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What You Need to Know

Page 1

A Tangle of Emotions

Page 2

Patient Results of Chemotherapy

Page 3

Cancer Cell Development

Page 4

The Effect on Healthy Cells

Page 5

Managing Your Treatment

Page 6

Summary

Page 7

Copyright (c) 2001 HCA, All Rights Reserved.
All content, including the artwork, is the property of HCA Cancer Care
(an affiliate of HCA The Healthcare Company).
Permission to copy any portions of this work
should be obtained from HCA.

What You Need to Know

Fighting cancer is a joint effort, a shared responsibility between you and your medical team. This partnership is based on honesty, communication, education, and a willingness to do your part. The medical team assumes responsibility for planning the most effective treatment and giving therapy and support. You have to assume responsibility for working on proper nutrition, proper physical exercise, and the proper mental attitude.

Cancer used to be thought of as a terminal illness. However, people are learning to view this disease in a different light. They are learning to live with a chronic disease, to manage symptomatic health problems and treatments, and to live as normal a life as possible. When people hear the word cancer, they may think of suffering, disability or hopelessness. Except in unusual situations, that is not the reality of cancer. Something can almost always be done. If you want to know the truth about cancer, talk to your oncologist and members of your healthcare team. Knowledge and understanding can help control your fears about cancer. Fears can be resolved when you understand what to expect: treatments, potential problems, realistic expectations of any discomfort, and how to deal with them.

A Tangle of Emotions

How you react to your cancer diagnosis depends on your personality. It is not unusual to be flooded with different emotions in a relatively short period of time - shock, anger, grief, feelings of loss, and feelings of isolation. These emotions can be completely overwhelming. Try to remember you have experienced emotions similar to these before. You may not recall them initially, because they are so over overwhelming. Almost all persons diagnosed with cancer go through an emotional upheaval. To feel what you are feeling is normal.

The treatment of cancer with chemical agents is called chemotherapy. Chemotherapy involves the use of medicines to destroy or slow down abnormal cell life, often - though not always - when they are dividing. (Note that healthy cells are affected as well. This will be explained later.) Chemotherapy medicines are taken intravenously, intramuscularly, by subcutaneous injection, or by mouth. Your doctor might recommend chemotherapy for several reasons:

  • to cure a specific cancer
  • to control tumor growth when a cure is not possible
  • to relieve symptoms such as pain
  • to shrink tumors before surgery or radiation therapy
  • to destroy microscopic metastases after tumors are removed surgically

Patient Results of Chemotherapy

  1. Complete remission. The tumor may seem to disappear completely, meaning there is a complete response to the medicine. Although this indicates the medicine is working, treatment must continue for a while so any undetected cells can be destroyed. (Some remissions may be permanent; others are temporary, lasting months or even years. Complete remission, therefore, is not the same as a cure.
  2. Partial remission. The tumor may shrink by more than half its size but not disappear. This is obviously a good result, but therapy must continue until the tumor either disappears or stops shrinking.
  3. Stabilization. The tumor may not shrink or grow. The period of stabilization can sometimes last months to years.
  4. Progression. The tumor may keep growing despite therapy. Your doctor will try to find this out as soon as possible after the therapy has had a fair trial so another treatment program may be considered.

Cancer Cell Development

Cancer cells develop to a point as normal cells do, except cancer cells bypass biological feedback controls that stop their abnormal growth or cell division rate. Abnormal growth and cell division rates are key concepts doctors use when considering chemotherapy, doses and schedules that will result in killing the most cancer cells. Cancer cells are more sensitive to chemotherapy when the cells are in the process of dividing. Cells that are dividing rapidly are most sensitive to chemotherapy. All human cells, normal and malignant, go through for phases in their growth: G1, S, G2, and M. A cell can go into a fifth, or resting, cycle also - the G0 phase.

The period of G1 through M is called the "cells generation time." This period can last hours or years, depending on the cell. When cells are exposed to chemotherapy, the generation time can change, interfering with stages of the cell cycle. The cycle is usually stopped or altered. Also, chemotherapy can affect cells at only certain phases of their cycle. Doctors choose chemotherapies that are cell cycle specific, cell-cycle non-specific, or a combination of the two types.

