Do What You Can to Ease Side Effects of Treatment for Liver Cancer

It's likely that you will have physical concerns since your cancer may cause symptoms and your treatment may cause side effects. In this section, you'll learn more about how to respond to some of the most common side effects and symptoms from treating liver cancer.

Here are some common side effects from treatment for liver cancer and how to ease them. You may not have all of these. We've listed them in alphabetical order so that 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 this oxygen, you may feel tired. Decreased red blood cell counts can be caused by small amounts of blood loss; by chemotherapy, radiation, or 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.

• 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.

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.

Taking these actions may 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 chance 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 or 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, and cancer treatments cause you to use more protein than usual. A nutritionist 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, such as 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 these foods to increase fluids: gelatin, pudding, soups, Popsicles, 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 biggest meal in the morning. Many people getting treatment for cancer find that this is when their appetite is greatest.

• 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.

Bruising and bleeding

The liver helps the blood to clot by making clotting factors and by signalling the bone marrow to make platelets. Both clotting factors and platelets are necessary to help stop bleeding when you get a cut or bruise. Cirrhosis and liver cancer may lower the amount of clotting factors and platelets. Chemotherapy can interfere with your body's ability to make platelets. The following are signs of excessive bleeding. If you notice them, report them to your doctor:

• 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

• Headaches or changes in vision

• A warm or hot feeling in the arms or legs

If your doctor tells you your platelet count is low, take these steps to help minimize your risk for bleeding:

• Check with your doctor before taking any prescription, over-the-counter, or herbal medications. Some, such as aspirin, may further increase your risk for bleeding.

• Check with your doctor before drinking alcohol.

• Only use a toothbrush with soft bristles to avoid inadvertent harm to your gums.

• Blow your nose gently to reduce your risk for 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 is less likely to cut you.

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 it's wise to take these preventive actions. 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

Many drugs can cause bowel changes. This may be a side effect of chemotherapy. Diarrhea, which includes loose or frequent bowel movements, or both, may lead to dehydration if you don't take these precautions:

• Avoid milk and milk products.

• 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.

Dry or irritated skin

This may be a side effect of radiation therapy. You can take care of your skin in the following ways:

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

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use any lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder on your skin within two hours after radiation treatment because 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 and 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.

• If you must shave the treated area, use only an electric shaver. Don't use lotion before shaving. And don't use hair-removal products.

• Keep your nails well-trimmed and clean.

Hair loss

Losing your hair (called alopecia) can be upsetting because baldness is a visible reminder that you are being treated for cancer. Chemotherapy and radiation to the head can cause hair loss. Keep in mind that your hair will probably grow back after treatment.        

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.

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 for 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 bite, cut, or tear your cuticles.

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

• Take good care of your teeth and gums.

• 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 bird cages.

• Avoid standing water, such as bird baths, vases, and humidifiers.

• 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 or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Menopausal symptoms

Some types of chemotherapy can harm a woman's ovaries. Or they may cause menopausal symptoms in women. These symptoms include hot flashes, vaginal dryness, mood swings, and weight changes. Periods may become irregular or may stop, and you may not be able to get pregnant. For some women, the loss of a menstrual period is permanent. These steps may help you cope:

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

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

• Report any unusual bleeding 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 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 because they may irritate the sores.

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

• Avoid tobacco because it may irritate the sores. Smoking can also make you more susceptible to sores.

• 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 or higher.

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, and the symptoms end within the first 24 hours.

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

• Anticipatory nausea and vomiting are 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, which triggers the actual reflex.

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

• Refractory vomiting occurs after one or more chemotherapy treatments; essentially, you're no longer responding to antinausea treatments.

To prevent nausea, take these actions. Most nausea can be prevented by medications taken at the time of the chemotherapy:

• 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 other medicines may 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, which may help decrease your nausea.

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.

Tiredness and fatigue

Tiredness is a very common symptom and side effect from chemotherapy and radiation treatments. It is also a symptom of anemia, which is a low red blood cell count as noted from blood tests. Or it can be caused from a B12 vitamin or iron deficiency, which your doctor may also find in a blood test. 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 for a while, even after treatment ends:

• Take short rests when you feel 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. It may help you sleep better.

• Save your energy for important tasks.

• Drink plenty of fluids. Dehydration leads to increased fatigue.

• Take action to treat a poor appetite because eating improperly can make you tired.

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.