Sexual Changes due to Chemotherapy

Some types of chemotherapy can cause sexual changes. These changes are different for women and men.
In women, chemotherapy may damage the ovaries, which can cause changes in hormone levels. Hormone changes can lead to problems like vaginal dryness and early menopause.
In men, chemotherapy can cause changes in hormone levels, decreased blood supply to the penis, or damage to the nerves that control the penis, all of which can lead to impotence.
Whether or not you have sexual changes during chemotherapy depends on if you have had these problems before, the type of chemotherapy you are getting, your age, and whether you have any other illnesses. Some problems, such as loss of interest in sex, are likely to improve once chemotherapy is over.
Problems for WOMEN include:

• Symptoms of menopause (for women not yet in menopause). These symptoms include:
  • Hot flashes
  • Vaginal dryness
  • Feeling irritable
  • Irregular or no menstrual periods
• Bladder or vaginal infections
• Vaginal discharge or itching
• Being too tired to have sex or not being interested in having sex
• Feeling too worried, stressed, or depressed to have sex

Problems for MEN include:

• Not being able to reach climax
• Impotence (not being able to get or keep an erection)
• Being too tired to have sex or not being interested in having sex
• Feeling too worried, stressed, or depressed to have sex

Pain and pain control

Some types of chemotherapy cause painful side effects. These include burning, numbness, and tingling or shooting pains in your hands and feet. Mouth sores, headaches, muscle pains, and stomach pains can also occur.
Pain can be caused by the cancer itself or by chemotherapy. Doctors and nurses have ways to decrease or relieve your pain
Talk about your pain with a doctor, nurse, or pharmacist. Be specific and describe:

• Where you feel pain. Is it in one part of your body or all over?
• What the pain feels like. Is it sharp, dull, or throbbing? Does it come and go, or is it steady?
• How strong the pain is. Describe it on a scale of 0 to 10
•  How long the pain lasts. Does it last for a few minutes, an hour, or longer?
• What makes the pain better or worse. For instance, does an ice pack help? Or does the pain get worse if you move a certain way?
• Which medicines you take for pain. Do they help? How long do they last? How much do you take? How often?
• Let your family and friends know about your pain. They need to know about your pain so they can help you. If you are very tired or in a lot of pain, they can call your doctor or nurse for you. Knowing about your pain can also help them understand why you may be acting differently.
• Practice pain control
  • Take your pain medicine on a regular schedule (by the clock) even when you are not in pain. This is very important when you have pain most of the time.
  • Do not skip doses of your pain medicine. Pain is harder to control and manage if you wait until you are in a lot of pain before taking medicine.
  • Try deep breathing, yoga, or other ways to relax. This can help reduce muscle tension, anxiety, and pain.
• Ask to meet with a pain or palliative care specialist. This can be an oncologist, anesthesiologist, neurologist, neurosurgeon, nurse, or pharmacist who will talk with you about ways to control your pain.
• Let your doctor, nurse, or pain specialist know if your pain changes. Your pain can change over the course of your treatment. When this happens, your pain medications may need to be changed.
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Nervous System Changes

Chemotherapy can cause damage to your nervous system. Many nervous system problems get better within a year of when you finish chemotherapy, but some may last the rest of your life. Symptoms may include:

• Tingling, burning, weakness, or numbness in your hands or feet
• Feeling colder than normal
• Pain when walking
• Weak, sore, tired, or achy muscles
• Being clumsy and losing your balance
• Trouble picking up objects or buttoning your clothes
• Shaking or trembling
• Hearing loss
• Stomach pain, such as constipation or heartburn
• Fatigue
• Confusion and memory problems
• Dizziness
• Depression
• Ways to manage

• Let your doctor or nurse know right away if you notice any nervous system changes. It is important to treat these problems as soon as possible.
• Be careful when handling knives, scissors, and other sharp or dangerous objects.
• Avoid falling. Walk slowly, hold onto handrails when using the stairs, and put no-slip bath mats in your bathtub or shower.Make sure there are no area rugs or cords to trip over.
• Always wear sneakers, tennis shoes, or other footwear with rubber soles.
• Check the temperature of your bath water with a thermometer. This will keep you from getting burned by water that is too hot.
• Be extra careful to avoid burning or cutting yourself while cooking.
• Wear gloves when working in the garden, cooking, or washing dishes.
• Rest when you need to.
• Steady yourself when you walk by using a cane or other device.
• Talk to your doctor or nurse if you notice memory problems, feel confused, or are depressed.
• Ask your doctor for pain medicine if you need it.

Nausea and Vomiting

Some types of chemotherapy can cause nausea, vomiting, or both. Nausea is when you feel sick to your stomach, like you are going to throw up. Vomiting is when you throw up. You may also have dry heaves, which is when your body tries to vomit even though your stomach is empty.
Nausea and vomiting can occur while you are getting chemotherapy, right after, or many hours or days later. You will most likely feel better on the days you do not get chemotherapy.
New drugs can help prevent nausea and vomiting. These are called antiemetic or antinausea drugs. You may need to take these drugs 1 hour before each chemotherapy treatment and for a few days after. How long you take them after chemotherapy will depend on the type of chemotherapy you are getting and how you react to it. If one antinausea drug does not work well for you, your doctor can prescribe a different one. You may need to take more than one type of drug to help with nausea. Acupuncture may also help. Talk with your doctor or nurse about treatments to control nausea and vomiting caused by chemotherapy.

