Information on Cancer by Antigonish C@P Site

CANCERCATC'

Living with Grief

1-800-81 3-HOPE (4673) Email info@cancercare.org

How Can You Help Yourself?

Web www.cancercare.org

When someone you love dies, your world changes forever. You must go on living and adjust to a world without the physical presence of your loved one. lt is important to treat yourself with compassion as you go through the grieving process. Here are some ways to care for yourself during this difficult time.

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Remember that your way of grieving is yours alone. There is no right or wrong way to grieve. Everyone affected by your loved one's death will grieve in his or her own way. Other members of your family may have ways of grieving that differ from yours. Many factors affect how you grieve, such as your relationship with the person who has died, your family responsibilities, and how your loved one's death affects your plans for the future.

Honor your feelings. You can expect to have many emotional ups and downs you grieve. Crief is often described as an emotional roller coaster. As you think about your loved one, and as your life goes on without him or her, many reactions may emerge. Rest assured that this is normal. Allow yourself to feel what you feel without judging your emotions. as

Give yourself special time to think about your loved one. Crief can appear when you least expect it and be overwhelming. One strategy that may help is to set aside special times to think about your loved one. By doing this, you may find that your feelings of grief are less likely to disrupt your daily routines. Take care of your health. Grief can leave you feeling tired and weak. Focusing on your own needs is an important part of grief. lt is important to get plenty of rest, eat regularly, and stay active. Consider seeing your family doctor for a check-up. He or she may be able to help you understand and cope with the physical effects of grief.

Tell others how to help you. Friends, family members, neighbors, co-workers, and others who know you want to find ways to help. Let them assist with practical tasks that you may find hard to manage on your own. For example, ask for help with making phone calls, preparing meals, picking up your children from school, and so on.

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Become informed. Many books and web sites offer information about coping with grief and recovering from the loss of a loved one. You may find it helpful to read what others have written about these experiences.

Wait to make major life-changing decisions. While you are grieving, it is hard to bring clear judgment to major life decisions. lf you can, wait to make these kinds of decisions until your feelings of grief are less intense. Plan ahead for how to cope on special days. Think about how you would like to honor your loved one on a birthday, anniversary or holiday. Give yourself permission to try something new. Be aware that the dread you may feel while thinking about upcoming special days may be harder to cope with than the days themselves. Seek support. Talk with a therapist or counselor who understands the special needs of people who are grieving. This may help you find new ways of coping with your grief. Attending a support group with others who have lost a loved one can help you feel less alone. lt can also give you a safe place to talk with people who understand what you are going through. CancerCare offers free individual and group counseling for people who are grieving the loss of a loved one.

CancerCore Can Help CancerCare's professional oncology social workers are available to help you cope with the loss of a loved one to cancer. We provide free individual counseling and support groups over the telephone, online and in person. CancerCare also offers practical help and referrals to other resources. For more information, call 1-800-8'13-HOPE (4673) orvisitwww.cancercare.org.

CAN CERCA re" Help and Hope

National Office

275 Seventh Avenue . New York, NY 10001 @ 2009 Cancer Care, lnc.

CANCERCATC 1-800-81 3-HOPE (4673) Email i nfo@cancercare.org

Web www.cancercare.org

Helping Children Who Have Lost a Loved One Suggestions appropriate for children ages 2

When a loved one dies, our world changes forever. This is true for both children and adults. lf your child is old enough to love, he or she is old enough to feel grief. Children coping with the loss of a loved one often look to their parents for comfort and guidance. Here are some suggestions on how to help your child during this difficult time. Be aware that children grieve differently than adults do. Play is the language of childhood. A child may cry or seem sad one moment, then ask to go out to play the next. Children sometimes work out difficult feelings during play. What appears to be regular play may be an important part of your child's grieving process. Playing with your child can comfort him or her and allow the two of you to connect without speaking. Use language that your child can understand. Children's understanding of death varies with their age. Saying that a loved one is "asleep," "lost" or "gone" may seem like a gentle concept to an adult, but it may alarm or confuse your child.

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Children ages 2 to 7 often see death as temporary. You may have to remind the child that the loved one has died and will not be coming back.

c Children oges 7 to 12 understand that death cannot be reversed. To cope with this knowledge, they may ask questions about the details of the loved one's death.

Allow your child to attend the funeral if she or he wants to. Funerals are difficult for everyone. You may be tempted to shield your child from this experience. However, children usually respond best when given the choice to attend or stay home. lf your child is younger than 12 and wishes to attend the funeral, bring some toys for him or her to play with. Arrange to have a friend or neighbor take the child home when he or she wants to leave. Share your faith and beliefs in ways your child can understand. For example, the idea of a loved one going to heaven may bring comfort to those whose beliefs include an afterlife. Keep in mind, though, that a child who does not understand that death is permanent might believe that he or she can visit the loved one in heaven. You would want to make it clear that this is not possible.

Hug your child often. A grieving child may need more physical comforting than usual.

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your child's fears. When a loved one dies, a young child may worry that other people he or she loves will also die. Or, your child may worry that he or she caused the loved one's death in some way. Pay close attention to your child so that you can help ease any fears that come up. Ease

lnclude your children in plans to cope with special days. Thinking about birthdays, anniversaries, and holidays is often more difficult than dealing with the days themselves. Talk to your children when you make plans for honoring your loved one. Cive yourself permission to try something new. Take care of yourself. Parents helping their children through grief are usually grieving as well. Crief can leave you feeling tired and weak. Make sure you eat and rest regularly. lt is important to help your child without forgetting about your own needs. Ask

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for help. Members of your extended family, friends, and neighbors can do things like shop

for groceries or sort the mail to give you more time to spend with your child. Get extra support. Consider consulting a professional who understands the special needs of bereaved children. You may learn new ways to help your child. For example, there are support groups available for children who have lost a loved one to cancer. There are also support groups for parents that may give you a chance to discuss your concerns. Contact CancerCore to learn about our free individual and group counseling services for children and adults.

CancerCare Can Help CancerCare's professional oncology social workers are available to help you cope with the loss of a loved one to cancer. We provide free individual counseling and support groups over the telephone, online and in person. CancerCare also offers practical help and referrals to other resources. For more information, call 1 -800-81 3-HOPE (4673) or visit www.cancercare.org.

CANCERCATC, Help and Hope

National Office

275 Seventh Avenue . New York, NY '10001 O 2009 Cancer Care, lnc.

Tips for Managing Hair Loss CANCERCCITC' 1-800-813-HOPE (4673\

Email info@cancercare.org Web www.cancercare. org

For many people, hair loss is a distressing aspect of cancer treatment. Losing our hair can change our sense of identify - that is, how we see ourselves and how we relate to others; this, in turn, can affect our quality of life. lf you are concerned about hair loss, talk it over with a member of your health care team. Your oncologist or oncology nurse, for example, can tell you whether hair loss is a possible side effect of your treatment. He or she will also be able to point you to resources available to help you cope.

QUESTTONS AND ANSWERS ABOUT HAIR LOSS

Why does hair loss happen? Hair loss from chemotherapy or radiation happens when hair follicles are weakened by the treatment. This causes your hair to fall out much more quickly than it normally would.

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When does hair loss happen? Depending on the type of treatment you receive, hair loss may start anywhere from seven to 21 days after treatment begins. Where does hair loss happen? Chemotherapy may lead to hair loss on your legs, arms, underarms, pubic area, chest, eyelashes and eyebrows, in addition to your head. Hair loss from radiation affects only the part of the body being treated.

Will my hair grow back? Your hair will start to grow back once you are finished with treatment, but it may take six to 12 months to grow back completely. New hair may even have a different texture - for example, curly hair can grow back straight, and dark hair can grow in lighter. These changes are usually not permanent. However, radiation sometimes causes permanent hair loss.

HERE ARE SOME TIPS FOR

OBTAINING, WEARING AND PAYING FOR A WIG:

Buy a wig before all of your hair falls out. This way, you will have a good match to your own hair color. Having a wig ahead of time will also help you feel more prepared.

Get a professional fitting. There are full-service wig salons that fit and style wigs. Some of these salons even specialize in helping women with treatment-related hair loss. (ove)

Use double-sided tape to keep your wig on. Many wigs have tape-tab materials called "stickies" that let you use double-sided tape to hold your wig in place. Ask your wig specialist

for hypoallergenic double-sided tape. Consider wearing a scarf or turban. Wig salons often sell turbans and scarves that come in a variety of colors and fabrics. These can be worn out in public instead of a wig, depending on your preference, or when you're at home. Find out if your health insurance company covers the cost of wigs. lf so, remember to save your receipt. lf your wig is not covered by your insurance company, save your receipt anyway; the purchase qualifies as a medical tax deduction.

lf you can't afford a wig, contact CancerCare. We may be able to provide you with a free wig, or we can refer you to an organization in your community that provides them at no cost. I

FINDING EMOTIONAL SUPPORT Talking to others who have experienced hair loss, or to individuals who have professional experience in the matter, will help you during this difficult period. Here are some suggestions:

Connect with o friend or onother patient who understonds what you are going through. Call this person when you're feeling sad or uncertain about what to do.

loin a support group. You'll get emotional support and feel less alone. can share your valuable tips with others and receive helpful guidance.

