Gastro-intestinal Side Effects
The gastro-intestinal (GI) tract includes the mouth, the salivary glands, taste buds, esophagus, the stomach, small intestine, large intestine and the rectum. The cells that line the GI tract are constantly dying and being reborn, making them especially susceptible to the effects of chemotherapy. Common side effects that occur within this system include:
- taste changes
- dry mouth
- mouth sores (mucositis)
- sore throat (esophagitis)
- decreased appetite.
- nausea
- vomiting
- diarrhea
- constipation
The specific side effects and degrees to which a person will experience them are very individual. Some people may experience mild nausea and moderate diarrhea, while others may have severe nausea and no diarrhea. The medications used in your particular therapy will help determine the side effects that you will be at the greatest risk for in the GI system. Prior to therapy your physician or nurse will review your specific medications and side effect profile with you.
Taste Changes & Dry Mouth
Taste Changes & Dry Mouth are common side effects of chemotherapy and in persons receiving radiation to the head and neck. These side effects may be caused by the effects of chemotherapy on the cells that line the inside of the mouth and/or the salivary glands.
Damage to the taste buds effects our perceptions of how things taste and damage to the salivary glands affects the amount of saliva that can be produced.
Our taste buds perceive four main flavors: bitter, salty, sour and sweet. Any or all of these perceptions may be affected. Many people complain of foods tasting bitter or salty. Others may complain of a metallic taste. You may be less sensitive to sweet foods. Food may simply taste bland. Taste changes can be mild or severe and may continue throughout treatment. Changes in taste and dry mouth usually resolve with a few weeks of completion of therapy.
A decrease in saliva production results in dry mouth. Saliva contributes much to our sense of taste by mixing with food and stimulating the taste buds on our tongues. So less saliva means less contact between food and the taste buds. Dry mouth can also cause difficulty swallowing and increase your risk for tooth decay. Saliva protects your teeth by neutralizing acids that are left on your teeth after eating sugary foods.
It is important that you let your physician or nurse know if you are experiencing taste changes or dry mouth. Changes in taste and dry mouth can have a negative affect on your appetite. Lose of appetite can result in loss of adequate nutrition and weight loss. It is crucial that we maintain your nutrition and weight throughout therapy.
Strategies for Coping with Taste Changes and Dry Mouth
There is no cure or treatment to eliminate taste changes or dry mouth. Treatments are centered primarily around comfort measures. Below, we have listed several strategies that you can employ to reduce or alleviate these side effects and, most importantly, to maintain your appetite:
- Brush your teeth or rinse your mouth prior to eating. Rinse mouth using a solution of baking soda and water (one teaspoon soda to 8 ounces warm water). Do not swallow the solution.
- Do not use mouthwashes with alcohol in them. These are very drying to the tissue lining the mouth.
- Eat small frequent meals and healthy snacks every 2-3 hours.
- If possible have other people prepare your meals to avoid the odor of cooking foods.
- Use poultry, fish, eggs and cheese instead of red meat.
- Try marinating meat or using sauces to promote taste.
- Avoid eating your favorite foods on the day of chemotherapy.
- Use plastic utensils if food tastes like metal.
- Use mints, peppermints, lemon drops or other hard candies to mask bitter or metallic tastes and to increase saliva. Use sugar free hard candies if you are a diabetic.
- Cool, frozen or room temperature foods may be more acceptable then warm or hot food. Hot foods have stronger odors and can stimulate an aversion to eating. Please note that if you are receiving Oxaliplatin (or Eloxatin), you will not be able to tolerate cool or cold food, so this advice is not for you.
- Avoid strong odors as they can affect your appetite.
- Drink plenty of water.
- Moist foods with gravies and sauces go down better with dry mouth.
- You and your physician may consider using Salagen to help stimulate the production of saliva.
- Think of food as being as essential to you as oxygen is. Even if things do not taste good your body needs food in order to cope with the effects of treatment and cancer.
Mouth Sores & Sore Throat
Mouth Sores & Sore Throat also known as mucositis (mouth) and esophagitis (throat) are common complications of standard chemotherapy and radiation therapy to the head & neck. They could also happen with targeted therapies. They usually occur within 4-5 days of standard chemotherapy, within the 2nd week of head & neck radiation and within the first six weeks after beginning of targeted agents. Mucositis and esophagitis may present as:
- Changes in taste
- Difficulty swallowing
- Pain when swallowing
- Changes in the quality of your voice (hoarseness)
- Changes in the color of the tissue lining your mouth
- Changes in saliva production (may get thick and ropey)
- Burning sensation or pain in the mouth
- Inflammation of the gums
- Generalized inflammation of the lining of the mouth
- Swelling of the tongue and lining of the mouth
- Actual ulcerations of the tissue lining the mouth and tongue
It is important that prior to the start of your therapy you have a dental exam and address any dental issues at that time. Once you have begun therapy the effects of treatment on your white blood cells and platelets may prevent you from receiving any dental procedures because of the risk of infection and bleeding. In addition, you need to keep your mouth clean and moist. This includes drinking plenty of fluids daily (minimum of 8-10 eight ounce glasses of water or other non-caffeinated, non-alcohol containing fluids). If you have been advised by a physician to restrict your fluids, let us know prior to the start of your therapy so that we can develop and alternative plan.
