Many people are concerned about the adverse effects of chemotherapy before they receive it, and even think that it can be “painful”. In fact, the adverse effects of chemotherapy are not completely intolerable, so you don’t have to worry too much.
Most chemotherapy drugs can cause the following adverse effects
Gastrointestinal reactions such as nausea, vomiting, bloating, diarrhea, hair loss, bone marrow suppression, joint and muscle pain, liver damage, kidney damage, neurotoxicity, and allergic reactions. However, they do not occur in everyone.
Among them gastrointestinal reactions and bone marrow suppression are more common.
1. Nausea and vomiting are the main gastrointestinal reactions, which can occur hours or days after chemotherapy. Most of the milder ones recover on their own, sometimes requiring symptomatic relief with drugs such as montelukast and intestinal flora. If you experience any of these symptoms, please tell your doctor promptly. He will give medication as appropriate.
2. Bone marrow suppression. Chemotherapy drugs attack bone marrow hematopoietic cells, affecting hematopoiesis, which in turn leads to a decrease in white blood cells, neutrophils, etc. This is medically known as myelosuppression. If you compare white blood cells to an army, then neutrophils are the main force in the fight against bacterial infections. In other words, myelosuppression increases the risk of infection. During chemotherapy, blood tests are usually done every 3 to 5 days to detect neutropenia in time. Doctors use this to determine if myelosuppression has occurred.
Some drugs may trigger an allergic reaction, and you will need to be accompanied by a family member while you are taking the drug and will need to be hospitalized for observation.
It is common to use acid-suppressing, antiemetic, and anti-allergic drugs before infusing chemotherapy drugs, and then infuse them slowly thereafter to avoid nausea and vomiting and allergies.
If you have a severe degree of adverse reactions, such as nausea and vomiting that severely interferes with eating, or recurrent severe myelosuppression, your doctor will promptly assess and in most cases relieve them by adjusting the dose of chemotherapy drugs. If the adverse reactions do not resolve after the drug is reduced, a change to another chemotherapy drug may also be considered.
Esophageal cancer chemotherapy drugs may bring the following adverse effects:
1.Paclitaxel tends to cause hair loss. However, you do not need to be too nervous because this hair loss is not permanent and the hair will grow back slowly after stopping the drug.
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2. Fluorouracil analogs may cause phlebitis. Intravenous infusions of fluorouracil analogs may cause phlebitis, and your doctor will choose the infusion accordingly.
To mitigate adverse reactions, you will need to have some tests to make sure the appropriate organs are functioning properly before treatment begins.
For example, before you start the cisplatin+paclitaxel regimen, you need to have blood drawn to check your kidney function. Your doctor may consider paclitaxel alone if your kidney function is abnormal and you have factors such as advanced age, weakness, poor bone marrow function, or high risk of esophageal fistula.
You should avoid cold or irritating foods during chemotherapy; drink more water and urinate more often to reduce possible nephrotoxicity from drugs such as cisplatin; and tell your doctor if you need to take other drugs at the same time to avoid drug-drug interactions that may aggravate the burden on your liver and kidneys.
The following complications may occur during chemotherapy for esophageal cancer itself:
Sometimes chemotherapy is so effective that the lesions fade rapidly and normal tissue repair may not be able to keep up with the speed of tumor “collapse,” leading to esophageal perforation, and furthermore, esophagotracheal fistula and lung infection.
If you experience choking on food or water and fever during treatment, you should be on the lookout for esophageal fistula and lung infection due to esophageal perforation. It is recommended that you seek medical attention as soon as possible so that your doctor can confirm the diagnosis with an upper gastrointestinal tract imaging, CT, or other tests. In case of perforation, you will need to stop chemotherapy and suspend food and water intake through the mouth. Your doctor will give you anti-infection and nutritional support, and you may consider an esophageal stent.
To summarize, everyone responds differently to chemotherapy, and you need to talk to your doctor regularly to give feedback on how your symptoms are changing and how you are tolerating chemotherapy. If you have an emergency such as sudden hemoptysis or choking at home, you should go to a nearby hospital immediately to avoid delaying treatment.
Co-written by:
Dr. Liu Chang, Department of Gastrointestinal Oncology, Peking University Cancer Hospital