Cancer is a devastating disease. And unfortunately, it’s still a big issue. Out of 100,000 men and women, around 442 of them will get cancer every year. If you’re diagnosed with cancer, you’ll have to see an oncologist for your treatment.
What is an oncologist? An oncologist is a doctor that specializes in cancer treatment. Finding the right oncologist can be tricky, simply because there are so many types of oncologists. The oncologist you see will depend on the type of cancer you have as well as your treatment.
Which type of oncologist is right for you? Here, we will cover the different types of oncologists and how they can help with your condition.
The Role of the Oncologist
Before covering the different types of oncologists, let’s look more at this type of doctor and how they assist cancer patients.
An oncologist diagnoses and treats different types of cancer. They will also manage a patient’s care throughout the course of the disease, which also includes reducing any side effects they experience from the disease and treatment.
A proper diagnosis follows specific steps:
- Identifying the type of cancer and stage
- Exploring treatment options
- Managing side effects and symptoms
Cancer is a debilitating and scary disease. That’s why your oncologist will be more than your doctor — they can serve as a support system. An oncologist is a unique doctor because they have special training in delivering high-quality care while showing compassion.
A typical oncologist has a specialty team that consists of:
- Oncology social worker
- Oncology nurse
- Doctors in other areas of medicine
- And more
All of these professionals are devoted to delivering the best care.
Types of Oncologists
Now that we have a better understanding of the oncologist, let’s look at the different types of oncologists. Keep in mind, this isn’t a complete list.
If you’ll need surgery, you’ll visit a surgical oncologist. They specialize in removing cancerous tumors as well as nearby tissue.
There are also surgical oncologists who specialize in certain operations for specific types of cancer. For example, otolaryngologists treat cancers of the head and neck while urologists perform surgeries for those with prostate cancer.
A surgical oncologist can also diagnose cancer, performing a biopsy. However, they may only be able to diagnose certain types of cancer.
After receiving their doctor of medicine (MD) or doctor of osteopathic medicine (DO), surgical oncologists will spend the next several years in a surgical residency program. Many graduates pursue general surgical oncology before choosing a specialty.
If chemotherapy falls into your treatment plan, you’ll need to see a medical oncologist. They may also give other treatments, such as immunotherapy and targeted therapy. Medical oncologists also prescribe medications that will alleviate any side effects and symptoms you’re experiencing.
Even if you’re not undergoing chemotherapy or another medical procedure, many use a medical oncologist as their primary specialist. They can coordinate care with other doctors and monitor your treatment.
After receiving their MD or DO, a medical oncologist completes an internal medicine or pediatrics residency that lasts approximately three years. From here, they join an oncology fellowship that lasts another three years.
This oncologist treats cancer specifically with radiation therapy. They may the area that needs to be treated, calculating the dose as well as the number of needles needed.
You may need radiation therapy for a couple of reasons. If you need surgery, radiation will eradicate any cancer cells you may have. If you received palliative care, radiation can be used to ease any pain you have. Stereotactic body radiotherapy (SBRT) is also used to treat specific tumors and other cancers in stages of metastasis.
After receiving their MD or DO, a radiation oncologist spends five-to-six years in a radiation oncology residency program.
Unfortunately, cancer can also occur in children and teenagers. This specialist treats cancer in children. Some cancers they can treat include leukemia, brain tumors, Ewing’s sarcoma, and osteosarcoma.
Even though a pediatric oncologist is specialized to work with children, they can also work with adults. Some cancers occur more commonly in children than adults. If an adult is diagnosed with these specific cancers, they can opt to visit a pediatric oncologist for treatment.
These oncologists specialize in gynecologic cancers (cancer of the woman’s reproductive organs). These include ovarian, uterine, and cervical cancers.
After receiving their MD or DO, a gynecologic oncologist undergoes obstetrics and gynecology residency. From here, they pursue their training through a gynecologic oncology fellowship. Here, they receive training on chemotherapeutic, surgical, and radiation techniques.
This oncologist specializes in blood cancers. They can diagnose and treat them. Common examples of blood cancers include lymphoma, leukemia, and myeloma. They have extra training in the human blood system as well as the bone marrow and lymphatic systems.
The Oncologist You’ll See by Cancer Type
The oncologist you see depends on the type of cancer you have. Fortunately, you can see a medical oncologist for many types of cancer, such as bladder cancer and breast cancer.
Depending on the treatment, your radiation oncologist will be your main oncologist. This may be the case if you have a type of cancer such as brain cancer; radiation will stop or slow the growth of brain tumors.
You may also have to see specialized surgeons for many of your treatments. For example, if you have colorectal cancer and need surgery, you’ll see a colorectal surgeon. If you need surgery for liver cancer, you’ll see a hepatobiliary surgeon.
How Do You Find the Best Types of Oncologists?
