Ongoing & Late Side Effects
Ongoing side effects are often called ‘persistent’ side effects. This means you had them during treatment and they continue after your treatment ends.
‘Late’ side effects of cancer treatment are health problems that can result from cancer and/or cancer treatment that do not show up until six months to one year or more after treatment. These problems and risks are often called late side effects because they start late (after treatment) and can have long-term effects on your health.
Ongoing and late side effects are related to the type of treatment you had, your type and stage of cancer, the effectiveness of your treatments, and your overall health after treatment.
With your oncologist (cancer doctor)
Speak to your oncologist or nurse at your follow-up appointments about possible late effects related to the type of treatment you had and what signs to watch for specifically.
Since these effects typically start one year or more after treatment ends, you may not be seeing your oncologist very often. For this reason it is important to write down your risks so you can discuss how to screen and maybe even prevent some of them with your family doctor.
Read about ongoing and late side effects above. Your family doctor can screen for these risks and problems. You and your doctor should pay attention to changes in your body and how you feel to monitor your health with the right tests.
With your family doctor, nurse practitioner and/or primary care team
Speak to your family doctor, nurse practitioner and/or primary care team about your risks for late effects of your cancer treatment. Some (but not all) treatments for colorectal cancer can lead to the ongoing and late side effects listed below. Your family doctor can screen for these risks and problems. You and your doctor should pay attention to changes in your body and how you feel to monitor your health with the right tests.
Cancer-Related Brain Fog
Research has shown that 1 in 3 people who have had treatment for cancer experience declines in their thinking abilities. This is sometimes called “cancer-related brain fog”.
Some symptoms of cancer-related brain fog are having a hard time:
- Focusing on a task for long
- Finding the right word or the name of someone you know
- Learning new information or skills
- Recalling information that you know
- Multitasking and organizing daily tasks
- Paying attention – losing your train of thought
- Getting things done as quickly as you did before
Causes
The precise causes of cancer-related brain fog are poorly understood. Causes may be different for different people and may change over time.
What you can do
There are currently no medical treatments for cancer-related brain fog. However, symptoms may be improved with changes in behaviour and adopting some methods to offset the effects of brain-fog. For more information read
Cancer-Related Brain Fog [PDF].
If you are concerned about your symptoms, ask your oncologist (cancer doctor) or family doctor if there are any blood tests or brain imaging tests that can help rule out other causes such as thyroid, B12, sleep apnea, anxiety, depression etc.
Attend a class at Princess Margaret Cancer Centre called “What you can do about brain fog”.
See the schedule for the 'What You Can Do About Brain Fog' class. You can also ask your doctor about a referral to the Neurocognitive Clinic.
More information
Changes in Bowel Function
Many people who have received treatment for colorectal cancer will experience changes in their bowel function. After some time these changes will go away and people will reach a “new normal” (a new stable pattern of bowel function).
Here are some of the most common changes in bowel function.
Low anterior resection syndrome
Low anterior resection syndrome is a temporary side-effect of surgery for rectal cancer. Low anterior resection syndrome is when people have many small bowel movements, that happen often and are urgent (come on suddenly).
Low anterior resection syndrome is the most common side effect of surgery for rectal cancer. This side-effect will improve over time. Most people have a return to a “new normal” pattern by 12-18 months after their surgery.
Other bowel changes
There are many other types of bowel problems that can result from cancer treatment. These include:
- More gas and bloating than before treatment
- Trouble digesting some types of food, such as foods that are high in fibre or fatty foods
- Bowel control problems
The following symptoms below may also be a sign of colorectal cancer recurrence. If you have any of the signs listed below please report these to your oncologist, family doctor, nurse practitioner and/or primary care team immediately.
- Pain in the belly area
- Blood in stool (red or black stools)
Two of the most common kinds of bowel problems after treatment are diarrhea and constipation.
Diarrhea
Diarrhea is loose, watery or soft bowel movements that you may have more than 3 or 4 times a day. You may have diarrhea along with stomach cramping and bloating. Diarrhea can last for as little as a few hours, or it can become a long-term problem.
Constipation
Constipation is the opposite of diarrhea. Constipation is when you do not have regular bowel movements for 2 or more days when compared to your normal bowel routine. Some things can make constipation worse, such as inactivity, immobility, or limited access to bathrooms.
After you have reached your “new normal” pattern it is important that you are aware of any new changes. Make sure that you report any new changes to your oncologist, family doctor, nurse, or another member of your health care team. For more information on which symptoms to report, please read the section Watch for possible signs of recurrence.
Causes
There are many causes of bowel problems, such as chemotherapy, radiation therapy to the abdominal area, and certain types of medicines for side effects.
