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 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.
With your family doctor, nurse practitioner and/or primary care team
Speak to your family doctor about your risks for late effects of your cancer treatment. Some (but not all) treatments for testicular 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
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
Infertility
Many people are not sure whether they will be able to have children after their cancer treatment. Read the sections below for information that may apply to you.
A note about having children: There is some concern that chemotherapy and radiotherapy patients may be at risk of having children with malformations. Although evidence is still unclear, use birth control for one year after you finish chemotherapy and radiotherapy treatment.
Causes
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Surgery: Having one of your testicles removed should not affect your ability to father a child; however, having both testicles removed causes permanent infertility.
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Radiation: Radiation therapy may cause a decrease in fertility, which lasts about a year or two. In a few years, your fertility may have returned to pre-treatment levels.
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Chemotherapy: After chemotherapy, it may take two years or more for your fertility to return to normal. It is important to note that any problems you have with sperm production will not stop you from getting an erection or enjoying sex.
What you can do about it
If you chose to use a sperm bank prior to your cancer treatment, you can now discuss future family planning with your doctor.
Read Fertility preservation for men starting cancer treatment [PDF] for more information about sperm banking.
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
- Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.
- Wickham R. Chemotherapy-Induced Peripheral Neuropathy: A Review and Implications for Oncology Nursing Practice. Clinical Journal of Oncology Nursing. 2007. Volume 11(3)361-376.
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Neuropathy (National Cancer Institute)
Sexual Issues
Testicular 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:
- 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.
Causes
Surgery - orchiectomy
In testicular cancer survivors, sexual dysfunction differs based on the type of cancer treatment(s) you have had. A unilateral orchiectomy is a surgery in which one testicle is removed. Having one testicle removed is unlikely to cause any long-term sexual health problems. However, the psychological impact of the diagnosis and surgery can affect your sexual well-being. Sexual dysfunction can result from the stress and negative emotions about having cancer. As a result, you may have lower sex drive, not perform as well as before or enjoy sex less. These changes often resolve on their own as you recover and adapt to your diagnosis and treatment. However, speak to your oncologist or family doctor to find out what else can be done to help you feel better sexually.
If both of your testicles were removed, you will have less interest in sex, have problems with erections, or having orgasms. As a result, you will likely need androgen replacement therapy (a hormone added to your system). Be sure to spend time with your doctor (be referred to a urologist) to find the right kind of androgen replacement therapy for you. Finding the right type of androgen replacement therapy for you can take months because it is complex.
Surgery - retroperitoneal lymph node dissection (RPLND)
Another type of surgery for testicular cancer is called retroperitoneal lymph node dissection (RPLND). RPLND involves removing lymph glands at the back of your belly area where cancer may have spread. This surgery does not affect your ability to have an erection or an orgasm. However, sometimes there is a small risk that the nerves controlling ejaculation may be cut during the surgery. This can lead to changes in ejaculation such as dry orgasms (having an orgasm without any semen).
You may also feel less attractive due to large scars from a RPLND and may fear the reaction of your partner or future partners. It appears however, that couples (and future partners) adjust well to changes in body image and continue to enjoy sex. In the scientific literature, married men commonly report fewer of these anxieties and usually report no change in intimacy after recovery. Some men claim that their sex lives improved after their experience with cancer, since they were able to communicate better with their partners.
Radiation & Chemotherapy
Radiation therapy and chemotherapy are not known to cause permanent changes to sexual function (i.e., erection, orgasm, ejaculation). Some men may lose sexual desire (libido) due to fatigue from cancer treatment. Generally, changes in energy levels are not permanent, and many men regain their ability to enjoy their sex life.
What Princess Margaret Cancer Centre 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
Some people feel less confident about their sexuality after losing a testicle. Know that you have the option to implant a prosthesis (an artificial testicle) to replace the lost testicle. Talk to your oncologist (cancer doctor) about it.