• Prevent nausea. One way to prevent vomiting is to prevent nausea. Try having bland, easy-to-digest foods and drinks that do not upset your stomach. These include plain crackers, toast, and gelatin. To learn more, see the list of foods and drinks that are easy on the stomach.
• Plan when it's best for you to eat and drink. Some people feel better when they eat a light meal or snack before chemotherapy. Others feel better when they have chemotherapy on an empty stomach (nothing to eat or drink for 2 to 3 hours before treatment). After treatment, wait at least 1 hour before you eat or drink.
• Eat small meals and snacks. Instead of 3 large meals each day, you might feel better if you eat 5 or 6 small meals and snacks. Do not drink a lot before or during meals. Also, do not lie down right after you eat.
• Have foods and drinks that are warm or cool (not hot or cold). Give hot foods and drinks time to cool down, or make them colder by adding ice. You can warm up cold foods by taking them out of the refrigerator 1 hour before you eat or warming them slightly in a microwave. 
• Drink cola or ginger ale that is warm and has lost its fizz.
• Stay away from foods and drinks with strong smells. These include coffee, fish, onions, garlic, and foods that are cooking.
•  Try small bites of popsicles or fruit ices. You may also find sucking on ice chips helpful.
• Suck on sugar-free mints or tart candies. But do not use tart candies if you have mouth or throat sores.
• Relax before treatment. You may feel less nausea if you relax before each chemotherapy treatment. Meditate, do deep breathing exercises, or imagine scenes or experiences that make you feel peaceful. You can also do quiet hobbies such as reading, listening to music, or knitting.
• When you feel like vomiting, breathe deeply and slowly or get fresh air. You might also distract yourself by chatting with friends or family, listening to music, or watching a movie or TV.
• Talk with your doctor or nurse. Your doctor can give you drugs to help prevent nausea during and after chemotherapy. Be sure to take these drugs as ordered and let your doctor or nurse know if they do not work. You might also ask your doctor or nurse about acupuncture, which can help relieve nausea and vomiting caused by cancer treatment.

Mouth and Throat Changes during and after Chemo

Some types of chemotherapy harm fast-growing cells, such as those that line your mouth, throat, and lips. This can affect your teeth, gums, the lining of your mouth, and the glands that make saliva. Most mouth problems go away a few days after chemotherapy is over.
Mouth and throat problems may include;

• Dry mouth (having little or no saliva)
• Changes in taste and smell (such as when food tastes like metal or chalk, has no taste, or does not taste or smell like it used to)
• Infections of your gums, teeth, or tongue
• Increased sensitivity to hot or cold foods
• Mouth sores
• Trouble eating when your mouth gets very sore

Ways to manage

• Visit a dentist at least 2 weeks before starting chemotherapy. It is important to have your mouth as healthy as possible. This means getting all your dental work done before chemotherapy starts. If you cannot go to the dentist before chemotherapy starts, ask your doctor or nurse when it is safe to go. Be sure to tell your dentist that you have cancer and about your treatment plan.
• Check your mouth and tongue every day. This way, you can see or feel problems (such as mouth sores, white spots, or infections) as soon as they start. Inform your doctor or nurse about these problems right away.
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Keep your mouth moist. You can keep your mouth moist by sipping water throughout the day, sucking on ice chips or sugar-free hard candy, or chewing sugar-free gum. Ask your doctor or nurse about saliva substitutes if your mouth is always dry.

• Brush your teeth, gums, and tongue after each meal and at bedtime.
• Use an extra-soft toothbrush. You can make the bristles even softer by rinsing your toothbrush in hot water before you brush.
• If brushing is painful, try cleaning your teeth with cotton swabs or Toothettes®.
• Use a fluoride toothpaste or special fluoride gel that your dentist prescribes.
• Do not use mouthwash that has alcohol. Instead, rinse your mouth 3 to 4 times a day with a solution of 1/4 teaspoon baking soda and 1/8 teaspoon salt in 1 cup of warm water. Follow this with a plain water rinse.
• Gently floss your teeth every day. If your gums bleed or hurt, avoid those areas but floss your other teeth. Ask your doctor or nurse about flossing if your platelet count is low. 
• If you wear dentures, make sure they fit well and keep them clean. Also, limit the length of time that you wear them.
• Be careful what you eat when your mouth is sore.
• Choose foods that are moist, soft, and easy to chew or swallow. These include cooked cereals, mashed potatoes, and scrambled eggs.
• Use a blender to puree cooked foods so that they are easier to eat. To help avoid infection, be sure to wash all blender parts before and after using them. If possible, it is best to wash them in a dishwasher.
• Take small bites of food, chew slowly, and sip liquids while you eat.
• Soften food with gravy, sauces, broth, yogurt, or other liquids.
• Eat foods that are cool or at room temperature. You may find that warm and hot foods hurt your mouth or throat.
• Suck on ice chips or popsicles. These can relieve mouth pain.
• Ask your dietitian for ideas of foods that are easy to eat. For ideas of soft foods that are easy on a sore mouth
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Infertility....another major side effect

Some types of chemotherapy can cause infertility. For a woman, this means that you may not be able to get pregnant. For a man, this means you may not be able to get a woman pregnant.
In women, chemotherapy may damage the ovaries. This damage can lower the number of healthy eggs in the ovaries. It can also lower the hormones produced by them. The drop in hormones can lead to early menopause. Early menopause and fewer healthy eggs can cause infertility.
In men, chemotherapy may damage sperm cells, which grow and divide quickly. Infertility may occur because chemotherapy can lower the number of sperm, make sperm less able to move, or cause other types of damage.
Whether or not you become infertile depends on the type of chemotherapy you get, your age, and whether you have other health problems. Infertility can last the rest of your life.
For WOMEN, talk with your doctor or nurse about;

• Whether you want to have children. Before you start chemotherapy, let your doctor or nurse know if you might want to get pregnant in the future. He or she may talk with you about ways to preserve your eggs to use after treatment ends or refer you to a fertility specialist.
• Birth control. It is very important that you do not get pregnant while getting chemotherapy. These drugs can hurt the fetus, especially in the first 3 months of pregnancy. If you have not yet gone through menopause, talk with your doctor or nurse about birth control and ways to keep from getting pregnant.
• Pregnancy. If you still have menstrual periods, your doctor or nurse may ask you to have a pregnancy test before you start chemotherapy. If you are pregnant, your doctor or nurse will talk with you about other treatment options

For MEN, talk with your doctor or nurse about:
 Whether you want to have children. Before you start chemotherapy, let your doctor or nurse know if you might want to father children in the future. He or she may talk with you about ways to preserve your sperm to use in the future or refer you to a fertility specialist.                                                  Birth control. It is very important that your spouse or partner not get pregnant while you are getting chemotherapy. Chemotherapy can damage your sperm and cause birth defects
 

The Main side effect....Infection!