More information
Fatigue
Fatigue is when your mind and body feel tired. Regular fatigue is when you feel tired but you feel better when you get rest and sleep. Cancer-related fatigue is more severe and lasts longer than other types of fatigue you may have felt before. It can make it hard for you to do things on a daily basis. This kind of fatigue is related to cancer or its treatment.
Cancer-related fatigue can affect your relationships, daily activities and ability to work. It can occur at any time during treatment, and can continue even after treatment ends. It can come and go, be mild or severe, last a short or long time.
Causes
Cancer-related fatigue can be caused by the cancer itself, cancer treatment, or many other things. It may not be possible to know the exact cause of your fatigue. It is important to speak to your doctor about other medical problems that may contribute to your cancer related fatigue.
What you can do
There are many ways you can reduce cancer-related fatigue. If you are still seeing your oncologist at Princess Margaret, you can ask them about referral to the Fatigue Clinic.
If you have stopped seeing your oncologist, ask your family doctor, nurse practitioner or your primary care team for resources.
More information
Hearing Problems
Hearing loss is a decrease in how well you hear. It can happen to 1 or both ears.
Causes
There are 2 main causes of hearing loss.
Damage to your nerves or inner ear
This can be caused by:
- Age
- Noise
- Some types of medicine (including chemotherapy)
Cisplatin, a chemotherapy medicine, can cause damage to the nerves or inner ear. It may go away with time. Sometimes, it can take months or years to go away. For some people, it may never go away.
Some other causes are infection, noise, medication, and radiation therapy.
Blocked ears
This can be caused by:
- Ear wax buildup
- A hole in the eardrum
- Fluid behind the eardrum
What you can do
Talk to your family doctor about your hearing loss. Make a list of what you notice and bring this list to your appointment. It is also helpful to write down how long you have noticed these changes.
More information
Incisional Hernia
Incisional hernias happen when part of the abdominal wall pushes through the surgical site, causing discomfort or pain. Incisional hernias are one of the most common complications after abdominal surgery.
Causes
Most incisional hernias occur in the first 2 years after abdominal surgery, but some might develop many years after surgery.
You are more likely to get an incisional hernia if you:
- Have an infection
- Are obese (overweight)
- Smoke
- Have diabetes
- Cough
- Vomit (throw up)
- Do heavy physical exercise (for example lifting heavy objects)
- Strain while having a bowel movement (pooping)
What you can do
There a number of things you can do to reduce your risk of incisional hernia. You can maintain a healthy diet, reduce smoking, and monitor the surgical site. You can also reduce heavy lifting or unnecessary abdominal strain. Talk to your doctor, nurse practitioner and/or primary care team if you notice any changes around your incision site.
More information
Lymphedema
Lymphedema is when a body part swells up. If you have lymphedema, you may have symptoms such as swelling or a feeling of stiffness in the affected areas.
Causes
Lymphedema is caused when parts of your body are not being drained properly because your lymphatic system was damaged by cancer treatment. The swelling is caused by a build-up of protein-rich fluid in your body tissues.
If you have had your lymph nodes removed or have received radiation to the lymph nodes, you are at risk for lymphedema in the affected area for the rest of your life.
If you had treatment for endometrial cancer, lymphedema may occur in your lower body.
What you can do
The swelling caused by lymphedema can be controlled and may even go away if you care for it regularly. Caring for your lymphedema can help reduce the symptoms you feel and prevent problems from happening in the future or getting worse.
You can ask your doctor about a referral to the Lymphedema Clinic.
More information
Neuropathy
Neuropathy (sometimes called peripheral neuropathy) happens when nerves are not able to send or receive information. Neuropathy can happen during or shortly after receiving a treatment. It can last a few days or it can last longer than a year. Sometimes, damage to your nerves can happen months or years after treatment.
Neuropathy can cause symptoms such as:
- Tingling
- Burning
- Weakness or numbness in your hands or feet
- Loss of sensation of touch
- Loss of balance or trouble walking
Causes
Sometimes chemotherapy medicine (and other health problems) can cause neuropathy. With chemotherapy, neuropathy is more likely to happen when you get higher doses. It is also more likely to happen if you get more than 1 dose.
What you can do
Tell your doctor if you notice any signs or symptoms of neuropathy. Write down the signs you noticed and when they started. Bring this list to your appointment.
More information
Radiation Enteritis
Radiation enteritis is damage to the colon caused by radiation therapy, which is a type of treatment for cancer. People who have had radiation therapy to the pelvis or belly may have a higher risk of radiation enteritis.