If you are experiencing any of the symptoms of sore mouth or throat, please report them to your physician or chemotherapy nurse right away. Mucositis and esophagitis can make eating and drinking difficult, impacting your overall nutritional status.
Strategies for Identifying & Coping with Mouth Sores and Sore Throat:
- Look at your mouth everyday, including your tongue, lips, gums, roof and floor of your mouth and the sides of your mouth. Report any changes in appearance or pain. If you wear dentures be sure to remove your dentures and look at the roof and floor of your mouth.
- Perform oral hygiene regularly, at the very least, after every meal and prior to bedtime. This includes brushing your teeth with a soft bristle toothbrush and rinsing with a baking soda and water solution (one teaspoon soda to 8 ounces of warm water). Do not swallow the solution. You may also rinse with other non-alcohol containing mouthwashes.
- If experiencing burning or ulcerations of the mouth you should increase rinsing of mouth to every 1-2 hours.
- Avoid the use of oral irrigators – they may force bacteria into damaged tissue.
- Avoid highly abrasive toothpaste, mouthwashes with alcohol or other oral astringents.
- Avoid hot, spicy, acidic or crunchy foods and beverages.
- Use a water based lip balm on dry or chapped lips.
- Pain medications may be needed. You and your physician will discuss this as needed.
- Medications such as Zantac or Prilosec may be recommended for pain related to esophagitis.
Nausea & Vomiting
Nausea & Vomiting are common side effects of cancer treatment and are probably the most feared. Acute nausea and/or vomiting may occur within minutes to hours after chemotherapy administration and can last up to 24-36 hours depending upon the specific chemotherapy regimen you have received. Delayed nausea and/or vomiting occur at least 24 hours after chemotherapy and may last for several days. There are only a few drugs with the potential for this type of nausea. Nausea and vomiting can also occur with targeted agents.
We are fortunate today to have multiple, effective medications for the prevention and control of nausea and vomiting . Your physician or nurse will review the potential for nausea and vomiting associated with your chemotherapy regimen and work with you to develop strategies to prevent and/or decrease this side effect. Usually, you will receive anti-nausea medications through your IV prior to the administration of your treatment. Your physician will also prescribe medications for you to take at home.
If, after receiving chemotherapy, you are having nausea and/or vomiting despite taking all anti-nausea medications as prescribed, please notify your physician or nurse right away. Nausea is not only uncomfortable; it can result in dehydration, which needs to be addressed promptly. There are multiple alternative and complimentary strategies we can use to take control of this unpleasant side effect. It is important to remember that for the most part nausea can be controlled if we all work together.
Strategies for Coping with Nausea and Vomiting:
- Eat small, frequent meals every 2-3 hours instead of sitting down to large planned meals.
- Avoid fatty, spicy, fried or highly salted foods with strong odors. Chemotherapy causes sensitivity to smells, and strong odors can cause food aversion.
- Have other people prepare meals if at all possible to avoid strong food odors.
- Try cold or room temperature foods instead of hot foods as these have less odor. Please note that if you are receiving Oxaliplatin (or Eloxatin), you will not be able to tolerate cool or cold food, so this advice is not for you.
- Avoid favorite foods on the day of therapy and while nausea and vomiting persists. Eating favorite foods while feeling sick or vomiting can also cause food aversion.
- Foods containing ginger may help with nausea and vomiting.
- Drink plenty of fluids (8-10 eight ounce glasses daily)
- Foods such as rice, applesauce, mashed bananas, baked potato without butter, pudding cups, boiled or poached eggs, beef or chicken broth and other bland foods may help. See our Recipes in the Lifestyle: Nutrition for other food ideas.
Abdominal pain
It is important to remember that pain in the abdominal area can occur for a variety of reasons, some of them quite serious, so it is important to tell you physician as soon as possible if you are having abdominal pain so that the cause can be determined. Please review Call us immediately if – tab section for more information.
Abdominal pain is not a common complication of chemotherapy. It can indirectly be caused by medications which affect activity of the intestines. An increase in activity may cause stool to travel faster and be less formed, resulting in cramping and/or diarrhea (please review the section on Diarrhea – tab). A decrease in intestinal activity may cause stool to travel slower becoming hard and dry, causing constipation (please review the section on Constipation – tab). In addition, chemotherapy can kill the “good bacterial flora” that is present in the intestines. This can cause an imbalance in the intestines that allows “bad bacteria” to grow and result in poor digestion, increased gas production, cramping and diarrhea. Occasionally, the “bad bacteria” like C.Difficile may cause a more serious infection. Chemotherapy could also irritate lining of the stomach, causing heartburn and dull achy pain in the upper abdomen.
A rare complication of targeted therapy with an antibody Avastin is a rupture of the intestinal wall. This complication could result in severe abdominal pain and requires immediate medical attention.
The treatment of abdominal pain is dependent upon the cause. Some things that you can do to prevent common problems are:
- Drink plenty of fluids
- Take medications with food unless you are told to take in on an empty stomach.
