Cancer treatments and cancer can cause side effects. Side effects are problems that occur when treatment affects healthy tissues or organs. Speak up about any problems you have. Your health care team can treat and/or talk with you about ways to reduce these side effects, so you feel better.

Learn about steps you can take to prevent or manage the side effects listed below:

• Anemia
• Appetite Loss
• Bleeding and Bruising (Thrombocytopenia)
• Constipation
• Delirium
• Diarrhea
• Edema (Swelling)
• Fatigue
• Fertility Issues in Boys and Men
• Fertility Issues in Girls and Women
• Flu-Like Symptoms
• Hair Loss (Alopecia)
• Infection and Neutropenia
• Lymphedema
• Memory or Concentration Problems
• Mouth and Throat Problems
• Nausea and Vomiting
• Nerve Problems (Peripheral Neuropathy)
• Immunotherapy and Organ-Related Inflammation
• Pain
• Sexual Health Issues in Men
• Sexual Health Issues in Women
• Skin and Nail Changes
• Sleep Problems
• Urinary and Bladder Problems

Keep in mind that side effects vary from person to person, even among people receiving the same type of cancer treatment.

What Is Anemia?

Anemia is a condition in which the number of red blood cells is below normal.

What Are Signs of Anemia?

Anemia can make you feel very tired, short of breath, and lightheaded. Signs of anemia may also include feeling dizzy or faint, headaches, a fast heartbeat, and/or pale skin.

What Causes Anemia in People with Cancer?

Cancer treatments, such as chemotherapy and radiation therapy, as well as cancers that affect the bone marrow, can cause anemia. When you are anemic, your body does not have enough red blood cells. Red blood cells are the cells that that carry oxygen from the lungs throughout your body to help it work properly.

You will have blood tests to check for anemia. Treatment for anemia is also based on your symptoms and on what is causing the anemia.

Ways to Manage Anemia

Here are some steps you can take if you have fatigue caused by anemia:

• Save your energy and ask for help. Choose the most important things to do each day. When people offer to help, let them do so. They can take you to the doctor, make meals, or do other things you are too tired to do.
• Balance rest with activity. Take short naps during the day, but keep in mind that too much bed rest can make you feel weak. You may feel better if you take short walks or exercise a little every day.
• Eat and drink well. Talk with your doctor, nurse, or a registered dietitian to learn what foods and drinks are best for you. You may need to eat foods that are high in protein or iron.

Questions to Ask Your Health Care Team about Anemia

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What is causing the anemia?
• What problems should I call you about?
• What steps can I take to feel better?
• Would medicine, iron pills, a blood transfusion, or other treatments help me?
• Would you give me the name of a registered dietitian who could also give me advice?

Cancer treatments may lower your appetite or change the way food tastes or smells. Side effects such as mouth and throat problems, or nausea and vomiting can also make eating difficult. Cancer-related fatigue can also lower your appetite.

Talk with your health care team if you are not hungry or if your find it difficult to eat. Don’t wait until you feel weak, have lost too much weight, or are dehydrated, to talk with your doctor or nurse. It’s important to eat well, especially during treatment for cancer.

Ways to Manage Appetite Loss

Take these steps to get the nutrition you need to stay strong during treatment:

• Drink plenty of liquids. Drinking plenty of liquids is important, especially if you have less of an appetite. Losing fluid can lead to dehydration, a dangerous condition. You may become weak or dizzy and have dark yellow urine if you are not drinking enough liquids.
• Choose healthy and high-nutrient foods. Eat a little, even if you are not hungry. It may help to have five or six small meals throughout the day instead of three large meals. Most people need to eat a variety of nutrient-dense foods that are high in protein and calories. Learn ways to add calories and protein to your diet in our Eating Hints booklet.
• Be active. Being active can actually increase your appetite. Your appetite may increase when you take a short walk each day.

Talking With Your Health Care Team about Appetite Loss

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What symptoms or problems should I call you about?
• What steps can I take to feel better?
• What food and drink choices are best for me?
• Do you recommend supplemental nutrition drinks for me?
• Are there vitamins and supplements that I should avoid? Are there any I should take?
• Would you recommend a registered dietitian who could also help me?

Some cancer treatments, such as chemotherapy and targeted therapy, can increase your risk of bleeding and bruising. These treatments can lower the number of platelets in the blood. Platelets are the cells that help your blood to clot and stop bleeding. When your platelet count is low, you may bruise or bleed a lot or very easily and have tiny purple or red spots on your skin. This condition is called thrombocytopenia. It is important to tell your doctor or nurse if you notice any of these changes.

Call your doctor or nurse if you have more serious problems, such as:

• Bleeding that doesn’t stop after a few minutes; bleeding from your mouth, nose, or when you vomit; bleeding from your vagina when you are not having your period (menstruation); urine that is red or pink; stools that are black or bloody; or bleeding during your period that is heavier or lasts longer than normal.
• Head or vision changes such as bad headaches or changes in how well you see, or if you feel confused or very sleepy.

Ways to Manage Bleeding and Bruising

Steps to take if you are at increased risk of bleeding and bruising:

• Avoid certain medicines. Many over-the-counter medicines contain aspirin or ibuprofen, which can increase your risk of bleeding. When in doubt, be sure to check the label. Get a list of medicines and products from your health care team that you should avoid taking. You may also be advised to limit or avoid alcohol if your platelet count is low.
• Take extra care to prevent bleeding. Brush your teeth gently, with a very soft toothbrush. Wear shoes, even when you are inside. Be extra careful when using sharp objects. Use an electric shaver, not a razor. Use lotion and a lip balm to prevent dry, chapped skin and lips. Tell your doctor or nurse if you are constipated or notice bleeding from your rectum.
• Care for bleeding or bruising. If you start to bleed, press down firmly on the area with a clean cloth. Keep pressing until the bleeding stops. If you bruise, put ice on the area.

Talking With Your Health Care Team about Bleeding and Bruising

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What steps can I take to prevent bleeding or bruising?
• How long should I wait for the bleeding to stop before I call you or go the emergency room?
• Do I need to limit or avoid things that could increase my risk of bleeding, such as alcohol or sexual activity?
• What medicines, vitamins, or herbs should I avoid? Could I get a list from you of medicines to avoid?

If you are currently being treated for cancer, it is important to know that you are at increased risk for developing a blood clot. The good news, though, is blood clots may be preventable and treated if discovered early.

While everyone is at risk for developing a blood clot (also called venous thromboembolism or VTE), having cancer and some of its treatments increase the risk for a blood clot. Learn other interesting facts about blood clots below.

Why Are People with Cancer at Risk for Developing a Blood Clot?

• Some cancers pose a greater risk for blood clots, including cancers involving the pancreas, stomach, brain, lungs, uterus, ovaries, and kidneys. Certain blood cancers, such as lymphoma and myeloma, also increase risk.
• Treatments for these cancers involving hospitalization, surgery, chemotherapy, hormonal therapy, and catheters (small tubes placed in veins to administer treatments) may also increase your risk for blood clots.

Several other factors may also increase the risk for a blood clot in a person being treated for cancer, such as

• A previous blood clot
• Family history of blood clots or inherited clotting disorder
• Hospitalization for illness or major surgery, particularly those involving the pelvis, abdomen, hip, or knee
• Broken bone or severe muscle injury
• Severe physical trauma, such as a motor vehicle accident
• Serious medical conditions, such as heart and lung diseases or diabetes
• Sitting too long, such as traveling for more than 4 hours, especially with legs crossed
• Other causes of immobility, such as extended bedrest
• Being overweight or having obesity
• Smoking

Take Steps to Protect Yourself from Blood Clots During Your Cancer Treatment

• Know the signs and symptoms of blood clots. Discuss your risks with your cancer doctor.
  • A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). Signs and symptoms of a DVT include
    • Swelling of the affected limb
    • Pain or tenderness not caused by injury
    • Skin that is warm to the touch, red, or discolored

If you have these signs or symptoms, alert your cancer doctor as soon as possible.

• A blood clot in the legs or arms can break off and travel to the lungs. This is called a pulmonary embolism (PE), and can be life threatening. Signs and symptoms of a PE include
  • Difficulty breathing
  • Chest pain that worsens with a deep breath or cough
  • Coughing up blood
  • Faster than normal or irregular heartbeat

Seek immediate medical attention if you experience any of these signs or symptoms.

• Talk with your cancer doctor and other healthcare providers about factors that might increase your risk for a blood clot. Let them know if you or anyone else in your family has ever had a blood clot.

What Is Constipation?

Constipation is when you have infrequent bowel movements and stool that may be hard, dry, and difficult to pass. You may also have stomach cramps, bloating, and nausea when you are constipated.

What Causes Constipation?

Cancer treatments such as chemotherapy can cause constipation. Certain medicines (such as pain medicines), changes in diet, not drinking enough fluids, and being less active may also cause constipation.

Ways to Prevent or Treat Constipation

There are steps you can take to prevent constipation. It is easier to prevent constipation than to treat its complications which may include fecal impaction or bowel obstruction.