Some of the symptoms of radiation enteritis include:
- Nausea
- Vomiting
- Frequent urges to have a bowel movement
- Stomach cramping
- Rectal bleeding
- Watery diarrhea
- Weight loss
What you can do
There a number of things you can do to manage changes in bowel function after radiotherapy:
- Slowing the passage of stool through the bowel (diet management)
- Emptying the bowel more effectively
- Strengthening the muscles used for bowel control
Talk to your doctor if you notice the signs and symptoms of radiation enteritis.
Sexual Issues
Colorectal cancer and its treatment affects people in different ways. Sometimes it can change your ability to enjoy or have sex. This is called 'sexual dysfunction', and can include:
- Dyspareunia (difficult or painful sex)
- Less interest in sex
- Not being able to get or sustain an erection (erectile dysfunction)
- Taking longer to achieve orgasm
- Having an orgasm without any semen or with urine instead of semen (ejaculation problems)
These problems can often be treated and managed.
Sexual dysfunction often involves the need to talk to your partner, see the resources under "More information" below.
Surgery - Abdominoperineal resection
Abdominoperineal resection is surgery to remove the lower colon, rectum, and anus. During this surgery, the surgeon creates a stoma (artificial opening) in the abdominal wall that allows stool to leave your body. This procedure is called a colostomy. A special bag or pouch (colostomy bag) is attached to the stoma to collect food waste from the colon.
Many people can reach an enjoyable sex life while living with a stoma- it may just take some adjustment and planning.
Some peoples’ sexual preference includes anal intercourse. If you have had colon cancer, there is no restriction with respect to anal intercourse. If you have had rectal cancer, anal intercourse may be traumatic to the colorectal anastomosis (reconnection). You should discuss this with your surgical oncologist (cancer doctor who performed your surgery). Your recommendations will depend on the details of the surgery you had, how much time passed from your surgery, and your overall treatment.
Radiation and Chemotherapy
Radiation and chemotherapy can cause some side-effects on sexual function.
For people with penises, radiation to the pelvis can cause problems with erections. About 40% of people who have had no erectile problems before their cancer treatment, can develop impotence or erectile problems as a result of radiation.
For people with vaginas, radiation can cause:
- Vaginal dryness
- Vaginal stricture (tightness)
- Dyspareunia (difficulty or painful sex)
- Bleeding during sex
- Early menopause
Some types of chemotherapy can also cause early menopause.
Some people may lose sexual desire (libido) due to fatigue from cancer treatment. Generally, changes in energy levels are not permanent, and many people regain their ability to enjoy their sex life.
Sexual problems, which may be caused by treatments or by psychological reactions and mood, often fall into one of four categories:
- Libido (sex drive) or desire disorders, which is the decrease or loss of sexual fantasies and desire
- Arousal disorders, which include the inability to achieve or maintain sexual arousal, such as lubrication or swelling
- Orgasmic disorders, which is the delay or absence of orgasm following normal arousal
- Pain disorders, which is genital pain during sexual intercourse
Causes
In colorectal cancer survivors, sexual dysfunction differs based on the type of cancer treatment(s) you have had. Sexual dysfunction can also result from the stress and negative emotions about having cancer.
What your doctor will do
Sexual health is part of overall health and healing. You can talk to members of your health care team about your concerns.
What you can do
For detailed ideas about what you can do, see the resources under "More information" below.
More information
Skin Effects from Radiation
You may experience skin sensitivity in the groin and anal area (perineum) before, during and after having radiation therapy.
What you can do
There are a number of things you can try to help you manage local skin effects, such as:
- Wash the treated area gently with warm water using a mild, unperfumed and unscented soap like baby soap or Dove.
- Take showers instead of baths. Sitz baths may help. Dry the skin using a soft towel or a hairdryer on a cool setting.
- Wear natural fibres such as cotton instead of synthetic fibres.
More information
Vaginal Dryness
The vagina makes its own natural fluid (lubrication, also known as “lube”). The fluid keeps the vagina elastic and healthy. When sexually aroused, the vagina will produce extra fluid. This fluid helps reduce friction. It makes putting anything into the vagina more comfortable. This also makes sex feel more pleasurable.
When the vagina does not produce enough fluid, it causes vaginal dryness.
Causes
There are many causes of vaginal dryness. Some causes of vaginal dryness include:
- Older age
- Lower amounts of estrogen in the body
- Chemotherapy
- Radiation to the pelvis or vagina
- Surgery to the vagina or reproductive organs
What you can do
There are two things you can do:
- Ask your doctor if you can take estrogen. This will reduce vaginal dryness and other menopause symptoms.
- Use vaginal moisturizers and lubricants. They will help make your vagina less dry and more comfortable. Vaginal moisturizers and lubricants will also help increase your pleasure during sex. You can buy these without a prescription. They are a safe and useful choice for most people.
More information