Plus, you

Tolk to o counselor or oncology sociol worker. He or she can assist you in finding resources, guide you through difficult decision-making, and help you feel more

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CancerCore Can Help CancerCare's professional oncology social workers are available to help you cope with hair loss and other side effects of cancer treatment. We provide individual counseling and support groups by telephone, online, or in person. CancerCare also offers education, financial assistance, and referrals to other resources. To learn more about how we help, call us at 'l -8OO-81 3-HOPE (4673') or visit

www.cancercare.org.

CAN CERCA re' National Office . 275 Seventh Avenue . New York, NY 10001 @

2010 Cancer Care, Inc.

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CANCERCA re" 'r -800-81 3-HOPE (4673) Email info@cancercare.org Web vwwv.cancercare.org

Prostate Cancer: What You Should Know About Screening and Diagnosis Cancer of the prostate gland is the most common cancer affecting men. Most of the time when prostate cancer is diagnosed, the tumor is still confined to the gland. Prostate cancer screening is important in the early detection of prostate cancer. This is because many men diagnosed with prostate cancer do not have symptoms. And the earlier cancer is found, the more treatable it is.

What screening tests are available? The following tests are used to check for prostate cancer: Prostate exom - For this test, also called a digital rectal exam, the doctor inserts a lubricated, gloved finger into the rectum and feels the surface of the prostate for any lumps, swelling or other abnormalities.

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blood test- PSA refers to "prostate-specific antigen," a protein produced by the prostate gland. Older men generally have higher levels of PSA than younger men, as prostate gland size and PSA levels increase with age. Your doctor can tell you if your test results are normal for your age. High blood levels of PSA may indicate the presence of prostate cancer. Cenerally, levels under four nanograms per millimeter (4 nglmL) of blood (a very tiny amount) are considered normal.

What are the screening recommendations for prostate cancer?

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All men should talk with their doctor about the pros and cons of being screened for prostate cancer. The following guidelines may help you in talking with your doctor about prostate cancer screening: Men at overoge risk of prostate cancer prostate screening at age 50.

Start talking with your doctor about

Men who are ot higher risk of prostote cancer - Starting at age 45, talk with your doctor about what screening schedule is right for you. Men at highest risk- (for example, those who have had several relatives diagnosed with prostate cancer at an early age) Ask your doctor about screening starting at age 40.

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What are the risk factors for prostate cancer? All men are at risk of developing prostate cancer based on their having a prostate gland. The following are some of the other known risk factors. Talk to your doctor about your risk. Age

Prostate cancer is more common in men over 50. Most cases of prostate cancer (about

80o/o) are diagnosed in men age 65 or older. Race

- African-American men are at a higher

risk of developing prostate cancer. The reasons for this are not fully understood.

Family history - Having a father, grandfather, uncle or brother with prostate cancer increases your risk. Having several close relatives diagnosed with prostate cancer at an early age puts you at a higher risk. Diet - A diet high in animal fat and red meat may increase the risk for prostate cancer.

What are the symptoms of prostate Gancer? Eorly-stoge prlstnte cnncer usunlly hos no symptoms. lf you nre experiencing ony of the following, check with your doctor, os they moy be signs of benign (non-cancerous) prostote diseose or prostnte clncer:

. Frequent urination . Weak or interrupted urine flow

. Blood in the urine . The urge

to urinate frequently at night

Pain or burning during urination

CancerCore@ Can Help The professional oncology socialworkers at CancerCare can help you cope with a diagnosis of prostate cancer. We offer individual counseling, support groups, education, practical help and referrals. All our services are completely free of charge. To learn more, call us at 1 -800-8 1 3-H OPE (4673) or visit www.cancercare.org.

National Office .

CANCERCATC"

275 Seventh Avenue . New York, NY 10001 @ 2010 Cancer Care, lnc.

"Doctor, Can We Talk?" CANCERCATC, 1-800-81 3-HOPE (4573)

Email info@cancercare.org Web www.cancercare.org

Tips for Communicating With Your Health Care Team Talking to your doctor can be difficult. Regardless of your diagnosis, hearing about it may leave you feeling frightened or overwhelmed. Good communication with your doctor will help improve the quality of the care you receive. Here are some ways to improve communication with your health care team: Remember that you are the consumer. As a patient, it is important to remember that you are a consumer of health care. The best way to begin making difficult decisions about health care is to educate yourself.

Bring someone with you to your appointments. lt is always helpful to have support, and the person can serve as a second set of ears. He or she may also be able to think of questions to ask your doctor or remember details about your symptoms you may have forgotten.

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Prepare a list of questions beforehand. This way, you won't forget to ask about something that was important to you. Make your questions specific and brief, as your doctor has limited time. Once you're at your appointment, ask your most important questions first.

Write down your doctor's answers. Taking notes will help you remember your doctor's responses and instructions. lt also allows you to go over the information later when you have more time to concentrate or do research. lf your doctor allows it, tape-record your visit. Taping your conversation to hear specific information again or share it with family

gives you a chance

members or friends.

SAYING AND HEARING: CancerCare's Tips

for Understanding Your Doctor

Use "1" statements. lf you're having trouble understanding something, saying "l don't understand" will be much more effective than saying "You're being unclear."

Be assertive. lf you don't know what a word means, ask. Make your questions specific and brief. lf there is something you can't understand or resolve, ask your doctor if there is another time that the two of you can discuss it in more detail.

. lf something

is unclear, try repeating it back to your doctor. You might start with the words "So you mean I should..." lf you understand better with visual aids, ask to see the X-rays or slides, or ask your doctor to draw a diagram.

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QUESTTONS TO ASK YOUR DOCTOR

Here are some questions you may want to ask your doctor or nurse to help you understand your treatment and follow-up:

What are my treatment options?

What is the recommended treatment?

. How often will I receive treatment? o

What are the possible side effects?

What are the possible benefits and risks of this treatment?

. How much will my treatment

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cost?

. lf I have questions

during my treatment and my doctor is not available, who can I ask? For example, is a nurse, social worker, or other specialist available?

Where can I get more information about this treatment

. ls there anything

procedure?

else I should know?

CancerCore Can Help The professional oncology social workers at CancerCore know the importance of having good communication with the members of your health care team. We are available to help you with any concerns you may have in this area. CancerCore free services include counseling, support groups, education, financial help, and referrals to other resources. To learn more, call us at 1-8OO-813-HOPE (4673) or visit www.cancercare.org.

National

CANCERC4 re" Office . 275 Seventh Avenue . New York, NY 10001 @

2010 Cancer Care, lnc.

CAN CERCA re' 1-800-813-HOPE (4673) Email i nfo@cancercare.org

Talking to Your Kids About Your Diagnosis

Web www.cancercare.org

Your cancer diagnosis has a profound impact on your entire family. There is new information to learn. There are treatment decisions to make. And if you have children, you're probably also concerned about how much to tell them about your diagnosis and what you are

going through. Here are CancerCore's 10 tips for communicating with your children:

1. Give your children accurate, ageappropriate i nformation about cancer. Don't be afraid to use the word "cancer." Tell or show them where the cancer is in the body. Practice your explanation beforehand so you feel more comfortable. Remember that if you don't talk to your kids about cancer, they may invent their own explanations, which can be even more frightening than the facts.

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2. Explain the treatment plan and how it will affect their lives. Prepare your children for any physical changes you might go through during treatment (for instance, hair loss, extreme tiredness, weight loss). Let your children know that their needs will continue to be taken care of (for example, "Daddy will take you to soccer practice instead of Mom for a while.") 3. Answer your children's questions as accurately as possible. Take into account their age and prior experience with serious illness in the family. lf you do not know the answer to a question, don't panic. lt's okay to say, "l don't know. I will try to find out the answer and let you know."

4. Reassure your children. Explain to them that no matter how they have been behaving or what they've been thinking, they did not do anything to cause the cancer. Let your children know that they cannot "catch" cancer like they can catch a cold. 5. Let them know they can turn to other members of your support system, too. These people include your spouse or partner, relatives, friends, clergy, teachers, coaches, and members of your health care team. Let your children know that they can ask questions of these adults and talk to them about their feelings. 6. Allow your children to participate in your care. Cive them age-appropriate tasks such as bringing you a glass of water or an extra blanket.

7. Encourage your children to express their feelings. Let them know that they can express any feelings, even those that are uncomfortable. Let them know, too, that

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it's okay to say, "l don't feel like talking right now," if that is the case.

Talking About Feelings

8. Reassure your children that they will be cared for. Let them know that even if you can't always provide the care directly, their needs are important and will be taken

Children have many different reactions when they learn a parent or relative has cancer. They can be afraid or confused, or feel guilty or angry.

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9. To the extent possible, make communicating with your children a priority. Cancer treatments may leave you with less energy, but make every effort to really listen to your children. This will show them how much you love them, and help them to feel comfortable coming to you with their concerns in the future.

your children know that:

Feelings ore never wrong.

Whotever they ore feeling is okoy ond normal.

It is even normal to feel one woy one doy ond another woy the next. Tell your children that you, too, have a wide range of

10. As always, show your children a lot of love and affection. Let them know that although things are different now, your love for them has not changed.

feelings.

