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Pancytopenia
Pancytopenia is a lowering of all blood counts. It's treated with growth factors, such as Neupogen, Procrit, or Neumega, or with transfusions of red cells, platelets, or irradiated whole blood. See "Infection" for additional information.

Peripheral neuropathy
See "Fingers," "Feet," and "Neurotoxicity."

Pneumonitis
Intravenous administration of cyclophosphamide, mitomycin, vinblastine, or vindesine can cause pneumonitis, appearing as painful or difficult breathing. Report these symptoms to your doctor immediately.
When the lungs are irradiated, pneumonitis may develop within the first year following treatment. Usually, the area damaged coincides with tissue that was irradiated, but on occasion, other lung tissue is affected as well. The symptoms of pneumonitis resemble pneumonia, and it must be distinguished from pneumonia. Pneumonitis is treated with steroids.

Postsurgical confusion
Anything from mild confusion to overt psychotic behavior occurs in some people following general anesthesia, especially in those over age 50. Although time is the best cure, a change in pain medication or room location might also help.
Post-treatment constitutional syndrome
Some patients who have had lung surgery experience a collection of symptomspain at the surgical site, malaise, appetite and weight loss, and decreased lung capacity-known as post-treatment constitutional syndrome. The symptoms might persist for weeks or months after treatment. Rest, exercise, and good nutrition may help overcome them.

Psychological damage
Post-traumatic stress disorder, depression, and anxiety are recognized as frequent short- and long-term sequels to cancer's stress and can be addressed by a professional experienced in handling the psychological issues of cancer survivorship. See Chapter 16, Getting Support. A lung cancer survivor notes that anxiety impacts breathing:
In the pulmonary therapy group I'm part of we have a doctor who has lung cancer. His depression and nerves have been a real problem. He's found an anti-depressant pill that helps him. If you get anxious, you don't breathe as well or as deeply.
Pulmonary thrombosis See "Blood clots."

Pus and discharge
See "Fistulae" and "Infection."

Radiation fibrosis
Radiation fibrosis is the formation of fibrous scar tissue within the lung, caused by the immune system's reaction to radiation. It develops months or years after radiation therapy and might or might not be preceded by pneumonitis. This fibrous tissue is knotty and stiff and interferes with an organs ability to do its job. Fibrosis in the chest structures or lungs can interfere with breathing. Larry Coffman, five-year survivor of SCLC, deals today with scarring from radiation therapy:
I happen to be one of those people who scars a lot, and when I received radiation therapy, my lung was damaged extensively. The resulting scar tissue has pretty much prevented its use, so I am on oxygen at the present time. Not because I can't get enough air; but because of the carbon dioxide buildup in the blood stream, as the blood still flows to the damaged lung and the gases are not exchanged as they normally would. I still suffer tiredness and weakness to an extent. I thank the Lord for my survival and enjoy each and every day. I'd rather be a little scarred than-well, we know what the alternative would be!

There is some recent evidence that administering steroid drugs or certain experimental agents, such as interferon, simultaneously with radiotherapy can reduce the immune reaction that causes fibrosis. Administering steroids after radiation therapy must be done promptly upon noticing the onset of fibrosis because delay causes steroid therapy to be ineffective.
Recent research with hyperbaric oxygen has shown some promise in reducing the negative effect of radiotherapy on certain tissues, such as blood vessels in the brain.

Radiation pneumonitis
See "Pneumonitis" and "Lung damage."

Recall sensitivities
Radiation therapy and certain chemotherapies can damage tissue in a way that leaves it reactive to further treatment for months or years afterward. Radiation to an area can cause tissue in that area to react with pain and dysfunction when chemotherapy is administered afterward, even if the chemotherapy is injected elsewhere.
If you have experienced extravasation (see "Vein problems") during IV chemotherapy, the damaged tissue might remain sensitive to the drug used for years after.
If you believe you're experiencing recall sensitivity, contact your oncologist.

Scar tissue
Scar tissue can form in chest structures following surgery or radiation therapy, causing pain or constriction of organs. There is no treatment yet for this condition.

Second cancers
One of the most serious late risks associated with lung cancer is the risk of developing a second cancer; that is, a tumor whose development is distinct from a recurrence or metastasis of the first tumor.
The chief risk of second cancer that lung cancer survivors face is development of a second lung tumor. It is thought that the same environmental or genetic aberrations that triggered the first tumor, especially tobacco smoking, remain to cause a second primary cancer. If you still smoke, you should quit.

Some lung cancer survivors are more likely to develop second primary tumors in other organs than are the general population. The most common sites of second tumors are the breast, esophagus, head, or neck.
Radiation therapy is linked to the development of second solid tumors. Second tumors that arise following radiotherapy almost always arise in or very near sites of previous irradiation, called radiation ports. The incidence of radiation-induced tumors begins to rise about fifteen years after treatment.