Take these steps to prevent or treat constipation:

• Eat high-fiber foods. Adding bran to foods such as cereals or smoothies is an easy way to get more fiber in your diet. Ask your health care team how many grams of fiber you should have each day. If you have had an intestinal obstruction or intestinal surgery, you should not eat a high-fiber diet.
• Drink plenty of liquids. Most people need to drink at least 8 cups of liquid each day. You may need more based on your treatment, medications you are taking, or other health factors. Drinking warm or hot liquids may also help.
• Try to be active every day. Ask your health care team about exercises that you can do. Most people can do light exercise, even in a bed or chair. Other people choose to walk or ride an exercise bike for 15 to 30 minutes each day.
• Learn about medicine. Use only medicines and treatments for constipation that are prescribed by your doctor, since some may lead to bleeding, infection, or other harmful side effects in people being treated for cancer. Keep a record of your bowel movements to share with your doctor or nurse.

Talking with Your Health Care Team about Constipation

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What problems should I call you about?
• What information should I keep track of and share with you? (For example, you may be asked to keep track of your bowel movements, meals that you have, and exercise that you do each day.)
• How much liquid should I drink each day?
• What steps can I take to feel better?
• Would you give me the name of a registered dietitian who can tell me about foods that might help?
• Should I take medicine for constipation? If so, what medicine should I take? What medicine should I avoid?

What Is Delirium?

Delirium is a confused mental state that includes changes in awareness, thinking, judgment, sleeping patterns, as well as behavior. Although delirium can happen at the end of life, many episodes of delirium are caused by medicine or dehydration and are reversible.

The symptoms of delirium usually occur suddenly (within hours or days) over a short period of time and may come and go. Although delirium may be mistaken for depression or dementia, these conditions are different and have different treatments.

Different Types of Delirium and Symptoms

The three main types of delirium include:

• Hypoactive delirium: The patient seems sleepy, tired, or depressed.
• Hyperactive delirium: The patient is restless, anxious, or suddenly agitated and uncooperative.
• Mixed delirium: The patient changes back and forth between hypoactive delirium and hyperactive delirium.

Causes of Delirium

Your health care team will work to find out what is causing delirium, so that it can be treated. Causes of delirium may include:

• advanced cancer
• older age
• brain tumors
• dehydration
• infection
• taking certain medicines, such as high doses of opioids
• withdrawal from or stopping certain medicines

Early monitoring of someone with these risk factors for delirium may prevent it or allow it to be treated more quickly.

Changes caused by delirium can be upsetting for family members and dangerous to the person with cancer, especially if judgment is affected. People with delirium may be more likely to fall, unable to control their bladder and/or bowels, and more likely to become dehydrated. Their confused state may make it difficult to talk with others about their needs and make decisions about care. Family members may need to be more involved in decision-making.

Ways to Treat Delirium in People with Cancer

Steps that can be taken to treat symptoms related to delirium include:

• Treat the causes of delirium: If medicines are causing delirium, then reducing the dose or stopping them may treat delirium. If conditions such as dehydration, poor nutrition, and infections are causing the delirium, then treating these may help.
• Control surroundings: If the symptoms of delirium are mild, it may help to keep the room quiet and well lit, with a clock or calendar and familiar possessions. Having family members around and keeping the same caregivers, as much as possible, may also help.
• Consider medicines: Medicines are sometimes given to treat the symptoms of delirium. However, these medicines have serious side effects and patients receiving them require careful observation by a doctor.
• Sometimes sedation may help: After discussion with family members, sedation is sometimes used for delirium at the end of life, if it does not get better with other treatments. The doctor will discuss the decisions involved in using sedation to treat delirium with the family.

Talking with Your Family Member's Health Care Team

Prepare for the visit by making a list of questions to ask. Consider adding these questions to your list:

• Is my family member at risk for delirium?
• What is causing the delirium?
• What problems should we call you about?
• What treatments are advised for my family member?

What Is Diarrhea?

Diarrhea means having bowel movements that are soft, loose, or watery more often than normal. If diarrhea is severe or lasts a long time, the body does not absorb enough water and nutrients. This can cause you to become dehydrated or malnourished.

What Causes Diarrhea?

Cancer treatments, or the cancer itself, may cause diarrhea or make it worse. Some medicines, infections, and stress can also cause diarrhea. Tell your health care team if you have diarrhea.

What Are the Dangers of Diarrhea?

Diarrhea that leads to dehydration (the loss of too much fluid from the body) and low levels of salt and potassium (important minerals needed by the body) can be life threatening. Call your health care team if you feel dizzy or lightheaded, have dark yellow urine or are not urinating, or have a fever of 100.5 °F (38 °C) or higher.

Ways to Manage Diarrhea

You may be advised to take steps to prevent complications from diarrhea:

• Drink plenty of fluid each day. Most people need to drink 8 to 12 cups of fluid each day. Ask your doctor or nurse how much fluid you should drink each day. For severe diarrhea, only clear liquids or IV (intravenous) fluids may be advised for a short period.
• Eat small meals that are easy on your stomach. Eat six to eight small meals throughout the day, instead of three large meals. Foods high in potassium and sodium (minerals you lose when you have diarrhea) are good food choices, for most people. Limit or avoid foods and drinks that can make your diarrhea worse.
• Check before taking medicine. Check with your doctor or nurse before taking medicine for diarrhea. Your doctor will prescribe the correct medicine for you.
• Keep your anal area clean and dry. Try using warm water and wipes to stay clean. It may help to take warm, shallow baths. These are called sitz baths.

Questions to Ask Your Health Care Team about Diarrhea

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What is causing the diarrhea?
• What symptoms should I call you about?
• How much liquid should I drink each day?
• Can I speak to a registered dietitian to learn more about foods and drinks that are best for me?
• What medicine or other steps can I take to prevent diarrhea and to decrease rectal pain?

What Is Edema?

Edema, a condition in which fluid builds up in your body’s tissues, may be caused by some types of chemotherapy, certain cancers, and conditions not related to cancer.

What Are Signs of Edema?

Signs of edema may include:

• swelling in your feet, ankles, and legs
• swelling in your hands and arms
• swelling in your face or abdomen
• skin that is puffy, shiny, or looks slightly dented after being pressed
• shortness of breath, a cough, or irregular heartbeat

Tell your health care team if you notice swelling. Your doctor or nurse will determine what is causing your symptoms, advise you on steps to take, and may prescribe medicine.

Some problems related to edema are serious. Call your doctor or nurse if you feel short of breath, have a heartbeat that seems different or is not regular, have sudden swelling or swelling that is getting worse or is moving up your arms or legs, you gain weight quickly, or you don’t urinate at all or urinate only a little.

Ways to Prevent or Lessen Edema

Steps you can take to prevent or lessen edema-related swelling include:

• Get comfortable. Wear loose clothing and shoes that are not too tight. When you sit or lie down, raise your feet with a stool or pillows. Avoid crossing your legs when you sit. Talk with your health care team about wearing special stockings, sleeves, or gloves that help with circulation if your swelling is severe.
• Exercise. Moving the part of your body with edema can help. Your doctor may give you specific exercises, including walking, to improve circulation. However, you may be advised not to stand or walk too much at one time.
• Limit salt (sodium) in your diet. Avoid foods such as chips, bacon, ham, and canned soup. Check food labels for the sodium content. Don’t add salt or soy sauce to your food.
• Take your medicine. If your doctor prescribes a medicine called a diuretic, take it exactly as instructed. The medicine will help move the extra fluid and salt out of your body.

Talking with Your Health Care Team about Edema

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• Are my medications or treatment likely to increase my risk of developing edema?
• Are there steps I can take to prevent edema?
• What symptoms or problems should I call you about?
• What steps can I take to feel better if I notice swelling?
• Are there foods, drinks, or activities I should avoid?

Cancer fatigue is a condition caused by cancer or cancer treatment in which you feel exhausted or extremely tired. Some people with cancer have extreme fatigue most of the time and are unable to carry out day-to-day tasks. Others feel only very tired. Cancer fatigue may also be called cancer-related fatigue or cancer treatment–related fatigue.

Cancer fatigue is different from fatigue you may have felt in the past. When a healthy person is tired, fatigue is usually caused by activity and goes away after resting or sleeping. However, cancer fatigue is not completely relieved by sleep or rest and may happen after no or minimal activity.

Cancer fatigue is common

Cancer fatigue is one of the most common side effects of cancer treatment. More than 80% of people with cancer experience fatigue while receiving chemotherapy or radiation therapy.

Cancer fatigue can occur at any time

Fatigue can begin at any time—before, during, or after cancer treatment. Sometimes it’s an early symptom of cancer, or it can be brought on by the stress of a cancer diagnosis. Fatigue may worsen gradually as you go through treatment, or it may come on suddenly. Fatigue usually decreases after cancer treatment ends, but some people may still feel fatigue for months or years.

Cancer fatigue can affect many areas of your life

Fatigue can affect not only your daily activities but also your family, work, and social life. Although cancer fatigue can feel overwhelming, your health care team can help you find ways to manage, treat, and cope with fatigue that are tailored to you.

Many cancer treatments can affect a boy’s or a man’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may lower fertility or cause infertility. However, not all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation.

