also lead to higher cholesterol in your blood, which can increase your risk of diseases that affect your heart and blood vessels.
       
    Tips: Relieving menopause symptoms

    Here are some tips that have helped others deal with menopause symptoms:

    • Quit smoking.
    • Exercise-both weight-bearing and muscle strengthening.
    • Eat wisely. A balanced diet will provide most of the nutrients and calories your body needs to stay healthy.
    • Through exercise and diet, try to maintain a healthy weight.
    • Drink plenty of water.

    If you are having hot flashes, try making a diary of when they happen and what may start them. This may help you find out what to avoid. Otherwise:

    • When a hot flash starts, go somewhere that is cool, or carry a small fan with you.
    • Sleep in a cool room; this may keep hot flashes from waking you up during the night.
    • Dress in layers that you can take off if you get warm.
    • Use cotton sheets, and wear clothing that lets your skin "breathe."
    • Try having a cold drink (water or juice) at the beginning of a flash.
    • Try not to eat a lot of spicy foods. Limit the alcohol and caffeine you drink.

    Intimacy and sexuality

    You may have changes in your sex life after cancer treatment-many people do. About half of women who have had long-term treatment for breast and reproductive organ cancers and more than half of men treated for prostate cancer report long-term sexual problems. Many cancer survivors say they were not prepared for the changes in their sex lives.

    Sexual problems after cancer treatment are often caused by changes to your body-from surgery, chemotherapy, or radiation, or by the effects of pain medicine. Sometimes these problems are caused by depression, feelings of guilt about how you got cancer, changes in body image after surgery, and stress between you and your partner.

    What types of problems occur? People report four main concerns:

    • Losing interest in sex. Some may struggle with their body image after treatment. Even thinking about their partners seeing them without clothes is stressful. Others are worn out or in pain, and sex is the last thing on their minds. Chemotherapy and some cancer medicines can also reduce sex drive.
    • Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that also change your sex life.
      • Some men can no longer get or keep an erection after treatment for prostate cancer, cancer of the penis, or cancer of the testes. Some treatments can also weaken a man's orgasm or make it dry.
      • Some women find it harder, or even painful, to have sex after cancer treatment. Some cancer treatments, like chemotherapy, surgery, or radiation, can cause these problems; sometimes, there is no clear cause for these problems.
       
    • Having menopause symptoms. When women stop getting their periods, they can get hot flashes, dryness or tightness in the vagina, and/or other problems that can affect their desire to have sex.
    • Losing the ability to have children. Some cancer treatments can cause infertility, making it impossible for cancer survivors to have children. Depending on the type of treatment you had, your sex and age, and the length of time you've been out of treatment, you may still be able to have children.
    Getting help with sexual problems from your doctor or nurse

    Your doctor may be able to help you deal with these problems, but he or she may not bring up the subject. You may need to "break the ice" yourself. If you think you might have trouble getting started, bring this document with you and show this section to your doctor or nurse.

    Often, sexual problems will not get better on their own. To get help with many of these problems, it is important to talk to your doctor. Ask about:

    • Any medical problem that may be causing changes in your sex life. You may be able to get treatment for the problems you are having. These may include:
      • Erection problems. Medicines, counseling, finding ways to please yourself, surgery, or other approaches may help.
      • Vaginal dryness. Dryness or tightness in the vagina, which can be caused by menopause. Ask whether using a water-based lubricant during sex, using vaginal dilators before sex, and/or taking hormones or using a hormone cream are options for you.
      • Ways you can gain muscle control by doing Kegel exercises. You can help strengthen muscles in your genital area by doing these exercises. Practice by controlling your muscles to stop the flow of urine. You can do these exercises even when you are not urinating. Just tighten and relax the muscles as you sit, stand, or go about your day.
      • Concerns about having children, and what you can do. Discuss family planning concerns with your doctor. If you are a woman, ask if you still need to use birth control even if you are not getting your period.
      • Seeing a sex therapist. He or she may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.
       

    Other health problems

    For some survivors, the long-term effects of cancer and its treatment may be made worse by the effects of aging, or by other health conditions, such as diabetes or heart disease, that you may have had before cancer. Breast cancer survivors who have had surgery may find everyday activities like reaching or stretching painful; health conditions such as arthritis can make these activities even more difficult. Colorectal or prostate cancer survivors may find that the aging process also affects their bowel or bladder control.

    It is very important that you tell your doctor about:

    • All your health conditions
    • All the medicines you are taking for these conditions

    Some cancer treatments may cause future health problems. Sometimes these problems don't appear right away; some don't appear until years after treatment.

    Ask your doctor:

    • Whether your treatment can put you at risk for short-term or long-term problems
    • What those problems are
    • What you should do to take care of your health

    Source: U. S. National Cancer Institute, Facing Forward Series: Life After Cancer

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