- Avoid aspirin or aspirin containing products and NSAIDs (ibuprofen, Advil, Motrin) unless they are specifically prescribed for you.
- Do not use narcotic pain medications for abdominal pain unless recommended by your physician. The cause of abdominal pain must be determined first.
- Avoid drinking alcohol
- Eat bland foods in small amounts
Again, remember that abdominal pain can be a sign of a serious problem and should be discussed with your physician or nurse as soon as possible.
Diarrhea
Diarrhea - defined as frequent loose watery stool, is a common side effect of standard chemotherapy and targeted therapies. Diarrhea can be a serious complication if not addressed promptly. Some factors that can put you at a higher risk for diarrhea would be the use of antibiotics, irritable bowel syndrome, and diabetes. So it is important that you let you physician know if you suffer from any problems that effect your bowels.
Strategies for Coping with Diarrhea:
- Fluid intake cannot be stressed enough. You are going to hear it over and over throughout this website and throughout your treatment. You need to have a minimum of 8-10 eight ounce glasses of “good” fluids daily (water, juices, sports drinks, bouillon). If you have been placed on fluid restriction by another physician please let us know so that we can identify alternative strategies for you.
- Watch your diet and avoid foods that are fried, spicy or fatty. If you are actively having diarrhea, avoid milk and milk products.
- Avoid foods that are stimulating or irritating to the GI tract such as nuts, seeds, popcorn, raw vegetables, and rich pastries.
- Avoid caffeine-containing products, alcohol and tobacco.
- Eat foods at room temperature. Hot or cold foods may irritate.
- If having diarrhea, consider bland foods such as the BRAT diet (bananas, rice, applesauce and dry toast). Please note that BRAT diet should not be used for more than 2 days – it does not have sufficient nutrients to keep up your weight. You can also try baked potato without butter, pudding cups, boiled, scrambled or poached eggs, beef or chicken broth. See our Lifestyle: Nutrition:Recipes section for other ideas.
- Eat foods with pectin such as avocados, avocados, bananas, peeled apples, beets or ginger tea could help.
- If having irritation in the perianal area take a warm sitz bath 3-4 times a day. Keep perianal area clean as this is an area susceptible to infection.
- Use the anti-diarrhea medications you have been instructed to use by your physician or nurse.
- If you are using anti-diarrheal medications and are having still having 4-6 loose stools in a 24 hour period you must call the physician or nurse. If you have severe diarrhea that persists for longer than 12 hours you must call the physician or nurse. Please also review Call us immediately if .
Constipation
Constipation is less common than diarrhea and is defined as a change in frequency of bowel movements from what is normal for you. There are several agents used in standard chemotherapy that can have a direct effect on the nerves within the large intestines causing a decrease in motility and rectal emptying. Most common causes, however, are pain medications, not drinking enough fluids, decreased activity, or dietary issues such as not enough fiber in your diet. We have ways of helping you manage this side effect. It is very important that you keep us informed because occasionally, constipation can be a sign of a serious problem, for example blockage in the bowels or damage to your spinal nerves Please see Call us immediately if.
Strategies for Coping with Constipation:
- Drink plenty of fluids. Try to drink 8-10 eight ounce glasses of non-caffeinated and non-alcohol containing fluids daily. If you have been placed on fluid restriction by another physician please let us know so that we can identify an alternative plan for you.
- Maintain normal activity levels as much as possible. A decrease in activity can lead to a decrease in motility in the intestines. Moderate activity such as walking daily will help.
- Watch your diet. Eat foods high in fiber such as vegetable, bean and fruit. If necessary we can consider a fiber substitute.
- Laxatives or stool softeners may be required to maintain adequate bowel function.
- Report changes in bowel habits promptly. This is one problem that the sooner you address it the easier it is to resolve.
Heartburn
Heartburn is an irritation of the esophagus sometimes referred to as indigestion or gastric reflux. Heartburn occurs when food from the stomach backflows upward into the esophagus. This causes a burning sensation that begins at the breastbone and moves up toward the throat. Heartburn is a relatively common occurrence and is caused by multiple factors. Frequent causes include stress, smoking, certain foods such as deep fried foods, caffeine, alcohol and medications, including chemotherapy.
Symptoms of heartburn include:
- Food or liquid coming back into the mouth or throat.
- An acid or bitter taste at the back of the throat.
- Pain behind the breastbone that gets worse when lying down or bending over.
- Burning pain in the chest that moves up toward the throat.
Fortunately, there are many ways to manage heartburn:
- Limit your caffeine intake.
- Limit your alcohol intake.
- Stop smoking if you can.
- Avoid foods that can cause heartburn. For example: chocolate, citrus fruits, fried, spicy or fatty foods.
- Do not eat 2-3 hours before going to bed.
- Elevate the heat of your bed when lying down or sleeping.
- If it is okay with your physician you can try one of the over-the-counter antacids. If these don’t work notify you physician.
- Take medications for heartburn as prescribed and let your physician know if they are not working.
If you continue to experience heartburn despite making lifestyle changes and using the medications you have been prescribed you need to let your physician know.