Whether or not your fertility is affected depends on factors such as:

• your baseline fertility
• your age at the time of treatment
• the type of cancer and treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• the amount of time that has passed since treatment
• other personal health factors

It’s important to learn how the recommended cancer treatment may affect fertility before starting treatment if at all possible. Consider asking questions such as:

• Could treatment increase the risk of, or cause, infertility?
• Are there other recommended cancer treatments that might not cause fertility problems?
• Which fertility preservation options would you advise for me?
• What fertility preservation options are available at this hospital? At a fertility clinic?
• Would you recommend a fertility specialist (such as a reproductive endocrinologist) that I could talk with to learn more?
• Is condom use advised, based on the treatment I’m receiving?
• Is birth control also recommended?
• What are the chances that my fertility will return after treatment?

Cancer Treatments May Affect Your Fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your healthcare team to learn what to expect based on your treatment(s):

• Chemotherapy (especially alkylating drugs) can damage sperm in men and sperm-forming cells (germ cells) in young boys.
• Hormone therapy (also called endocrine therapy) can decrease the production of sperm.
• Radiation therapy to the reproductive organs as well as radiation near the abdomen, pelvis, or spine may lower sperm counts and testosterone levels, causing infertility. Radiation may also destroy sperm cells and the stem cells that make sperm. Radiation therapy to the brain can damage the pituitary gland and decrease the production of testosterone and sperm. For some types of cancers, the testicles can be protected from radiation through a procedure called testicular shielding.
• Surgery for cancers of the reproductive organs and for pelvic cancers (such as bladder, colon, prostate, and rectal cancer) can damage these organs and/or nearby nerves or lymph nodes in the pelvis, leading to infertility.
• Stem cell transplants such as bone marrow transplants and peripheral blood stem cell transplants, involve receiving high doses of chemotherapy and/or radiation. These treatments can damage sperm and sperm-forming cells.
• Other treatments: Talk with your doctor to learn whether or not other types of treatment, such as immunotherapy and targeted cancer therapy, may affect your fertility.

Emotional Considerations and Support for Fertility Issues

For some men, infertility can be one of the most difficult and upsetting long-term effects of cancer treatment. Although it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and learning about options to preserve their fertility.

Although most people want to have children at some point in their life, families can come together in many ways. For extra support during this time, reach out to your health care team with questions or concerns, as well as to professionally led support groups.

Fertility Preservation Options for Boys and Men

Men and boys with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic.

Talk with your doctor about the best option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving. The success rate, financial cost, and availability of these procedures varies.

• Sperm banking (also called semen cryopreservation) is the most common and easy option for young men of reproductive age who would like to have children one day. Samples of semen are collected and checked under a microscope in the laboratory. The sperm are then frozen and stored (banked) for the future. Sperm can be frozen for an indefinite amount of time.
• Testicular shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body to shield the testicles from scatter radiation to the pelvis when other parts of the body are being treated with radiation.
• Testicular sperm extraction (TESE) is a procedure for males who are not able to produce a semen sample. Sperm is collected through a medical procedure and frozen for future use.
• Testicular tissue freezing (also called testicular tissue cryopreservation) is still considered an experimental procedure at most hospitals. For boys who have not gone through puberty and are at high risk of infertility, this procedure may be an option.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation procedures whenever possible.

Many cancer treatments can affect a girl’s or woman’s fertility. Most likely, your doctor will talk with you about whether or not cancer treatment may increase the risk of, or cause, infertility. However, not all doctors bring up this topic. Sometimes you, a family member, or parents of a child being treated for cancer may need to initiate this conversation.

Whether or not fertility is affected depends on factors such as:

• your baseline fertility
• your age at the time of treatment
• the type of cancer and treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• the amount of time that has passed since cancer treatment
• other personal health factors

It’s important to learn how the recommended cancer treatment may affect fertility before starting treatment, whenever possible. Consider asking questions such as:

• Could treatment increase the risk of, or cause, infertility? Could treatment make it difficult to become pregnant or carry a pregnancy in the future?
• Are there other recommended cancer treatments that might not cause fertility problems?
• Which fertility option(s) would you advise for me?
• What fertility preservation options are available at this hospital? At a fertility clinic?
• Would you recommend a fertility specialist (such as a reproductive endocrinologist) who I could talk with to learn more?
• Is condom use advised, based on the treatment I’m receiving?
• Is birth control recommended?
• After treatment, what are the chances that my fertility will return? How long might it take for my fertility to return?

Cancer Treatments May Affect Your Fertility

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. Changes to your fertility may be temporary or permanent. Talk with your health care team to learn what to expect, based on your treatment(s):

• Chemotherapy (especially alkylating agents) can affect the ovaries, causing them to stop releasing eggs and estrogen. This is called primary ovarian insufficiency (POI). Sometimes POI is temporary and your menstrual periods and fertility return after treatment. Other times, damage to your ovaries is permanent and fertility doesn’t return. You may have hot flashes, night sweats, irritability, vaginal dryness, and irregular or no menstrual periods. Chemotherapy can also lower the number of healthy eggs in the ovaries. Women who are closer to the age of natural menopause may have a greater risk of infertility. The National Institute for Child Health and Human Development (NICHD) has more information about primary ovarian insufficiency.
• Radiation therapy to or near the abdomen, pelvis, or spine can harm nearby reproductive organs. Some organs, such as the ovaries, can often be protected by ovarian shielding or by oophoropexy—a procedure that surgically moves the ovaries away from the radiation area. Radiation therapy to the brain can also harm the pituitary gland. This gland is important because it sends signals to the ovaries to make hormones such as estrogen that are needed for ovulation. The amount of radiation given and the part of your body being treated both play a role in whether or not fertility is affected.
• Surgery for cancers of the reproductive system and for cancers in the pelvis region can harm nearby reproductive tissues and cause scarring, which can affect your fertility. The size and location of the tumor are important factors in whether or not fertility is affected.
• Hormone therapy (also called endocrine therapy) used to treat cancer can disrupt the menstrual cycle, which may affect your fertility. Side effects depend on the specific hormones used and may include hot flashes, night sweats, and vaginal dryness.
• Bone marrow transplants, peripheral blood stem cell transplants, and other stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage the ovaries and may cause infertility.
• Other treatments: Talk with your doctor to learn whether or not other types of treatment such as immunotherapy and targeted cancer therapy may affect your fertility.

Emotional Considerations and Support for Fertility Issues

For some women, infertility can be one of the most difficult and upsetting long-term effects of cancer treatment. While it might feel overwhelming to think about your fertility right now, most people benefit from having talked with their doctor (or their child’s doctor, when a child is being treated for cancer) about how treatment may affect their fertility and about options to preserve fertility.

Although most people want to have children at some point in their life, families can come together in many ways. For extra support during this time, reach out to your health care team with questions or concerns, as well as to professionally led support groups.

Fertility Preservation Options for Girls and Women

Women and girls with cancer have options to preserve their fertility. These procedures may be available at the hospital where you are receiving cancer treatment or at a fertility preservation clinic.

Talk with your doctor about the best option(s) for you based on your age, the type of cancer you have, and the specific treatment(s) you will be receiving. The success rate, financial cost, and availability of these procedures varies.

• Egg freezing (also called egg or oocyte cryopreservation) is a procedure in which eggs are removed from the ovary and frozen. Later the eggs can be thawed, fertilized with sperm in the lab to form embryos, and placed in a woman’s uterus. Egg freezing is a newer procedure than embryo freezing.
• Embryo freezing (also called embryo banking or embryo cryopreservation) is a procedure in which eggs are removed from the ovary. They are then fertilized with sperm in the lab to form embryos and frozen for future use.
• Ovarian shielding (also called gonadal shielding) is a procedure in which a protective cover is placed on the outside of the body, over the ovaries and other parts of the reproductive system, to shield them from scatter radiation.
• Ovarian tissue freezing (also called ovarian tissue cryopreservation) is still considered an experimental procedure, for young girls who haven’t gone through puberty and don’t have mature eggs. It involves surgically removing part or all of an ovary and then freezing the ovarian tissue, which contains eggs. Later, the tissue is thawed and placed back in a woman. Although pregnancies have occurred as a result of this procedure, it’s only an option for some types of cancer.
• Ovarian transposition (also called oophoropexy) is an operation to move the ovaries away from the part of the body receiving radiation. This procedure may be done during surgery to remove the cancer or through laparoscopic surgery.
• Radical trachelectomy (also called radical cervicectomy) is surgery used to treat women with early-stage cervical cancer who would like to have children. This operation removes the cervix, nearby lymph nodes, and the upper part of the vagina. The uterus is then attached to the remaining part of the vagina, with a special band that serves as the cervix.
• Treatment with gonadotropin-releasing hormone agonist (also called GnRHa), a substance that causes the ovaries to stop making estrogen and progesterone. Research is ongoing to assess the effectiveness of giving GnRHa to protect the ovaries.

If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation, whenever possible.

Flu-like symptoms (also called flu-like syndrome) are a group of related side effects that may be caused by cancer treatments, such as chemotherapy and immunotherapy. If flu-like symptoms are severe, you may be advised to seek immediate medical attention. Some people who receive higher doses of treatment, or more than one treatment at a time, may have more severe flu-like symptoms.