Now that you know the different types of oncologists, you may be wondering how to find the best one. Don’t worry, we make this process easy. We provide access to oncologists for free 24/7. Register today!
Headache is a very common problem. It is also a symptom many cancer patients experience, whether alone or with other symptoms.
There are two types of headache depending on the cause;
- Primary headache; this is the type of headache mostly caused or aggravated by stress, like tension headache, migraine headache, and cluster headache.
- Secondary headache; is the headache that happens as a result of other problems affecting the brain like brain tumors, infections, or medications.
Both types of headache can affect cancer patients, thus the headaches you might experience can vary in site, type and severity according to the cause.
The most common causes of headache in cancer patients include:
1- If the cancer is originally in the brain, spinal cord or pituitary gland tumors, or tumors in other places that had spread to the brain.
2- As a side-effect of chemotherapy, brain radiation therapy or other cancer treatments.
3- As a side-effect of other medications, such as high blood pressure treatments, antibiotics or antiemetics.
4- Cancer related conditions as anemia or dehydration.
6- Stress, anxiety, fatigue, poor appetite and sleep.
5- Infections as sinusitis or meningitis.
How to manage headaches:
If you started having new headaches, you must tell your healthcare team about them.
- Describe how frequent and severe they are, the exact site, if they occur at certain times of the day, describe if they were sharp, throbbing, dull or pressure like, and whether you are having any other symptoms as well.
- Symptoms your doctor would want to know if you have are:
- Blurring of vision
- Pain and stiffness in your neck that is worse by moving
- Limb weakness, change in your sensations, or inability to talk.
- Poor appetite and decreased fluid intake.
- Fatigue, looking pale, decreased activity, or shortness of breath.
- Talk to your doctor if you have low mood or feeling anxious.
- Your team can order some tests to rule out some of the causes as:
- Blood tests can tell whether or not you are having anemia.
- Brain imaging like CT or MRI scans, in case of suspected new brain mass or change in size of an old mass.
- Talk to your healthcare team about you medication list and their possible side-effects.
- If possible, your doctors will treat the conditions causing you headache like giving antibiotics for infections, or iron supplement for anemia.
- Your doctors might also prescribe medications for headache, depending on its type and cause. These medications might include; paracetamol, non steroidal anti-inflammatory as ibuprofen, triptans, antidepressants, steroids in case of brain cancer or cancer spread,
Tips to help you cope with headaches:
- Eat an adequate healthy diet and drink enough fluids to prevent fatigue and anemia.
- Sleep well and give your body the rest it needs.
- Avoid noisy or crowded places when you are experiencing the headache.
- Avoid stress and tell your doctors if you’re having low mood.
- If you are also experiencing dizziness, make sure your house is safe and organized to avoid the risk of falling.
- Certain techniques can help you cope with headaches including relaxation, yoga, massage, ask your doctors about their availability and if they will be helpful in your case.
- Tell your doctor if headache is becoming more frequent or severe, if it changes in character or doesn’t go away.
Feel free to watch this video as many times as you would like. If you have any additional questions, you are welcome to reach out to your doctor’s office.
- Hair loss is a very stressful symptom in cancer patients.
- It usually occurs as a treatment side effect.
- Not necessarily all patients receiving cancer treatments develop hair loss. Also some drugs have higher risk than others
- The amount of hair loss also differs among patients. It depends on the drug you take, its dose and even the way you receive it, whether as a pill or through veins.
Causes in cancer patients are:
- Some chemotherapy medications
- Hormonal therapy
- Radiation therapy
- Some targeted therapy medications
- Anemia, poor nutrition, thyroid problems, stress and anxiety can also cause hair loss in cancer patients.
- Chemotherapy drugs usually cause hair loss throughout the body, this includes scalp hair, eyelashes, eyebrows, arms, legs, underarms and pubic area.
- Targeted therapy doesn’t cause complete hair loss, but hair may become thinner or drier.
- Radiotherapy only causes localized hair loss at the site of exposure. With higher radiation doses, the regrown hair might be thinner or with different texture than the original hair.
- Hormonal therapy can affect hair after several years of therapy. However it does not cause complete hair loss.
- Hair loss as a side-effect of cancer treatments doesn’t start right away with starting treatment but takes weeks to start.
- Hair loss is usually temporary. Patients start regrowing hair back usually 1-3 months after ending treatment.
- It usually takes 6-12 months for new hair to completely grow back. New hair may be thinner or thicker, may have different color than the normal hair but usually returns to its normal in the following years.
How to cope with hair loss:
- Hair loss can cause social and emotional distress for many patients. It’s important to deal with it as a major problem that affects quality of life.
- It is also important for patients to understand the time needed for their body to heal, and use the coping mechanisms until that happens.
- Talk to your healthcare team to understand the amount of risk of hair falling with your cancer treatment.
