What are the Side Effects of Cancer Treatment?

Several different modalities are utilized in the treatment and manageent of cancer. The major approaches include chemotherapy, radiotherapy and surgery, all of which are beneficial to varying degrees in different types and stages of cancer. However, these treatments also have a host of adverse effects which every cancer patient should be aware about. Nevertheless, it should not detract a person with cancer from seeking medical assistance and following the advice of the oncologist.

What are the side effects of chemotherapy?

Side Effects of Anti-Cancer Drugs

Chemotherapy is associated with significant toxicity as the toxic chemicals in the anti-cancer drugs affects not only the cancer cells but also on the normal cells. The patterns and severity of these adverse effects vary with the different types of chemotherapy drugs.

Bone Marrow Toxicity

Bone marrow suppression often limits the flexibility dosing of anticancer drugs. Some of the drugs, like cyclophosphamide and chlorambucil, cause acute neutropenia (reduced neutrophil count) which often recovers in 2 to 3 weeks. Thrombocytopenia (low platelet count) and anemia (low hemoglobin/red blood cell count) is seen with several anticancer drugs. Some anticancer drugs may also cause delayed and prolonged bone marrow suppression which takes a longer time to recover. Reversible immunosuppression is seen with some chemotherapeutic agents. Infections secondary to immunosuppression/neutropenia can be fatal if untreated.

Mucosal and Gastrointestinal Toxicity

Anticancer drugs can be highly toxic to the rapidly dividing mucosal cells resulting in oral and intestinal ulcerations which lead to severe pain, bleeding and secondary infections. High dose anticancer protocols are associated with severe mucosal toxicity. Severe nausea and vomiting is common and can be debilitating. It can be very severe with drugs like carmustine and cisplatin. Some drugs, like irinotecan and gefitinib, can cause severe diarrhea which can be dose-limiting. On the other hand, drugs like vincristine and thalidomide can cause constipation.

Neurotoxicity

Apart from the nausea and vomiting which is also a manifestation of neurotoxicity, some drugs like ifosfamide can produce altered mental status, coma, seizures, and cerebellar ataxia. Vinca alkaloids and thalidomide can cause neuropathy. Thalidomide can also cause prominent sedation.

Skin toxicity

Hair loss, dermatitis, hypersensitivity and rash are common skin toxicities of anticancer drugs like methotrexate and alkylating agents. Extravasation of drugs like alkylating agents while injecting, can cause necrosis of the tissue.

Liver toxicity

Several anticancer drugs cause liver toxicities like hepatic fibrosis and cirrhosis and some may cause reversible elevation of liver enzymes.

Pulmonary toxicity

Anticancer drugs like methotrexate can cause acute pulmonary complication like pneumonitis while alkylating agents and bleomycin can cause delayed and serious complications like pulmonary fibrosis.

Genitourinary and reproductive system toxicity

Several anticancer drugs like ifosfamide can lead to kidney damage resulting in renal failure. Anticancer drugs can also cause permanent sterility due to their toxic effects on reproductive system. Anticancer drugs are known to cause miscarriage and fetal abnormalities. Cyclophosphamide-like drugs can cause hemorrhagic inflammation of urinary bladder.

Cardiovascular toxicity

Cardiomyopathy is a serious long term side effect seen with doxorubicin. Severe fluid retention (edema) is seen with drugs like imatinib.

Secondary Cancer

Some anticancer drugs like melphalan are known to increase risk of development of leukemia at later stage.

What are the side effects of radiation therapy?

Side effects of radiation therapy primarily depend on the site and the dose of radiation. Acute effects include :

• nausea
• vomiting
• fatigue
• dermatitis
• hair loss
• pericarditis
• liver injury
• mucosal toxicity

Delayed side effects include :

• pneumonitis
• dry mouth
• fibrosis
• brain necrosis
• myelitis
• infertility
• secondary cancer

What are the side effects of cancer surgery?

Surgical management of cancer is associated with operation-related complications like :

• bleeding
• injury to surrounding organs
• post-operative pain
• effects of surgical removal affecting normal body function
• operative mortality
• anesthesia-related complications like seizures, respiratory depression, cardiac arrest, coma
• psychological problems related to surgery like anxiety, depression

The post-operative period may have complications like infections and pain. The most common causes of death after surgery are pneumonia, heart failure, myocardial infarction, pulmonary embolism, and respiratory failure.

What treatments help to reduce side effects of cancer therapy?

The use of leucovorin with methotrexate, treatment with blood forming agents like darbopoietin (for anemia), sargramostim (for neutropenia) and romiplostim (for thrombocytopenia) have been found to reduce the bone marrow toxicity of anticancer therapy.

Antiemetics like granisetron have been used to reduce the nausea and vomiting due to anticancer drugs and radiation therapy.

Mesna has been used to minimize urinary bladder complications of cyclophosphamide. Dexrazoxane may be used with doxorubicin to reduce cardiotoxicity. Palifermin used for reducing incidence and severity oral mucosal toxicity.

Dr. Christian Glesener

He is a distinguished General Practitioner renowned for his extensive medical knowledge and dedication to patient care. With years of experience, he has become a trusted healthcare provider known for his commitment to promoting the health and well-being of his patients.