Talk with your doctor so you know what flu-like symptoms to expect, based on your cancer treatment.

• Some types of chemotherapy can cause flu-like symptoms within a few hours after treatment. These symptoms generally last for 2 to 3 days.
• Some types of immunotherapy increase your body’s natural immune response, which can cause mild to severe flu-like symptoms. These symptoms often peak shortly after treatment and become less severe over time. Immunotherapy treatments such as CAR T-cell therapy and some monoclonal antibodies may cause cytokine release syndrome (CRS), a condition that can lead to severe flu-like symptoms as well as a rash, rapid heartbeat, low blood pressure, and trouble breathing. Doctors may refer to severe cases of CRS as a cytokine storm.

Ask Your Health Care Team about Flu-Like Symptoms

• What signs and symptoms might I have, based on the type of cancer treatment I am receiving?
• Which flu-like symptoms should I call you about? Which can be managed at home?

Make note of flu-like symptoms you should call your health care team about:

• Appetite loss
• Body aches (muscle or joint aches)
• Chills
• Diarrhea
• Fatigue; lack of energy
• Fever of 100.5°F (38°C) or higher
• Headache
• Nausea and/or vomiting

Ways to Manage Flu-Like Symptoms during Cancer Treatment

Keep in mind that when these symptoms occur in people receiving immunotherapy they may be diagnosed, managed, and treated differently than when they are caused by other cancer treatments.

When your doctor recommends self care, here are steps you can take to feel better:

• Appetite loss: Drink water and other fluids advised by your health care team to stay hydrated. Drinking fluids is especially important if you are not eating much. It may be easier to eat small meals, and to eat more often. Choose foods that are high in calories and protein to give your body strength. Learn more about how to manage appetite loss.
• Chills: Chills are your body’s way of increasing your temperature. Ask your health care team what steps you should take if you have chills. Your health care team may advise you not to pile on blankets, since this can cause your temperature to rise even higher. When chills are severe, doctors may prescribe medicine.
• Diarrhea: Drink plenty of water to replace fluids you lose when you have diarrhea. Water and other fluids will help prevent dehydration, which may cause you to feel weak, dizzy, and disoriented. Your doctor may prescribe an over-the-counter diarrhea medicine. If you are receiving immunotherapy, diagnostic tests may be advised to rule out gastritis, a more serious medical condition. Learn more about how to manage diarrhea.
• Fatigue: Balance periods of rest with periods of activity. Choose the time of the day when you have the most energy to do an activity or to exercise. Regular exercise can help you to keep up your strength and stamina during treatment. Learn more about how to manage fatigue.
• Fever: Your body loses fluids when you have a fever, so it’s important to drink water to prevent dehydration. You may want to rest and put an ice pack on your forehead. Sometimes taking medicine to lower a fever can mask a more serious problem. For this reason, you may be advised to call your doctor before taking medicine to lower a fever.
• Headache and/or body aches: Use ice packs or place a cold washcloth on your forehead to get relief. If advised by your doctor, take over-the-counter pain relievers such as acetaminophen, ibuprofen, or aspirin.
• Nausea and vomiting: Try to take small sips of water, fruit juices, ginger ale, tea, and/or sports drinks, if recommended, throughout the day. Learn more about how to manage nausea and vomiting.

If these symptoms last or become severe, your doctor may advise diagnostic tests to identify what is causing these problems and determine how best to treat them.

Talking with Your Health Care Team about Flu-Like Symptoms

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What flu-like symptoms are common for the type of treatment I'm receiving?
• What problems should I call you about? Are there any symptoms that need urgent medical care?
• When might these symptoms start? How long might they last?
• Should I keep track of any symptoms?
• How much fluid should I drink every day? What types of fluids are best for me to drink?
• Are there medicines I should take to feel better? Are there medicines I should avoid or call you before taking?
• How often should I check my temperature?

Some types of chemotherapy cause the hair on your head and other parts of your body to fall out. Radiation therapy can also cause hair loss on the part of the body that is being treated. Hair loss is called alopecia. Talk with your health care team to learn if the cancer treatment you will be receiving causes hair loss. Your doctor or nurse will share strategies that have helped others, including those listed below.

Ways to Manage Hair Loss

Talk with your health care team about ways to manage before and after hair loss:

• Treat your hair gently. You may want to use a hairbrush with soft bristles or a wide-tooth comb. Do not use hair dryers, irons, or products such as gels or clips that may hurt your scalp. Wash your hair with a mild shampoo. Wash it less often and be very gentle. Pat it dry with a soft towel.
• You have choices. Some people choose to cut their hair short to make it easier to deal with when it starts to fall out. Others choose to shave their head. If you choose to shave your head, use an electric shaver so you won’t cut yourself. If you plan to buy a wig, get one while you still have hair so you can match it to the color of your hair. If you find wigs to be itchy and hot, try wearing a comfortable scarf or turban.
• Protect and care for your scalp. Use sunscreen or wear a hat when you are outside. Choose a comfortable scarf or hat that you enjoy and that keeps your head warm. If your scalp itches or feels tender, using lotions and conditioners can help it feel better.
• Talk about your feelings. Many people feel angry, depressed, or embarrassed about hair loss. It can help to share these feelings with someone who understands. Some people find it helpful to talk with other people who have lost their hair during cancer treatment. Talking openly and honestly with your children and close family members can also help you all. Tell them that you expect to lose your hair during treatment.

Ways to Care for Your Hair When It Grows Back

• Be gentle. When your hair starts to grow back, you will want to be gentle with it. Avoid too much brushing, curling, and blow-drying. You may not want to wash your hair as frequently.
• After chemotherapy. Hair often grows back in 2 to 3 months after treatment has ended. Your hair will be very fine when it starts to grow back. Sometimes your new hair can be curlier or straighter—or even a different color. In time, it may go back to how it was before treatment.
• After radiation therapy. Hair often grows back in 3 to 6 months after treatment has ended. If you received a very high dose of radiation your hair may grow back thinner or not at all on the part of your body that received radiation.

Talking With Your Health Care Team about Hair Loss

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• Is treatment likely to cause my hair to fall out?
• How should I protect and care for my head? Are there products that you recommend? Ones I should avoid?
• Where can I get a wig or hairpiece?
• What support groups could I meet with that might help?
• When will my hair grow back?

An infection is the invasion and growth of germs in the body, such as bacteria, viruses, yeast, or other fungi. An infection can begin anywhere in the body, may spread throughout the body, and can cause one or more of these signs:

• fever of 100.5 °F (38 °C) or higher or chills
• cough or sore throat
• diarrhea
• ear pain, headache or sinus pain, or a stiff or sore neck
• skin rash
• sores or white coating in your mouth or on your tongue
• swelling or redness, especially where a catheter enters your body
• urine that is bloody or cloudy, or pain when you urinate

Call your health care team if you have signs of an infection. Infections during cancer treatment can be life threatening and require urgent medical attention. Be sure to talk with your doctor or nurse before taking medicine—even aspirin, acetaminophen (such as Tylenol®), or ibuprofen (such as Advil®) for a fever. These medicines can lower a fever but may also mask or hide signs of a more serious problem.

Some types of cancer and treatments such as chemotherapy may increase your risk of infection. This is because they lower the number of white blood cells, the cells that help your body to fight infection. During chemotherapy, there will be times in your treatment cycle when the number of white blood cells (called neutrophils) is particularly low and you are at increased risk of infection. Stress, poor nutrition, and not enough sleep can also weaken the immune system, making infection more likely.

You will have blood tests to check for neutropenia (a condition in which there is a low number of neutrophils). Medicine may sometimes be given to help prevent infection or to increase the number of white blood cells.

Ways to Prevent Infection

Your health care team will talk with you about these and other ways to prevent infection:

• Wash your hands often and well. Use soap and warm water to wash your hands well, especially before eating. Have people around you wash their hands well too.
• Stay extra clean. If you have a catheter, keep the area around it clean and dry. Clean your teeth well and check your mouth for sores or other signs of an infection each day. If you get a scrape or cut, clean it well. Let your doctor or nurse know if your bottom is sore or bleeds, as this could increase your risk of infection.
• Avoid germs. Stay away from people who are sick or have a cold. Avoid crowds and people who have just had a live vaccine, such as one for chicken pox, polio, or measles. Follow food safety guidelines; make sure the meat, fish, and eggs you eat are well cooked. Keep hot foods hot and cold foods cold. You may be advised to eat only fruits and vegetables that can be peeled, or to wash all raw fruits and vegetables very well.

Talking With Your Health Care Team about Infection

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• Am I at increased risk of infection during treatment? When am I at increased risk?
• What steps should I take to prevent infection?
• What signs of infection should I look for?
• Which signs signal that I need urgent medical care at the emergency room? Which should I call you about?

Lymphedema is a condition in which the lymph fluid does not drain properly. It may build up in the tissues and causes swelling. This can happen when part of the lymph system is damaged or blocked, such as during surgery to remove lymph nodes, or radiation therapy. Cancers that block lymph vessels can also cause lymphedema.

Lymphedema usually affects an arm or leg, but it can also affect other parts of the body, such as the head and neck. You may notice symptoms of lymphedema at the part of your body where you had surgery or received radiation therapy. Swelling usually develops slowly, over time. It may develop during treatment or it may start years after treatment.