Some types of chemotherapy make it harder for your bone marrow to produce new white blood cells. White blood cells help your body fight infection. Therefore, it is important to avoid infections, since chemotherapy decreases the number of your white blood cells.
There are many types of white blood cells. One type is called neutrophil. When your neutrophil count is low, it is called neutropenia. Your doctor or nurse may do blood tests to find out whether you have neutropenia.
It is important to watch for signs of infection when you have neutropenia. Check for fever at least once a day, or as often as your doctor or nurse tells you to. You may find it best to use a digital thermometer. Call your doctor or nurse if your temperature is 100.5°F or higher.

• Your doctor or nurse will check your white blood cell count throughout your treatment. If chemotherapy is likely to make your white blood cell count very low, you may get medicine to raise your white blood cell count and lower your risk of infection.
• Wash your hands often with soap and water. Be sure to wash your hands before cooking and eating, and after you use the bathroom, blow your nose, cough, sneeze, or touch animals. Carry hand sanitizer for times when you are not near soap and water.
• Use sanitizing wipes to clean surfaces and items that you touch. This includes public telephones, ATM machines, doorknobs, and other common items.
• Be gentle and thorough when you wipe yourself after a bowel movement. Instead of toilet paper, use a baby wipe or squirt of water from a spray bottle to clean yourself. Let your doctor or nurse know if your rectal area is sore or bleeds or if you have hemorrhoids.
• Stay away from people who are sick. This includes people with colds, flu, measles, or chicken pox. You also need to stay away from children who just had a "live virus" vaccine for chicken pox or polio. Call your doctor, nurse, or local health department if you have any questions.
•  Stay away from crowds. Try not to be around a lot of people. For instance, plan to go shopping or to the movies when the stores and theaters are less crowded.
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  Be careful not to cut or nick yourself. Do not cut or tear your nail cuticles. Use an electric shaver instead of a razor. And be extra careful when using scissors, needles, or knives.
• Watch for signs of infection around your catheter. Signs include drainage, redness, swelling, or soreness. Let your doctor or nurse know about any changes you notice near your catheter.
• Maintain good mouth care. Brush your teeth after meals and before you go to bed. Use a very soft toothbrush. You can make the bristles even softer by running hot water over them just before you brush. Use a mouth rinse that does not contain alcohol. Check with your doctor or nurse before going to the dentist. 
• Take good care of your skin. Do not squeeze or scratch pimples. Use lotion to soften and heal dry, cracked skin. Dry yourself after a bath or shower by gently patting

Hair Loss and dealing with it

Hair loss (also called alopecia) is when some or all of your hair falls out. This can happen anywhere on your body: your head, face, arms, legs, underarms, or the pubic area between your legs. Many people are upset by the loss of their hair and find it the most difficult part of chemotherapy.
Some types of chemotherapy damage the cells that cause hair growth. Hair loss often starts 2 to 3 weeks after chemotherapy begins. Your scalp may hurt at first. Then you may lose your hair, either a little at a time or in clumps. It takes about 1 week for all your hair to fall out. Almost always, your hair will grow back 2 to 3 months after chemotherapy is over. You may notice that your hair starts growing back even while you are getting chemotherapy.
Your hair will be very fine when it starts growing back. Also, your new hair may not look or feel the same as it did before. For instance, your hair may be thin instead of thick, curly instead of straight, and darker or lighter in color
Before hair loss:

• Talk with your doctor or nurse. He or she will know if you are likely to have hair loss.
• Cut your hair short or shave your head. You might feel more in control of hair loss if you first cut your hair or shave your head. This often makes hair loss easier to manage. If you shave your head, use an electric shaver instead of a razor.
• If you plan to buy a wig, do so while you still have hair. The best time to choose your wig is before chemotherapy starts. This way, you can match the wig to the color and style of your hair. You might also take it to your hair dresser who can style the wig to look like your own hair. Make sure to choose a wig that feels comfortable and does not hurt your scalp.
• Ask if your insurance company will pay for a wig. If it will not, you can deduct the cost of your wig as a medical expense on your income tax. Some groups also have free "wig banks." Your doctor, nurse, or social worker will know if there is a wig bank near you.
• Be gentle when you wash your hair. Use a mild shampoo, such as a baby shampoo. Dry your hair by patting (not rubbing) it with a soft towel.
• Do not use items that can hurt your scalp. These include:
  • Straightening or curling irons
  • Brush rollers or curlers
  • Electric hair dryers
  • Hair bands and clips
  • Hairsprays
  • Hair dyes
  • Products to perm or relax your hair
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Fatigue: another major side effect

Fatigue from chemotherapy can range from a mild to extreme feeling of being tired. Many people describe fatigue as feeling weak, weary, worn out, heavy, or slow. Resting does not always help.
Many people say they feel fatigue during chemotherapy and even for weeks or months after treatment is over. Fatigue can be caused by the type of chemotherapy, the effort of making frequent visits to the doctor, or feelings such as stress, anxiety, and depression. If you receive radiation therapy along with chemotherapy, your fatigue may be more severe
Fatigue can happen all at once or little by little. People feel fatigue in different ways. You may feel more or less fatigue than someone else who gets the same type of chemotherapy.
Ways to manage