When helping your children cope with your diagnosis, it's almost impossible to be prepared for every situation. Sometimes, you may not know what to say. This is normal and okay. Remember: you are the expert on your children. Cancer can be overwhelming and disruptive, but it doesn't change the fact that you know your children best. Trustyour sense of how to best support them during this difficult time.

CancerCore for Kidso Can Help CancerCare for Kids has a staff of professional oncology social workers that can help yourfamily cope with a cancer diagnosis. Our services, which include counseling, support groups, education and financial assistance, arecompletelyfree of chorge. To learn more, call us at 1-800-813-HOPE (4673)or visit us online at www.cancercareforkids.org.

cANCERc4rr

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. 275 Seventh Avenue O 2009 Cancer Care, lnc.

CancerCore National Office

New York, NY 10001

Look Good Feel Bettei

A program 0f the Canadian Cosmetic, Toiletry and Fragrance Association Foundation

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Lcck Gccd Feel Bettel' The Look Good Feel Better Program is a unique, nalional non-profit program committed to helping women manage the appearance related effects of

cancer and its treatment. By taking control of how they look, using cosmetics and hair alternatives, women with cancer can strengthen the positive attitude that is so important in cancer trealment

- and feel better

about themselves. ln the spirit ol giving back to the community that supports

their industry, the members ol the Canadian Cosmetic, Toiletry

and

Fragrance Associalion (CCTFA) are proud to be the lounders and conlinuous supporters of the Look Good Feel Better Program since its inception in 1 992.

lree Z-hcur wcrkshop The cornerstone of the Program, the workshop is a hands-on, step-by-step experience led by volunteers, all of whom are industry-trained cosmeticians and hair alternatives specialists who generously donate their time and skill.

Participants learn make-up tips, hair alternalives, nail and skin care, and cosmelic hygiene, and go home with

a valuable complimentary kit

cosmetics and personal care products. The workshops also provide a sale

and supportive environment where women benefit from the experiences ol olher women with cancer.

For more information on Look Good Feel Better call 1.800.91 4.5665 or

visit www.lookgoodfeelbetter.ca

Look Good

Feel Bettei

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f Our annual, one-week summer camp for children living with cancer.

NOVA SCOTIA DIVISION

CancerConnection 1 -888-939-3333 A nation-wide, telephone-based peer support service that matches people living with cancer and/or their family members with trained volunteers who have had a similar cancer experience.

Cancer lnformation Service 1-888-939-3333 lf you or a family member are preparing lor treatment, coping with treatment or learning to live beyond cancer, our lree and confidential Cancer lnformation Service is here to help. Our qualified and compassionate Cancer lnformation Specialists will provide reliable information on any aspect of cancer, including where to get support in your community.

CanSurmount 1 -888-939-3333 This face-to-face peer support program matches people living with cancer (other than breast cancer) with trained volunteers who have had a similar cancer experience. Reach to Recovery 1-888-939-3333 This faceto-face peer support program matches women who are living with breast cancer with trained volunteers who have also experienced breast cancer.

Smokers' Helpline 1 -877-51 3-5333 A telephone-based information and support service that helps people quit smoking.

Support Groups 1 -888-939-3333 Group support programs are offered in communities throughout Nova Scotia. Participants receive information and support in a caring group environment.

www.cancer.ca A comprehensive and easy to use source of information on all aspects of cancer including services available in your community.

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Canadian Soci6t6

Cancer Society

NOVA SCOTIA DIVISION

canadienne du cancer

Canadian Societe

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Camp Goodtime 1 -800-639-0222

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and meals. Friends and family are welcome to visit Lodge residents.

The Canadian Cancer Society's Lodge That Gives offers accommodations to cancer patients and their families living more than 50 km away from the cancer treatment centre in Halifax.

The Lodge is often referred to as a'home away from home'. Fully accessible, the Lodge offers a family-style kitchen, outdoor patio, laundry facilities, living rooms, TV rooms and web/email access. Bedrooms provide double occupancy with a private bath. Hai rdressers provide complimentary services and our hair care room offers a free wig service. Nutritious meals are prepared by a professional cook and the kitchen is always open for snacks.

Located on South Street in Halifax, the Lodge is within walking distance of the Nova Scotia Cancer Treatment Centre, the Queen Elizabeth ll Health Sciences Centre's VG Site and the IWK Health Centre. The Lodge hours are Sunday 4:00 pm to Friday 5:00 pm.

Evening activities include musical performances, card parties, arts and crafts, bingo and movie nights. Lodge residents are invited to access Canadian Cancer Society supportive care programs, including support groups and information services. The Lodge is a tobacco free and scent free environment.

Cancer patients stay free-of-charge and meals are provided at no cost. Family members and/or support persons are invited to accompany a patient at the Lodge and pay a small daily rate for their room and meals. There is no charge for a parent or guardian staying with a child, an escort required by a transplant patient or families experiencing economic hardship.

Firsttime reservations for the Lodge can be made through a booking clerk at the Nova Scotia Cancer Treatment Centre, a local representative of the Canadian Cancer Society, or by a cancer specialist. lf you have stayed at the Lodge in the last year, you can phone to make your own reservation. You will be asked to show your medical appointment card upon arrival.

Relatives of hospitalized cancer patients are welcome to stay at the Lodge and pay a small daily rate for their room

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Residents may arrive the night before their appointment and are welcome to stay one night following their appointment if necessary.

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What we do Thanks to the work of our volunteers and

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and the generosity of our donors, the Canadian

Canaclian Societe

Catrcer 1 Societv

canaclienne cllr cancer

Cancer Society is leading the way in the fight against cancer. The Canadian Cancer Socien':

funds excellence in research for all n-pes

of cancer

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advocates for healthy public policv

promotes healthy lifestyles to help reduce cancer risk

provides information about cancer

supports people living with cancer

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Canadian Soci6t6

Cancer Society

canadienne du cancer

Let's Make Cancer History' 1 888 939-3333 | www.cancer.ca

This is geneml information developed by the Canadian Cancer societ\: It is not intended to replace the advice of a qualified healthcare proliden The material in this publication may be copied or reproduced without permission; however, the following citation must bc used:

Cancer Facts:Wbat men can do.Canadian Cancer Societ\'2oo3.

Let's Make Cancer History

canadian cancer Society 2003 | Revised July 2006 | Printed July 2006 |

1 888 939-3333 | www.cancer.ca

21 1-01 5

Prostate cancer Prostate cancer is the most frequently diagnosed cancer in Canadian men. It is a tumour of the

There are many good reasons to take charge of your health. As we grow oldeq the risk of developing a chronic disease like cancer increases. Understanding what's normal for your body is an important part of staylng healthy. So take control of your health by getting to know your body, learning the warning signs of cancer and following a healthy lifestyle.

prostate gland,a gland located just below the bladder where the semen is produced.While pfostate cancer occufs most frequently in men o.\/er the age of 55, those with a family history of the disease or who are of African ancestry are at higher risk of developing the disease at a younger age.

What you can do

Screening tests

Ifyou are 50 years of age or older talk to your

Scientists are researching new tests and

doctor about the risks and benefits of screening

examinations to find cancer before it has a chance

for prostate cancer.

to grow and spread. Already some common types of cancer can be found eady through screening tests. Different cancers require different tests. There are many types of cancer that don't have effective screening tests. Some people may be at higher risk for a particular type of cancer and may be screened more often. It's important to talk to your doctor about what screening programs are appropriate for you and make sure you take

Ifyou are at higher risk for prostate cance!you may wish to discuss the possibility of starting screening at a younger age.

The screening tests for prostate cancer include:

. .

advantage of them.

This pamphlet describes the four common cancers in men that have screening tests. It lists their eady warning signs and tells you what can be done to find them eady. Having the signs or symptoms of cancer does not necessarily mean that you have cancer - they could be caused by other problems, so see your doctor to be sure . The eadier cancer is found, the more successful the treatment is likely to be .

Cover photograph: O Comstock, lnc.

Digital rectal exam (DRE), when your doctor feels for abnormalities inside your rectum with a gloved finger. PSA test, a blood test that measures prostate-

specific antigen, a substance made by the prostate. It is normal to have small quantities of PSA in the blood, but a problem with your prostate can cause your PSA level to rise.

What to watch for . frequent, difficult or painful urination

dribbling urination

or pus pain in the lower back, pelvic area or

upper thigh pain during ejaculation

. urine that contains blood

Colorectal cancer

\l/hat to watch for

Colorectal cancer is the third most common cancer in Canadian men and women. Colorectal cancer is one of the most detectable and, if found eady, most treatable types of cancer. It includes cancer of the colon (large bowel), the rectum, appendix and some anal cancers. Most colorectal cancers start as small growths (polyps) on rhe bowel wall.

What you can do

anv change in bowel habits (diarrhea,

constipation) that lasts more than a few days bloating, ftillness and cramping that lasts more

than a few days

tiequent gas pains blood in or on the stool stools that are narrower than usual a strong and continuing need to empty your bos'el. but with little result a t'eeling that you are nor completely emptying

All men over 50 should have a fecal occult blood test (FOBT) to check for blood in their

vour bowel

stool. The test should be repeated at least every

tiredness

sveight loss

two years.

