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| 25 years ago, at about this time of year, while anxious over finishing my Ph.D, I found out that I had cancer and had my first chemotherapy treatment which was described in the preceding entry. This entry focuses on the side effects of the chemotherapy not including nausea and vomiting that occur in the few hours after administration of the anti-cancer drugs which was detailed in the previous entry. |
| As I have written several times before, cancer chemotherapy is a selective poisoning which seeks to kill a greater percentage of the cancer cells than the normal body cells. Because cancer cells are normal cells that have mutated, drugs that are toxic to the cancer cells are also going to be toxic to the normal cells. Because the drugs are in the body for a short time, the worst effects are experienced by the most rapidly dividing cells which include the cancer cells and several classes of normal cells such as hair, blood stem cells in the marrow, cells of the gastrointestinal system and any mucous membranes. I am going to describe the side effects in what I believe is increasing danger to the patient's health. |
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Loss of hair -- Hair is quite susceptible to cancer drugs because of its continual growth. When one receives a chemotherapy treatment, the hair that is affected does not fall out immediately or the next day, but several days later. This is because the hair cells that are killed at the root of the hair. This is below the skin. It takes a while for the hair which has been cut at the root to make its way to the surface. Not all the hair cells are killed at once. I would estimate that I lost about a quarter of my original amount of hair with each treatment. I actually looked carefully under a microscope at one of my hairs that fell out and compared it to a healthy hair that I pulled out of my head. The healthy hair has approximately the same diameter until one gets to the root which looks like a bulbous growth at the end. It is shaped like a scallion. The hair that was killed by chemotherapy did not flair out at the end, but tapered to a point. It was shaped like a sharpened pencil. The taper at the end of the hair actually measured the concentration of chemotherapy drug, narrowing the hair shaft as the concentration of drugs increases until the hair is severed from the root. I lost every hair on my body by about the 4th treatment. |
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Overall fatigue (also known as general malaise) -- The shocks the body receives from the toxins used in cancer chemotherapy are debilitating. It makes one tired and tired all the time. There are periods of some energy, but they are not frequent. It can be frustrating, and the long term effects can lead to depression. The fatigue can be increased by the effects of anemia described in the section on bone marrow side effects below. For me this was the worst side effect. Not being able to be active, or being able to do everything one wants to do is draining. and dispiriting. |
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Gastrointestinal effects -- The entire gastrointestinal tract is lined with cells that are constantly being renewed. Damaging these cells causes adverse effects throughout the system. The taste buds are dulled. Damages to the stomach and small intestines can cause intestinal distress and interfere with the absorption of nutrients. Depending on the drugs used effects in the colon can either cause diarrhea or constipation. Eating and taking pleasure in a good meal is no longer fun. Eating becomes boring and is done manly for survival and not out of enjoyment. For these reasons, many cancer patients lose weight due to lack of appetite and lack of enjoyment of eating. Food did not have much taste for me during treatment. I hated this part. I was aware of the effect, so I ate small meals, and occasionally indulged in high calorie treats like ice cream because I knew it would be easy to eat, somewhat enjoyable through the cold sensation, and would replace calories lost elsewhere in the diet. In one treatment period, I actually gained a few pounds. That surprised my doctors. After my treatments ended, it took about 4-6 months before food tasted correctly. |
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Damage to blood stem cells in the marrow -- The most harmful, and most closely monitored side effects are the consequences of damage to stem cells in the bone marrow. The three main cells that are in the blood: red blood cells, white blood cells, and platelets are derived from a single type of stem cell that grows and differentiates into the three different types of cells. These cells are continually produced in the marrow at the rate of about a trillion a day. Cells are continually entering and leaving the blood stream to keep a steady number in the blood. It takes about a week to 10 days for the cells to mature from their origin to the final form. During a chemotherapy treatment, a large portion of the trillion stem cells are killed which causes a deficiency when these cells are due to enter the blood. The lower concentration of cells causes side effects based on the function of the different blood cells. This will be described for each cell type below. Because of the possible severe consequences of lowered blood cell counts, 10 to 14 days after a treatment the blood is drawn and analyzed. A low count of any of the cells may require allowing the patent to recover before additional treatments. |
| Possible side effects associated with blood cells-- |
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Red blood cells-- Red blood cells have one function: to transport oxygen throughout the body. Oxygen is crucial to respiration and capture of energy from food. Lack of required oxygen make the organs function poorly. Lowered red blood cell counts leads to anemia. The major symptom of anemia is weakness, and anemia contributes to the overall sense of malaise. Severe anemia can lead to heart complications and possible heart failure. I had one minor bout with anemia during my treatment which caused some heart palpitations. |
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White blood cells-- There are a large number of different white blood cells. Their have in common that they are part of the immune system. The white blood cells fight all types of invaders of the body. A compromised immune system makes the body susceptible to infections and damage by toxic substances.Chemotherapy patients must be careful to avoid possible infections. I suffered no immune system effects. |
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Platelets-- Platelets are the cells in the blood responsible for the clotting of wounds. A low platelet count can lead to excessive bleeding or bruising. I suffered no platelet effects. |
| There are also specific side effects for a given drug. For example, Adriamycin, one of the drugs that I was given, has cumulative cardiac toxicity. Patients are limited in the total lifetime dose of this drug to prevent heart complications. Most anticancer drugs are themselves carcinogenic which can lead to tumor formation from the treatment. Another not well understood side effect is called post-chemotherapy cognitive impairment, better known as chemo-brain which I will discuss in a later entry. |
| There are side effect from every chemotherapy drug. Treatment protocols must balance the killing of the cancer with the reduction in the quality of life due to the adverse effects of the drugs. My drugs were given in a 21 day cycle. During day 1-5, the damage of the original dose of drugs was inflicted. After a short 5-7 day recovery, the blood cells that were destroyed were due to come into the bloodstream. The inadequacy in the number of blood cells at this point causes a shock to the system lasting a few days. The body recovers for about a week, and then it is time for the next cycle. |
| Stay tuned for more of the story. |
| (Cancer Chronicles is a series of status updates that account the events of 25 years ago when I went through a bout with cancer. Its purposes are multi-fold: catharsis, education, information, celebration, etc. ) |
| This originally was posted to facebook November 5, 2012. |
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