- Use gentle shampoo to wash your hair, do not wash it everyday or scrub it vigorously.
- Use wide-toothed comb and pat your hair dry to avoid any damage.
- A shorter haircut can help you care for your hair, and help your hair taking less time to grow back.
- Avoid blow-drying your hair with heat, hair straightener or curler, and chemical hair products and dyes.
- Cover your head to protect it from the sun, and use sunscreen over areas with hair loss.
- Talk to your doctors about vitamin supplements that can help your hair become stronger and grow back.
- Talk to your doctors about scalp cryotherapy or cold cap therapy. This type of therapy helps preventing hair loss from chemotherapy drugs given into veins. It works through narrowing the scalp blood vessels at time of chemotherapy infusion thus reducing the amount reaching the scalp.
- You can use Natural looking wigs and hairpieces pieces. You can style them the way you want until your hair grows back to normal. Insurance companies may cover for them as well. Or you can use other options include fashionable scarfs.
- Care for the regrowing hair the same way. You can also ask your doctor about hair growing medications as minoxidil, as well as vitamins, creams and lotions.
- Follow your doctors’ instructions on caring for associated problems as treating anemia and nutritional deficiencies.
- Support groups can help you express your emotions and let out your feelings. Use all the support you can get and give your body time to heal.
Feel free to watch this video as many times as you would like. If you have any additional questions, you are welcome to reach out to your doctor’s office.
Causes of cancer related fatigue include:
- Cancer Itself.
- Aggressive cancer treatments as surgery, chemotherapy or radiotherapy, or as a side-effect of other non-cancer drugs.
- Drugs that make you drowsy.
- Lack of sleep.
- Anxiety or mental stress.
- Other side-effects of drugs as vomiting or diarrhea resulting in dehydration, or loss of appetite. This can cause loss of nutrients and fatigue.
Fatigue due to cancer or as side-effect of cancer treatment is different from any other. You may feel that it is always accompanying you and nothing is making it go away completely, even rest and sleep.
How can you cope with fatigue?
- Have better quality sleep time:
-Making your priority to have good night sleep.
-Lie in bed for sleep only, and avoid noise caused by electronic devices and television.
-Take frequent naps as much as your body needs.
-Avoid caffeine and alcohol before bed time.
- Exercising can boost your energy and make you feel better. -Plan ahead a daily schedule for simple exercises.
-Choose the exercise that suits you and don’t strain yourself. -Simple exercises as walking each day even if inside your house, swimming, cycling or yoga are very beneficial.
- Maintain a routine during the day for activity and rest, and distract yourself with simple activities.
- Eat a healthy diet rich in protein, calories, vitamins and iron, and drink a lot of fluids. Talk to your doctor if you need dietary consultation.
- Talk to your doctor if you are feeling sad or depressed, some medications can help you feel better, also keep your support system of family or friends close.
- Talk to your doctor about any other uncontrolled symptom that can be contributing to your fatigue. As pain, vomiting, diarrhea, fainting or loss of appetite.
- Support groups and talk therapy have been proved to control cancer-associated fatigue. Talking about your feelings of fatigue, depression or any fears can help you get through it.
Dizziness is a symptom many cancer patients experience.
If you feel dizzy, you might feel that the room is spinning around you or that you have lost your balance.
Dizziness can be related to cancer and its medications or other problems you might also be having.
Cancer-related causes include:
1- Chemotherapy. Many chemotherapy drugs include dizziness as one of their side-effects.
2- Anemia. Cancer and many treatments can cause anemia. When you have anemia you brain doesn’t get enough oxygen and nutrients which causes your feeling of dizziness.
3- Inadequate eating or drinking, also nausea and vomiting can cause your feeling of dizziness.
4- If the tumor in the brain or have reaches the brain, this might be the cause of dizziness.
Other causes for dizziness include:
1- Changes in your blood pressure.
2- Changes in your blood sugar.
5- Ear problems.
6- Other medications.
- If you experienced dizziness, call your healthcare team, your team will need to find out possible causes and rule out anything serious as dehydration, stroke, low blood sugar or even tumor spread to the brain.
- Tell your healthcare team about any other symptoms you are experiencing, particularly if you have nausea, vomiting, blurring of vision, hearing problems, headache, diarrhea, feeling cold, sweaty or chills.
- Make sure your healthcare team knows about all the drugs you are taking.
- Once your doctor find the cause of dizziness, they will be able to reach the plan for managing it.
- Call your doctor if any symptoms are bothering you or don’t go away.
Here are Some tips to help you cope with dizziness:
1- Keep yourself hydrated by drinking a lot of fluids, try to drink up to 10 glasses each day.
2- Avoid drinks with too much caffeine.
3- Have adequate nutrition.
4- Avoid standing or changing positions too fast.
5- Be careful on walking, make sure you hold on the railing while walking downstairs.