• Relax. You might want to try meditation, prayer, yoga, guided imagery, visualization, or other ways to relax and decrease stress.
• Eat and drink well. Often, this means 5 to 6 small meals and snacks rather than 3 large meals. Keep foods around that are easy to fix, such as canned soups, frozen meals, yogurt, and cottage cheese. Drink plenty of fluids each day--about 8 cups of water or juice.
• Plan time to rest. You may feel better when you rest or take a short nap during the day. Many people say that it helps to rest for just 10 to 15 minutes rather than nap for a long time. If you nap, try to sleep for less than 1 hour. Keeping naps short will help you sleep better at night.
• Be active. Research shows that exercise can ease fatigue and help you sleep better at night. Try going for a 15-minute walk, doing yoga, or riding an exercise bike. Plan to be active when you have the most energy. Talk with your doctor or nurse about ways you can be active while getting chemotherapy.
• Try not to do too much. With fatigue, you may not have enough energy to do all the things you want to do. Choose the activities you want to do and let someone else help with the others. Try quiet activities, such as reading, knitting, or learning a new language on tape.
• Sleep at least 8 hours each night. This may be more sleep than you needed before chemotherapy. You are likely to sleep better at night when you are active during the day. You may also find it helpful to relax before going to bed. For instance, you might read a book, work on a jigsaw puzzle, listen to music, or do other quiet hobbies.
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  Plan a work schedule that works for you. Fatigue may affect the amount of energy you have for your job. You may feel well enough to work your full schedule. Or you may need to work less--maybe just a few hours a day or a few days each week. If your job allows, you may want to talk with your boss about ways to work from home. Or you may want to go on medical leave (stop working for a while) while getting chemotherapy.
• Let others help. Ask family members and friends to help when you feel fatigue. Perhaps they can help with household chores or drive you to and from doctor's visits. They might also help by shopping for food and cooking meals for you to eat now or freeze for later.
• Learn from others who have cancer. People who have cancer can help by sharing ways that they manage fatigue. One way to meet others is by joining a support group--either in person or online. Talk with your doctor or nurse to learn more.
• Keep a diary of how you feel each day. This will help you plan how to best use your time. Share your diary with your nurse. Let your doctor or nurse know if you notice changes in your energy level, whether you have lots of energy or are very tired.
• Talk with your doctor or nurse. Your doctor may prescribe medication that can help decrease fatigue, give you a sense of well-being, and increase your appetite. He or she may also suggest treatment if your fatigue is from anemia

Diarrhea : another side effect, concern

Diarrhea is frequent bowel movements that may be soft, loose, or watery. Chemotherapy can cause diarrhea because it harms healthy cells that line your large and small bowel. It may also speed up your bowels. Diarrhea can also be caused by infections or drugs used to treat constipation.
Ways to manage

• Eat 5 or 6 small meals and snacks each day instead of 3 large meals.
• Ask your doctor or nurse about foods that are high in salts such as sodium and potassium. Your body can lose these salts when you have diarrhea, and it is important to replace them. Foods that are high in sodium or potassium include bananas, oranges, peach and apricot nectar, and boiled or mashed potatoes.
• Drink 8 to 12 cups of clear liquids each day. These include water, clear broth, ginger ale, or sports drinks such as Gatorade® or Propel®. Drink slowly, and choose drinks that are at room temperature. Let carbonated drinks lose their fizz before you drink them. Add extra water if drinks make you thirsty or nauseous (feeling like you are going to throw up).
• Eat low-fiber foods. Foods that are high in fiber can make diarrhea worse. Low-fiber foods include bananas, white rice, white toast, and plain or vanilla yogurt. See the section on Low-Fiber Foods for other ideas.
• Let your doctor or nurse know if your diarrhea lasts for more than 24 hours or if you have pain and cramping along with diarrhea. Your doctor may prescribe a medicine to control the diarrhea. You may also need IV fluids to replace the water and nutrients you lost. Do not take any medicine for diarrhea without first asking your doctor or nurse.
• Be gentle when you wipe yourself after a bowel movement. Instead of toilet paper, use a baby wipe or squirt of water from a spray bottle to clean yourself after bowel movements. Let your doctor or nurse know if your rectal area is sore or bleeds or if you have hemorrhoids.
• Ask your doctor if you should try a clear liquid diet. This can give your bowels time to rest. Most people stay on this type of diet for 5 days or less. See Liquid Foods for a list of clear liquids.

Constipation: another Main Side Effect

Constipation is when bowel movements become less frequent and stools are hard, dry, and difficult to pass. You may have painful bowel movements and feel bloated or nauseous. You may belch, pass a lot of gas, and have stomach cramps or pressure in the rectum.
Drugs such as chemotherapy and pain medicine can cause constipation. It can also happen when people are not active and spend a lot of time sitting or lying down. Constipation can also be due to eating foods that are low in fiber or not drinking enough fluids.
Ways to manage

• Keep a record of your bowel movements. Show this record to your doctor or nurse and talk about what is normal for you. This makes it easier to figure out whether you have constipation.
• Drink at least 8 cups of water or other fluids each day. Many people find that drinking warm or hot fluids, such as coffee and tea, helps with constipation. Fruit juices, such as prune juice, may also be helpful. 
•  Be active every day. You can be active by walking, riding a bike, or doing yoga. If you cannot walk, ask about exercises that you can do in a chair or bed. Talk with your doctor or nurse about ways you can be more active.Ask your doctor, nurse, or dietitian about foods that are high in fiber. Eating highfiber foods and drinking lots of fluids can help soften your stools. Good sources of fiber include whole-grain breads and cereals, dried beans and peas, raw vegetables, fresh and dried fruit, nuts, seeds, and popcorn.