At first, lymphedema in an arm or leg may cause symptoms such as:

• swelling and a heavy or achy feeling in your arms or legs that may spread to your fingers and toes
• a dent when you press on the swollen area
• swelling that is soft to the touch and is usually not painful at first

Lymphedema that is not controlled may cause:

• more swelling, weakness, and difficulty moving your arm or leg
• itchy, red, warm skin, and sometimes a rash
• wounds that don’t heal, and an increased risk of skin infections that may cause pain, redness, and swelling
• thickening or hardening of the skin
• tight feeling in the skin; pressing on the swollen area does not leave a dent
• hair loss

Lymphedema in the head or neck may cause:

• swelling and a tight uncomfortable feeling on your face, neck, or under your chin
• difficulty moving your head or neck

Tell your health care team as soon as you notice symptoms. Early treatment may prevent or reduce the severity of problems caused by lymphedema.

Ways to Manage Lymphedema

Steps you may be advised to take to prevent lymphedema or to keep it from getting worse:

• Protect your skin. Use lotion to avoid dry skin. Use sunscreen. Wear plastic gloves with cotton lining when working in order to prevent scratches, cuts, or burns. Keep your feet clean and dry. Keep your nails clean and short to prevent ingrown nails and infection. Avoid tight shoes and tight jewelry.
• Exercise. Work to keep body fluids moving, especially in places where lymphedema has developed. Start with gentle exercises that help you to move and contract your muscles. Ask your doctor or nurse what exercises are best for you.
• Manual lymph drainage. See a trained specialist (a certified lymphedema therapist) to receive a type of therapeutic massage called manual lymph drainage. Therapeutic massage works best to lower lymphedema when given early, before symptoms progress.

Ways to Treat Lymphedema

Your doctor or nurse may advise you to take these and other steps to treat lymphedema:

• Wear compression garments or bandages. Wear special garments, such as sleeves, stockings, bras, compression shorts, gloves, bandages, and face or neck compression wear. Some garments are meant to be worn during the day, while others are to be worn at night.
• Other practices. Your health care team may advise you to use compression devices (special pumps that apply pressure periodically) or have laser therapy or other treatments.

Talking With Your Health Care Team about Lymphedema

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What can I do to prevent these problems?
• What symptoms should I call you about?
• What steps can I take to feel better?
• Would you recommend that I see a certified lymphedema therapist?
• If lymphedema advances, what special garments should I wear during the day? During the night?

Whether you have memory or concentration problems (sometimes described as a mental fog or chemo brain) depends on the type of treatment you receive, your age, and other health-related factors. Cancer treatments such as chemotherapy may cause difficulty with thinking, concentrating, or remembering things. So can some types of radiation therapy to the brain and immunotherapy.

These cognitive problems may start during or after cancer treatment. Some people notice very small changes, such as a bit more difficulty remembering things, whereas others have much greater memory or concentration problems.

Your doctor will assess your symptoms and advise you about ways to manage or treat these problems. Treating conditions such as poor nutrition, anxiety, depression, fatigue, and insomnia may also help.

Ways to manage memory or concentration problems

It’s important for you or a family member to tell your health care team if you have difficulty remembering things, thinking, or concentrating. Here are some steps you can take to manage minor memory or concentration problems:

• Plan your day. Do things that need the most concentration at the time of day when you feel best. Get extra rest and plenty of sleep at night. If you need to rest during the day, short naps of less than 1 hour are best. Long naps can make it more difficult to sleep at night. Keep a daily routine.
• Exercise your body and mind. Exercise can help to decrease stress and help you to feel more alert. Exercise releases endorphins, also known as "feel-good chemicals,"which give people a feeling of well-being. Ask what light physical exercises may be helpful for you. Mind–body practices such as meditation or mental exercises such as puzzles or games also help some people.
• Get help to remember things. Write down and keep a list handy of important information. Use a daily planner, recorder, or other electronic device to help you remember important activities. Make a list of important names and phone numbers. Keep it in one place so it’s easy to find.

Talking with your health care team about memory or concentration problems

It’s important for you or a family member to talk with your doctor or nurse about any memory or cognitive changes you may have. Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• Am I at increased risk of cognitive problems based on the treatment I am receiving?
• When might these problems start to occur? How long might they last?
• Are there steps I can take to decrease these problems?
• What symptoms or other problems should I, or a family member, call you about?
• Could I meet with a social worker to get ideas about additional support and resources?
• Are there specialists who could assess, treat, or advise me on these problems (such as a neuropsychologist, an occupational therapist, a vocational therapist, and others)?

Cancer treatments may cause dental, mouth, and throat problems. Radiation therapy to the head and neck may harm the salivary glands and tissues in your mouth and/or make it hard to chew and swallow safely. Some types of chemotherapy and immunotherapy can also harm cells in your mouth, throat, and lips. Drugs used to treat cancer and certain bone problems may also cause oral complications.

Mouth and throat problems may include:

• changes in taste (dysgeusia) or smell
• dry mouth (xerostomia)
• infections and mouth sores
• pain or swelling in your mouth (oral mucositis)
• sensitivity to hot or cold foods
• swallowing problems (dysphagia)
• tooth decay (cavities)

Mouth problems are more serious if they interfere with eating and drinking because they can lead to dehydration and/or malnutrition. It’s important to call your doctor or nurse if you have pain in your mouth, lips, or throat that makes it difficult to eat, drink, or sleep or if you have a fever of 100.5 °F (38 °C) or higher.

Ways to Prevent Mouth and Dental Problems

Your doctor or nurse may advise you to take these and other steps:

• Get a dental check-up before starting treatment. Before you start treatment, visit your dentist for a cleaning and check-up. Tell the dentist about your cancer treatment and try to get any dental work completed before starting treatment.
• Check and clean your mouth daily. Check your mouth every day for sores or white spots. Tell your doctor or nurse as soon as you notice any changes, such as pain or sensitivity. Rinse your mouth throughout the day with a solution of warm water, baking soda, and salt. Ask your nurse to write down the mouth rinse recipe that is recommended for you. Gently brush your teeth, gums, and tongue after each meal and before going to bed at night. Use a very soft toothbrush or cotton swabs. If you are at risk of bleeding, ask if you should floss.

Ways to Manage Mouth Problems and Changes in Taste

Your health care team may suggest that you take these and other steps to manage these problems:

• For a sore mouth or throat: Choose foods that are soft, wet, and easy to swallow. Soften dry foods with gravy, sauce, or other liquids. Use a blender to make milkshakes or blend your food to make it easier to swallow. Ask about pain medicine, such as lozenges or sprays that numb your mouth and make eating less painful. Avoid foods and drinks that can irritate your mouth; foods that are crunchy, salty, spicy, or sugary; and alcoholic drinks. Don’t smoke or use tobacco products.
• For a dry mouth: Drink plenty of liquids because a dry mouth can increase the risk of tooth decay and mouth infections. Keep water handy and sip it often to keep your mouth wet. Suck on ice chips or sugar-free hard candy, have frozen desserts, or chew sugar-free gum. Use a lip balm. Ask about medicines such as saliva substitutes that can coat, protect, and moisten your mouth and throat. Acupuncture may also help with dry mouth.
• For changes to your sense of taste: Foods may seem to have no taste or may not taste the way they used to or food may not have much taste at all. Radiation therapy may cause a change in sweet, sour, bitter, and salty tastes. Chemotherapy drugs may cause an unpleasant chemical or metallic taste in your mouth. If you have taste changes it may help to try different foods to find ones that taste best to you. Trying cold foods may also help. Here are some more tips to consider:
  • If food tastes bland, marinate foods to improve their flavor or add spices to foods.
  • If red meat tastes strange, switch to other high-protein foods such as chicken, eggs, fish, peanut butter, turkey, beans, or dairy products.
  • If foods taste salty, bitter, or acidic, try sweetening them.
  • If foods taste metallic, switch to plastic utensils and non-metal cooking dishes.
  • If you have a bad taste in your mouth, try sugar-free lemon drops, gum, or mints.

Talking with Your Health Care Team about Mouth and Throat Problems

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• When might these problems start to occur? How long might they last?
• What steps can I take to feel better?
• What medicines can help?
• What symptoms or problems should I call the doctor about?
• What pain medicine and/or mouthwashes could help me?
• Would you recommend a registered dietitian who I could see to learn about good food choices?
• For people receiving radiation therapy to the head and neck: Should I take supplements such as zinc, to help my sense of taste come back after treatment?

What Is Nausea?

Nausea is when you feel sick to your stomach, as if you are going to throw up.

What Is Vomiting?

Vomiting is when you throw up.

What Cancer Treatments Can Cause Nausea and Vomiting?

Nausea and/or vomiting can be side effects of most cancer treatments. For example, surgery, some types of chemotherapy, immunotherapy, targeted therapy, and radiation therapy to certain parts of the body may cause these side effects.

What Are the Different Types of Nausea and Vomiting?

The different types of nausea and vomiting caused by cancer treatment, include acute, delayed, and anticipatory nausea and vomiting.

What Serious Problems Can Nausea and Vomiting Cause?