. If the FOBT is positive, it should be followed with a colonoscopy (when a flexible lighted tube is gently inserted through the rectum to see the entire colon), or a double-contrast barium enema (a special x-ray of the large

bowel) and sigmoidoscopy (when a hollow flexible tube is gently inserted into the rectum to view the rectum or lower colon or both). Occasionally rectal tumours may be found

during a digital rectal exam or DRE. A DRE is when your doctor feels for abnormalities inside the rectum with a gloved finger. DRI is not as reliable as FOBT in finding colorectal cancer. Ifyou have a higher than average risk for colorectal cancer, you may need to start screening at an eadier age. Talk to your doctor if you have:

. a p^renq sibling or child with colorectal

cancer

(especially if the relative was diagnosed at young age) a personal history of colorectal cancer

with inflammatory bowel disease, some inherited syndromes or already been diagnosed

benign polyps

Skin cancer Skin cancer has become one of the most common

n'pes of cancer in Canada. The different types of skin cancer @asal cell. squamous cell or melanoma) begin in the different cells of the skin. The skin's top laver is made of flat, scall' squamous cells. Deeper lavers are made up of round basal cells and melanocrtes. *hich give the skin its colour. Basal cell and squamous cell skin cancers are two of the most preventable and treatable types of cencer.

What you can do . Learn s'hat to look for and check your skin reguladr-. as most skin cancers can be treated

ther"re caught

earl.r- enough. Make sure you or someone else checks hard-to-see places such as

vour back and the back of ,vour neck, ears and legs.

Check n-ith vour doctor if 1'ou notice any ch:rnges or are not sure about what you should be looking for.

What to watch for . any change in the shape, colour,

Reducing your risk of cancer size or surface

of a birthmark or a mole any new growth on your skin (for example pale, peady nodules that grow larger and crust or red, scaly, sharply defined patches) any sofe that does not heal any patch of skin that bleeds, oozes, swells, itches or becomes red and bumpy

Testicular cancer Although testicular cancer is quite rare, it is the most common cancer in men befween the ages

2O and

45.But it can almost always be treated

successfully. The testicles are located behind the penis in a sac called the scrotum. Testicular cancer may cause one or both of the testicles to enlarge

or it may cause a lump in the scrotum. There may or may not be pain with the swelling.

What you can do

All men aged 15 or over should check their testicles regulady. Testicular self-examination is

quick and simple, and should be done after a hot bath or shower, because the warmth causes the testicles to drop and the scrotum to relax. Become famrliar with your testicles so you can detect any changes eady. See your doctor right away if you notice anlthing unusual or need help learning self-examination. Have regular medical check-ups by your doctor that include testicular examination.

At least

of cancers can be prevented through healthy living and policies that protect the public. Take these steps now to reduce your risk of developing cancer. 5O%

1. Be a non-smoker and avoid second-hand smoke. 2. Eat 5 to 10 servings ofvegetables and fruit a day. Choose high fibre, lower fat foods. If you drink alcohol, limit your intake to 1 to 2 drinks a day. 3. Be physically active on a regular basis; this will also help you maintain a healthy body weight. 4. Protect yourself and your family from the sun,

particulady between 11 a.m. and 4 p.m. when the sun's rays are at their strongest, or any time of the day when the IJV Index"' is 3 or more. Check your skin regulady and report any changes to your doctor. 5. Follow cancer screening guidelines - discuss testicular exams, prostate testing and colorectal screening with a health professional. 6. Visit your doctor or dentist if you notice a change in your normal state of health. 7. Follow health and safety instructions both at home and at work when using, storing and disposing of hazardous materials. And remember:

. Getto knowyourbody. . Don't ignore the warning signs. . Follow a healthy lifestyle.

What to watch for . any change in size, shape, consistency,

. . . .

swelling or sensation ofyour testicles or scrotum pain in the testicles or scrotum a dull ache or heaviness in your lower abdomen unusual and persistent backache unexplained weight loss

I0fhen you want to know more about cancer or seryices available in your community, call one of our information specialists toll-ffee at 1 888 939-3333, e-mail us at info@cis.cancer.ca

or visit our website www.cancer.ca.

\.4 I

What we do Thanks to the work of our volunteers and stafi and the generosity of our donors, the Canadian

Canaclian Soci6t6 Cancer canadienne

Society

clu cancer

Cancer Society is leading the way in the fight against cancer. The Canadian Cancer Society:

funds excellence in research for all types

of cancer

. .

advocates for healthy public policy

promotes healthy lifestyles to help reduce cancer risk

. .

provides information about cancer supports people living with cancer

irt

Canadian Soci6t6

Cancer canadienne Society du cancer

Let's Make Cancer History 1 888 939-3333 | www.cancer.ca

This is geneml information developed by thc Canadian Cancer Socieq'. is not intended to replacc the advice of a qualified healthcare provider

The material in this publication may bc copicd or reproduced without permission;however, the following citation must bc used: Concer Facts:WlJat uotnen can do.Cnnadi^n Cancer Societ)'2OO3. O canadian Cancer society 2003 I Revised july 2006 Printed July 2006 | 21'l-01

Let's Make Cancer History 0

1 888 939-3333 | www.cancer.ca

Breast cancer Breast cancer is the most frequently diagnosed cancer in Canadian women. It starts in breasl

There are many good reasons to take charge of your health. As we grow older, the risk of developing a chronic disease like cancer increases. Understanding what's normal for your body is an important part of staying healthy. So take control ofyour health by getting to know your body, learning the warning signs of cancer and following a healthy lifestyle.

Screening tests

tissue, in the area between the armpit and the

breastbone. All women are at risk of developing breast cance! but some women are at higher risk because of their age,famtly history or reproductive

history. Many women are alive and well today because their breast cancer was found and treated eady.

What you can do . Women between the ages of 50 and 69 should have a mammogram every two years. If you are under 50, over 70, or have a higher risk of

Scientists are researching new tests and examinations to find cancer before it has a chance

breast cancer,your doctor may suggest a

advantage of them.

This pamphlet describes the four cofilmon cancers

in women that have screening tests. It lists their eady warning signs and tells you what can be done to find them eady. Having the signs or symptoms of cancer does not necessarily mean that you have cancer - they could be caused by other problems, so see your doctor to be sure. The eadier cancer is found, the more successful the treatment is likely to be.

any changes.

What to watch for . any place in your breast

that feels lumpy like a pea or that is thicker or harder than the rest

. puckering, . . .

Cover photograph: Q Wonderfile

different schedule for mammograms. AII women should have a clinical breast examination by a doctor or trained health professional at least every two years. All women, but particulady those over the age of 40, should get to know their breasts. Breast self-examination alone is not as reliable as clinical breast examination or mammography in finding breast cance! but it helps you learn what is normal for your breasts and to notice

dimpling or swelling of the skin on your breast or around your nipples orange peel skin - patches of skin which may or may not be discoloured, and the pores stand out bleeding or discharge from your nipples, or crusting on your nipples tenderness, redness or pain in your breasts

Colorectal cancer

\^i

hat to watch for

Colorectal cancer is the third most common cancer in Canadian men and women. Colorectal cancer is one of the most detectable and. if found eady, most treatable fypes of cancer. It includes cancer of the colon (large bowel), the rectum.

anl change in bowel habits (diarrhea, constipation) that lasts more than a few days

appendix and some anal cancers. Most colorectal cancers start as small growths (pol,vps) on the bowel wall.

blood in or on the stool stools that are narrower than usual a strong and continuing need to empty your bon'el. but with little result a t-eeling that you are not completely emptying r-our bowel n-eight loss

What you can do . All women over 50 should have a fecal occult blood test (FOBT) to check for blood in their stool. The test should be repeated at least every

bloating. fullness and cramping that lasts more

than a few davs trequent gas pains

tiredness

two years.

. If the FOBT is positive, it should be follo*'ed (when a flexible lighted gently inserted through the rectum to tube is see the entire colon), or a double -contrast barium enema (a special x-rav of the large bowel) and sigmoidoscopy (when a hollowflexible tube is gently inserted into the rectum to view the rectum or lower colon or both).

with

a colonoscopy

Occasionally rectal tumours mav be found

during a digital rectal exam or DRE. A DRE is when your doctor feels for abnormalities inside the rectum with a gloved finger. DRE is not as reliable as FOBT in finding colorectal cancer. Ifyou have a higher than average risk for colorectal cancer, you may need to start screening at an eaflier age . Talk to 1'our doctor if you have:

a parent, sibling

or child with colorectal cancer

(especially if the relative was diagnosed at

young age) a personal history of colorectal cancer already been diagnosed with inflammatory

bowel disease, some inherited syndromes or benign polyps

5kin cancer Skin cancer has become one of the most cofirmon

n'pes of cancer in Canada. The different types of skin cancer @asal cell, squamous cell or melanoma) begin in the different cells of the skin. The skin's top laver is made of flat, scaly squamous cells. Deeper lavers are made up of round basal cells and melanoc\tes, which give the skin its colour. Basal cell and squamous cell skin cancers are fwo of the most preventable and treatable types of cancer.