Bleeding, another major side effect concern

Platelets are cells that make your blood clot when you bleed. Chemotherapy can lower the number of platelets because it affects your bone marrow's ability to make them. A low platelet count is called thrombocytopenia. This condition may cause bruises (even when you have not been hit or have not bumped into anything), bleeding from your nose or in your mouth, or a rash of tiny, red dots.
Ways to manage
Do:

• Brush your teeth with a very soft toothbrush
• Soften the bristles of your toothbrush by running hot water over them before you brush
• Blow your nose gently
• Be careful when using scissors, knives, or other sharp objects
• Use an electric shaver instead of a razor
• Apply gentle but firm pressure to any cuts you get until the bleeding stops
• Wear shoes all the time, even inside the house or hospital

Do not:

• Use dental floss or toothpicks
• Play sports or do other activities during which you could get hurt
• Use tampons, enemas, suppositories, or rectal thermometers
• Wear clothes with tight collars, wrists, or waistbands

Check with your doctor or nurse before:

• Drinking beer, wine, or other types of alcohol
• Having sex
• Taking vitamins, herbs, minerals, dietary supplements, aspirin, or other over-the-counter medicines. Some of these products can change how chemotherapy works

Another side effect, Appetite Changes

What they are and why they occur
Chemotherapy can cause appetite changes. You may lose your appetite because of nausea (feeling like you are going to throw up), mouth and throat problems that make it painful to eat, or drugs that cause you to lose your taste for food. They can also come from feeling depressed or tired. Appetite loss may last for a day, a few weeks, or even months.
It is important to eat well, even when you have no appetite. This means eating and drinking foods that have plenty of protein, vitamins, and calories. Eating well helps your body fight infection and repair tissues that are damaged by chemotherapy. Not eating well can lead to weight loss, weakness, and fatigue.
Some cancer treatments cause weight gain or an increase in your appetite. Be sure to ask your doctor, nurse, or dietitian what types of appetite changes you might expect and how to manage them.
Ways to manage

• Eat 5 to 6 small meals or snacks each day instead of 3 big meals. Choose foods and drinks that are high in calories and protein. See Foods and Drinks That Are High in Calories or Protein for a list of these foods.
• Set a daily schedule for eating your meals and snacks. Eat when it is time to eat, rather than when you feel hungry. You may not feel hungry while you are on chemotherapy, but you still need to eat.
• Drink milkshakes, smoothies, juice, or soup if you do not feel like eating solid foods. Liquids like these can help provide the protein, vitamins, and calories your body needs. See Liquid Foods for a list of liquid foods.
• Use plastic forks and spoons. Some types of chemo give you a metal taste in your mouth. Eating with plastic can help decrease the metal taste. Cooking in glass pots and pans can also help.
• Increase your appetite by doing something active. For instance, you might have more of an appetite if you take a short walk before lunch. Also, be careful not to decrease your appetite by drinking too much liquid before or during meals.
• Change your routine. This may mean eating in a different place, such as the dining room rather than the kitchen. It can also mean eating with other people instead of eating alone. If you eat alone, you may want to listen to the radio or watch TV. You may also want to vary your diet by trying new foods and recipes.
• Talk with your doctor, nurse, or dietitian. He or she may want you to take extra vitamins or nutrition supplements (such as high protein drinks). If you cannot eat for a long time and are losing weight, you may need to take drugs that increase your appetite or receive nutrition through an IV or feeding tube

One of the main side effects that occurs....Anemia

What it is and why it occurs;  Red blood cells carry oxygen throughout your body. Anemia is when you have too few red blood cells to carry the oxygen your body needs. Your heart works harder when your body does not get enough oxygen. This can make it feel like your heart is pounding or beating very fast. Anemia can also make you feel short of breath, weak, dizzy, faint, or very tired.
Some types of chemotherapy cause anemia because they make it harder for bone marrow to produce new red blood cells.
Ways to manage

• Get plenty of rest. Try to sleep at least 8 hours each night. You might also want to take 1 to 2 short naps (1 hour or less) during the day.
• Limit your activities. This means doing only the activities that are most important to you. For example, you might go to work but not clean the house. Or you might order take-out food instead of cooking dinner.
• Accept help. When your family or friends offer to help, let them. They can help care for your children, pick up groceries, run errands, drive you to doctor's visits, or do other chores you feel too tired to do.
• Eat a well-balanced diet. Choose a diet that contains all the calories and protein your body needs. Calories will help keep your weight up, and extra protein can help repair tissues that have been harmed by cancer treatment. Talk to your doctor, nurse, or dietitian about the diet that is right for you. (To learn more, see Appetite Changes.)
• Stand up slowly. You may feel dizzy if you stand up too fast.

Chemotherapy Side Effects

What are side effects?

Side effects are problems caused by cancer treatment. Some common side effects from chemotherapy are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, mouth sores, and pain.

What causes side effects?

Chemotherapy is designed to kill fast-growing cancer cells. But it can also affect healthy cells that grow quickly. These include cells that line your mouth and intestines, cells in your bone marrow that make blood cells, and cells that make your hair grow. Chemotherapy causes side effects when it harms these healthy cells.

Will I get side effects from chemotherapy?

You may have a lot of side effects, some, or none at all. This depends on the type and amount of chemotherapy you get and how your body reacts. Before you start chemotherapy, talk with your doctor or nurse about which side effects to expect.

How long do side effects last?

How long side effects last depends on your health and the kind of chemotherapy you get. Most side effects go away after chemotherapy is over. But sometimes it can take months or even years for them to go away.
Sometimes, chemotherapy causes long-term side effects that do not go away. These may include damage to your heart, lungs, nerves, kidneys, or reproductive organs. Some types of chemotherapy may cause a second cancer years later. Ask your doctor or nurse about your chance of having long-term side effects.

