Cancer happens when cells
divide and multiply much faster than most normal cells. Uncontrolled cell growth can
lead to masses of cancer cells called tumors, or to a situation where
healthy cells are crowded out and can no longer do their jobs efficiently.
What Are Side Effects?
Chemotherapy (or "chemo")
and radiation therapy are
the two most common types of cancer treatment. They work by destroying these fast-growing
cells. But other types of fast-growing healthy cells (such as blood and hair cells)
also can be damaged along with cancer cells, causing adverse reactions, or side
effects.
Side effects can range from tiredness and flu-like symptoms to hair loss and blood
clotting problems. Because it's hard for doctors to predict how the body will react,
a child who is being treated for cancer is closely monitored. Doctors weigh the amount
and severity of side effects against the benefits of treatments.
Fortunately, most side effects are temporary. As the body's normal cells recover,
these problems start to go away.
Side effects vary:
Some can be merely unpleasant, while others can be much more serious.
Some show up right away, while others develop over time.
Some kids have just a few, while others have many over the course of treatment.
What Are Common Side Effects of Chemo and Radiation?
Chemo and radiation cause similar side effects. Chemo's side effects depend on
the type of drug used, the dosage, and a child's overall health. These effects are
more likely to affect the whole body.
Radiation's side effects, on the other hand, tend to affect the area being treated.
But they do still depend on the dose of radiation given, the location on the body,
and whether the radiation was internal or external.
Here are some of the side effects associated with these cancer treatments, and
how to manage them:
Fatigue
Tiredness (fatigue) is the most common side effect of both chemotherapy and radiation.
Even the most active kids are likely to find themselves exhausted and perhaps even
a little "foggy-headed" during treatment — and possibly for a while afterward.
This is normal. Encourage your child to scale back on activities and to rest as much
as possible. When treatment is over, your child's energy should return.
Flu-like Symptoms
Some cancer medicines appear to trigger the body's normal inflammatory response,
producing flu- or cold-like symptoms, such as a runny nose, chills, and cough. Drinking
plenty of fluids can help clear excess mucus. Also ask your doctor which, if any,
over-the-counter medicines might help.
Pain
Some chemo drugs cause headaches, muscle pains, stomach pains, or even temporary
nerve damage, which can result in burning, numbness, or tingling in the hands and
feet. If this happens, your doctor can prescribe medicines that can help. Never use
over-the-counter or herbal medicines without your doctor's OK, though, as these can
interact with the chemo drugs.
Mouth, Gum, and Throat Sores
Both chemo and radiation (specifically to the head and neck) can lead to mouth
sores, sensitive gums, an irritated throat, and an increased risk of tooth decay.
The doctor may prescribe a mouth rinse to reduce irritation. Soft, cool foods might
be easier to eat, and high-acid foods and juices (like oranges or tomatoes) should
be avoided. Regular dental checkups are important too.
Gastrointestinal Problems
Many types of chemo drugs are known to cause nausea, vomiting,
loss of appetite, constipation,
or diarrhea. Medicines can
prevent or ease a lot of these symptoms. It's also common for kids to find that their
taste preferences change while on chemo (they can't tolerate certain smells or textures,
for example).
If your child's appetite wanes, try offering several small servings of something
rather than three large meals. Also concentrate on keeping your child hydrated with
water, juices, and broths.
Gastrointestinal symptoms related to radiation tend not to be as severe as those
from by chemo, except in children who get radiation to the pelvis or abdomen.
Skin Changes
Chemo drugs commonly cause rashes, redness, and other types of skin irritation
— especially if your child had radiation before the chemo (this is called "radiation
recall"). Radiation alone can cause similar symptoms, along with blisters, peeling,
and swelling, in the area of treatment.
Wearing loose, soft cotton clothing may help with the discomfort. Your doctor might
also recommend or prescribe creams or ointments. Because the affected area can be
more sensitive to the sun for a while after treatment, your child should always wear
sunscreen with an SPF of at least 30 whenever going outdoors.
Weight Changes
Some kids have weight loss or weight gain. It's common for those taking steroids
to have an increased appetite and gain weight in unusual places, like the cheeks or
back of the neck. Other kids might have decreased appetites or trouble keeping food
down (especially if they're feeling nauseated after chemo).
If you're concerned about your child's weight, talk to the doctor about helping
your child maintain a healthy weight based on his or her medical needs.