6- Avoid driving if you feel dizzy more often.
Feel free to watch this video as many times as you would like. If you have any additional questions, you are welcome to reach out to your doctor’s office.
Diarrhea is a common side-effect of cancer treatment.
It is either caused by chemotherapy or immunotherapy drugs.
Other causes in cancer patients can be; radiation therapy to the abdomen or pelvis, or infections.
Diarrhea can be complicated if not managed properly, Complications include:
- Dehydration and loss of minerals.
- Fluid and mineral loss if severe, may cause heart or kidney failure.
- Malnutrition and weight loss.
- Persistent diarrhea may affect treatment course by dose reduction, delaying or discontinuing of treatment.
Management of diarrhea:
- Report diarrhea to your health care provider. It is necessary to exclude serious causes for diarrhea as infections.
Some symptoms should also be reported as they are considered warning signs if existed with diarrhea, they indicate infection or dehydration.
- Severe abdominal pain
- Blood in stool
- Dizziness on standing
- Feeling of thirst
- Decreased amount of urine
- Stool incontinence
- If your diarrhea is less than 6 times a day, with no warning symptoms:
-Your doctor will prescribe a drug called Imodium (or Loperamide) capsules, Start with 2 capsules (4 mg), then take 1 capsule (2mg) every 4 hours or after each loose stools, up to 8 capsules (16 mg) in a day.
-Loperamide should be continued for 12 hours after resolution of diarrhea.
- If diarrhea persisted for more than 24 hours or became worse, call your doctor o exclude any complication, the dose of loperamide can be increased starting with 2 capsules (4 mg) then 1 capsule (2 mg) every 2 hours. If you develop any of the symptoms above, tell your doctor immediately.
- To cope with diarrhea and prevent its complications:
- Remember to drink no less than 10 glasses of water each to replace the fluids lost.
- If you were taking any stool softeners, don’t forget to stop taking them.
– Avoid food and drinks that worsens diarrhea as fatty, spicy food, milk products, coffee and alcohol.
– Do not avoid eating. Instead you can increase the intake of food that improves diarrhea, as the BRAT diet, which is a diet consisting of Bananas, Rice, Apple sauce, and Toast, is thought to help in controlling diarrhea. Increase intake of clear fluids as water, broth, and clear juices.
What is a Port?
- A port is a device that is usually placed under the skin in the right side of the chest or under the arm. (picture of Single and Dual Ports). A port can have one or two access points.
- The port goes either under the skin of your chest or upper arm.
- It is attached to a thin, flexible tube (also called catheter) that is threaded into a large vein above the right side of the heart ((Picture of septum)
- A surgeon or a radiologist implants a port, usually with local anesthesia or conscious sedation in the operating room.
How does the port works?
- Your port will look like a small, raised area under your skin. The center of the disk which is raised somewhat is called the septum (Picture of port-a-cath and highlighted text below by the side)
- Fluids are put into or taken out of the port using a special needle that goes into the septum.
- The catheter connects to the septum to take the medicine or inject fluids right into the blood.
- Blood for lab tests can also be taken out through the catheter.
- When the needle is removed from the septum, no fluids or blood can leak out. (remove picture)
What is the purpose of implanting a port?
A port is used
- to give intravenous fluids, blood transfusions, chemotherapy, and other drugs as well as can be used for taking blood samples.
- for treatments, like continuous infusion therapy, that last longer than 1 day.
- to reduce the number of times a healthcare provider needs to insert a needle in your veins, and
- to reduce the risk of tissue and muscle damage with repeated needle sticks.
- The port can be used on the same day it is put in and may stay in place for weeks or months
During first 24 to 48 hours after surgery, the incision area will be tender and a little red. Most people don’t need pain medications and the discomfort usually goes away within 48 hours. If your pain persists, please contact your Oncologist.
You should also call your surgical nurse if you develop
- Severe pain
- Increased pain, swelling, warmth, or redness around the port.
- A fever of 100.5 F or above
- Bleeding from the port
- Swelling or a growing bruise.
Keeping it secure and dry:
- The incision wound will be covered by bandage till the wound heals for about 5-7 days.
- Please keep the bandage and wound areas dry. It may be a good idea to take a sponge bath or
- Take shower only after making sure the port site is covered and secured with a plastic wrap so water doesn’t not reach it.
- If you notice the bandage is pulling away, reinforce it with medical tape until you see your oncology nurse.
- The nurse will check on your dressing within the next days after surgery.
- Check your bandage daily for bleeding.
- If there’s bleeding, press firmly with a gauze for 15 minutes.
- If bleeding didn’t stop call your oncology nurse immediately. If it’s heavy bleeding visit emergency.
- Wearing the seatbelt will put pressure on your wound, try to avoid this by placing small pillow or folded towel between the strap and the wound.