Coping with your feelings during chemotherapy

• Relax. Find some quiet time and think of yourself in a favorite place. Breathe slowly or listen to soothing music. This may help you feel calmer and less stressed.
• Exercise. Many people find that light exercise helps them feel better. There are many ways for you to exercise, such as walking, riding a bike, and doing yoga. Talk with your doctor or nurse about ways you can exercise.
• Talk with others. Talk about your feelings with someone you trust. Choose someone who can focus on you, such as a close friend, family member, chaplain, nurse, or social worker. You may also find it helpful to talk with someone else who is getting chemotherapy.
• Join a support group. Cancer support groups provide support for people with cancer. These groups allow you to meet others with the same problems. You will have a chance to talk about your feelings and listen to other people talk about theirs. You can find out how others cope with cancer, chemotherapy, and side effects. Your doctor, nurse, or social worker may know about support groups near where you live. Some support groups also meet online (over the Internet), which can be helpful if you cannot travel.

Talk to your doctor or nurse about things that worry or upset you. You may want to ask about seeing a counselor. Your doctor may also suggest that you take medication if you find it very hard to cope with your feelings.

Tips for Meeting With Your Doctor

• Make a list of your questions before each appointment. Some people keep a "running list" and write down new questions as they think of them. Make sure to have space on this list to write down the answers from your doctor or nurse.
• Bring a family member or trusted friend to your medical visits. This person can help you understand what the doctor or nurse says and talk with you about it after the visit is over.
• Ask all your questions. There is no such thing as a stupid question. If you do not understand an answer, keep asking until you do.
• Take notes. You can write them down or use a tape recorder. Later, you can review your notes and remember what was said.
• Ask for printed information about your type of cancer and chemotherapy.
• Let your doctor or nurse know how much information you want to know, when you want to learn it, and when you have learned enough. Some people want to learn everything they can about cancer and its treatment. Others only want a little information. The choice is yours.
• Find out how to contact your doctor or nurse in an emergency. This includes who to call and where to go.

How can you best work with your insurance plan?

• Read your insurance policy before treatment starts to find out what your plan will and will not pay for.
• Keep records of all your treatment costs and insurance claims.
• Send your insurance company all the paperwork it asks for. This may include receipts from doctors' visits, prescriptions, and lab work. Be sure to also keep copies for your own records.
• As needed, ask for help with the insurance paperwork. You can ask a friend, family member, social worker, or local group such as a senior center.
• If your insurance does not pay for something you think it should, find out why the plan refused to pay. Then talk with your doctor or nurse about what to do next. He or she may suggest ways to appeal the decision or other actions to take.

Does my health insurance pay for chemotherapy?

Talk with your health insurance plan about what costs it will pay for. Questions to ask include:

• What will my insurance pay for?
• Do I or does the doctor's office need to call my insurance company before each treatment for it to be paid for?
• What do I have to pay for?
• Can I see any doctor I want or do I need to choose from a list of preferred providers?
• Do I need a written referral to see a specialist?
• Is there a co-pay (money I have to pay) each time I have an appointment?
• Is there a deductible (certain amount I need to pay) before my insurance pays?
• Where should I get my prescription drugs?
• Does my insurance pay for all my tests and treatments, whether I am an inpatient or outpatient?

How much does chemotherapy cost?

It is hard to say how much chemotherapy will cost. It depends on:

• The types and doses of chemotherapy used
• How long and how often chemotherapy is given
• Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay
• The part of the country where you live

What are clinical trials and are they an option ?

Cancer clinical trials (also called cancer treatment studies or research studies) test new treatments for people with cancer. These can be studies of new types of chemotherapy, other types of treatment, or new ways to combine treatments. The goal of all these clinical trials is to find better ways to help people with cancer.
Your doctor or nurse may suggest you take part in a clinical trial. You can also suggest the idea. Before you agree to be in a clinical trial, learn about:

• Benefits. All clinical trials offer quality cancer care. Ask how this clinical trial could help you or others. For instance, you may be one of the first people to get a new treatment or drug.
• Risks. New treatments are not always better or even as good as standard treatments. And even if this new treatment is good, it may not work well for you.
• Payment. Your insurance company may or may not pay for treatment that is part of a clinical trial. Before you agree to be in a trial, check with your insurance company to make sure it will pay for this treatment.

Contact the NCI's Cancer Information Service if you are interested in learning more about clinical trials. See Ways To Learn More for ways to contact them.

Things to know about getting chemotherapy through an IV

Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you are getting IV chemotherapy.
IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump.

• Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter. For more information on infection, see Infection.
• Ports. A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of infection around your port. For more information on infection, see Infection.
• Pumps. Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps are placed under your skin during surgery.

Prostate Cancer Sexual Side Effects

Prostate cancer sexual side effects are often the first thing a man thinks of after a diagnosis. And for good reason, because prostate cancer sexual side effects can not only affect the man diagnosed, but his partner as well. It is important to know both the effects that prostate cancer can have on sexual function as well as different methods to cope.
Patients should think of themselves as an advocate for their own health. It is important to educate yourself on prostate cancer side effects and ask your doctor how any method of treatment can contribute to them.

What Happens before your Release

Transplant centers don’t send patients home until they meet the following criteria;  •They have no fever for 48 hours •They are able to take and keep down pills or other drugs for 48 hours •Their nausea, vomiting, and diarrhea are controlled with medicine •Their neutrophil count (absolute neutrophil count or ANC) is at least 500 to 1,000/mm3•They have a hematocrit of at least 25% to 30% •They have a platelet count of at least 15,000 to 20,000/mm3•They have someone to help them at home and a safe and supportive home environment If patients do not meet all of these requirements, but still don’t need the intensive care of the transplant unit, they may be moved another oncology unit. When you do go home, you may need to stay near the transplant center for some time, depending on your condition.