Yihat you can do Learn s-hat to look for and check your skin reguledr-. as most skin cancers can be treated

ther"re caught earlv enough. Make sure you or someone else checks hard-to-see places such as

vour back and the back of vour neck, ears and legs.

Check \\-ith _vour doctor if you notice any changes or are not sure about what you should be looking for.

What to watch for

Reducing your risk of cancer

At least

any change in the shape, colour, size or surface

of a birthmark or a mole any new growth on your skin (for example pale, peady nodules that grow larger and crust or red, scaly, sharply defined patches) any sore that does not heal any patch of skin that bleeds, oozes, swells, itches or becomes red and bumpy

of cancers can be prevented through healthy living and policies that protect the public. Take these steps now to reduce your risk of developing cancer.

1. Be a non-smoker and avoid second-hand smoke. 2. Eat 5 to 10 servings of vegetables and fruit a day. Choose high fibre, lower fat foods. If you drink alcohol, limit your intake to I to 2 drinks a day.

Cervical cancer Cervical cancer is usually a slow-growing cancer that starts in the cells of the cervix. The cervix is at the tip of the uterus (or womb) and connects the uterus to the vagina. A woman is at higher risk of developing cervical cancer if she becomes sexually active at a young age or has multiple sexual partners, both of which increase her risk of exposure to the human papillomavirus QIPV a sexually transmitted disease). There has been a big

drop in cervical cancer incidence and

mortality in Canada because of regular Pap testing. During a Pap test, a doctor takes cells from the cervix that are then checked for signs of cancer.

What you can do

Once you become sexually active, have a Pap

test and pelvic examination every one to three years, depending on the screening guidelines in your province and your previous test results. Even if you have stopped having sex or have had a hysterectomy, you should continue to have the tests. Use a condom during sex to help avoid an HPV infection.

What to watch for . abnormal vagrnal bleeding or blood-stained vagina'l discharge between your periods

. bleeding after intercourse . pain, which may occur during intercourse

5O%

Be physically active on a regular basis; this

will

also help you maintain a healthy body weight.

4. Protect yourself and your family from the sun, particulady between 11 a.m. and 4 p.m. when the sun's rays are at their strongest, or any time of the day when the IJV IndexrM is 3 or more. Check your skin regular$ and report any changes to youf doctof. 5. Follow cancer screening guidelines - discuss mammograms, Pap tests, breast exams and colorectal screening with a health professional.

6. Visit your doctor or dentist if you notice a change in your normal state of health.

7. Follow health and safety instructions both at home and at work when using, storing and disposing of hazardous materials. And remember:

. Get to knowyourbody. . Don't ignore the warning signs. . Follow a healthy lifestyle.

When you want to know more about cancer or services avarlable in your community, call one of our information specialists toll-ffee at 1 888 939-3333, e-mail us at info@cis.cancer.ca

or visit our website www.cancer.ca.

\.t(

What we do

The Canaclian Cirncer Socictr c;rnccr b1':

Canadian Soci6t6

Cancer

1 Society

canadienne du cancer

^-i

cloing everlthing we call to prcvent

funcling research to olltsmart cunccr empowering, infbrming ancl su1'rporting Canaclians liviug with cancer ;rclvocating fbr public policies tl-re l-realth

of Can:rclians

rally.ing Canaclians to get inrolr-ccl

fight against clulcer

Contnct us for up-to-clate infomation lrltoul caucer, our services of to make a clortlttiort.

* \r*

iat

Canaclian Societe

Cancer Society

cartaclierrrre clu cancer

Let's Make Cancer Historr 1 888 939-3333 | www.cancer.ca

'Ihis isgencml infi)nrlttion clcrelopctl l)\ lh( (.f,nrlrli.rn ( -!rr(: \ !ri:. It is n()t intcn(lc(l to rcl)hcc the rthicc 0l r clrr.rlilictl h..Llrlrr.r.! :': .:.:i: 'I lrc

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---

Let's )'I;rke C;rncer Flistory 1 888 939-3333 | www.cancer.ca

Early detection and screening finding cuflcer Lt an eady stage. When cancer is found eady, it is often easier to treat. Recognizing symptoms and getting regular checkups help detect cancer eady. Be aware of your body and don't ignore any changes. The sooner you report symptoms to youf doctor, the sooner a problem can be dealt with. Early detection means

It's hard to sa\' \\'h\' one person gets cancef :urd :rnother does not. It mav seem that cancer can't be ar-oided. but there are things that vou can do to reduce r-our risk of the disease. \bu can start bv living a healthy lifesnle and taking charge of vour health. This brochure describes four common cancers in men that can be detected eady b1' screening tests or by having signs and symptoms checked by your doctor: prostate, testicular, colorectal and skin. Many symptoms can be caused by problems that are much less serious than cancer. See your doctof to be sure. If cancer can't be prevented, treatment is more likely to be successful if it's found early.

the early detection of cancer by testing or checking for disease when you don't have any symptoms. Many types of cancer don't have a screening test, but some cancefs can be found before you,ve even noticed that something might be wrong. Screening tests can help find cancer at its eadiest, most treatable stages. Some screening tests can also help detect pfecancefous conditions that can be treated before cancef develops. If a screening test shows something unusual, follow-up tests will be needed. Screening is

Screening programs that offer screening tests for certain types of cancer are available across Canada. Programs can vary from province to province. These screening programs are offered to people in specific age groups

who don't have any signs or symptoms of cancer. If you have a farnily history of a specific cancer you may be at a higher risk for developing cancer and could be tested at an eaflier age or more often. Talk to your doctor about a personal plan testing.

Photographs: O Getty tmages I cenied m.lteri.l ir ior illustrdtive p!rposet only; peEons depkted dre model,

It's important to know that no screening test for cancer is 100% accurate. For example , a screening test can sometimes show cancer when there isn't, or not show cancer when there is. But overall, screening tests save lives.

Prostate cancer Prostate cancef starts in the cells of the prostate gland. It is the most common cancer

in Canadian men and is diagnosed most often in men over the age of 65. Men with a family history of prostate cancer or men who are of African ancestry are at higher risk of developing the disease at a younger age.

The PSA and DRE tests can help detect pfostate cancef eady, but they can also cause "false alarms" or miss pfostate cancer that is present. In some cases, these tests can detect prostate cancef that may not pose a serious threat to your health.It is important to talk to your doctor about your personal risk of developing pfostate cancer, and about the benefits and risks of testing.

Whot to wotch for These signs and symptoms may be caused by prostate cancer or by other health problems, such as an inflamed or enlarged prostate. See

Whot you con do If you are 5O or older, talk to your doctor about the risks and benefits of testing for pfostate cancef.

. . .

your doctor if you have:

the need to urinate often, especially at night an intense need to urinate

difficulty in starting or stopping the urine

flow

If you are at a higher risk for pfostate cancef because of your family history or African ancestry, discuss the possibility of starting testing at a youngef age. These tests may be used for the ear$ detection of prostate cancer:

. Digital rectal exam (DRE): a physical exam of

. an inability to urinate . weak, decreased of interrupted urine stream . a feeling that the bladder hasn't completely emptied

. burning or pain during urination . blood in the urine or semen . painful ejaculation

the prostate gland through the rectum. The doctor inserts a gloved finger into the rectum to feel the prostate for lumps or anlthing else that seems unusual.

. Prostate-specific

antigen (PSA) test: a blood

test that measlrfes prostate-specific antigen, a substance made by the prostate.

farly Detection and Screening

F1cts t'or men

O Canadian

Cancer Society

2007

Testicular cancer

Colorectal cancer

Testicular cancef starts in the cells of a testicle.While testicular cancer is quite rare, men between the ages of 15 ancl 49 are at

Most colorectal cancers start in the cells that line the inside of the colon and the fectlrm. It is the third most common cancer in Canada for both men and women. Colorectal cancer often grows slowly and in a predictable way. It may not cause any symptoms in its eady stages because the lower abdomen (below the stomach area) has lots of room for a tumolrf to gfow and expand. Screening tests help find colorectal cancer before symptoms develop.It can usually be treated successftilly when diagnosed early.

increased risk of developing it. Treatment for testicular cancer is usually successful. especially if the cancer is found early.

Whot you con do Become familiar with your testicles and check them regularly. The best time to do it is after a warm bath or shower, when the testicles clescend ancl the muscles of the scrotlrm are relaxecl. See your doctor right away if you notice anything unusual. Have regular medical checkups by your

doctor that include testicular examination.

Whot to wotch for These signs ancl symptoms may be caused by testicular cancef or by other health problems. See

your doctor if you have:

lump on the testicle

If the FOBT shows traces of blood in the stool, follow-up tests may include a:

testicle

of heaviness or dragging lower abdomen or scrotum a feeling

dull ache

Whot you con do Ifyou are 50 or older, have a fecal occult blood test (FOBT) at least every 2 years. This test checks your stool for blood that can be seen only with a microscope. Having blood in the stool doesn't always mean that yotr have cancer. It could have other callses for example, polyps (non-cancerous tissue growth), ulcers or even hemorrhoids.

the

the lower abdomen and groin

. Colonoscopy: a test that lets the doctor look at the lining of the entire colon using a thin, flexible tube with a light and camera at the end.