Hair Loss
During chemo, hair thinning and hair
loss may happen all over the body. Radiation therapy to the head and neck may
cause hair loss in that area. But radiation anywhere else will not cause the hair
on the head to fall out.
Though some kids take hair loss in stride, others find it upsetting. Tell your
child that the hair will grow back — though it might be a slightly different
color or texture. In the meantime, many kids choose to wear baseball hats, bandanas,
scarves, or wigs.
Before treatment, some kids get shorter haircuts, as it can be easier to watch
shorter strands of hair fall rather than long ones.
Kidney and Bladder Problems
Some chemo drugs affect the kidneys.
Frequent blood tests will check kidney function. Staying well hydrated can help. Tell
the doctor if your child has blood
in the pee or any problems urinating.
Anemia
Chemotherapy drugs and radiation can destroy all types of healthy blood cells and
harm the body's production of new ones. Low levels of red blood cells (the cells that
carry oxygen) can lead to anemia,
which causes fatigue, paleness, shortness of breath, and a fast heartbeat.
Frequent blood draws throughout treatment will monitor the levels of these cells.
If they get too low, your child may get donor cells through a blood
transfusion.
Blood Clotting Problems
Cells that help blood to clot, called platelets, are another type of blood cell
that can be affected during cancer treatment, especially chemo. Low platelets, or thrombocytopenia,
can lead to bleeding. This may cause small red spots on the skin, bloody or black
bowel movements or vomit, or bleeding from the nose, gums, or line site (the
area where fluids and medicines are given to people with cancer).
Kids with a low platelet count have to take it easy to reduce the risk of bleeding.
That means avoiding rough play and contact sports (like football), and brushing with
a soft toothbrush and flossing very gently. In very serious cases of thrombocytopenia,
a child might need a blood transfusion.
Neutropenia
White blood cells (WBCs) also can be depleted during or after cancer treatment.
WBCs called neutrophils help fight infection. Having too few can put a child at increased
risk of serious infection, a condition called neutropenia.
A fever can be a sign of serious
infection, so tell your doctor right away if your child gets one.
Kids with neutropenia need to take special precautions against germs. Like all
kids, they should wash their hands well and often, especially before eating, after
using the bathroom, and after touching animals. They also need to avoid crowded indoor
places or visiting with friends or family members who have contagious illnesses (such
as a cold, the flu, or chickenpox).
People who have recently received live-virus vaccines, such as measles or oral
polio, can pass these viruses to kids with low blood cell counts, so it's also important
to avoid contact with them. To prevent food-borne infection, kids with neutropenia
shouldn't eat raw seafood, undercooked meat, or eggs.
Infection
Because their immune systems
are compromised, kids with cancer (especially those with neutropenia) can't fight
off
and other germs
that enter the body. So a seasonal virus or a cold can quickly turn into a life-threatening
infection.
Signs of infection include fever or chills, coughing or congestion, vomiting or
diarrhea, and pain (perhaps in the ears, throat, belly, or head, or pain when going
to the bathroom). Or there might be redness, swelling, pain, or oozing around the
line site.
If your child has any of these symptoms, especially a fever, contact your doctor
right away.
How Long Do Side Effects Last?
Most side effects start to go away after cancer treatment ends and the healthy
cells have a chance to grow again. How long this takes typically on a child's overall
health and the types and amounts of drugs and/or radiation he or she had.
Sometimes, though, cancer treatment can cause lasting changes to a growing body.
These long-term side effects (called late
effects) can include damage to the heart, lungs, brain, nerves, kidneys,
thyroid gland, or reproductive organs. In some cases, kids and teens who've had some
types of chemotherapy have a higher risk of developing a second type of cancer later
in life.
Before treatment, the doctor will talk to you about your child's risk of late effects
and what precautions can be taken before treatment, if any. For example, some teens
who undergo treatments with fertility
risks can take preventive measures like egg or sperm preservation.
What Else Should I Know?
Cancer treatment has come a long way. But it can be hard for kids and teens to
cope with the sometimes painful or uncomfortable side effects of treatment. Fortunately,
doctors have many ways to make treatments easier to manage.
Your child also might feel the emotional effects of having a serious illness. Answer
questions and help explain what's going on in an age-appropriate way. You also can
talk with the care team. A hospital support group, life specialist, social worker,
or psychologist from the care team can help your child and your whole family before,
during, and after cancer treatment.