- No exhausting activities until your wound heals.
- Also please do not to lift objects heavier than 10 pounds (4.5 kg) during this time.
After your wound heals, you can return to your normal daily activities.
You can swim with your implanted port as long as there is no needle in place.
Avoid playing any contact sports, such as football or rugby.
How a port is used in the hospital:
- Before you start receiving chemotherapy, Nurses will handle the port with sterile procedures as hand washing, sterile gloves and alcohol scrubbing. You can always ask if you noticed any different handling of your port.
- A dressing will also be placed over the port when it’s in use.
- During chemotherapy infusion, nurses will check your port for any signs of inflammation.
- If blood tests were needed, hands or arms’ veins will usually be used to get blood. This helps to avoid multiple accessing of the port, which increases risk of infection.
- The port will be flushed by a nurse after each use, and every 4 weeks when it’s not being used, to prevent becoming blocked with blood clots. Saline and heparin (a blood thinning medicine to prevent blood clots) are used.
What are the risks and side effects of the port?
Potential side effects include
- blockage and
Caring for the port helps to prevent these side effects.
Caring for the port at home:
- Always wash your hands with soap and water before and after caring for the port.
- Remind everyone who cares for your port to wash their hands.
- Wear clean medical gloves when you care for your port.
- Avoid touching the port if not needed.
- Clean the skin area surrounding the port every day.
- Check daily for redness, swelling, and oozing at the site of the port.
- Keep the port covered with bandage whenever the needle is in place.
- You will be able to feel the port under your skin, but it will not be noticeable by people.
- The skin covering the port will not need any special care.
- No bandage will be needed if the port is not in use.
Your oncology nurse will instruct you if it’s needed and they will demonstrate you or a family member how to do it.
- Never try to use your port without proper training from your caregiver.
- Do not hesitate to call us for training
- Have a well-trained nurse to help you at home if possible
- Supplies needed: gloves, alcohol pads, gauze, tubing and needle, saline syringe, heparin syringe
I will review with you the steps of accessing and flushing the port:
- Create a clean working space,
- Sterilize the surface with alcohol
- Wash your hands properly with soap and water
- Wear a mask during preparing and accessing your port
- First you will need to remove the air in the tubing attached to the needle
- Attach a syringe that contains saline to the tubing
- Open the clamp and slowly push saline through the tubing and needle. Then close the clamp and leave the syringe attached
- Wear clean medical gloves. Clean the port site and the surrounding skin with alcohol pads for 90 seconds then allow it to dry completely
- Feel the edges of the port with one hand, use the same hand to stretch the skin across your port and hold the port in place
- With the other hand insert the needle through your skin, into the center of the port and push it until you hit the back wall of the port.
- Open the tubing clamp, and slowly pull back on the syringe.
- If blood flows back into the tubing and syringe, the needle is in the proper place. If you do not see blood, you will need to change the position of the needle.
- Close the clamp on the tubing.
- For port flushing you will need:
- 10 ml normal saline syringe
- 10 ml heparin solution syringe
- Connect the saline syringe by opening the cap, avoid touching the tip of the syringe. Push the saline slowly.
- Clamp the tube after flushing with saline and before you connect the heparin syringe to prevent air bubbles from entering the tube.
- Push the heparin slowly. Then clamp the tubing. After that you can carefully remove the needle.
I want to go over some general nutrition recommendations in three short videos.
I will go over
- about using nutrition to manage side effects in Video 2 (log in to view)
- about food safety in Video 3 (log in to view)
While this is broad guidance based on quality evidence, we recommend you consult with our Registered Dietitian, to tailor a plan to your specific needs.
How to maintain a healthy weight.
- During many cancer treatments, patients can experience loss of appetite or decreased oral intake due to uncomfortable GI side effects such as nausea, vomiting, diarrhea, or constipation, or as a result of some medications.
- The main focus of our nutrition interventions is to help you to take in sufficient calories to maintain your current weight through the course of treatments, so ensure your body stays healthy and can recuperate from treatments accordingly.
- There may be instances in which weight loss before or after treatment in obese persons is appropriate, but your doctor would let you know if it is needed in your case.
- You can also consider adding oral supplemental shakes to your diet, if you feel you are not eating well. Your Registered Dietitian can guide you about which supplements are right for your body, and how much to take in to meet your needs.
- Weigh yourself regularly. If you notice weight loss that is more rapid than 1 pound per week, contact your Registered Dietitian, so that they can help you manage this appropriately.
Getting essential nutrients.
- Getting essential nutrients means consuming a variety of foods, with balanced portions of protein, carbohydrates, and fats, alongside plenty of fluids. During your treatments, your healthcare team does not recommend any dietary restrictions, unless medically necessary due to your cancer diagnosis or other conditions, which would be discussed with you at your visits.