Nausea and vomiting can cause serious health problems such as malnutrition and dehydration. Controlling nausea and vomiting can help to prevent these problems. It can also help you to feel better.

Ways to Manage Nausea and Vomiting

Your doctor or nurse will work to figure out what is causing your symptoms. Medicines called anti-nausea drugs or antiemetics work well and are effective in preventing or reducing many types of nausea and vomiting. The medicine is taken at specific times to prevent and/or control symptoms of nausea and vomiting.

Here are some practical tips and steps you can take to feel better when you have nausea and vomiting:

• Take an anti-nausea medicine. Talk with your doctor or nurse to learn when to take your medicine. Most people need to take an anti-nausea medicine even on days when they feel well. Tell your doctor or nurse if the medicine doesn’t help. There are different kinds of medicine and one may work better than another for you.
• Drink plenty of water and fluids. Drinking will help to prevent dehydration, a serious problem that happens when your body loses too much fluid and you are not drinking enough. Try to sip on water, fruit juices, ginger ale, tea, and/or sports drinks throughout the day.
• Avoid certain foods. Don’t eat greasy, fried, sweet, or spicy foods if you feel sick after eating them. If the smell of food bothers you, ask others to make your food. Try cold foods that do not have strong smells, or let food cool down before you eat it.
• Try these tips on treatment days. Some people find that it helps to eat a small snack before treatment. Others avoid eating or drinking right before or after treatment because it makes them feel sick. After treatment, wait at least 1 hour before you eat or drink.
• Learn about complementary medicine practices that may help. Acupuncture relieves nausea and/or vomiting cause by chemotherapy in some people. Deep breathing, guided imagery, hypnosis, and other relaxation techniques (such as listening to music, reading a book, or meditating) also help some people.

Talking with Your Health Care Team about Nausea and Vomiting

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What symptoms or problems should I call you about?
• What medicine could help me? When should I take this medicine?
• How much liquid should I drink each day? What should I do if I throw up?
• What foods would be easy on my stomach? What foods should I avoid?
• Could I meet with a registered dietitian to learn more?
• What specialists could I see to learn about acupuncture and other practices that could help to lower my symptoms?

Some cancer treatments cause peripheral neuropathy, a result of damage to the peripheral nerves. These nerves carry information from the brain to other parts of the body. Side effects depend on which peripheral nerves (sensory, motor, or autonomic) are affected.

Damage to sensory nerves (nerves that help you feel pain, heat, cold, and pressure) can cause:

• tingling, numbness, or a pins-and-needles feeling in your feet and hands that may spread to your legs and arms
• inability to feel a hot or cold sensation, such as a hot stove
• inability to feel pain, such as from a cut or sore on your foot

Damage to motor nerves (nerves that help your muscles to move) can cause:

• weak or achy muscles. You may lose your balance or trip easily. It may also be difficult to button shirts or open jars.
• muscles that twitch and cramp or muscle wasting (if you don’t use your muscles regularly).
• swallowing or breathing difficulties (if your chest or throat muscles are affected)

Damage to autonomic nerves (nerves that control functions such as blood pressure, digestion, heart rate, temperature, and urination) can cause:

• digestive changes such as constipation or diarrhea
• dizzy or faint feeling, due to low blood pressure
• sexual problems; men may be unable to get an erection and women may not reach orgasm
• sweating problems (either too much or too little sweating)
• urination problems, such as leaking urine or difficulty emptying your bladder

If you start to notice any of the problems listed above, talk with your doctor or nurse. Getting these problems diagnosed and treated early is the best way to control them, prevent further damage, and to reduce pain and other complications.

Ways to Prevent or Manage Problems Related to Nerve Changes

You may be advised to take these steps:

• Prevent falls. Have someone help you prevent falls around the house. Move rugs out of your path so you will not trip on them. Put rails on the walls and in the bathroom, so you can hold on to them and balance yourself. Put bathmats in the shower or tub. Wear sturdy shoes with soft soles. Get up slowly after sitting or lying down, especially if you feel dizzy.
• Take extra care in the kitchen and shower. Use potholders in the kitchen to protect your hands from burns. Be careful when handling knives or sharp objects. Ask someone to check the water temperature, to make sure it’s not too hot.
• Protect your hands and feet. Wear shoes, both inside and outside. Check your arms, legs, and feet for cuts or scratches every day. When it’s cold, wear warm clothes to protect your hands and feet.
• Ask for help and slow down. Let people help you with difficult tasks. Slow down and give yourself more time to do things.
• Ask about pain medicine and integrative medicine practices. You may be prescribed pain medicine. Sometimes practices such as acupuncture, massage, physical therapy, yoga, and others may also be advised to lower pain. Talk with your health care team to learn what is advised for you.

Talking With Your Health Care Team

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What symptoms or problems might I have? Which ones should I call you about?
• When will these problems start? How long might they last?
• What medicine, treatments, and integrative medicine practices could help me to feel better?
• What steps can I take to feel better? What precautions should I take to stay safe?
• Could you refer me to a specialist who could give me additional advice?

Immunotherapy is a type of cancer treatment that strengthens your immune system’s response to cancer. One type of immunotherapy, called immune checkpoint inhibitor therapy, can trigger an immune response that causes inflammation to organs in your body. You’ll notice the suffix “-itis” (which means inflammation) in the names of many of these conditions.

Doctors and researchers are working to learn more about the best ways to prevent or manage inflammation-related side effects. Sometimes these side effects are managed with medicines, such as steroids, that work to slow down an overactive immune response. These side effects may be serious and even life-threatening. It’s important to talk with your health care team to know what signs and symptoms to expect, as well as when they may happen and what to do if they occur.

For people with an autoimmune disease it’s especially important to discuss this disease with your health care provider before starting treatment.

Side Effects in People Receiving Immunotherapy

This list of side effects can be a helpful reference as you learn more from your health care team about what to expect, based on the treatment you will be receiving.

Side effects are more common in these organs and systems:

• Digestive system: Inflammation to organs in your digestive system, called colitis, may cause stomach or abdominal pain, diarrhea, and black or bloody stools. Some people have mild hepatitis, which is diagnosed during a blood test.
• Endocrine system: When hormone-producing glands are inflamed you may have some of the problems listed below. Your doctor will check your hormone levels regularly to detect and diagnose these problems.
  • Pituitary gland inflammation is the most common endocrine system-related inflammatory problem; it may cause headaches and fatigue.
  • Adrenal gland inflammation may cause fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain.
  • Thyroid gland inflammation can cause problems such as hypothyroidism (which may cause weakness, constipation, dry skin, weight gain, and sensitivity to cold) and hyperthyroidism (which may cause diarrhea, weight loss, sweating, sensitivity to heat, and, in rare cases, atrial fibrillation).
  • Pancreatic inflammation, called pancreatitis, may cause severe abdominal pain, nausea, and vomiting.
• Musculoskeletalsystem: Inflamed joints and muscles may cause you to feel pain and weakness. Inflammation of the muscles is referred to as myositis. You may also have rheumatologic problems.
• Respiratory system (lung problems): Inflammation in the lungs, called pneumonitis, can cause you to feel short of breath and have a bad cough.
• Skin: Skin inflammatory problems may include rashes, itchy skin, blisters, and sores. Learn more about how to manage skin and nail changes.

Side effects are less common in these organs and systems:

• Blood (hematologic problems): You may bleed or bruise easier, a condition called thrombocytopenia. Other blood-related problems include anemia and neutropenia.
• Eyes: You may have vision changes and/or eye pain caused by inflammatory problems such as uveitis or episcleritis.
• Heart inflammation, called myocarditis, may lower your blood pressure. In rare cases, it may lower your heart’s ability to pump blood, disrupt your heartbeat, and cause a heart attack.
• Kidney inflammation, called nephritis, may decrease the amount of urine you produce. You may see blood in your urine.
• Liver inflammation, called hepatitis, may cause your skin and eyes to be yellowish. You may also have nausea or vomiting, stomach pain, fatigue, darker urine, and bleeding or bruising.
• Nervous system inflammation may cause your hands, feet, and sometimes your face to tingle and feel numb or weak. Inflammation to the brain, called encephalitis, may cause mild flu-like symptoms or more serious side effects, such as a sudden and high fever, confusion, hallucinations, seizures, and vomiting.

Be Alert for Changes and Problems

It’s important to have any possible inflammatory problems assessed by your oncologist. Your oncologist may advise you to call him or her first about inflammatory symptoms, or you may be advised to seek emergency medical care.

Write down key information about your treatment and keep it handy, in case you need to share it with doctors in the emergency room. It’s important for other medical professionals to know you are receiving immunotherapy, so you’ll want to write down:

• the drug name(s)
• your doctor’s contact information
• your hospital’s contact information

After Talking with Your Health Care Team, Make Sure You Have Answers to These Questions

• What organ-related inflammatory side effects might I have, based on the type of immunotherapy I am receiving?
• Should I try to manage any of these side effects at home?
• What side effects should I call you about? Which side effects need urgent medical care? Where should I go to get urgent medical care?
• When might these side effects start? How long might they last?
• What type of medicine or therapy is used to treat side effects that I may have?
• How long will it take to resolve any side effects?
• How long after treatment might these side effects occur?