. Sigmoidoscopy:

doctor look at the lining of the rectllm and lower part of the colon using a thin, flexible tube with a light and camera at the end.

Early Detection and Screening fo(ts far ffte]

a test that lets the

Canadian tancer 5ociety 2007

Doubfe-contlast barium enema:

anx-ny of

nausea or vomiting

the colon and rectum that uses a special dye (called barium) that helps the docror see the lining of the colon more clearly.

fatigue (feeling very tired)

weight loss

Some men have a higher than average risk

for colorectal cancer. Talk to your doctor about when and how often you should have the tests if you have:

. . .

a patent,brother, sister or child with colorectal cancer (especially if the relative was diagnosed before the age of 45) a personal

The different types of skin cancer @asal cell, squamous cell and melanoma) begin in different kinds of cells in the skin. Basal cell and squamous cell skin cancers are very common in Canada,but both types can usually be treated easily and successfully.

history ofcolorectal cancer

akeady been diagnosed with inflammatory

bowel disease or polyps

Skin cancer

an inherited condition such as familial adenomatous polyposis (FAp) or hereditary

non-polyposis colon cancer GINCC;

Whot to wotch for These signs and symptoms may be caused by colorectal cancer or by other health

Whot you con do The best way to pfevent skin cancer is to protect yourself from the sun. Here are a few tips on how to stay safe in the sun:

problems. See your doctor if you have:

general discomfort in the abdomen (bloating, fullness, cramps)

in bowel habits, such as diarrhea or constipation, for no apparent reason

blood in the stool (either bright red or very dark)

a change

. stools that are naffower than usual . an urgent need to have a bowel movement . a feeling that the bowel hasn't completely emptied

farly Detection and screening

focts fot men

Protect yourself and your family particularly between 11 a.m. and 4 p.m. when the sun's rays afe at their stfongest, or any rime of the day when the LIV Index is 3 or higher. Stay in the shade - under trees, an awning or an umbrella _ and try to plan outdoor activities before l1 a.m. or after 4 p.m. Cover your afms, legs and head. Choose clothing that is loose-fitting, tightly woven and lightweight. Don't forget your hat to

protect your head, face, ears and neck.

with a sun protection factor (SPF) of 15 or higher. Don,t forget to apply sunscreen on cloudy days and during the winter. Use a sunscreen

O (dnadian

Cancer Society

2007

'Wear

sunglasses to help prevent damage to

your eyes. Choose glasses with even shading, medium to dark lenses, and IIVA and U\rB protection.

Preventing cancer Live well. Moke heolthy choices.

Be a non-smoker and avoid second-hand smoke.

. Avoid

using indoor tanning equipment. Just like the sun, tanning lights and sun lamps give off ultraviolet rays that can callse sunburn, damage skin and increase

Keep a healthy body weight. Be active and eat well.

Know the risks of alcohol. The less you drink, the more you reduce your risk.

the risk of skin cancef.

. Check your skin regularly. Get to know

Protect your skin. Be safe in the sun and don't use tanning beds.

the skin you're in and report any changes to your doctor.

Get enough vitamin D from the sun, supplements and your diet.

Whot to wotch for These signs and symptoms may be caused by skin cancer or by other skin problems. See

your doctor if you have:

changes in the shape, colour or size

Be owore. Look ofter yourself. . Know your body and watch for signs of cancer.

birthmarks or moles

. sores that don't heal . patches of skin that bleed, itch or become

Report any changes in your health to your doctor. Get screened and help find cancer early. Check your family's cancer history. Understand how hormones and infections

red and bumpy

affect your cancer risk. Get ricl of harmftrl substances at work ancl at home.

Get involved. Help reduce risks for

everyone.

Raise awareness about cancef pfevention

in your community. Reduce cancer risks for the next generation.

Fight for public policy to make healtlry

living easier for everyone. Find out how you can help the Society fight for change right now. tarly Detection and Srreening

Facts f1r men

[Jnadi.]n Can(er SorietV 2007

0ANCE,p.CATe

Connect'

Understanding and Managing ChemotherapY Side Effects Presented by

Richardf.Gralla,MD

Multinational Association of Supportive Care in Cancer Nancy G. Houlihan, RN, MA, AOCN@ Memorial Sloan-Kettering Cancer Center

Carolyn Messner, DSW CancerCore Learn about:

r Common side effects . Practical information . lmproving qualitY of life r The role of your health care team

CANCEF(C4TC' HelP and HoPe

\ffith better control of chemotherapy side effects, cancer treatment is going more smoothly for many patients. As most people knory the goal of chemotherapy is to destroy cancer cells. Traditional chemotherapies work by killing cells that divide rapidly. As they wipe out fast-growing cancer cells, though, they can also damage fast-growing

normal cells.

to blood cells leads to side effects like anemia, fatigue, and infections. Chemotherapy can also damage the cells that line the mucous membranes found throughout the body, such as those inside the mouth, throat, and stomach. This leads to mouth sores, diarrhea, or other problems with the digestive system. And damage to cells in the hair follicles leads to hair loss. For example, damage

Each person with cancer reacts differently to chemotherapy and its various side effects. Fortunately, doctors now have many ways to reduce and even prevent these side effects. ln this booklet, you'llfind practical information on managing side effects so that your treatment goes as smoothly as possible.

You should note that there are newer medications, not discussed in this booklet, known as targeted treatments. They generally cause less severe side effects than traditional

chemotherapy. Many people taking these drugs develop a skin rash and other bothersome skin and nail conditions. Patients most likely to be affected are those taking a particular type of targeted treatment called an ECFR inhibitor. You can learn more about how to cope with skin rash from targeted treatments in the CancerCore Connect@

-When-ChemoJherapyDamages Blood Cells Even as chemotherapy kills cancer cells,

it also damages

fast-growing normal cells in the body such as:

White blood cells

These cells help fight infections and

are an imPortant Part of our immune defense system. A low white blood cell count, called neutroPenia, can increase the risk of infection'

Red blood cells These doughnutshaped iron-containing cells carry vital oxygen from the lungs to the muscles and other tissues in the bodY' A low red blood cell count, called anemia, can lead to fatigue, weakness, and difficultY breathing.

Platelets These structures in the

blood help stop bleeding by plugging lead to a leaks in the blood vessels. Low levels of platelets cause condition known as thrombocytopenia, which can bleeding. or bruising eria-

Dry

booklet Tips for Managing Treatment-Related Rosh and the book at Skln. Obtain a free copy by downloading (4673)' www.cancercare.org or by calling 1-800-813-HOPE

Nausea and Vomiting

that: When it comes to nausea and vomiting, we know r Younger people are at higher risk than older people' I Women are at a slightly higher risk than men'

Certain drugs commonly cause these side effects' including c'rsplatin (Platinol and others)' doxorubicin

With Nausea ___, -Coping ,l These tips can

Eat and drink slowly. Try having small meals throughout the day instead of your usual breakfast, lunch, and dinner.

Avoid sweet, fried, or fatty foods, as well as foods with strong odors. Eating foods cold or at room temperature can help you avoid strong smells. Be sure that you fully understand your doctor's and nurse's instructions for taking anti-nausea medicines. See that you have a sufficient supply of the correct drugs. Be sure that you are drinking enough fluids. Ask your nurse or doctor about proper nutrition during this time.

Find out from your doctor if any other medicines you may be taking require special precautions.

(Adriamycin and others), and cyclophosphamide. Doctors have used these standard chemotherapies for many years. Many surveys have shown that patients and their family members believe that nausea and vomiting occur with all types of chemotherapy. More than 20 years ago that was true, and it was difficult to control the symptoms. Today, doctors do a much better job of preventing and easing these symptoms. Generally, if there's more than a 1 0 percent risk of causing nausea or vomiting with chemotherapy, patients are given anti-nausea medicines-also known as antiemetics-as a preventive. The most common form of anti-nausea medication is

combination of dexamethasone (a type of steroid) and

serotonin blocker-a compound that stops the natural

substance serotonin from sending a message to the brain that triggers nausea. serotonin blockers include dolasetron

(Anzemet), granisetron (Kytril and others), ondansetron (Zofran and others), and palonosetron (Aloxi). This combination helps prevent the

acute nausea and vomiting that can occur in the firsl24 hours after

chemotherapy. Doctors usually recommend patients continue using this drug combination for two to three days following treatment to prevent delayed nausea. By taking medication to prevent these different types of nausea, patients also can avoid developing anticipatory nausea_the queasy feeling that can come before chemotherapy.

Aprepitant (Emend) is an anti-emetic drug that can be added to the combination of dexamethasone and a serotonin blocker to protect against both acute and delayed nausea and vomiting. Aprepitant, taken as a capsule, *ork, by counteracting the effects of a chemicar produced in the body called "sLlbstance p.,, A related drug, fosaprepitant (Emend for lnjection), gives patients receiving chemotherapy another option for

preventing nausea and vomiting. Delivered intravenously, fosaprepitant is converted to aprepitant in the body. There are many options available to help you manage nausea and vomiting. Talk with your doctor about *hi.h

on"

is best for you. Remember, anti_nausea medicines are given to prevent the problem from occurring.