Recovery after the Stem Cell Transplant

The recovery stage begins after the stem cell infusion. During this time, you and your family wait for the cells to engraft, or “take,” after which they begin to multiply and make new blood cells. The time it takes to start seeing a steady return to normal blood counts varies depending on the patient and the transplant type, but it’s usually about 2 to 6 weeks. You’ll be in the hospital or visit the transplant center daily for at least a few weeks. During the first couple of weeks you will have low numbers of red and white blood cells and platelets. Right after transplant, when your counts are the lowest, you may be given antibiotics to help keep you from getting infections (this is called prophylactic antibiotics). You may get a combination of anti-bacterial, anti-fungal, and anti-viral drugs. These are usually given until your white blood cell count reaches a certain level. Still, you can have problems, such as infection from too few white blood cells (neutropenia), or bleeding from too few platelets (thrombocytopenia). Many patients have high fevers and need IV antibiotics to treat serious infections. Transfusions of red blood cells and platelets are given until the bone marrow is working again and new blood cells are being made by the infused stem cells. Except for graft-versus-host disease, which only happens with allogeneic transplants, the side effects from autologous, allogeneic, and syngeneic stem cell transplants are much the same. Problems may include gastrointestinal (GI) or stomach problems, and heart, lung, liver or kidney problems.  You might also go through feelings of distress, anxiety, depression, joy, or anger. Adjusting emotionally after the stem cells can be hard because of the length of time you feel ill and isolated from others. Having a transplant is a big decision. Your life and your relationships will be disrupted. Your future becomes uncertain, the process makes you feel bad, and financially it can be overwhelming. You might feel as if you are on an emotional roller coaster during this time. Support and encouragement from family, friends, and the transplant team are very important to get you through the challenges of transplant.

Day 1; Rebirth the Infusion of the Stem Cells

After the conditioning treatment, you will be given a couple of days to rest before getting the stem cells. They will be given through your IV catheter, much like a blood transfusion. If the stem cells were frozen, you might get some drugs before the stem cells are given. This is done to reduce your risk of reacting to the preservatives that are used in freezing the cells. If the stem cells were frozen, they are thawed in warm water then given right away. For allogeneic or syngeneic transplants, the donor cells may be harvested (removed) in an operating room, and then processed in the lab. Once they are ready, the cells are brought in and infused (given to you). The length of time it takes to get all the stem cells depends on how much fluid the stem cells are in. You will be awake for this process, and it doesn’t hurt. This is a big step and often has great meaning for recipients and their families. Many people consider this their rebirth or chance at a second life. They may celebrate this day as they would their actual birthday. Infusion side effects are rare and usually mild. The preserving agent used when freezing the cells (called dimethylsulfoxide or DMSO) causes many of the side effects. You might have a strong taste of garlic or creamed corn in your mouth. Sucking on candy or sipping flavored drinks during and after the infusion can help with the taste. Your body will also smell like this. The smell may bother those around you, but you might not even notice it. The smell, along with the taste, may last for a few days, but slowly fades away. Often having cut up oranges in the room will offset the odor. Patients who have transplants from cells that were not frozen do not have this problem because the cells are not mixed with the preserving agent. Other short-term or immediate side effects of the stem cell infusion might include: •Fever or chills •Shortness of breath •Hives •Tightness in the chest •Low blood pressure •Coughing •Chest pain •Less urine output •Feeling weak

My Cancer Circle

My Cancer Circle, a free, private support community for caregivers of people facing cancer. My Cancer Circle was created by Boehringer Ingelheim Pharmaceuticals, Inc. ("Boehringer Ingelheim") in collaboration with CancerCare. To learn more about this tool and its features, watch and share the My Cancer Circle video. At Boehringer Ingelheim and CancerCare, we understand that cancer profoundly affects family members, friends and others who are close to a person diagnosed with cancer. It can be especially difficult and overwhelming for that individual who also becomes the primary caregiver. As a caregiver, you may be juggling multiple tasks, in addition to managing a family, work and other priorities in your own life. You also may have several people asking, “What can I do to help?”
Now, with My Cancer Circle, you have a simple online tool to help organize the community of people who want to help you. It coordinates their efforts to more efficiently support you and your loved one facing cancer. Learn more about coordinating these efforts by viewing the My Cancer Circle Fact Sheet.

Bone Marrow Preparation or Myeloablation

Conditioning, also known as bone marrow preparation or myeloablation, is treatment with high-dose chemo and/or radiation therapy. It’s the first step in the transplant process and typically takes a week or two. It’s done for one or more of these reasons: •To make room in the bone marrow for the transplanted stem cells •To suppress the patient’s immune system to lessen the chance of graft rejection •To destroy all of the cancer cells anywhere in the patient’s body The conditioning treatment is different for every transplant. Your individual treatment will be planned based on the type of cancer you have, the type of transplant, and any chemo or radiation therapy you have had in the past. If chemo is part of your treatment plan, it will be given in an intravenous (IV) line or as pills. If radiation therapy is planned, it’s given to the entire body (called total body irradiation or TBI). TBI may be given in a single treatment session or in divided doses over a few days.This phase of the transplant can be very uncomfortable because high treatment doses are used. Chemo and radiation side effects can make you sick, and it may take you months to fully recover. A very common problem is mouth sores that will need to be treated with strong pain medicines. You may also have nausea, vomiting, be unable to eat, lose your hair, and have lung or breathing problems. If you know what medicines your doctors will be using for conditioning, you can find out more about them in our Guide to Cancer Drugs, or call us for more information. Conditioning can also cause premature menopause in women and often makes both men and women sterile (unable to have children). Before you have a transplant, you need to discuss the transplant process and all its effects with your doctors. It also helps to talk to others who have already had transplants.