Cancer itself and the side effects of cancer treatment can sometimes cause pain. Pain is not something that you have to “put up with.” Controlling pain is an important part of your cancer treatment plan. Pain can suppress the immune system, increase the time it takes your body to heal, interfere with sleep, and affect your mood.

Talk with your health care team about pain, especially if:

• the pain isn’t getting better or going away with pain medicine
• the pain comes on quickly
• the pain makes it hard to eat, sleep, or perform your normal activities
• you feel new pain
• you have side effects from the pain medicine such as sleepiness, nausea, or constipation

Your doctor will work with you to develop a pain control plan that is based on your description of the pain. Taking pain medicine is an important part of the plan. Your doctor will talk with you about using drugs to control pain and prescribe medicine (including opioids and nonopioid medicines) to treat the pain.

Ways to Treat or Lessen Pain

Here are some steps you can take, as you work with your health care team to prevent, treat, or lessen pain:

• Keep track of your pain levels. Each day, write about any pain you feel. Writing down answers to the questions below will help you describe the pain to your doctor or nurse.
  • What part of your body feels painful?
  • What does the pain feel like (is it sharp, burning, shooting, or throbbing) and where do you feel the pain?
  • When does the pain start? How long does the pain last?
  • What activities (such as eating, sleeping, or other activities) does pain interfere with?
  • What makes the pain feel better or worse? For example, do ice packs, heating pads, or exercises help? Does pain medicine help? How much do you take? How often do you take it?
  • How bad is the pain, on a scale of 1 to 10, where “10” is the most pain and “1” is the least pain?
• Take the prescribed pain medicine. Take the right amount of medicine at the right time. Do not wait until your pain gets too bad before taking pain medicine. Waiting to take your medicine could make it take longer for the pain to go away or increase the amount of medicine needed to lower pain. Do not stop taking the pain medicine unless your doctor advises you to. Tell your doctor or nurse if the medicine no longer lowers the pain, or if you are in pain, but it’s not yet time to take the pain medicine.
• Meet with a pain specialist. Specialists who treat pain often work together as part of a pain or palliative care team. These specialists may include a neurologist, surgeon, physiatrist, psychiatrist, psychologist, or pharmacist. Talk with your health care team to find a pain specialist.
• Ask about integrative medicine. Treatments such as acupuncture, biofeedback, hypnosis, massage therapy and physical therapy may also be used to treat pain.

Talking With Your Health Care Team about Pain

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What problems or levels of pain should I call you about?
• What is most likely causing the pain?
• What can I do to lessen the pain?
• What medicine should I take? If the pain doesn’t go away, how much more medicine can I take, and when can I take it?
• What are the side effects of this pain medicine? How long will they last?
• Is there a pain specialist I could meet with to get more support to lower my pain?

Men being treated for cancer may experience changes that affect their sexual life during, and sometimes after, treatment. While you may not have the energy or interest in sexual activity that you did before treatment, being intimate with and feeling close to your spouse or partner is probably still important.

Your doctor or nurse may talk with you about how cancer treatment might affect your sexual life or you may need to be proactive and ask questions such as: What sexual changes or problems are common among men receiving this type of treatment? What methods of birth control or protection are recommended during treatment?

Whether or not you’ll have problems that affect your sexual health depends on factors such as:

• the type of cancer
• the type of treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• your age at time of treatment
• the amount of time that has passed since treatment
• other personal health factors

Cancer Treatments May Cause Sexual Problems in Men

Many problems that affect a man’s sexual activity during treatment are temporary and improve once treatment has ended. Other side effects may be long term or may start after treatment.

Your doctor will talk with you about side effects you may have based on your treatment(s):

• Chemotherapy may lower your testosterone levels and libido during the treatment period. You may be advised to use a condom, because semen may contain traces of chemotherapy for a period of time after treatment. Chemotherapy does not usually affect your ability to have an erection.
• External-beam radiation therapy to the pelvis (such as to the anus, bladder, penis, or prostate) and brachytherapy (also called internal radiation therapy) can affect a man’s sexual function. If blood vessels or nerves are damaged, it may be difficult to get or keep an erection; this is called erectile dysfunction. If the prostate is damaged, you may have a dry orgasm.
• Hormone therapy can lower testosterone levels and decrease a man’s sexual drive. It may be difficult to get or keep an erection.
• Surgery for penile, rectal, prostate, testicular, and other pelvic cancers (such as the bladder, colon, and rectum) may affect the nerves, making it difficult to get and keep an erection. Sometimes nerve-sparing surgery can be used to prevent these problems.
• Medicines used to treat pain, some drugs used for depression, as well as medicines that affect the nerves and blood vessels may all affect your sex drive.

Health problems, such as heart disease, high blood pressure, diabetes, and smoking, can also contribute to changes in your sexual health.

Ways to Manage Sexual Health Issues

People on your health care team have helped others cope during this difficult time and can offer valuable suggestions. You may also want to talk with a sexual health expert to get answers to any questions or concerns.

Most men can be sexually active during treatment, but you’ll want to confirm this with your doctor. For example, there may be times during treatment when you are at increased risk of infection or bleeding and may be advised to abstain from sexual activity. Depending on the type of treatment you are receiving, condom use may be advised.

Your health care team can help you:

• Learn about treatments: Based on symptoms you are having, your oncologist or a urologist will advise you on treatment options. For example, there are medicines and devices that may be prescribed once a sexual health problem has been diagnosed. Medicines can be given to increase blood flow to the penis. There are also surgical procedures in which a firm rod or inflatable device (penile implant) is placed in the penis, making it possible to get and keep an erection.
• Learn about condoms and/or contraceptives: Condoms may be advised to prevent your partner’s exposure to chemotherapy drugs that may remain in semen. Based on your partner’s age, contraceptives may be advised to prevent pregnancy.
• Manage related side effects: Talk with your doctor or nurse about problems such as pain, fatigue, hair loss, loss of interest in activities, sadness, or trouble sleeping, that may affect your sex life. Speaking up about side effects can help you get the treatment and support you need to feel better.
• Get support and counseling: During this time, it will help to share your feelings and concerns with people you are close to. You may also benefit from participating in a professionally moderated or led support group. Your nurse or social worker can recommend support groups and counselors in your area.

Talking with Your Health Care Team about Sexual Health Issues

As you think about the changes that treatment has brought into your life, make a list of questions to ask your doctor, nurse, or social worker. Consider adding these to your list:

• What sexual problems are common among men receiving this treatment?
• What sexual problems might I have during treatment?
• When might these changes occur?
• How long might these problems last? Will any of these problems be permanent?
• How can these problems be prevented, treated, or managed?
• What precautions do I need to take during treatment? For example, do I need to use a condom to protect my partner?
• Should my partners and I use contraception to avoid a pregnancy? What types of contraception (birth control) do you recommend?
• Is there a support group that you recommend?
• What specialist(s) would you suggest that that I talk with to learn more?

Women being treated for cancer may experience changes that affect their sexual life during, and sometimes after, treatment. While you may not have the energy or interest in sexual activity that you did before treatment, feeling close to and being intimate with your spouse or partner is probably still important.

Your doctor or nurse may talk with you about how cancer treatment might affect your sexual life, or you may need to be proactive and ask questions such as: What sexual changes or problems are common among women receiving this type of treatment? What methods of birth control or protection are recommended during treatment?

Other questions to consider asking are listed at the end of this page.

Whether or not your sexual health will be affected by treatment depends on factors such as:

• the type of cancer
• the type of treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• your age at time of treatment
• the amount of time that has passed since treatment
• other personal health factors

Cancer treatments may cause skin and nail changes. Talk with your health care team to learn what side effects your treatment may cause. While skin problems caused by radiation therapy and chemotherapy are often mild, they may be more severe if you are receiving a stem cell transplant, targeted therapy, or immunotherapy. Let your health care team know if you notice any skin changes so they can be treated promptly.

• Sometimes radiation therapy can cause the skin on the part of your body receiving radiation to become dry and peel, itch (called pruritus), and turn red or darker. Your skin may look sunburned or become swollen or puffy. You may develop sores that become painful, wet, and infected. This is called a moist reaction.
• Some types of chemotherapy can cause your skin to become dry, itchy, red or darker, or peel. You may develop a minor rash or sunburn easily; this is called photosensitivity. Some people also have skin pigmentation changes. Your nails may be dark and cracked, and your cuticles may hurt. If you received radiation therapy in the past, the area of skin where you received radiation may become red, blister, peel, or hurt. This is called radiation recall. Signs of an allergic response to chemotherapy may include a sudden or severe rash or hives or a burning sensation.
• Stem cell transplants can cause graft-versus-host disease (GVHD), which may cause skin problems such as a rash, blisters, or thickening of the skin.
• Some types of immunotherapy can cause a severe and sometimes extensive rash. Your skin may be dry or blister.
• Some types of targeted therapy may cause dry skin, a rash, and nail problems. If you develop a rash, it is important to talk with your doctor before stopping targeted therapy.

Ask Your Health Care Team about Skin and Nail Changes

• What skin and nail changes might I have, based on the cancer treatment I am receiving?
• Which symptoms can be managed at home? Which symptoms need urgent medical care?