Fatig ue Feeling factors:

r I

tired-really tired-can be tied to a number of

The cancer itself Treatment of the disease

These tips can help you reduce your fatigue: Take several short naps or breaks in a comfortable chair

rather than in bed. Take short walks or do some

r r

light exercise if possible.

The emotional aspects of dealing with cancer and cancer pain

Anemia (low levels of red blood cells)

lf you are experiencing fatigue, you should know that this is a symptom for which you can ond should seek help. lf your

doctor doesn't ask you about fatigue, be sure to bring it up. That's the best way to find and treat the cause. To determine whether there is an underlying physical cause, your doctor will order a blood test to find out if your

red blood cell count is abnormally low (anemic). lf you are anemic, there are many treatment options. Oncology social workers and oncology nurses can also help you manage fatigue. They can work with you to address any

psychological concerns that may be causing symptoms and help you develop practical strategies for coping.

Don't try to treat yourself with over-the-counter medicines for "iron-poor blaod." These drugs have not proved to be hetpful,

Mouth Sores (Mucositis) Sores inside the mouth and on the lining of the throat and digestive tract can result from radiation treatments and

a from some types of chemotherapy' Mucositis can be infections' serious probiem because it can cause pain and treatment Once swallow' and drink, eat, making it difficult to it's fade' they before But ends, irouth sores do disappear' team care health important that you work closely with your to manage this side effect of cancer treatment' Here are some of the most imPortant stePs:

Visit your dentist before treatment' A small problem on' couldiurn into a large one if mouth sores develop later Take <are of Your mouth and keep it clean.

r r

Use the softest bristle brush'

lf toothpaste irritates your mouth, 1/z teasPoon salt use a mixtu re of with 4 cuPs water. Gargling maY helP. Use a solution

made uP of: 1 quart Plain water 7z teasPoon table salt 7z teasPoon baking soda

Drink PlentY of fluids' Soothe mouth sore Pain with:

r r

lce chiPs or PoPsicles. lbuprofen (such as Motrin) or acetaminophen (such as Tylenol) for mild pain'

rover-the-counteranesthetics,suchasAnbesolororajel. especially if Let your doctor know if you are using them'

he or she prescribes a lidocaine-based mouthwash' Gelclair-an oral gel designed to coat and soothe mouth mouth' This is sores by forming i protective barrier in the available bY PrescriPtion onlY'

lf you ore receiving high'dose chemothe.rapy followed the drug by bone marrow tronsplont for a blood cance'

palifermin (Kepivance) may be prescribed. Palifermin, given intravenously, has been shown to protect the lining of the mouth, reducing severe mucositis. The safety and effectiveness of this drug for people with other types of cancer are not yet known.

Don't resist taking stronger drugs for severe pain. For example,

opiates,

that includes morphine, may be prescribed to help you cope with mouth pain. lt's important to manage pain because it can affect your quality of life and even slow progress toward better health. lf swallowing pills is difficult, severe pain can be treated with intravenous drugs. And when your pain is controlled, you will be better able to eat and drink fluids. a class of drugs

Nerve Damage Some people on chemotherapy experience pain, numbness,

or tingling in their hands and feet, what doctors call peripheral neuropathy. Symptoms related to neuropathy and other types of nerve damage can include:

r r r I r

Difficulty picking up objects or buttoning clothing Problems

with balance

Difficulty walking Jaw pain

Hearing loss

These symptoms can build over time. Some people don't notice them until they have had several chemotherapy

treatments. lt's important to tell your doctor as soon as possible if you experience these types of side effects. He or she may want to adjust some of your medicines or chemotherapy and may want to see if there is another reason for the problem that can be treated. Often, nerve damage is temporary; it will usually get better, but it can take time. That's because the nerve fibers re-grow

very slowly-less than a millimeter (1lzs of an inch) per day. ln the meantime, take extra caution when handling hot, sharp, or dangerous objects. And use handrails on stairs and in the tub or shower.

lnfections As we mentioned earlier, chemotherapy can lower the levels of infection-fighting white brood ceils, a condition known as neutropenia. Of special concern for cancer patients is

their levels of neutrophirs, the most abundant of the three types of white blood cells. These cells contain tiny packets filled with potent chemicals called enzymes that can destroy bacteria when the chemicals are released Bacteria are the most common source of infection for

patients receiving chemotherapy. The normal number of white blood cells in one microliter of blood (a tiny droplet, one millionth of a liter) is between 4,OOO and 1,l,000; the risk of infection is greatest when the neutrophil count drops to 1,000 or fewer. lf your neutrophil count dips below this number, the only symptoms you might experience are chills, fever, or sweats. lf you are feeling unwell in any woy after receiving chemotherapy, it's vital to take your temperature. Temperatures from 99"F (37.2"C) to 100"F (3Z.g"C) are fairly common. But if your temperoture rises to l\O.S'F (3g.l,C) or abave, call your doctor or nurse immediately. Fever may be your only sign of an infection. Unless fever is treated promptly, infections can become life_threatening. Make sure

you have a good thermometer (the digital on", ur" fine) that is easy to use and read. Also, be sure to have your doctor,s telephone number in case there is a problem. Doctors use antibiotics to treat infections. Although most people think of antibiotics as piils, intravenous antibiotics are often recommended for patients receiving chemotherapy.

reventi

ngJntectionl

simple You can lower your risk of infection by taking these steps:

Wash your hands frequently with soap and water' especially after using the toilet and before eating'

and Clean cuts and scrapes right away' Use an antiseptic heal' they until dry keep wounds clean and

you in Carry alcohol-based sanitizers, such as Purell' with case you don't have access to soap and water'

using a Be extra careful not to nick or cut yourself when razor, knife, or scissors.

r r

up' Wear protective gloves when gardening or cleaning Avoid contact with cat litter boxes, bird cages, and fish tanks.

the Using intravenous antibiotics knocks out infections until normal' to white blood cell count returns

Depending on a number of things, including the type of chemotherapy you receive, another approach is to take white blood cell growth factors' ln some patients' these Crowth medicines can reduce the risk of getting infections' factors stimulate the bone marrow to replenish blood cells affected bY chemotheraPY' Commonly used white blood cell growth factors include filgrastim (Neupogen) and pegfilgrastim (Neulasta)' Both oith"r" drugs have to be given by injection' Your doctor or

nursecantrainyouoracaregivertoadministerthisinjection just once' at home if you prefer. Pegfilgrastim may be given a day or two after chemotheraPY'

Diarrhea Defined as two or more loose stools per day, diarrhea may be caused by some types of chemotherapy, including irinotecan (Camptosar and others), 5-fluorouracil (5-FU), erlotinib (Tarceva), and gefitinib (lressa). lf diarrhea persists, especially large and frequent stools, you should report it to your doctor or nurse. There are also some things you can do to help control diarrhea:

Make changes to Your diet. Many foods can nourish you without contributing to diarrhea. Here are some suggestions: cHoo5E

INSTEAD OF

High-protein foods such as eggs (well cooked); lean meat, fish, or poultry; smooth Peanut

Fried or fatty foods (such as sausage, bacon, chicken nuggets, or fried seafood),

butter*; beans* Skim or low-fat milk, yogurt, or cottage cheese (use lactosefree dairy products if you are lactose intolerant)

pizza

Cooked vegetables* such as

carrots, green beans, mushrooms

Raw vegetables, especiallY those with thick skins, seeds, or stringy fibers

Fresh fruits without the skin;

Dried fruits

canned fruit (except prunes) Desserts low in fat and lactose such as sorbets, fruit ices, or

graham crackers

Regular milk or cheese with more than 9 grams of fat per ounce

High-fat ice creams; any candies, gum, or breath mints containing sorbitol, mannitol, or xylitol

Note: Foods marked with on asterisk ore high in soluble fiber, which solidifies stool but adds to the omount of stool. Choose them when the volume of stool is manageoble.

Replace lost fluids and salts. r Drink plenty of fluids. lf you are getting behind in fluids, make sure that your doctor or nurse knows about the problem you are having with diarrhea' t lncrease your intake of drinks such as Catorade or Pedialyte, an over-the-counter solution made for infants that can be used by adults as well. These drinks provide electrolytes-the body's salts that must stay in balance in order for cells to work properly. Occasionally, intravenous fluids are needed if the diarrhea is especially severe' Take medicine, but only include:

if you need it' Options

Over-the-counter medicines Use these medicines only if necessary. Discuss their proper use with your health care team.Themostrecommendedover-the-countermedicine for diarrhea is lmodium AD. But you should remember that this used to be a prescription medicine and can be quite powerful. ln general, if the diarrhea is bad enough for you to need a medicine, including an over-the-counter one, you should discuss the diarrhea and treatment with your doctor or nurse.

