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

It's likely that you will have physical concerns because your cancer may cause symptoms and your treatment may cause side effects. The side effects depend on your treatment and that depends largely on how much the cancer has spread outside your stomach or to other organs. We've listed some common side effects from stomach cancer treatments and how to ease them. They are listed in alphabetical order, so you can find help when you need it.

Abdominal Pain

See "Dumping Syndrome" and "Heartburn."

Anemia (Low Red Blood Cell Levels)

Throughout your treatment your doctor will take small samples of your blood. One thing he or she is checking is your level of red blood cells. Red blood cells carry oxygen throughout the body. Surgery may decrease your level of red blood cells. You may feel tired. This condition is called anemia.

The main reason for anemia with stomach cancer is that iron, a mineral that helps the red blood cells pick up and carry oxygen, is not well absorbed from your stomach. Removing your stomach makes it harder for your body to digest, absorb, and use iron. Your body also may not be able to absorb folate and vitamin B12, vitamins that help with the iron-absorption process. Anemia can also be caused by small amounts of blood loss, chemotherapy or radiation, or the cancer itself. If your doctor tells you that you have anemia, take these actions to feel better.

• Talk with your doctor about medications or treatments that may help manage your anemia. You'll probably need to take iron and folate supplements, as well as receive vitamin B12 shots monthly.

• 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. It may help you sleep better.

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

• Drink plenty of water. Dehydration adds to fatigue.

• Meet with a dietitian to be sure you are doing all you can to get enough iron and folate in your diet.

Anxiety and Depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back during 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.

Constipation

Constipation, which includes difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. This may be a side effect of chemotherapy or some pain medicines. Taking narcotic 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. It softens stools to prevent constipation.

• 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 includes loose or frequent bowel movements, or both. It may be a side effect of external beam radiation therapy. Many chemotherapy drugs may cause bowel changes, too. Diarrhea may lead to dehydration if you don't take these precautions.

• Avoid milk and milk products when you have severe diarrhea.

• 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.

• Also follow the tips under "Dumping Syndrome."

Dumping Syndrome

The most common long-term problem after stomach cancer surgery is called dumping syndrome. The food you eat travels quickly into your small intestine, within about 10 to 20 minutes after eating. Your stomach and duodenum may no longer be able to aid digestion and remove excess fluid. So the rest of your digestive system has to do that work.

As a result, you may notice a feeling of fullness and pain in the stomach area. You may also have cramping, flushing, diarrhea, and dizziness, and feel your heart racing. These symptoms usually all go away once you have emptied your bowels.

These are steps you can take to prevent or lessen these problems.

• Eat small meals frequently during the day instead of three larger meals.

• Eat foods high in protein and low in carbohydrates.

• Try not to drink liquids when eating food.

• Stay in the upright position for at least one hour after meals.

• If problems continue, ask to see a dietitian to help with planning your meals.

Hair Loss (also called Alopecia)

Losing your hair can be upsetting because thinning or baldness is a visible reminder that you are being treated for cancer. Keep in mind that your hair will grow back after chemotherapy.

Try these coping tips.

• Consider cutting your hair short 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.

Heartburn

Surgery for stomach cancer may cause bloating, abdominal pain, and heartburn. You may feel full after eating small meals. These side effects can be relieved with changes in diet. Try these tips.

• Eat smaller meals more frequently throughout the day, rather than a couple of large meals a day.

• Increase your fiber intake, including fresh fruits, vegetables, and whole grains. Some types of fiber add bulk to your food and help it to move more quickly through the digestive tract. Good sources of fiber include apples, pears, figs, strawberries, raisins, carrots, whole grain breads and cereals, corn, peas, and peanuts, to name a few.

• Reduce fats and oils. Excess fat slows digestion.

• Drink plenty of fluids. Fluids lubricate food waste so that it passes more easily through the digestive tract. Water is best, but other beverages that are at least 90 percent water are good choices as well.

• Talk with your doctor before taking over-the-counter antacids. This is important because antacids can interact with many different prescription drugs. Furthermore, some antacids can cause constipation or diarrhea, which may further complicate other side effects you may be experiencing.

Increased Infections

Throughout your treatment you doctor will take small samples of your blood. One thing he or she is checking is your level of white blood cells. Many types of chemotherapy can cause low white blood cell counts, 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 stay healthy.

• Avoid crowds or people with colds.

• Wash your hands often or use hand sanitizer throughout the day to kill germs.

• 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.

Mouth Sores (also called Mucositis)

Some types of chemotherapy may cause these. Mouth sores 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.

If you get sores in your mouth, taking these actions can ease the pain.

• 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. You may also notice nausea and vomiting after eating. It may help you to understand the different types of nausea.

After surgery, you may have a smaller stomach or even no stomach left to contain the food you eat. Digestion-related nausea and vomiting can result from too much food inside a smaller stomach.

• 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 anti-nausea treatment to prevent it. It requires additional anti-nausea treatment.

• Refractory vomiting occurs after one or more chemotherapy treatments. Essentially, you are no longer responding to anti-nausea 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 may need to be changed or other medicines may be added to it.

• Eat smaller, more frequent meals.

• Avoid drinking fluid while eating.

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 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 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. Some types of chemotherapy are known to cause this. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, take these precautions to protect yourself.

• Take extra care walking and moving so that you don't fall.

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

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They 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

You may have pain or tenderness from the cancer itself or from surgical incisions. Try these tips to ease the pain.

• Take your pain medications regularly. Don't wait for your pain to become severe. Also, 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 relaxation techniques, such as yoga or meditation, or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Sexual Changes

Feelings of depression from having cancer or fatigue from other treatments can also have a negative impact on your sexual desires. Here are some ways you may cope.

• Talk with your partner about changes in your desire to have sex.

• Discuss it with your doctor and other members of your health care team. They may be able to refer you to a sexual rehabilitation program.

• Request a referral to a counselor who specializes in sexual problems.

Skin Irritation or Dryness

This may be a side effect of some chemotherapy or external beam radiation treatment.

• 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 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 because it's less dehydrating.

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

Thinking and Memory 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

Tiredness is a very common symptom and side effect from surgery, chemotherapy, and radiation treatments. You may feel only slightly tired or you may suffer from extreme fatigue. Fatigue can last four to six weeks after treatment ends. Taking these actions may help increase your energy level.

• 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.

• Follow the tips under "Anemia."

Vitamin and Mineral Deficiencies

The stomach and duodenum normally help digest and absorb vitamins and minerals from the food you eat. When these organs are partially or totally removed, they aren't able to do this. So if you have part or all of your stomach removed, you may experience nutritional deficiencies. Most often, this includes iron, vitamin B12, and folate.

Here are some steps you can take to be sure you're getting enough of these vitamins and minerals.

• Talk with your doctor about taking vitamin supplements. You'll probably need to take iron and folate pills and receive monthly vitamin B12 shots.

• Eat more fresh fruits and vegetables.

• Meet with a dietitian to plan meals that are easy on your system but still provide enough nutrients.

Weight Gain

This can result from chemotherapy. To help lose weight, take these actions.

• Increase the amount of your daily exercise, under your doctor's supervision.

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

• Ask your doctor to recommend a weight-management program.