Lung cancer survivors who were treated with high-dose chemotherapy that contains such drugs as etoposide might be at increased risk of developing treatment-related leukemias. Too few lung cancer patients have been treated with high-dose chemotherapy to quantify the risk, although this finding is well documented among lymphoma and breast cancer patients treated with high doses of etoposide.
For all lung cancer survivors, regular surveillance with some combination of chest xrays, CT scans, MRI, blood tests, or mammography is mandatory.

Seizures
See "Neurotoxicity" and "Metabolic imbalances."

Sexual problems
A variety of problems with fertility, sexual performance, and sexual enjoyment can arise during or after surgery or chemotherapy for lung cancer.
A discussion group for those dealing with issues of sexuality following cancer treatment exists on the Internet. Visit listserv.acororg to enroll in the Cancer-Sexuality discussion group.
For an excellent and compassionate discussion of sexual issues after cancer treatment, see Sexuality and Fertility After Cancer by Dr. Leslie Schover (Iohn Wiley &:. Sons, 1997).

Shingles
All who had chicken pox as a child harbor within their nerve cells a herpesvirus called varicella zoster, the virus that causes chicken pox and shingles, two manifestations of the same illness. When the immune system becomes suppressed or dysfunctional, varicella zoster may re-emerge from nerve endings, causing quite terrible pain and blisters called herpes zoster, or shingles. The virus can affect any or all nerve endings within the entire body, but it is most likely to appear along the side of the face, neck, arm, or side of the body Although ten to twenty percent of those with shingles may never produce blisters, they will still experience itching, pain, or both. The blisters tend to appear in a line, following the path of nerves. Shingles that affect the eye can cause temporary or permanent blindness.
There are many human herpesviruses; varicella zoster is just one. It should not be confused with the genital herpesvirus that is transmitted sexually

As soon as symptoms appear, call your doctor. An antiviral medication, such as acyclovir, and perhaps pain medication, as well, should be started promptly It is not unusual to require codeine or even morphine briefly for severe shingles episodes. Shingles normally heal within four to six weeks, but some patients experience lingering pain for years afterward. If this happens, a procedure called a nerve block or glycerine block can be performed by a neurosurgeon. It should alleviate pain for several months and can be repeated if needed.

Skin problems
A variety of skin problems-pain, burning, discoloration, thickening, sweat gland changes, scaling, wrinkling, dryness, rash, hives, redness, peeling, sun sensitivity, or ulceration-are associated with radiation therapy, photodynamic therapy, or certain chemotherapies used for lung cancer.
Radiation burn really slowed me down, on the spot just above my breastbone. I was told it wasn't uncommon, because they want to make that area doggone hot. There is burning and scar tissue. The scar doesn't let oxygen into my bloodstream.
The change in skin color that might accompany treatment is often a tanned effect, but this is not a true suntan that will protect you from the suns rays. In fact, your skin might be overly sensitive to sunlight and prone to wrinkling, freckling, or premature aging, and should be protected accordingly:

Call your doctor about skin reactions. Dermatologic problems can be complex and hard to diagnose, and certain skin symptoms might be a sign of tumor spread to other organs. Common remedies, such as lotions that contain alcohol, might make the problem worse, especially if itching is your chief complaint or if radiotherapy is still underway:

Steroid-related effects
Prednisone and Decadron, the most commonly prescribed glucocorticoids for controlling cough or inflammation associated with tumor activity or radiotherapy, can be responsible for many adverse effects if given in high doses, especially after long-term use. Adverse effects associated with high doses or long-term use can include a suppressed immune response, appetite increases, rapid mood changes, insomnia, stomach pain, gastric ulcers, pancreatitis, diabetes, depression, weight gain (especially in the trunk and face), changes in blood chemistry, menstrual irregularities, impotence, facial redness, thinning of skin, stretch marks, acne, bruising, changes in bodily hair, cataracts, glaucoma, protrusion of the eyeballs, weakening of muscles, osteoporosis, avascular necrosis of bone, high blood pressure, seizures, and, rarely, psychosis.
Fortunately, there is an excellent book available about Prednisone and its side effects. Coping With Prednisone (Griffin, 1998), written by patient Eugenia Zukerman and her sister, Julie Ingelfinger, who is a medical doctor, can answer just about all questions you might have about using this drug.

Thirst
Cyclophosphamide, prednisone, or certain hormone-producing lung tumors can induce diabetes in certain people. Notify your doctor immediately if you experience prolonged, unexplained thirst.
See "Dehydration" and "Metabolic imbalances."

