Do What You Can to Ease Side Effects of Treatment for Carcinoma of Unknown Primary Origin

Here are some common side effects from treatment for carcinoma of unknown primary origin (CUP) and how to ease them. You may not have all of these. We've listed them in alphabetical order so you can find help when you need it.

Anemia (low red blood cell levels)

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing he or she is checking for is your red blood cell count. Red blood cells carry oxygen throughout the body. If your body does not have enough oxygen, you may feel tired. If your red blood cell count is low, you have anemia. Decreased red blood cell counts can be caused by small amounts of blood loss due to bleeding, by chemotherapy, radiation, stem cell transplants, or by the cancer itself.

If your doctor tells you that you have anemia, take these actions to feel better.

• Take short rests when you're tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine. This may help you sleep better.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of water. Dehydration adds to fatigue.

• Talk with your doctor about medications or treatments that may help manage your anemia.

• Eat iron-rich foods such as spinach, beans, chickpeas, and red meat.

Anxiety and depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back throughout treatment. All of  these feelings are a normal response to cancer. However, there are steps you can take to ease your mental stress.

• Talk with your family or friends.

• Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

• Ask your doctor about medications for depression and anxiety.

Appetite loss

Eating well during cancer treatment can help you maintain your strength, stay active, and lower your chances of infection. When you're being treated for cancer, a diet high in calories and protein is best. The problem is that side effects of treatment can change the way food tastes to you. It can also reduce your appetite.

Try these tips to stimulate your desire to eat.

• If you can, eat foods high in protein several times a day. These foods include milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue. Cancer treatments cause your body to use more protein than usual. A dietitian can help you learn what is best for you to eat and drink during your cancer treatment.

• If you can, eat high calorie foods to help you maintain your weight. High-calorie foods include margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

• Get plenty of fluids to help control your body temperature and improve food elimination. In addition to water, apple juices, and other liquids, try gelatin, pudding, soups, frozen juice bars, and ice cream.

• Eat small meals throughout the day instead of three large ones.

• Keep snacks handy to eat when you are hungry.

• Eat with friends or play your favorite music at mealtime to boost your appetite.

• Eat your largest meal in the morning. Many people getting treatment for cancer find this is when they have their biggest appetite.

• If you can, increase your activity level. Doing so may stimulate your appetite.

• On days you don't feel like eating at all, don't worry about it. Try again the next day. If you find your appetite doesn't improve in several days, talk with your doctor or nurse. There are medications that can help increase your appetite.

Bruising and bleeding

Chemotherapy can interfere with your body's ability to make certain blood cells called platelets. Platelets help stop bleeding when you get a cut or bruise. Without enough platelets, you may bruise or bleed too much. Tell your doctor if you notice these signs of excessive bleeding.

• Unexpected bruising

• Small red spots under the skin

• Signs of blood in your urine (reddish or pinkish color)

• Black tarry stools or blood on the toilet tissue after a bowel movement

• Bleeding from your nose or gums

• Vaginal bleeding not related to your period or heavier bleeding than usual during your period                                                                                                                       

• Headaches or changes in vision

• A warm to hot feeling in the arms or legs

If your doctor tells you your platelet count is low, you have a condition called thrombocytopenia. Take these steps to help minimize your risk of bleeding.

• Check with your doctor before taking any prescription drugs, over the counter medications, supplements, or herbal medications. Many of them, including aspirin and certain herbal remedies, may further increase your risk of bleeding.

• Check with your doctor before drinking alcohol.

• Use a toothbrush with soft bristles so you don't cause gums to bleed.

• Blow your nose gently to reduce your risk of nosebleeds.

• Be especially careful not to cut yourself when using knives, scissors, clippers, or other sharp tools.

• Be careful not to burn yourself when cooking or ironing.

• Avoid contact sports.

• Ask your doctor if you should avoid sexual activity.

• Use an electric razor instead of a blade because it reduces your risk of cuts.

Constipation

This may be a side effect of chemotherapy or some pain medicines. Constipation may include difficult or infrequent bowel movements. It can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation. So, take these preventive actions ahead of time. These same steps will give you relief if you are already constipated.

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative only as prescribed by your doctor.

Diarrhea

This may be a side effect of chemotherapy. Diarrhea includes loose or frequent bowel movements, or both. It may lead to dehydration. Many drugs can cause bowel changes. Take these steps to ease diarrhea.

• Avoid milk and milk products such as ice cream, high fat yogurt, and soft cheese.

• Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

• Eat low-residue, low-fiber foods such as those included in the BRAT diet (bananas, rice, applesauce, and toast).

• Drink more fluids, such as water and broth, to prevent dehydration.

• Ask your doctor about medications that may help.

Hair loss

Losing your hair is known as alopecia. It can be upsetting because baldness is a visible reminder that you are being treated for cancer. Chemotherapy and radiation can cause hair loss. Keep in mind that your hair will likely grow back after treatment, though it may look different than it did before.

Try these coping tips.

• Consider cutting your hair before treatment starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair, and you'll be ready with head coverings if you choose to use them.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Hot flashes

Hot flashes may result from hormone therapy. To ease them, try these tips.

• Ask your doctor about medications you can take to ease symptoms.

• Try keeping a diary to identify what actions or situations trigger a hot flash. Recognizing what causes the hot flashes may help you avoid them.

Infection

Because chemotherapy can reduce the number of white blood cells in your body, it can decrease your body's ability to fight off infection.

Taking these actions may reduce your risk of infection.

• Wash your hands often, especially before eating and after going to the bathroom or touching animals.

• Stay away from people who are sick with an illness you could catch, such as a cold or the flu.

• Avoid crowds. If you must go out, choose a time when fewer people will be out, such as during the week or late at night.

• Avoid children who have recently been given "live virus" vaccines.