Allogenic Stem Cell Transplants

In the most common type of allogeneic transplant, the stem cells come from a donor whose tissue type closely matches the patient’s. (This is discussed later under “HLA matching” in the section called “ Donor matching for allogeneic transplant.”) The best donor is a close family member, usually a brother or sister. If you do not have a good match in your family, a donor might be found in the general public through a national registry. This is sometimes called aMUD (matched unrelated donor) transplant. Transplants with a MUD are usually riskier than those with a relative who is a good match. Blood taken from the placenta and umbilical cord of newborns is a newer source of stem cells for allogeneic transplant. Called cord blood, this small volume of blood has a high number of stem cells that tend to multiply quickly. But the number of stem cells in a unit of cord blood is often too low for large adults, so this source of stem cells is limited to small adults and children. Doctors are now looking at different ways to use cord blood for transplant in larger adults, such as using cord blood from 2 donors.
Pros of allogeneic stem cell transplant: The donor stem cells make their own immune cells, which could help destroy any cancer cells that remain after high-dose treatment. This is called the graft-versus-cancer effect. Other advantages are that the donor can often be asked to donate more stem cells or even white blood cells if needed, and stem cells from healthy donors are free of cancer    Cons to allogeneic stem cell transplants: The transplant, also known as the graft, might not take — that is, the donor cells could die or be destroyed by the patient’s body before settling in the bone marrow. Another risk is that the immune cells from the donor may not just attack the cancer cells – they could attack healthy cells in the patient’s body. This is called graft-versus-host disease. There is also a very small risk of certain infections from the donor cells, even though donors are tested before they donate. A higher risk comes from infections you have had, and which your immune system has under control. These infections often surface after allogeneic transplant because your immune system is held in check (suppressed) by medicines called immunosuppressive drugs. These infections can cause serious problems and even death. Allogeneic transplant is most often used to treat certain types of leukemia, lymphomas, multiple myeloma, myelodysplastic syndrome, and other bone marrow disorders such as aplastic anemia.

Human Leukocyte Antigen(HLA) Matching

A more common problem is that when the donor stem cells make their own immune cells, the new cells may see the patient’s cells as foreign and turn against their new home. This type of attack is called graft-versus-host disease. The grafted stem cells attack the body of the person who got the transplant. This is another reason it’s so important to find the closest match possible. HLA matching Many factors play a role in how the immune system knows the difference between self and non-self, but the most important for transplants is the human leukocyte antigen (HLA) system. Human leukocyte antigens are proteins found on the surface of most cells. They make up a person’stissue type, which is different from a person’s blood type. Each person has a number of pairs of HLA antigens. We inherit one of each of these pairs from each of our parents (and pass one of each pair on to each of our children). Doctors try to match these antigens when finding a donor for a person getting a stem cell transplant. How well the donor’s and recipient’s HLA tissue types match plays a large part in whether the transplant will work. A match is better when all 6 of the known major HLA antigens are the same — a 6 out of 6 match. People with these matches have a lower chance of graft-versus-host disease, graft rejection, having a weak immune system, and getting serious infections. For bone marrow and peripheral blood stem cell transplants, sometimes a donor with a single mismatched antigen is used — a 5 out of 6 match. For cord blood transplants a perfect HLA match doesn’t seem to be as crucial for success, and even a sample with a couple of mismatched proteins may be OK. Doctors keep learning more about better ways to match donors. Today, fewer tests may be needed, for siblings since their cells vary less than an unrelated donor. But more than the basic 6 HLA antigens are often tested on unrelated donors to reduce the risks of mismatched types. Sometimes doctors will want to look at 5 pairs of antigens, for example, to try and get a 10 out of 10 match. Certain transplant centers now require high-resolution matching, which looks more deeply into tissue types. Other centers are doing clinical trials with related half-matched donors and different chemotherapy schedules. This is an active area of research because it’s often hard to find a good HLA match.

Evaluation and Preparation for Stem Cell Transplant

You will first be evaluated to find out if you are eligible for a transplant. A transplant is very hard on your body. For many people, transplants can mean a cure, but complications can lead to death in some cases. You will want to weigh the pros and cons before you start. Transplants can be hard emotionally, too. They often require being in the hospital, being isolated, and there is a high risk of side effects. Many of the effects are short-term, but some problems can go on for years. This can mean changes in the way you live your life. For some people it’s just for a while, but for others the changes may be lifelong. It’s also very hard going through weeks and months of not knowing how your transplant will turn out. This takes a lot of time and emotional energy from the patient, caregivers, and loved ones. It’s very important to have the support of those close to you. You will need, for instance, a responsible adult who will be with you to give you medicines, help watch for problems, and stay in touch with the team after you go home. Your transplant team will help you and your caregiver learn what you need to know. The team can also help you and your loved ones work through the ups and downs as you prepare for and go through the transplant. Many different medical tests may be done, and questions will be asked to try to find out how well you can handle the transplant process. These might include: •HLA tissue typing, including high-resolution typing •A complete health history and physical exam •Evaluation of your psychological and emotional strengths •Identifying who will be your primary caregiver throughout the transplant process •Bone marrow biopsy •CT (computed tomography) scan or MRI (magnetic resonance imaging) •Heart tests, such as an EKG (electrocardiogram) or echocardiogram •Lung studies, such as a chest x-ray and PFTs (pulmonary function tests) •Consultations with other members of the transplant team, such as a dentist, dietitian, or social worker •Blood tests, such as a complete blood count, blood chemistries, and screening for viruses like hepatitis B, CMV, and HIV You will also talk about your health insurance coverage and related costs that you might have to pay. You may have a central venous catheter (thin tube) put into a large vein in your chest. This is most often done as outpatient surgery, and usually only local anesthesia is needed (the place where the catheter goes in is made numb). Nurses will use the catheter to draw blood and give you medicines. If you are getting an autologous transplant, a special catheter can be placed that can also be used for apheresis (a-fur-REE-sis) to harvest your stem cells. The catheter will stay in during your treatment and for some time afterward, usually until your transplanted stem cells have engrafted and your blood counts are on a steady climb to normal.