PROSTATE Cancer

Below you will find information and links to resources about the side effects of colon cancer treatment. It is important to understand that if you undergo surgery, chemotherapy or radiation therapy, you will not necessarily have all (or any) side effects. Some people have only a few or no side effects; others have many of them. It varies from person to person.

Recovery After Surgery For Colon Cancer

Recovering from surgery for colon cancer is similar to recovery after any other major surgery. Your doctor will most likely give you specific instructions to aid in your recovery. It will be important for you to follow the doctor's instructions, watch for any signs of infection such as fever or redness, swelling or pus around your surgical incision and to try to become active when possible. Your surgeon may even get you up and walking soon after surgery. You may have pain after surgery, particularly gas pain. There is much that can and should be done to relieve pain, do not be afraid to tell your nurse or doctor about any pain you are having, so it can be controlled before it becomes severe.

It is possible but usually not necessary for colon cancer patients to have a nasogastric tube (NG tube) after surgery. This tube drains fluid from your stomach while your digestive system is shut down and is passed through your nose. Your doctor or nurse can adjust the tube if it is uncomfortable for you.

Until the second day after surgery, you will be fed intravenously and have ice chips and maybe a little water. Your diet will then be advanced to clear liquids, with a regular diet beginning on around day four after surgery. It will be important for you to meet with a dietician before leaving the hospital so you can know what to eat and what foods will irritate your colon. Ask the dietician for guidelines about what kinds of foods are best, and what kinds of foods to avoid. If you are not scheduled to see a dietician, ASK to see one!

Bowel and bladder function may be affected after colon cancer surgery. Urination may hurt the first few times after surgery once the urinary catheter is removed. Depending on how much of your colon has been removed, you may encounter loose stools and some bleeding at first. Normal bowel function usually returns within two weeks. Again, it is important to ask your doctor what is normal, and what you should be concerned about, so you can communicate any problems.

Patients usually do not require a colostomy, either temporary or permanent after colon surgery. However, after rectal surgery, either may be required. Temporary colostomy allows a newly reconstructed rectum to heal completely. It may be needed for a period of two to three months. After that time, a simple procedure done by the surgeon can reverse the colostomy and soon after return bowel functions to normal.

If the lowest portion of the rectum is removed permanent colostomy may be needed. This happens when the cancer is so close to the anus that none of the surrounding muscles that control bowel movements can be saved. The opening of the colostomy on the body (called a stoma) is usually a quarter-sized opening in the left lower abdomen. A pouch (called an ostomy appliance) is worn over the opening to collect waste. It is flat and is not visible under clothing. It is made of a special form of plastic, which is held to the body with an adhesive skin barrier. Many sizes and styles of pouches are available. The pouch is disposable and you empty or change it as needed. You can feel secure about the pouch and the adhesive barrier, "accidents" are not common, and the pouches have no odor.

People with colostomies usually perform their own colostomy care although it may take some time to adjust. There are nurses who specialize in taking care of colostomies and other "ostomies" called enterostomal therapists (ET's). They are expert at teaching patients and family members how to manage a colostomy.

Chemotherapy and Radiation

Some side effects of cancer treatment are difficult to control. When chemotherapy or radiation is used to remove or destroy cancer cells some healthy cells and tissues can be affected. The good news is that the drugs used for colon cancer do not produce the same intensity of side effects that drugs for other cancers may. If you do have side effects, however, there are ways to minimize them. The key to dealing with side effects is to:

* Watch for warning signs (fever, swelling, etc)
* Tell your doctor
* Take action quickly

For information about coping with side effects from chemotherapy and radiation treatments including hair loss, pain, nausea and loss of appetite, click here.

Fatigue

Fatigue, a temporary condition for most people that occurs after strenuous activity, is a common medical condition for cancer patients. If you have colon cancer and are undergoing chemotherapy, your fatigue may be chronic- that is it won't go away. Fatigue can severely affect your health and limit your activity.Signs of fatigue include:
Weakness
Exhaustion
Leg pain
Difficulty climbing stairs or walking short distances
Shortness of breath after light activity
Difficulty concentrating
Losing patience easily
Losing interest in hobbies or pastimes

Fatigue is a medical condition and that should be reported to your doctor. For more information about treatments and what you can do for yourself to help fatigue, click here.

Pain

Not everyone experiences cancer pain, however for those who do, there are many ways to treat it. Pain can be caused from cancer treatments or the cancer itself. Today, there is no reason that cancer pain should go untreated or ignored. Early treatment of pain is almost always more effective than waiting until the pain is severe or unbearable. If left unattended, cancer pain can lead to disruption in a person's ability to work, their relationships, and their view of the world. Above all, under-and untreated cancer pain can lead to unnecessary suffering and despair. For comprehensive information on how to manage cancer pain, click here.

Nausea and Upset Stomach

For reasons we don't fully understand, cancer affects a person's metabolism. Eating well, therefore, is an important challenge for people with any type of cancer. Proper nutrition (getting enough calories and protein to prevent weight loss and regain your strength) will make a big difference in your quality of life and outlook during the course of your disease. It is critical that you eat as much as you can during treatment and drinks lots of fluids. Cancer patients who eat and drink well are better able to fight infection and will also handle side effects better. Their bodies will rebuild healthy tissue faster as well.

The disease and treatments will sometimes make you feel as though you don't want to eat. Cancer generally decreases appetite. So does chemotherapy, because it changes the taste of many foods in your mouth. Nausea that may occur with treatment also will affect your appetite.

As discussed previously, you may be asked to modify your diet after surgery for colon cancer. Working with a skilled dietician on what foods you should eat and what foods will irritate the colon is important to managing your disease.