• Do not cut or tear your cuticles because even small cuts can let in bacteria.

• Take extra care when using knives, scissors, or other sharp objects.

• Take good care of your teeth and gums so you don't have bleeding areas, which can allow bacteria into your bloodstream.

• Do not squeeze or scratch cuts or blemishes.

• Take a warm bath, shower, or sponge bath every day. Do not use harsh bath products, such as skin scrubs. Do not rub your skin too hard with washcloths or towels.

• If your skin is dry or cracked, ask your doctor if lotion or oil will help.

• Clean any cuts or scrapes right away. Wash them with soap and warm water, followed by an antiseptic. Continue to wash cuts and scrapes once a day until they heal.

• Ask someone else to clean up litter boxes, animal waste, fish tanks, and birdcages.

• Avoid standing water, such as bird baths, vases, and humidifiers, since bacteria can multiply rapidly under these conditions.

• Wear protective gloves when gardening or cleaning.

• Do not get any immunizations, such as a flu shot, without asking your doctor first.

• Do not eat raw or undercooked seafood, fish, meat, or eggs.

• Use an electric razor instead of a blade to minimize the risk of cuts.

Call your doctor right away if you have any of these signs of infection.

• A temperature of 100.5 degrees Fahrenheit or higher

• Severe chills

• A cough

• Pain

• Burning during urination

• Any sores or redness

Menopausal symptoms

Some types of chemotherapy and hormone therapy can cause menopausal symptoms. This may be because the drugs damage a woman's ovaries. Or they may prevent the release of the female hormone, estrogen. The result may be these menopausal symptoms, even if you've not yet reached menopause.

• Hot flashes

• Vaginal dryness

• Mood swings

• Weight changes

• Irregular or stopped periods

For some women, the loss of a menstrual period is permanent. If this happens to you, then you will no longer be able to get pregnant. To cope with symptoms of menopause, try these suggestions.

• If needed, talk with your doctor about birth control before treatment begins.

• Talk with your doctor about ways to manage menopausal symptoms. These might include using lubricants for vaginal dryness, doing mild exercise, and talking with a therapist about mood swings or signs of depression.

• Report any unusual bleeding or pain to your doctor.

• Continue with regular pelvic exams.

Mouth sores (mucositis)

Some types of chemotherapy may cause mouth sores. These may hurt and make eating an unpleasant experience.

To prevent sores in your mouth, take these actions.

• Brush your teeth after meals and before bedtime. Floss gently every day.

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

To ease the pain if you get sores in your mouth, take these actions.

• Avoid alcohol and mouthwashes containing alcohol. They may irritate the sores.

• Avoid hot, rough, or spicy foods. They may irritate the sores.

• Avoid tobacco. It may irritate the sores. Smoking can also make you more susceptible to sores and can make your cancer more difficult to treat.

• Ask your doctor about topical mouth medications.

• Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

• Call your doctor or nurse if your temperature reaches 100.5 degrees Fahrenheit or higher. This may mean you have an infection.

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy or radiation treatment for cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea.

• Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five to six hours after treatment. The symptoms usually end within the first 24 hours.

• Delayed-onset vomiting develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting is learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously. This triggers the actual reflex.

• Breakthrough vomiting occurs despite treatment to prevent it. It requires additional treatment.

• Refractory vomiting occurs after one or more antinausea treatments. It occurs because you're no longer responding to antinausea treatments.

To prevent nausea, take these actions. Most nausea can be prevented.

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then, make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed or new drugs can be added.

To help ease nausea or vomiting if you have it, try these tips.

• Try eating foods and drinking beverages that were easy to take or made you feel better when you've had the flu or were nauseated from stress. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

• Eat room-temperature or cold foods. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists. This may help decrease your nausea.

Skin dryness or irritation

This may be a side effect of radiation therapy. Take these steps for relief.

• Protect your skin from sun exposure by wearing sunscreen of at least 15 SPF (sun protection factor).

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use anything on your skin within two hours after treatment. This includes lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder. They may cause irritation.

• Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

• Don't scratch, rub, or scrub treated skin. After washing, gently blot dry.

• Don't bandage skin with tape. If you must bandage it, use paper tape. Ask your nurse to help you place the dressings so that you can avoid irritation.

• Don't apply heat or cold to the treated area. Bathe only with lukewarm water because it's less drying.

• If you must shave the treated area, use only an electric shaver because it reduces the chance that you'll cut yourself. Don't use lotion before shaving. Avoid hair-removal products. Both can irritate your skin.

• Keep your nails well trimmed and clean. This prevents scratching sensitive skin. It also lowers the risk of infection.

Thinking and remembering problems

You may have mild problems with concentration and memory during and after chemotherapy. Being tired can make this worse.

Taking these actions may help.

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

If you have trouble remembering names, directions, task sequences, etc., be certain to let your medical provider know, and ask what can be done to help improve your cognitive health. Cognitive interventions may be especially important after treatment ends.

Tiredness and fatigue

Tiredness is a very common symptom of carcinoma of unknown primary origin and side effect from chemotherapy and radiation treatments. It is also a symptom of anemia, which is a low red blood cell count. Or it can be caused from a B12 vitamin or iron deficiency. Whatever the cause, you may feel only slightly tired, or you may suffer from extreme fatigue.

Taking these actions may help increase your energy level. Fatigue can last four to six weeks after treatment ends.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

• Follow the tips under "Anemia."

Weight gain

You may gain weight if you have hormone therapy to treat CUP. Take these actions to help manage your weight.

• Increase your daily exercise. Strive to be active every day.

• Eat a balanced, low-calorie diet.

• Increase the amount of fruits and vegetables you eat. Be sure to drink more water. These can help fill you up--and are good for you--without adding a lot of calories.