If you have a severe, extensive, blistering, or painful rash and are receiving immunotherapy, call your doctor to get their advice. It’s especially important to call about rashes that involve the eyes or a mucous membrane, such as your mouth, caused by immunotherapy.

Make note of all problems you should call your health care team about.

Skin changes:

• Acne (Acneiform eruptions)
• Bed sores (pressure ulcers)
• Blisters
• Burning or skin pain
• Dry skin
• Hand-foot syndrome (palmar-plantar erythrodysesthesia)
• Hyperpigmentation (darker areas of skin, tongue, and joints)
• Hypopigmentation (patches of skin that are lighter)
• Itchy skin (pruritus)
• Keratoacanthoma (dome-shaped skin growth)
• Peeling, flakey, or crusty skin
• Photosensitivity (sunburn easily)
• Rash
• Red or darkened skin
• Sores that are painful
• Swollen skin

Nail changes:

• Cracked nails
• Cuticles that are swollen and/or painful
• Nail infections (acute paronychia)
• Yellow nails

Ways to Prevent or Manage Mild Skin and Nail Changes during Cancer Treatment

Talk with your health care team to learn if you should manage these problems at home. Depending upon the treatment you are receiving, your health care team may advise you to take these steps:

• Use only recommended skin products. Use mild soaps that are gentle on your skin. Ask your nurse to recommend specific skin products. If you are receiving radiation therapy, ask about skin products, such as powder or antiperspirant, that you should avoid using before treatment.
• Prevent infection: Radiation therapy can cause skin in the treatment area to peel, become painful, and wet. Most often this happens in areas where the skin folds, such as around your ears, breast, or bottom. Try to keep the area clean and dry so it does not become infected. Your nurse will talk with you about how to clean the area and may prescribe special dressings that you can apply to the area and/or antibiotics.
• Moisturize your skin. Use recommended creams or lotions to prevent your skin from becoming dry and itchy. Irritated skin can become infected. Ask about special creams or ointments for severely dry, itchy, or painful skin.
• Protect your skin: Use sunscreen and sun-protective lip balm. Wear a loose-fitting long-sleeved shirt, pants, and a hat with a wide brim when outdoors to prevent sunburn. If you are receiving radiation therapy, don’t use heating pads, ice packs, or bandages on the treatment area. You may want to shave less often and use an electric razor or stop shaving if your skin is tender and sore.
• Prevent or treat dry, itchy skin. Avoid products that list alcohol or fragrance as an ingredient, since they can dry or irritate your skin. Your nurse may suggest you add colloidal oatmeal to your baths, as it can reduce itching. Take short showers or baths in lukewarm, not hot, water. Put on skin cream or ointment that is recommended by your nurse after drying off from a shower but while your skin is still a little damp. Apply a cool washcloth or ice to dry, itchy skin.
• Prevent or treat minor nail problems. Keep your nails clean and cut short to avoid accidentally tearing them. Protect your hands and nails by wearing gloves when you wash the dishes, or clean the house, for example. Avoid getting manicures and pedicures. Don’t wear tight-fitting shoes. Ask your nurse to recommend products that can be used to treat nail problems.
• Learn about treatments for irritating or painful skin rashes: Sometimes skin problems need medical treatment. Your rash may be treated with a medicated cream (topical corticosteroids) or with medicine that you take as a pill (oral corticosteroids or antibiotics).

Talking With Your Health Care Team about Skin and Nail Changes

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What skin-and nail related side effects are common for the type of treatment I’m receiving?
• Are there steps I can take to prevent any of these problems?
• What problems should I call you about? Are there any problems that need urgent medical care?
• When might these problems start? How long might they last?
• What brands of soap and lotion would you advise me to use on my skin? On my nails?
• Are there skin and nail products I should avoid?
• Should I see a dermatologist so I can learn more about how to prevent or manage skin problems?

What Sleep Problems Are Common in People Being Treated for Cancer?

Sleep problems such as being unable to fall asleep and/or stay asleep, also called insomnia, are common among people being treated for cancer.

What Causes Sleep Problems?

Sleep problems may be caused by the side effects of treatment, medicines you are taking, long hospital stays, stress, and other factors. Studies show that as many as half of all people have sleep-related problems during treatment for cancer.

How Are Sleep Problems Assessed?

Your doctor, or a sleep specialist, can do an assessment, which may include a polysomnogram (recordings taken during sleep that show brain waves, breathing rate, and other activities such as heart rate) to correctly diagnose and treat sleep problems. Assessments may be repeated from time to time, since sleeping problems may change over time. Learn more about when a sleep study may be useful, what to expect, and what your doctor may recommend after a sleep study.

Why Is a Good Night's Sleep Important?

Sleeping well is important for your physical and mental health. A good night’s sleep may help you to think more clearly, lower your blood pressure, help your appetite, and strengthen your immune system. Sleep problems that go on for a long time may increase the risk of anxiety or depression.

Ways to Manage Sleep Problems

Talk with your health care team if you have difficulty sleeping, so you can get the help you need. There are steps that you and your health care team can take to help you sleep well again.

• Tell your doctor about problems that interfere with sleep. Getting treatment to lower problems such as pain or other side effects such as urinary and bladder problems, or diarrhea, may help you sleep better.
• Cognitive behavioral therapy (CBT) and relaxation therapy may help. Practicing these therapies can help you to relax. For example, a CBT therapist can help you learn to change negative thoughts and beliefs about sleep into positive ones. Strategies such as muscle relaxation, guided imagery, and self-hypnosis may also help you.
• Set good bedtime habits. Go to bed only when sleepy, in a quiet and dark room, and in a comfortable bed. If you do not fall asleep, get out of bed and return to bed when you are sleepy. Stop watching television or using other electrical devices a couple of hours before going to bed. Don’t drink or eat a lot before bedtime. While it’s important to keep active during the day with regular exercise, exercising a few hours before bedtime may make sleep more difficult.
• Sleep medicine may be prescribed. Your doctor may prescribe sleep medicine, for a short period if other strategies don’t work. The sleep medicine prescribed will depend on your specific problem (such as trouble falling asleep or trouble staying asleep) as well as other medicines you are taking.

Talking with Your Health Care Team about Sleep Problems

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• Why am I having trouble sleeping?
• What problems should I call you about?
• What steps can I take to sleep better?
• Would you recommend a sleep therapist who could help with the problems I am having?
• Would sleep medicine be advised for me?

Some cancer treatments, such as those listed below, may cause urinary and bladder problems:

• Radiation therapy to the pelvis (including reproductive organs, the bladder, colon and rectum) can irritate the bladder and urinary tract. These problems often start several weeks after radiation therapy begins and go away several weeks after treatment has been completed.
• Some types of chemotherapy and immunotherapy can also affect or damage cells in the bladder and kidneys.
• Surgery to remove the prostate (prostatectomy), bladder cancer surgery, and surgery to remove a woman’s uterus, the tissue on the sides of the uterus, the cervix, and the top part of the vagina (radical hysterectomy) can also cause urinary problems. These types of surgery may also increase the risk of a urinary tract infection.

Symptoms of a Urinary Problem

Talk with your doctor or nurse to learn what symptoms you may experience and ask which ones to call about. Some urinary or bladder changes may be normal, such as changes to the color or smell of your urine caused by some types of chemotherapy. Your health care team will determine what is causing your symptoms and will advise on steps to take to feel better.

Irritation of the bladder lining (radiation cystitis):

• pain or a burning feeling when you urinate
• blood in your urine
• trouble starting to urinate
• trouble emptying your bladder completely
• feeling that you need to urinate urgently or frequently
• leaking a little urine when you sneeze or cough
• bladder spasms, cramps, or discomfort in the pelvic area

Urinary tract infection (UTI):

• pain or a burning feeling when you urinate
• urine that is cloudy or red
• a fever of 100.5 °F (38 °C) or higher, chills, and fatigue
• pain in your back or abdomen
• difficulty urinating or not being able to urinate

In people being treated for cancer, a UTI can turn into a serious condition that needs immediate medical care. Antibiotics will be prescribed if you have a bacterial infection.

Symptoms that may occur after surgery:

• leaking urine (incontinence)
• trouble emptying your bladder completely

Ways to Prevent or Manage

Here are some steps you may be advised to take to feel better and to prevent problems:

• Drink plenty of liquids. Most people need to drink at least 8 cups of fluid each day, so that urine is light yellow or clear. You’ll want to stay away from things that can make bladder problems worse. These include caffeine, drinks with alcohol, spicy foods, and tobacco products.
• Prevent urinary tract infections. Your doctor or nurse will talk with you about ways to lower your chances of getting a urinary tract infection. These may include going to the bathroom often, wearing cotton underwear and loose fitting pants, learning about safe and sanitary practices for catheterization, taking showers instead of baths, and checking with your nurse before using products such as creams or lotions near your genital area.

Talking With Your Health Care Team

Prepare for your visit by making a list of questions to ask. Consider adding these questions to your list:

• What symptoms or problems should I call you about?
• What steps can I take to feel better?
• How much should I drink each day? What liquids are best for me?
• Are there certain drinks or foods that I should avoid?