The Effect on Healthy Cells

As previously mentioned, healthy cells are also affected by chemotherapy. The medicines used in chemotherapy are growth inhibitors - very good at turning off cells that grow quickly (those found in the mouth, the lining of the intestines, the hair follicles, and the bone marrow). The downside to chemotherapy is that it cannot tell a normal cell from an abnormal cell. Chemotherapy turns off every fast growing cell. Although most healthy cells recover from the chemotherapy within a few weeks, the bone marrow cells take longer. This is important because the cells manufactured in the marrow are:

  • White blood cells to help fight infections.
  • Red blood cells that carry oxygen to our tissues.
  • Platelets which are instrumental i stopping bleeding.

Managing Your Treatment

While patients are on chemotherapy, frequent blood counts are taken to assure healthy cells are minimally damaged and cancer cells are destroyed maximally. If necessary, changes in chemotherapy dosaging or additional treatments (antibiotic therapy, blood transfusions, platelet pheresis) may be required. At times during your illness and treatments, you will be more susceptible to infections - particularly when white blood cell count is at its lowest (nadir). You need to do everything you can to avoid sources of infection. The best single prevention measure is to wash your hands often and thoroughly.

Additional guidelines:

  • Avoid people with colds or flu.
  • Avoid intimate contact with people with cold sores or viral infections.
  • Avoid public areas such as malls, restaurants and churches.
  • Shave with electric shavers instead of razor blades.
  • Use gloves to do chores that might damage bare skin.
  • Avoid raw vegetables or fruit that cannot be peeled.
  • Do not eat undercooked meat or poultry.
  • Avoid contact with animal's stools or urine (e.g. cat litter boxes or bird cages).
  • Don't play in the dirt. Let someone else tend your garden and plants

Call your doctor immediately if you develop:

  • Fever of 101F or higher
  • Redness, swelling or pain of any wound
  • Coughing, sore throat, and stuffy or runny nose
  • Sores or white patches in your mouth or throat
  • Burning or frequency of urination, or change in color or odor of urine.

Loss of appetite, nausea, and vomiting are common problems associated with cancer and cancer treatment. There are many ways to relieve nausea and vomiting and to help improve appetite. When your body is trying to fight cancer, it needs nutrition. It needs proteins and calories to help lessen the effects of cancer and the treatment.

Some tips to help increase your appetite:

  • Mild exercise to stimulate your appetite.
  • Avoid drinking liquids before meals. They can fill you up. When you're thirsty, drink nutritious juices and milk.
  • Eat with family or friends. Make it a social event, not a chore.
  • Eat a variety of foods, experiment with herbs and sauces.
  • Don't fill up on salads or diet foods.
  • Eat smaller meals more often.

The following are ways to cope with nausea and vomiting:

  • Eat soda crackers or suck on hard candy to relieve queasiness.
  • Eat cold or room temperature foods.
  • Avoid salty, fatty, sweet foods; or foods with strong odors. Try bland foods or creamy foods.
  • Stay away form nauseating sights, odors, or sounds.
  • Sleep during episodes of nausea, if possible.

If vomiting does occur, avoid eating or drinking until your stomach has settled. Begin with sipping clear liquids. When you can tolerate the liquids, try bland foods a few hours later. Report to your doctor or nurse if you have nausea or vomiting more than a day or two. Treatment may be available to help you through this period.

Summary

In summary, this is not the end of your education, but just the beginning. The healthcare team you have chosen to treat your cancer can help you understand your treatment plan, your disease, and how to manage any complications or side effects from your cancer or cancer treatment. To get the information you need, please don't hesitate to talk to your doctor, office nurse, or nurses at the hospital when you visit.

Text by Linda Dolhay, R.N.,O.C.N.
Ocala Regional Medical Center
ph: 352-401-1247 or Linda.Dolhay@hcahealthcare.com

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