Tumor lysis syndrome
The waste products of a tumor as it dies might disrupt natural levels of body substances, such as electrolytes or antidiuretic hormones. Tumor lysis syndrome, arising from the death of large tumors, might arise shortly after chemotherapy is started. Symptoms of kidney failure caused by excessive amounts of calcium, phosphate, and potassium released by dying tumors are possible and can be offset with oral or IV hydration, careful monitoring of electrolytes, and use of diuretics.
If you or your loved ones notice any unusual symptoms, especially excessive thirst, unusually high or low levels of urination, swollen limbs, yellowing skin, decreased sweat, abdominal pain, or heart or circulatory symptoms, call the doctor.
See "Kidney damage" and "Metabolic imbalances."

Ulceration
Following radiation therapy, healthy skin that was in the path of the radiation beam might ulcerate. The condition might become chronic.
See "Nonhealing wounds" and "Skin problems" for more information.

Urinary problems
See "Infection," "Bladder damage," and "Kidney damage."

Vein problems
At times, chemotherapy that is administered intravenously can leak out of the vein into surrounding tissue, an adverse event called extravasation. The reaction of the body to a high concentration of chemotherapy in the skin or other tissue can be serious and painful. The vein might be unusable for chemotherapy thereafter; the skin might die, slough off, and fail to regrow. Symptoms of extravasation include pain, redness, swelling, or burning at the IV or catheter site, during or after the administration of chemotherapy Notify the medical staff immediately if you have these symptoms during or just after treatment.
If administered into the arm veins, certain drugs-such as cisplatin, vincristine (Oncovin), vinorelbine (Navelbine), or doxorubicin (Adriamycin)-may cause pain, stiffness, redness, or swelling of veins; in some cases, even if no leakage has occurred.

If you notice lengths of rigid, painful, swollen, or red veins in the days or weeks following chemo, tell your doctor. Geri Capasso tells of her brother Anthony's reaction to chemo:
Monday night my brother felt pain in his left arm just above the elbow and it looked a little swollen. Yesterday he went in for his fourth round of Gemzar (he had his fourth round of cisplatin a few days earlier). The doctor thinks it might be an infection, and prescribed KeJlex. Last night and this morning he had no temperature. Early this morning the pain got bad, and it is redder and more swollen.
Ice packs or warm (not hot) compresses may relieve the pain associated with veins that have reacted to chemotherapy To spare your veins from additional damage, your doctor may recommend that you have a venous access device, such as a PICC line or central catheter, inserted.

Water retention
See "Fluid retention," "Kidney damage," and "Heart and cardiovascular changes."

Weight gain
Long-term use of steroids to control coughing or pain might cause weight gain. Usually, this weight is lost when steroid therapy is reduced or ended. Larry Coffman describes his weight gain:
I was told that in some cases, the weight gain after treatment is a defense mechanism to ensure survival. I know that in my case I started at about 190 seven or eight months before diagnosis, and when I was diagnosed I weighed in at a hefty 235. After treatment, I gained up to a paunchy 252.

Weight loss
Most chemotherapies, as well as radiotherapy for lung cancer, cause rapidly dividing cells to die more frequently than other cells. The cells lining the gastrointestinal tract are rapidly dividing cells, so when they are exposed to anticancer drugs, they die sooner than their natural cycle would dictate. As a result, it might become difficult to absorb nutrients during treatment for lung cancer; the effect is made worse if nausea and diarrhea are present. larry Coffman tells how he dealt with weight loss:
'Just goes to show that just when you think you got it bad, somebody else has it worse." I can't remember the author of that phrase, but it sure does apply to lung cancer and its treatment.

I actually began to gain weight (235 pounds) before my diagnosis (imagine that), and that in itself was a small miracle, although I was unaware of this at the time. I was a 5' 10" butterball-okay folks, no turkey jokes.
I dropped over 70 pounds during treatment. I was given some concoction of Maalox and 2 percent Lidocaine to numb my esophagus for up to 30 minutes in order that I could drink my dietary supplement (Sustacal). Well, it worked, for about 30 seconds, then they tried straight 2 percent Lidocaine, one teaspoon before a meal. That lasted long enough for me to put the bottle away. i tried to tell them that I had a very high pain threshold, but alas, they wanted to try it their way-go figure. Therefore, I just quit trying to eat altogether.

I believe to this day that the weight gain, albeit not advisable for everyone, is the Single most important reason for my survival, not to in any way diminish the importance of the radiation therapy or chemotherapy. It re-enforces my notion that health care professionals can talk statistics all they want, but the body, mind and spilit will know things that we are unaware of ... well, let me put my matchbox (my very small soapbox) away.
You know, come to think of it, I have met very Jew patients or survivors that would actually fit into one of the health communities' statistical categories anyway. Especially me!
If you are losing weight during treatment, notify your doctor and see the suggestions included under "Appetite or taste changes," "Diarrhea," and "Nausea and vomiting."

skin is the largest organ of the integumentary system made up of multiple layers of epithelial tissues that guard underlying muscles and organs. Skin pigmentation. varies among populations, and skin type can range from dry skin to oily skin.there are a number of disease on the skin like acne blackheads and more .


acne treatments