- Getting the appropriate amount of total calories for maintaining your weight, as well as staying hydrated are most important while fighting cancer. Your Registered Dietitian will provide you with goals for calorie intake and fluids to meet these needs, and help monitor your intake and adjust through your treatment course.
- Depending on your needs, taking a multivitamin or specific vitamins and minerals that you aren’t getting enough of during treatment may be necessary. Nutritional supplements such as Boost or Ensure also can help you meet these needs. Before taking any supplements, please discuss with your healthcare team.
It is important to remain as active as you can.
- Exercising to maintain your muscle mass as best possible is key to fighting through treatment with energy and rebuilding strength after treatments.
- For example, take a daily walk or incorporate lower impact activities such as tai chi, yoga, meditation and stretching, or swimming into your exercise pattern.
- Once your treatment is complete, ask your healthcare team about our Cancer Exercise Rehab Program available for patients.
While this is broad guidance based on quality evidence, we recommend that you consult with our Registered Dietitian, either personally or using the computer, to tailor a plan to your specific needs.
How to use nutrition to manage treatment side effects?
Cancer treatment often causes side effects, such as nausea, mouth sores, and taste changes which may make it difficult to eat or drink.
Follow these tips to help you manage side effects:
- If water tastes unpleasant to you:
- take in more liquid through foods and other drinks like soups, popsicles, or
- fruits like watermelon, flavored water, beverages like Gatorade, Powerade, or
- try tea, lemonade, or milk.
- If food tastes bland,
- try seasoning it with flavorful spices such as lemon, garlic, and rosemary.
- Some prefer to simply eat bland foods, such as breads, oats, pastas, mashed potatoes, dairy products, as this helps to mentally cope the taste alterations.
- If you have a metallic taste in your mouth.
- Try things such as mints, chewing gum, teeth brushing more frequently
- Even bites of fresh citrus (yes even sucking on lemon slices), or drinking tomato juices can help
- use plastic or bamboo utensils and cook in nonmetal pots and pans, especially avoiding cast-iron cookware.
- If you experience mouth sores or gum tenderness,
- choose soft, moist, non-acidic and non-spicy foods.
- Use a blender or food processor to make vegetables and meats smooth.
- Smoothies or milkshakes may be a great option that can also help you get additional calories in a texture that is comfortable for you.
- Tricks such as adding butter, mild sauces, gravy, ricotta, or cream to meals or recipes are great ways to add calories and a soothing texture.
- If you feel FULL with smaller portions
- try frequent meals are a great way to get those much needed calories
- try eating 6 small meals a day instead of 3 large meals.
- Choose calorie and protein packed items for those small meals.
- If meat becomes unappealing,
- try getting protein from other foods like fish, eggs, cheese, beans, nuts, nut butters, tofu, or high-protein smoothies or shakes.
- Also sneaking things like ricotta and silken tofu into mixed dishes can be a great way to add extra protein.
- If you are experiencing nausea or vomiting,
- be sure to take all medications as prescribed.
- Unless directed specifically, do not take medications on an empty stomach as this may exacerbate symptoms.
- Some dietary approaches include eating regular meals and snacks, drinking plenty of fluids, and eating bland foods such as crackers, chicken noodle soups, mashed potatoes, toast with peanut butter, etc. Some patients find that drinking ginger teas, or sucking on ginger candies or peppermints help to curb nausea, as well.
While diet can play a role, please reach out to your dietitian if you are experiencing severe constipation or diarrhea.
While this is broad guidance based on quality evidence, we recommend you consult with our Registered Dietitian, either personally or using the computer, to tailor a plan to your specific needs.
Many treatment options weaken the immune system and increase the risk of experiencing food-borne illness.
Patients receiving cancer treatment should follow some basic rules to make sure they are practicing food safety:
- Wash your hands before you handle food, as well as all food prep surfaces.
- Rinse vegetables and fruit thoroughly before eating them.
- Store meat and fish on the bottom shelf of the refrigerator.
- Use separate cutting boards for meat and vegetables.
- Refrigerate food after everyone has been served.
- Eat fully cooked foods and skip raw meats, seafood, or sushi.
- Do not eat unpasteurized foods and pay close attention to cheeses, milk, cider, and juices.
- Follow expiration dates and safe food storage practices.
Food safety is very important. If you have additional questions, talk with our Registered Dietitian at St. Bernard’s.
Eating a balanced diet that incorporates vegetables, beans and legumes, whole grains, and fruits is important during both treatment and recovery.
While there may be more specific recommendations tailored to you based on your specific cancer and treatment course, a healthy overall diet is important to regaining strength and achieving and maintaining a healthy weight.
These are broad evidence-based guidelines. We always recommend patients to consult our Registered Dietitian either personally or using the telehealth platform to tailor a plan to your specific needs.
Feel free to watch this video as many times as you would like or download scripts to read.
