Do What You Can to Ease Side Effects of Treatment for Soft Tissue Sarcoma

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 symptoms and side effects from treating soft tissue sarcoma.

Here are some common side effects from treatment for soft tissue sarcoma 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)/tiredness and fatigue

Tiredness is a 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. 

Your doctor will take blood samples from you for blood tests throughout your treatment. 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, or radiation.

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

• 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.

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

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

• 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. 

• 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 chances of infection. When you’re being treated for cancer, a diet high in calories and protein is often best. The problem is that side effects of treatment can change the way food tastes to you or reduce your appetite. In addition, treatments that affect your throat may make it hard to eat.

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 and its 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 juice, and other liquids, try these foods to increase fluids: gelatin, pudding, soups, Popsicles, and ice cream.

• If your mouth is irritated, avoid foods that may cause more irritation. Foods that are acidic, such as vinegar, orange juice, and lemonade, or foods that can be chafing, such as crusty bread, may cause pain.

• 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 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.

Bleeding or bruising

Throughout your treatment, your doctor will take small samples of your blood. One thing he or she is checking is your level of platelets. The blood cells help your blood clot. Chemotherapy can interfere with your body’s ability to make platelets, which help stop bleeding when you get a cut or bruise. If your doctor tells you your platelet count is low, take these steps to minimize your risk of bleeding:

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

• Check with your doctor before drinking alcohol.

• Only use a toothbrush with soft bristles.

• 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 decreases your chance of cuts.

Constipation

Constipation may include difficult or infrequent bowel movement. It can range from mildly uncomfortable to painful. This may be a side effect of chemotherapy or some pain medicines. Taking pain medications can lead to constipation, so it’s wise to take these preventive actions. These same steps may 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

Diarrhea is loose or frequent bowel movements, or both. This may be a side effect of chemotherapy or radiation near your stomach. Diarrhea can lead to dehydration if you don’t take these steps to manage it:

• Avoid milk and milk products if these seem to make your diarrhea worse.

• 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.

Dryness or irritation of the skin

Red, dry, or itchy skin may be a side effect of radiation therapy. Here’s what you can do for relief:

• Protect your skin from sun exposure by covering it up and wearing sunscreen of at least 30 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 any lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder on your skin within two hours after 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 because it is less irritating to your skin. Don’t use lotion before shaving. And don’t use hair-removal products. Both can irritate your skin.

• Keep your nails well trimmed and clean so you don’t accidentally scratch yourself.

Hair loss

Losing your hair (called alopecia) can be upsetting because baldness is a visible reminder that you are being treated for soft tissue sarcoma. Chemotherapy and radiation can cause hair loss. Remember 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

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing he or she is checking for is your white blood cell count. Many types of chemotherapy can cause low white blood cell counts, as can the cancer itself. A low white blood cell count is called neutropenia. Without enough white blood cells, your body may not be able to fight infection.

If your doctor tells you that your white blood cell count is low, take these actions to 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 a small cut can become infected.

• 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, like skin scrubs. Do not rub your skin too hard with washcloths or towels.

• If you 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 your 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; a burning sensation during urination; or any sores or redness.

Menopausal symptoms

Some types of chemotherapy can damage a woman’s ovaries. Or they may cause menopausal symptoms in women who’ve not yet reached menopause. 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.

Try these tips for managing menopausal symptoms:

• 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. Also ask about how mild exercise and talking with a therapist can help you cope with mood swings or 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 sores can hurt and make eating difficult.

To help prevent sores in your mouth, take these actions:

• Brush your teeth after meals and before bedtime; floss every day if this is part of your normal routine and with your doctor's permission. 

• 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 and with your doctor's permission. 

• Call your doctor or nurse if your temperature reaches 100.5 degrees Fahrenheit 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. This 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. This develops more than 24 hours after treatment.

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

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

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

To prevent nausea, most of which can be prevented, take these actions:

• 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.

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 for other reasons. 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 to decrease your nausea.

Numbness, tingling, or muscle weakness in your hands or feet (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. This can be a side effect of chemotherapy or a symptom of the cancer itself. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have side effects such as these, your doctor may adjust your dose. Or your doctor may prescribe medicine or some vitamins. You should also take these precautions to protect yourself:

• Take extra care walking and moving so that you don’t fall. Wear only well-fitting shoes.

• Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing to improve your stability.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. He or she can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

Pain

Pain might be from the tumor, from the surgery, from radiation, or from other treatments. Try these tips to ease pain:

• Take your pain medications regularly; don’t wait for your pain to become severe. (Take steps to avoid constipation, a common side effect of pain medications.)

• Change your activity level. See if you feel better if you rest more or move around more--either may help.

• Distract yourself with music, funny videos, or computer games.

• Use heat, cold, relaxation techniques (like yoga or meditation), or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Swelling in your arm or leg (lymphedema)

If doctors remove your lymph nodes during surgery, you may have swelling in your arms or legs, called lymphedema, on the side where you had surgery. Lymphedema may occur right after surgery or it may happen later. It is caused when excess lymph collects in tissue.

Here’s what you can do to reduce your risk or to improve symptoms of lymphedema:

• Keep your arm or leg raised above the level of your heart, when possible.

• Clean the skin of your arm or leg daily and use moisturizing lotion.

• Ask your doctor to recommend supportive stockings.

• Don’t have your blood pressure taken on the affected arm.

• Do not use elastic bandages with tight bands.

• Do not sit in one position for more than 30 minutes.

• Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs or symptoms appears.

• Do your prescribed exercises regularly.

• Keep regular follow-up appointments with your doctor.

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.