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Non-melanoma skin cancer

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Potential side effects of systemic chemotherapy for non-melanoma skin cancer

Side effects can occur with any type of treatment for non-melanoma skin cancer, but not everyone has them or experiences them in the same way. Side effects of systemic chemotherapy will depend mainly on:

  • the type of drugs
  • the dose
  • the person’s overall health

Chemotherapy kills cancer cells, but it can also damage healthy cells. Different cells and tissues in the body tolerate chemotherapy differently.

Side effects can happen any time during, immediately after, or a few days or weeks after chemotherapy. Most side effects go away after chemotherapy is finished. Late side effects can occur months or years after chemotherapy. Some side effects may last a long time or be permanent.

It is important to report side effects to the healthcare team. Doctors may also grade (measure) how severe certain side effects are. Sometimes chemotherapy treatments need to be adjusted if side effects are severe.

Nausea and vomiting

Not all chemotherapy drugs cause nausea and vomiting. Individual drugs vary in their effects, but nausea and vomiting are more likely when combinations of chemotherapy drugs are given.

Nausea and vomiting can occur within the first few hours after chemotherapy drugs are given and usually last about 24 hours. However, delayed nausea and vomiting may continue for a few days after treatment. Some people may have anticipatory nausea after having a few treatments, where they feel nauseated even before treatment is given because they expect to be sick.

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Loss of appetite

Loss of appetite can occur days to weeks after chemotherapy. Nausea and vomiting, fatigue or a buildup of waste products as cancer cells die can cause loss of appetite. Some chemotherapy drugs can cause temporary changes in taste and smell, which can make foods seem less appetizing. Some people lose interest in food completely and don’t eat, even though they know they need to. This can lead to weight loss and malnutrition. Maintaining good nutrition during and after chemotherapy is important to help a person recover from treatment.

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Sore mouth

A sore mouth (also called stomatitis or oral mucositis) occurs because of chemotherapy’s effect on cells inside the mouth. Many drugs can cause a sore mouth. It occurs more often when higher doses of drugs are used. A sore mouth occurs about a week (anywhere from 5–14 days) after chemotherapy is started. It often improves on its own a few weeks after treatment is finished.

Painful mouth sores, ulcers in the mouth and mouth infections can also develop. Thorough, regular mouth care can help prevent a sore mouth and reduce infection. The healthcare team will give instructions about how often to clean and rinse the mouth and what to use. Pain medicines or special oral solutions may be needed to relieve pain.

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Changes to fingernails and toenails

Nail changes are common during chemotherapy. Changes include darkening (usually fades a few months after chemotherapy ends), yellowing, brittleness, cracking, lines and partial separation of nails from the nail bed.

You can help relieve these side effects by:

  • using cuticle cream instead of tearing or cutting nail cuticles
  • protecting nails by wearing gloves when washing dishes, gardening or doing other household chores

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Skin changes

Some chemotherapy drugs can cause minor skin changes or skin irritation. Skin changes can occur during and for some time after chemotherapy. The most common skin reactions to chemotherapy for skin cancer are redness, itching and rash. Skin may be more sensitive or easily irritated by the sun during chemotherapy treatment.

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Hair loss

Hair loss (alopecia) is a common side effect of many, but not all, chemotherapy drugs. Hair follicles are sensitive to chemotherapy drugs because they grow fast. The extent and duration of hair loss is unpredictable because it depends on the type and dose of drugs used as well as personal factors. Hair loss can occur on all parts of the body, including the face and scalp. Hair loss can begin within a few days or 2–3 weeks after chemotherapy starts. Hair usually grows back once chemotherapy treatments are over.

Hair should not be permed, straightened, dyed or coloured during treatment. These products contain chemicals that can damage hair. It is best to wait until new hair growth becomes established and hair returns to its original state. This may take 6 months or more after treatment. Talk to the healthcare team about when you can use these products again.

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Bone marrow suppression

Bone marrow suppression is a condition in which one or more of the main types of blood cells are decreased.

  • A low white blood cell count (neutropenia) increases the risk of infection.
  • A low platelet count (thrombocytopenia) increases the risk of bruising and bleeding.
  • A low red blood cell count (anemia) causes fatigue, paleness and malaisemalaiseA general feeling of discomfort or illness..

Low blood cell counts occur because of chemotherapy’s effect on the bone marrow, where blood cells are made. Blood cell counts often reach their lowest level about 7–14 days after chemotherapy. Bone marrow suppression is a serious side effect of chemotherapy. When it happens, the dose of chemotherapy is adjusted right away or chemotherapy may have to be stopped temporarily. A stem cell transplant may be used to replace bone marrow severely damaged by high-dose chemotherapy or radiation.

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Hand-foot syndrome

Hand-foot syndrome (also known as palmar-plantar erythrodysesthesia or PPE) can be caused by several drugs used to treat non-melanoma skin cancer. Symptoms include redness, tenderness and peeling or scaling of the skin on the palms of the hands and the bottom of the feet. Tingling, pain or numbness can develop in the hands or feet.

Medicine may be given to treat hand-foot syndrome. It is important to avoid things that cause rubbing or heating of the hands and feet as this can make symptoms worse.

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Fatigue makes a person feel more tired than usual and can interfere with daily activities and sleep. It occurs for a variety of reasons. Fatigue may be caused by anemia, specific drugs, poor appetite or depression. It may also be related to toxic substances that are produced when cancer cells break down and die. Fatigue can occur days after a chemotherapy treatment cycle and can continue long after the person has finished their cancer treatment. It will get better as time goes by.

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Fertility problems 

Some chemotherapy drugs used to treat skin cancer can affect the function of the sexual organs. Some men may stop producing sperm and some women may have premature menopause (treatment-induced menopause). These side effects can result in fertility problems (infertility). Whether or not a person will have fertility problems depends on the type and dose of chemotherapy drugs given to treat skin cancer.

Infertility is sometimes permanent. People concerned about having children in the future should discuss the effects chemotherapy treatment may have on their fertility with their doctor. It is important to discuss fertility options before treatment begins.

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Kidney damage

Some chemotherapy drugs can be toxic to the kidneys. The kidneys break down and remove many chemotherapy drugs from the body. When chemotherapy drugs break down, they make products that can damage cells in the kidneys, ureters and bladder. The potential for kidney damage varies with the type of chemotherapy drug used.

Cisplatin (Platinol AQ) is a chemotherapy drug used to treat skin cancer that can cause kidney damage.

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Second cancers

Only a very small percentage of people develop a second cancer resulting from cancer treatment. The risk of developing a second cancer depends on the type and dose of chemotherapy drugs given and the length of treatment. The risk increases when high doses of chemotherapy are used, certain chemotherapy drugs are given (particularly alkylating drugs) and treatment is given for a long period of time.

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Note: Other side effects may occur. For more detailed information on specific drugs, go to sources of drug information.


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