Be sure to watch Video 1 on how to Maintain Healthy Body Weight and ensure you receive Essential Nutrients and Video 2 on how to Nutrition to manage Side Effects from Cancer and Treatments.
If you have any additional questions, you are welcome to reach to your doctor’s office
Thank you and good luck!
What is Carboplatin, Paclitaxel, Avastin and Tecentriq care plan, and how does it work?
It is a combination of chemotherapy and immunotherapy regimen used for certain types of stage 4 non-small cell lung cancer.
Carboplatin and Paclitaxel are chemotherapy treatment, Avastin is a targeted therapy treatment and Tecentriq is an immunotherapy treatment
∙ Carboplatin is also called “Platinum-therapy” and kills cancer cells through binding with their DNA, preventing their production and inducing their death.
∙ Paclitaxel is “Taxane” class of chemotherapy medicine which kills cancer cells by damaging the structure or the “skeleton” that supports them, thus preventing their growth and division.
∙ Avastin is also called Bevacizumab. It is a “Monoclonal antibody” that binds and inhibits growth factors important for new blood vessels formation especially in cancer, thus inhibiting cancer cells
∙ Tecentriq also known as “Atezolizumab” is an immunotherapy works by binding to a specific area on immune cells called PD-L1 receptor, helping Immune system to attack and kill cancer cells.
Who gets this regimen:
This regimen is mainly given for non-squamous non-small cell lung cancer that is
1. advanced or stage 4,
2. cancer cells are free of EGFR and ALK mutations and
3. In combination with chemotherapy Tecentriq is given for lung cancers with or without PDL1 expression.
How is this regimen given?
∙ Going back to the main anti-cancer therapy regimen – carboplatin, Paclitaxel and Avastin and Tecentriq, these medications are given by vein on the same day, followed by a rest period of 21 days.
∙ Each 21 days treatment is considered a cycle.
∙ Usually 6 cycles are given for a total treatment period of average 18 weeks.
∙ After 4 to 6 cycles of all four drugs, a maintenance treatment consisting of Avastin and Tecentriq every 3 weeks is usually given to prevent disease progression.
What are side effects?
Different agents have specific side effects. It is also important to remember you may not have every side effect related to each medicine of the combination therapy.
You should call your doctor if have:
• Shortness of breath which is of new onset.
• High fever > 100.4 F.
• Excessive diarrhea of equal to or more than 7 loose stools per day despite taking anti-diarrheal medication prescribed by your doctor.
• Diarrhea that is accompanied by significantly reduced urine output, dizziness upon standing up and low blood pressure.
• Abdominal pain with nausea and vomiting, fatigue and deep yellow skin and urine. This may indicate liver toxicity.
– Swelling of legs associated with pain especially, if one sided. This may indicate blood clots that can be precipitated by Avastin
– Stroke like symptoms ( sudden onset of weakness/ numbness on one side of the body, sudden unexplained speech disturbance) may indicate TIA or Stroke. Rarely, this could be precipitated by Avastin.
The most common side effects are:
• Allergic reaction during or after chemotherapy infusion. Tecentriq also can cause skin rash and itching which are immune mediated.
• Tiredness and weakness
• Reduced blood cells: resulting in fatigue, increased possibility of infections and bleeding.
• Constipation or diarrhea. Both chemotherapy and immunotherapy may cause diarrhea.
• Loss of appetite
– Tingling, numbness or pain in hands/ feet/ legs which may indicate NEUROPATHY that can be cased by Paclitaxel.
– Increased Blood Pressure is a common side effect of Avastin. If you are monitoring your BP at home and if it is unusually elevated compared to baseline, please call your doctor. Your doctor may use blood pressure medications to control it. Controlling your blood pressure and maintaining it in a healthy range is crucial while on Avastin.
– Increased Protein in the urine ( proteinuria) is a side effect of Avastin. Your doctor will monitor your urine samples for protein before you get Avastin. For this reason, you will be asked to give a urine sample prior to every treatment with Avastin.
• Hair loss
Please note that Tecentriq is an immunotherapy that activates your immune system and may attack any of the organs.
• Other than these common side effects, Tecentriq may cause skin rashes, liver, kidney, lung and thyroid problems.
• Your doctor will monitor thyroid and liver tests while you are on treatment. It is important to follow your directions for lab tests.
Please call your doctor if you feel you are not well and if side effects don’t reduce or go away after medications prescribed your doctor.
Please view the video “How to self-manage common symptoms before calling your doctor”:
Please tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over-the-counter medicines, to make sure they won’t interfere with your treatment.
Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. For managing a specific side effect.
What is Oral CMF:
This is a chemotherapy treatment with combination of three drugs used
to treat breast cancer.
Cyclophosphamide is given as oral tablets, and both methotrexate and fluorouracil will be given through infusion in the veins.