Prescription drugs Your doctor may

need

to prescribe

diphenoxylate and atropine something (Lomotil and others). Like all drugs, these products can interact with other drugs you may be taking, such as opiate pain relievers. lf your doctor prescribes Lomotil, be sure to tell him or her about any existing conditions you may have, such as heart disease or breathing or thyroid problems; taking this drug can make these problems stronger, such as

worse. For severe, unrelenting diarrhea that does not respond to

these oral medications, your doctor may consider giving you injections of octreotide (Sandostatin)' Although this irug has not been approved specifically for diarrhea caused t?

by chemotherapy or radiation treatments, your doctor may choose to prescribe it "off label."

Constipation Defined as fewer than three bowel movements a week (although fewer than four or five may be a reduced number for some people), this symptom can be caused by: r Vinorelbine (Navelbine and others), vincristine (Oncovin and others), and temozolomide (Temodar), commonly used chemotherapy drugs

r I I r I

lnactivity Low fluid intake

Low intake of dietary fiber Anti-nausea medications

Opiate pain medications

Oddly enough, in cases of severe constipation, liquid can seep around a blockage, which some patients mistake for diarrhea. They may take an antidiarrheal medication, making the problem worse. With prolonged constipation, other symptoms, such as confusion and retaining urine, can occur. It's very important

to use gentle, stimulating laxatives if

you're constipated. Stool softeners such as docusate sodium

Here are some things you can do to help prevent

constipation:

Eat plenty of dietary fiber. Crains, beans, and vegetables such as cauliflower or broccoli are good sources of fiber.

r r

Drink plenty of fluids. Make light exercise a part of your everyday schedule.

(Colace and others), although helpful, are not enough. Pharmacies carry a number of different laxatives that are available without a prescription, such as Senokot, bisacodyl (Correctol, Dulcolax, and others), magnesium hydroxide (milk of magnesia), Metamucil, and MiraLAX. The best thing to do, though , is to prevent constipation through diet, exercise, and careful use of laxatives. Prescription pain medicines may be one of the biggest reasons people with cancer become constipated. But your doctor can prescribe a special schedule of laxatives along with your pain medication so that you can still benefit from pain relief and avoid constipation.

Hair Loss Not all anti-cancer medicines cause hair loss; your doctor or nurse can tell you whether you might be affected. Hair loss is often one of the more trying aspects of cancer treatment. When hair falls out, it can affect self-image and quality of life. But there are ways to cope with this side effect. Everyone's experience is different, so it's important to talk with your doctor or nurse about how your particu lar treatment affects hair loss. Depending on the treatment, hair loss may start anywhere from seven to 21 days after the first chemotherapy session. Hair starts to grow back after you are finished with treatment. lt may have a different texture or color, but these changes are usually not permanent.

Cenerally, when they lose their hair, most people want to wear some kind of head covering, whether it's a scarf, turban, hat, or wig. Some insurance plans cover part of the 1"4

Take an Active Role Your Care

When coping with side effects, don't hesitate to ask questions so you can get the help you need. The more information you communicate with your doctors and nurses about how you are feeling, the more they can help you achieve the best

quality of life. Cood communication with your health care team is especially important if you decide to take part in a clinical trial. Clinical trials are studies that test new treatments to see how safe and effective they are for patients. Your doctor, who knows the most about your specific type and stage of cancer, can guide you in making a decision about whether a clinical trial is right for you.

cost. Organizations such as CancerCore@ can also provide suggestions for obtaining a wig. lf you choose to wear a wig, consider buying one before all of your hair falls out. This way/ you will have a good match to your own hair color. Having a wig ahead of time will also help you feel more prepared. You can have your wig professionally fitted and styled by a full-service wig salon. Some of these salons even specialize in hair loss from chemotherapy.

Your Support Team When you or a loved one is diagnosed with cancer, it's common for many emotions and issues to arise. Sometimes it helps to talk to someone. Just getting your concerns out into the open so you can make sense of them helps make them seem more manageable. It's perfectly normal to feel sad, angry, afraid, or frustrated

'l]ffif]1@#Ktat{*ffiffi@g&,*s&s*@wti*sdsf;i*$svrs?rryi@ar:{:ti?:?r#.:sqr.ir!t:***ffigg**ffin*E

about the side effects of chemotherapy. lf you are experiencing fatigue or nausea, for example, you may not be able to do all the things you,re used to doing. your family may feel the effects too. For example, p.ihup, yo, have a young child at home who doesn,t understand why you're lacking the energy to play. you may also need some accommodations made for you at work, such as a place where you can go to rest or more flexible hours. Social workers and oncology nurses can help. These health care professionals provide emotional suppoit, help you cope with your treatment and its side effects, and guide you to resources and g"i practical solutions for !; "' problems. CancerCare@ i offers free individual -t; counseling online, on the phone, and in person with oncology social workers on staff. Financial F;+2

assistance is also available to help offset costs such as transportation

to treatment or child care while you,re

receiving treatment.

Support groups are also available. you and your family members may also benefit from a support group, which can ease the feeling that you are going through treatment side effects alone. By providing reassurance and sharing

insight and suggestions, people in support groups often help each other learn new ways to cope. CancerCore offers free telephone and online support groups for people living with cancer/ caregivers, and loved ones. These groups are led by professional oncology social workers. To learn more about how CancerCare helps, call us at 1 -8OO-81 3-HOPE (4673) or visit vt/wul.cancercdre.org.

Frequently Asked Questions had some nerve damage as a side effect of Should my doctor consider changing treatment. my the type of chemotherapy l'm getting?

Q|,u"

A tfri, is a judgment call. You and your doctor have to weigh the risks and benefits of your treatment. The decision will depend on how severe your symptoms are, where you are in the course of your treatment, how responsive your tumor has been to chemotherapy, the current goals of treatment, and whether there are effective drugs that do not cause nerve damage that could be substituted. However, even if you stop using a medicine today, you will probably continue to have symptoms for some time. And because nerve damage is cumulative, the symptoms may get worse before they get better. Talk with your doctor or nurse about medications, as well as techniques such as relaxation exercises and acupuncture, which may help ease discomfort.

Qt haven't experienced many side effects from my -hemotherapy, so l'm wondering whether my treatment is really working. A

Sometimes, people can have a great benefit from chemotherapy without having a lot of side effects or possibly even ony side effects. An important goal is to prevent side effects, and it sounds as though you and your doctors have been able to do that. Not having side effects might be due to other factors as well. For example, every drug affects each person differently, and at different stages of treatment. And some chemotherapy drugs are known to cause less severe side effects than others.

Qwh"n

a patient has a low white blood cell

count-neutropenia-what is the most common organism that causes infections, and what

antibiotics are used?

There are many different organisms that can cause infection. That is why a broad-spectrum antibiotic is usuaily prescribed to treat infection. Doctors see different patterns of infection in different geographic regions. These patterns affect which medicines are given to treat infections and prevent them from becoming worse.

Qtn.r. have been many discussions in my support group and on the lnternet about the side effect referred to as ,,chemobrain.,, What "chemobrain" and what can be done about it?

lf you are having memory problems and trouble focusing on tasks, finding words, or managing daily activities, you are not alone. patients often notice these changes during chemotherapy treatment. But most people find that within a year of finishing treatment, these symptoms have either greatly improved or disappeared altogether. Researchers are still uncertain about the exact causes of

chemobrain. But a number of conditions that may lead to the symptoms can be treated effectively: low blood cell counts, depression, anxiety, and fatigue among them. Tell your doctor if you're having any of the symptoms of chemobrain. Sometimes, simply changing a prescription can make a real difference in how you feel, since some medications can also make you less alert.

G loss

ary

acute nausea and vomiting Symptoms that may occur within the first 24 hours after chemotherapy.

anemia A low red blood cell count that can lead to fatigue, weakness, and difficulty breathing.

anti-emetics

Medicines that act against nausea and vomiting.

delayed nausea A side effect of chemotherapy that may occur two to three days after treatment.

growth factor

A drug that stimulates the bone marrow to make blood cells, in this case, the white blood cells affected by chemotherapy. Commonly used white blood cell growth factors are filgrastim (Neupogen) and pegfilgrastim (Neulasta).

intravenously Fluid-in this case, medication-delivered through a needle into a vein. This form of treatment referred to as lV or intravenous.

mucositis

Sores inside the mouth and on the mucous

lining of the throat and digestive tract that can result from some types of radiation treatments and chemotherapy.

neutropenia A low white blood cell count that

can

increase the risk of infection.

neutrophils

The most abundant of the three types of infection-fighting white blood cells. Neutrophils contain tiny packets filled with potent chemicals called enzymes that can destroy bacteria when the chemicals are released.

opiates

A class of drugs that includes morphine for effective pain relief.

serotonin A natural chemical

messenger that has many important functions in the body, including stimulating movement in the intestines. When released by certain chemotherapy drugs, serotonin can send a signal to the brain that triggers nausea. n9

Resources (ancerCare 1-800-81 3-HOPE (4673)

www.cancercare.or9

American Cancer Soclety 1-800-227-234s www.cancer.org

CancenNet Patient information from the American Society of Clinical Oncology www.cancer.net

Cancer Support Community www. cancersu ppo rtcom m

ity.

org

Natlonal Cancer lnstitute Cancer lnformation Service 1-800-422-6237 www.cancer.gov

Natlonal Coalitlon for Cancer Survlvorshlp 1-877-622-7937 www. canceradvocacy.o rg