chemotherapy you are to receive is commonly known as CPT11 (Irinotecan or
Campto). As with all anti-cancer medicines CPT11 does have a number of side
effects which may become serious if you ignore them.
These side effects require special management to reduce the risk of
problems and you must listen carefully to your doctor or nurse when they explain
these to you. This information
leaflet will also summarise these side effects for you.
is given via a drip inserted into a vein on the back of your hand over a 90
minute period, once every three weeks. You
will be carefully monitored by the chemotherapy nurses. Listed below are the
side effects associated with your chemotherapy.
Nausea & sickness; Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different tablets can be prescribed for the next cycle. Some self help tips may also be useful.
is when your diarrhoea occurs within 24 hours after you receive the treatment.
This ‘early diarrhoea’ may be accompanied by other symptoms such as:
Sweating, abdominal cramps, watering eyes, visual disturbance, dizziness, low
blood pressure, feeling unwell, excessive mouth watering. These symptoms may
occur while you are actually having the treatment, but should resolve promptly,
either spontaneously or with specific medication.
They can be prevented at subsequent CPT11 infusions by giving specific
;If your diarrhoea starts more than 24 hours after the infusion this is called ‘delayed diarrhoea. It is most likely to occur about 1 week after chemotherapy. This may be severe if not promptly treated [i] with appropriate doses of anti-diarrhoea treatment. You will be given anti-diarrhoea tablets on leaving the hospital. It is important that you follow these instructions:
take two Loperamide capsules as soon as the first
liquid stool occurs and then one capsule every two hours for at least 12 hours,
and, in any case continuing up to 12 hours after the occurrence of the last
liquid stool. Do not decrease the dose or duration of the treatment by yourself.
You must drink large volumes of water and salted drinks (carbonated water,
sodas, soup) as long as the diarrhoea is ongoing.
You must tell your hospital Doctor/Nurse:
· If the diarrhoea persists for more than 24 hours despite the recommended Loperamide treatment.
· If you experience nausea and vomiting as well as diarrhoea.
· If you have a high temperature as well as the diarrhoea.
not take any treatment for diarrhoea other than that given to you by your
White Blood Cells (WBC) Shivering or shaking attacks of fever (flu like symptoms). If you feel hot or unwell check your temperature. A raised temperature indicates you have an infection which could be life threatening. A normal temperature is between 36oC and 37.2oC. If it is 38°C (100F) telephone the Hospital or cancer unit immediately and they will advise you. Do not take Paracetamol or Aspirin as this will bring your temperature down and mask the signs of infection. This is most likely to happen in the middle week (7-14 days) between cycles.
Haemoglobin (Hb) Tiredness, lethargy, breathlessness, dizziness (particularly on standing) and pale facial colour. Occasionally patients require a blood transfusion at some point during the whole course.
If you notice any bleeding, i.e. nose
bleeds, unexplained bleeding, bruising or persistent headaches contact the
Other advice on paracetamol; As mentioned above, if you have a temperature and feel unwell you may have an infection and may need treatment in hospital, we advise not to take paracetamol in this situation as it may mask your temperature, give false reassurance and delay you presenting to hospital for treatment. Taking paracetamol can otherwise be used with discretion. If for example you have a headache or a mild pain but otherwise feel well and your temperature is normal paracetamol can be used provided you check your temperature before each dose and allow a full six hours before each administration.
Contact to chicken pox; If you can't remember whether you've had Chicken Pox as a child and you come in contact with a person who as it or shingles you should contact your oncology team. They will arrange a blood test to find out if you are immune to chicken pox (the varcella virus). If not a series of injections can be administered to offer you temporary immunity.Fatigue All chemotherapy can cause fatigue. As your treatment progresses you will experience this. You may find that gentle exercise such as a short walk each day (if you are not working) may help. Fatigue and malaise may last up to 2-3 months (or longer) after the end of chemotherapy.
Weight gain; Over the entire course of chemotherapy many patients complain of weight gain. This is caused by a combination of the steroids increasing the appetite, the fatigue causing lack of mobility and the mild nausea often encouraging to nibble rather than eating correct meals - In order to prevent this we recommend regular light exercise and be aware of your calorie intake.
Weight loss may also be experienced by some patients during their course of chemotherapy particularly if there is more advances disease or other medical problems, in these cases dietary advice should be sought.
Sore mouth; You may have a sore mouth after chemotherapy and it is important that you maintain good oral hygiene. A soft, baby toothbrush may help and you may be given a mouthwash. If you develop mouth ulcers you should contact your clinic and they can prescribe special mouthwashes to help.
Hair loss; This chemotherapy does cause hair loss. It usually starts 3-4 weeks after the first course and may be lost completely. You may also experience thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will regrow after treatment, although it may at first be a different texture, very like a baby's hair. Some departments use a cold cap system to minimise hair loss. Your clinic nurse can arrange for you to have a wig before your treatment starts (NHS prescription charge, prices are approximately £55 for an acrylic wig, £140 for half real hair wig and £205 for a full real hair wig).
Your veins Three types of damage can occur, listed in order of seriousness:
Increase risk of blood clots - during chemotherapy there is an increased risk of blood clots, most commonly in the legs (deep vein thrombosis) or more seriously to the lungs (pulmonary embolus). If you get unexplained swelling and discomfort in the calf report this to the oncology unit. Likewise if you start experiencing unexplained breathlessness, cough up any blood or have a pain in the chest particularly when you breath contact the clinic as soon as possible. To avoid clots its important to stay as active as possible and (exercise & chemotherapy) taking light walks two to three times a day and avoid sitting around for long periods of time. If you are required to sit (for example while receiving the chemotherapy drugs) try to move your legs and ankles regularly. Occasionally, if your doctor feels you are at high risk of developing clots you may be started on drugs to thin your blood during chemotherapy.
Sore eyes; The front of the eyes (cornea) can occasionally feel dry and sticky, especially first thing in the morning. This usually comes on later in the course and can cause some redness and discomfort. Eye drops such artificial tears can be bought over the counter or prescribed by your medical team.
Nails; The grow of the nails can be impaired by chemotherapy. The amount of damage can vary but in most case there will be some slight discolouration and indentation seen in ridges across the nail beds - a bit like the rings of a tree, each representing an individual chemotherapy cycle. Occasionally the damage can be more troublesome, causing pain and breakdown of the nail bed causing it to lift and separate, possibly even leading to a total loss of the nail. Eventually after chemotherapy has finished the nail will grow back normally.
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.