How oral CMF Works:
o Cyclophosphamide is a type of chemotherapy medicine called an alkylating agent and also called Cytoxan. It stops cancer cells from reproducing.
o Both Methotrexate and Fluorouracil are related to another type of chemotherapy medicine called antimetabolites. They stop DNA synthesis in cancer cells thus preventing cancer cells growth and division.
Who Gets oral CMF:
- CMF is one of the chemotherapy regimens commonly used to treat early invasive breast cancer that has not spread to other body organs.
- It can be given before surgical removal of the cancer to shrink the tumor, this is called Neoadjuvant treatment. It can also be given after surgical removal of the cancer to kill any remaining cancer cells and prevent the return of cancer, in this case it is called Adjuvant treatment.
- It can also be used in people who have had a recurrence or spread of cancer depending on the medicines you received before.
How is oral CMF Given:
- Please tell your doctor about any medicines you are taking, including vitamins, herbal
supplements and over-the-counter medicines, to make sure they won’t interfere with your CMF treatment.
- This regimen is given in a chemotherapy clinic outpatient, which means you can go home after you receive your medications.
- Cyclophosphamide is taken as a tablet once daily starting from day 1 of the treatment cycle and for 14 days continuously.
- To take a cyclophosphamide tablet safely, make sure you swallow it as a whole, don’t cut or crush it before swallowing.
- It is very important with cyclophosphamide to drink plenty of fluids, at least 2-3 liters of water each day, and to not take cyclophosphamide tablets before bedtime.
- Both methotrexate and fluorouracil are given by vein in the same day, at day 1 and day 8 of each treatment cycle.
- This cycle is repeated every 28 days. You should receive 6 cycles of CMF for a total duration of treatment of 6 months.
What are the side effects from Oral CMF treatment:
It is important to remember that different medicines have different side effects for different people.
You may not have every side effect related to each medicine of the combination therapy.
Common side-effects of CMF include:
- Low blood counts: CMF chemotherapy affects rapidly dividing cancer cells but also some of the normal cells as blood cells.
Your doctor will be monitoring your blood counts weekly in the first two weeks of each cycle.
- Low red cell counts. referred to as Anemia. If you get too anemic, you may experience a lot of fatigue, palpitations/ increased heartbeat and shortness of breath with exertion. If you have symptoms and significant anemia, your doctor may choose to give you blood transfusions.
- Low white blood cell counts can result in reduced immunity and increased susceptibility to Infections.
- Low platelet counts can result in increased bleeding tendency, as heavy bleeding from small wounds, nose bleeding, bruising, coffee ground vomiting or blood in urine or stool.
- If you develop very low white blood cell or platelet count, the next cycle of treatment might be deferred until these counts rise to normal again.
- Your doctor might also decide to reduce the dose of medications or omit one or two if the counts remain very low.
- Watch for signs of anemia and bleeding tendency and call your doctor if any of these symptoms are bothering you.
- Infections: they can follow a low white blood count.
- Watch for signs of infection as; high fever, cough, sore throat, skin changes, burning urine, or diarrhea. Call your doctor whenever one of these symptoms are bothering you. Also call your doctor in case of fever > 100 degree F.
- Nausea and vomiting: you may experience nausea alone or with vomiting, as a result of CMF chemotherapy. Your doctors give you one or more anti-nausea medications before each cycle to prevent early nausea and vomiting which can happen in the first hours. You will also be given an oral medication to take for a few more days at home, and as needed after that.
It is very important to follow your doctor’s instructions regarding taking the antinausea medications, to avoid this side-effect and its complications.
- Bladder irritation: this is a side-effect of cyclophosphamide that happens in case of decreased fluid intake. It’s very important to drink plenty of fluids and at least 2-3 liters of water each day throughout your treatment duration.
- Diarrhea or constipation.
- Mouth sores and changes in taste.
- Loss of concentration.
- Hair loss or thinning.
- Eye soreness.
- Effects on fertility and symptoms of menopause: as hot flashes and mood changes. Your doctor will discuss with you the available options for preserving your fertility.
Less common but more serious side effects include:
- Heart changes:
This can sometimes occur with fluorouracil. Call your doctor right away in case you had chest pain, tightness at the center of your chest, palpitations or bounding chest.
- Allergic reactions: your doctor prescribes medications to prevent allergic reaction before chemotherapy infusion. If you have an allergic reaction, you may show symptoms such as chills, difficulty breathing or shortness of breath, flushing, rash, itching, face and tongue swelling. If you have any of these symptoms at any time call your healthcare team right away.
- Skin changes: ulceration, pigmentation or light sensitivity are less common symptoms. But to avoid more serious forms of skin problems, avoid excess sun exposure and make sure you wear sunscreen.
Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you
manage them. For managing a specific side effect, please watch our symptom specific video.