Chemotherapy: other side effects
Some chemotherapy drugs may, more rarely, cause the following effects. Your doctor will tell you if any of your chemotherapy drugs are likely to cause any of these.
Occasionally, a small number of patients may experience a severe, occasionally life-threatening, drug related reaction. Symptoms may include a feeling of swelling in the tongue or throat, a cough and breathlessness. You will be monitored closely during your treatment and if any of these symptoms occur, you will be treated appropriately.
Some drugs may cause discolouration of your urine after chemotherapy. For example, your urine may turn pink or red up to 24 hours following each treatment. Your chemotherapy nurse will warn you if this is likely to happen. If you think you notice blood in your urine you should report this to your doctor.
Rarely, a drug can cause irritation to the bladder (cystitis) since it is excreted in the urine. You should drink about an extra pint (half a litre) of fluid in the 24 hours after each injection.
Some cancers can increase the risk of developing blood clots. Some chemotherapy drugs (and some other anti-cancer drugs) can also increase the risk of developing blood clots. The type of blood clot seen most often occurs in the veins causing problems like deep vein thrombosis (DVT). This usually refers to a clot in one of the leg veins, causing swelling and/or pain in the leg.
If a part of the clot breaks free, it may travel to the lungs, causing shortness of breath or chest pain. This is called a pulmonary embolus (PE). Blood clots can be life-threatening, and treatment with blood-thinning drugs (anticoagulants) is usually given to help dissolve the clot and prevent further problems.
Blood clots in the arteries are rare but there is an increased risk with some anti-cancer drugs. For example, drugs which affect tumour blood vessels (‘anti-angiogenic’ drugs). Blood clots in the arteries may lead to a heart attack, stroke or prevent the blood supply reaching a limb. Please inform your doctor immediately if you are worried you may have a blood clot.
Your eyes may become dry, irritable or weepy (conjunctivitis). Please mention this to your doctor or nurse if you get any of these symptoms so that you can be given advice on how to relieve them.
You may notice swelling of your ankles (ankle oedema) or breathlessness. Usually, this is mild and goes away when treatment ends. Tell your doctor if you experience either of these symptoms.
Flu-like condition (fever, headaches, pain)
This reaction does not last very long and can be treated with simple painkillers.
Some chemotherapy drugs can cause tinnitus (a continual buzzing noise in the ears) or high frequency hearing loss. Tell your doctor if you are worried about changes in your hearing.
There may be changes in the way your kidneys work. You will be monitored closely if you are receiving a chemotherapy drug that could cause any damage. These are usually temporary effects and are unlikely to cause you any symptoms.
There may be changes in the way your liver works. You will be monitored closely if you are receiving a chemotherapy drug that could cause any damage. These are usually temporary effects and are unlikely to cause you any symptoms.
Memory and concentration
Some patients find that their short-term memory and concentration are not so good while they are undergoing chemotherapy. This usually resolves soon after treatment has finished, although it can rarely be a long-term effect. This may affect your ability to work during treatment if your job involves a great deal of mental effort.
Nervous system symptoms
Some chemotherapy drugs can cause problems with the nerves in the body. This is called peripheral neuropathy. It can cause sensations like tingling, burning, numbness or pins and needles in the hands and/or the feet. You may have difficulty with doing up buttons and other fine movements.
These sensations may worsen on exposure to cold and can also affect the nose and throat, causing swallowing and breathing problems. It may help to wear gloves, warm socks and a scarf. If your mouth is affected avoid cold drinks.
Tell your doctor if you get any of these sensations, so they can be monitored and if necessary changes can be made to the dose or the type of drug you receive. Most of the time, these symptoms will get better after your treatment ends, although it may take some time. If the symptoms become severe, the nerves could be damaged permanently and your chemotherapy drugs may be changed.
Steroids are natural substances made in the adrenal glands (located just above the kidneys) and in the reproductive organs. There are also man-made steroids.
Steroids, such as dexamethasone and prednisolone, can be given for different reasons. For some types of cancer, steroids have a direct anti-tumour effect. You may be given dexamethasone with your chemotherapy to help prevent sickness. Sometimes it is given to help prevent other side effects or to reduce an allergic-type reaction.
The side effects you may experience with steroids will depend on the dose and the length of time you are taking them. Discuss this with your doctor, nurse or pharmacist. The more common side effects include:
- irritation of the lining of the stomach causing indigestion or heartburn; you may be given drugs to prevent this, particularly with higher doses or longer courses of steroids
- an increased appetite and weight gain
- fluid retention; you may notice swelling of your ankles (ankle oedema); this is usually mild and goes away when treatment ends
- mood changes or difficulty in sleeping: you may find it helpful to discuss with your doctor which time of day is best to take your steroids; it is usually best to avoid taking them in the evening if possible.
Tissue damage (extravasation)
Some drugs can cause damage if they leak out of the vein while they are being injected. This may result in some pain and take some time to heal. If you feel any stinging, ‘burning’ or pain when you are receiving the drug, or develop any problems at the site, such as redness or blistering once you are home, tell your nurse or doctor straight away.