For helpful hints on coping with loss of appetite, click here or visit Eating Hints for Cancer Patients from the National Cancer Institute, which provides tips on diet and nutrition for cancer patients in treatment.

Sexual Functioning

Radiation or surgery for colon cancer can impact your sexual functioning if nerves at the base of the spine, which are critical to sexual functioning, are harmed. For men, radiation therapy aimed at the pelvic area can injure blood vessels that are needed for erection. For women, this treatment may result in reduced physical sensation and arousal in the genital area. Reduced arousal may mean less lubrication and vaginal irritation during intercourse.

Chemotherapy can sometimes cause a loss of libido (sexual desire) for both men and women during treatment. This usually returns after treatment has stopped.

Although a colostomy does not physically interfere in any way with sexual functioning, often people feel the presence of the pouch restrains sexual activity. Those with rectal cancer who have been able to have reconstructive surgery rather than colostomy may have leakage of stool, chronic loose stools or urgency when needing to have a bowel movement, which may create anxiety about sexual activity.

There are many options for coping with a change in sexual functioning:

* Before treatment, discuss with your doctor what if any effect the treatment will have on your sexual functioning, and what your pre-treatment functioning is like. Although this may not be an easy discussion to have, a clear picture of your sexual functioning before treatment will be helpful in identifying any problems after treatment.

* For women experiencing vaginal dryness, there are many good lubricants available to help this problem. Replens and KY-Jelly are just two. Ask your doctor or gynecologist for more recommendations on how to make sex more comfortable.

* Jumping right back into your normal sexual routine after treatment may be difficult, especially if you have a colostomy. Give yourself and your partner some time to adjust to the change. It is important to continue affectionate behavior until you feel ready for sexual activity. Counseling for you or you and your partner may help. Call the Cancer Care Counseling Line at 1-800-813-HOPE for support and referrals. For more information about sex with an ostomy appliance, the United Ostomy Association has several pamphlets on the subject, including Gay and Lesbian Ostomates and Their Caregivers, Sex, Courtship and the Single Ostomate, Sex and the Female Ostomate and Sex and the Male Ostomate. You can order these through their web site or their toll free number 800-826-0826.

* If reconstructive bowel surgery has you worrying about leakage during sex, you may want to limit your food intake hours before sexual activity and watch the type of foods you eat. Planning sex at times when you are less likely to have bowel movements may also be a strategy. For more information about bowel incontinence from the American Society of Colon and Rectal Surgeons, click here

* Before you make any treatment choices to restore erectile functioning, it is important to:

* Learn about all the treatment options first so you can make an informed choice and choose an option that works best for you.

* If you have a partner or a spouse, involve them in the decision making process. Whatever method you choose should be compatible with the way you and your partner enjoy sex. Most men and women have difficulty talking openly about these matters, however it is important that you try. One of the additional benefits of having this discussion may be a closer bond of intimacy with your partner. Counseling may be helpful for you and your partner if talking about sexuality is proving to be uncomfortable.

Options for Treatment to Restore Erectile Functioning

First, it is perfectly acceptable for men to choose no treatment to restore erections. You and your partner may make this choice together after exploring all the issues. Although you may not be aware of it, orgasm in a man is not dependent on an erection. There is no reason that you cannot enjoy a satisfying sex life in other ways besides having intercourse. For many men and their partners, this is the best choice. However, there are others:

* Counseling may help you and your partner talk about sexual issues. Counseling can help a man reduce anxiety about sexual functioning and body image issues. It also can help you deal with any depression or sadness you may be experiencing from your cancer diagnosis. For counseling, information and referrals in your area through our toll free counseling line and e-mail click here.

* A drug for treating erectile dysfunction (impotence) is Viagra. You may wish to discuss this medication with your doctor to find out if it is an option for you. For more information about Viagra, click here.

* Vacuum constriction devices (VCD, also called vacuum pumps or suction pumps) are a viable, non-invasive option that can be used immediately after a man recovers from surgery. It works by inserting the penis into a cylinder and activating the pump (by hand or by battery), which causes a vacuum that draws blood into the shaft of the penis. The penis becomes swollen and erect. An elastic ring is then placed at the base of the penis to retain the blood. This is done each time an erection is desired. Using the device can be built into the sexual experience, although some partners report discomfort with the disruption. Again, discussing these issues with your spouse or partner will help you make better choices.

* Injections of medication directly into the penile shaft can stimulate erections, or help maintain them. Despite sounding painful, most men actually report little discomfort after learning the procedure themselves. Partners can also learn to do the injections. The medication most often used is prostaglandin E1 (Caverject) or a combination of papaverine and phentolamine (Regitine). Combinations of all three drugs may be the best option for long-term use and decreased risk of side effects.

* A penile implant (also called penile prosthesis) can be surgically implanted into the penis to provide an erection rigid enough for sexual intercourse. Because having an implant will destroy the natural erection reflex, it is important to use this option only when erections are unlikely to improve on their own. Complications from the procedure include mechanical failure of the device and infection (about 10% of men have complications). The cost is usually between $15,000 and $20,000, which insurance usually covers when a medical problem has been documented. There are different models available. For a more comprehensive discussion of penile implants click here.

When dealing with erectile dysfunction, it may make sense to start with the least invasive method first, and proceed from there. For example, you may wish to try medication or the vacuum device first, and then try injection therapy or implant if these prove unsatisfactory.

Remember that even if you find a treatment that works for you, your erections will probably not feel the way it did before. Aim for goals that are attainable. A realistic goal is to achieve erections that are firm enough to allow penetration.