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.
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 endometrial 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.
Bladder Problems
Many cancer patients have bladder problems. You may wet yourself or need to urinate (pee) very often. Some people can have minor leaks of urine. This is called urinary incontinence. There are many types of urinary incontinence. Here are 3 common types:
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Stress incontinence. This happens when you leak urine when you do things that add pressure to your bladder. This may include laughing, sneezing, coughing, lifting something heavy.
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Urge incontinence. This happens when you need to urinate very suddenly. This can happen often during the day and at night. You may not have enough time to get to a toilet before some urine leaks.
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Overflow incontinence. This happens when you leak some urine because your bladder is full. This may just be a small amount of urine.
Causes
Urinary incontinence can be caused by:
- Surgery
- Radiation therapy
- Some medicines
- Cancer itself
What you can do
Talk to your doctor. Only your doctor can help with some causes of bladder problems. Your doctor can talk to you about different options that may help. You may need special tests to find out what is happening in your body. You may need a referral to a specialist. Your doctor may also adjust or prescribe new medicine to see if it helps.
Before you visit your doctor, write down how bladder problems are affecting your life. Bring this list with you to the appointment.
Tips to Improve Your Bladder Control
You can also try these tips to help improve your bladder control:
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Kegel exercises.
To do kegel exercises:
- Squeeze the muscles that prevent you from passing gas or emptying your bladder
- Hold while counting to 3
- Then relax them while counting to 3
10 exercises are called 1 set. Do 1 set, 5 times a day.
For more information on these exercises, read the resource called
Urinary Incontinence: Pelvic Floor Exercises [PDF]. You can also find it in the Princess Margaret Patient and Family Library.
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Bladder training.
There are 2 ways you can train your bladder:
- Wait a little before you urinate. You can begin with very small waiting times, such as a few minutes. Later, you can wait longer and longer.
- Plan your washroom breaks. For example, you can plan to empty your bladder every 2 hours. You can remind yourself by setting an alarm on your watch or phone.
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Body weight.
If you are overweight, losing weight may improve your bladder problems. The
Canadian Food Guide has information about healthy eating. Talk to your family doctor for more help.
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Avoid certain fluids.
Some fluids can make bladder problems worse. Avoid:
- Drinks that contain caffeine, such as: coffee, black tea, soda
- Drinks that contain alcohol, such as: beer, wine, liquor
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Stop smoking.
If you smoke cigarettes, try to stop smoking; it may help your bladder problems. It may also have other health benefits for you. Talk to your family doctor about ways to stop smoking.
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Absorbent products.
If you cannot control your bladder in public, you can wear absorbent pads. This will help protect your clothes from getting wet and avoid embarrassment. This way you can continue doing the things you do in your regular day.
More information
Bowel Problems
There are many types of bowel problems that can result from cancer treatment. These include:
- A sudden need to have a bowel movement and/or pass gas
- More gas and bloating than before treatment
- Pain in the belly area
- Blood in stool (red or black stools)
- Trouble digesting some types of food, such as foods that are high in fibre or fatty foods
- Diarrhea
- Constipation
Two of the most common kinds of bowel problems after treatment are diarrhea and constipation.
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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.
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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.
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
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.
You can attend a class at Princess Margaret Cancer Centre called
What you can do about brain fog. 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. You can ask your doctor about a referral to the Fatigue Clinic.
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
Infertility is being unable to become pregnant. Some cancer treatments can cause temporary infertility and some can cause permanent infertility. People react to infertility in different ways. For some, infertility can be very distressing to live with. It may seem especially hard when you have had a long journey with cancer.
Causes
The main treatments for cancer are chemotherapy, radiation therapy, and surgery. These treatments affect fertility in different ways.
What you can do
Some people find it helpful to talk things over with their partner, family or friends. Others may prefer to talk to a counsellor. Your family doctor or cancer specialist can arrange this for you.
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
Menopausal Symptoms
Some cancer treatments can cause early menopause as a side effect. This is called ‘treatment-induced menopause’. In this case, menopause may be temporary or permanent. It depends on the type of cancer treatment you had, and other factors.
Some common symptoms of menopause:
- Hot flashes
- Night sweats
- Problems sleeping, such as not being able to fall asleep
- Weight gain
- Vaginal dryness or vaginal itching
- Some loss of bladder control
- More frequent bladder infections
- Mood swings or getting easily irritated
- Problems with memory and concentration
You may have all of these symptoms or only a few. Every person is different.
Causes
Some surgeries to treat endometrial cancer can cause early menopause. When menopause starts, estrogen levels start to decrease and vaginal dryness and vaginal atrophy (shrinkage) may occur.
Some types of chemotherapy may also cause a sudden loss of estrogen production from the ovaries. The loss of estrogen can cause:
- Shrinking, thinning, and loss of elasticity of the vagina
- Vaginal dryness
- Hot flashes
- Urinary tract infections
- Mood swings
- Fatigue
- Irritability
What you can do
Speak to your oncologist or nurse at your follow-up appointments or call if your appointment is too far away. You can also speak to your family doctor.
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
- 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)
Osteoporosis
Osteoporosis is a condition where, over time, your bones become thin and brittle and are more likely to break. For most people, osteoporosis is linked to aging.
If you have gone through natural menopause (due to your age), you are not at increased risk for osteoporosis because of your treatment. You should be screened for osteoporosis at your annual check-up with your family doctor.
If you had a cancer treatment that caused you to start menopause early, osteoporosis is now a risk for you. Get screened for osteoporosis by your family doctor.
Causes
Based on the type of cancer treatment(s) you had, your body may now make less estrogen. Treatments that may affect your body making estrogen include:
- Surgery to remove your uterus and ovaries
- Radiation therapy to your pelvis
- Some types of chemotherapy
Estrogen is made by the ovaries, and protects your bones. Any treatment that impacts your ovaries can cause your body to make less estrogen, which means that your bones will not get the same level of protection.
What you can do
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Work with your family doctor. If you are going through menopause caused by your cancer treatment, and are younger than 50, ask your family doctor to screen you for osteoporosis. It is important to ask your family doctor to screen you because screening for osteoporosis is usually not done under age 50.
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Be proactive. Certain things can speed up bone loss or slow down bone growth, and this can lead to osteoporosis. For example, alcohol, cigarettes, and some medicines reduce bone mass. Some foods make it hard for your body to absorb calcium, which can lead to weaker bones.
There are many things you can do to help prevent osteoporosis.
- Limit the amount of alcohol you consume. Alcohol is a major cause of bone loss. Heavy drinking can cause osteoporosis even if you have no other risk factors.
- Do not smoke or cut back on the number of cigarettes you smoke. Smoking reduces bone mass and interferes with estrogen levels.
- Be active. Inactivity makes your bones lose strength and become thinner. Over time, thin bones may break. People who are not active are at a higher risk for osteoporosis.
- Talk to your doctor about your medicines. Certain medicines such as cortisone increase bone loss. They also decrease bone growth. Ask your health care provider about any side effects of your medicines and how they may impact osteoporosis.
- Watch what you eat. Protein-rich or salty foods eaten in large amounts may deplete your calcium.
- Do not drink or eat food with caffeine at the same time as having your calcium-rich food or drink (like milk, yogurt, cheese etc.) Caffeine increases calcium loss. People who drink a lot of coffee, tea, or colas lose more calcium than those who do not.
More information
Sexual Issues
Sexual problems may be caused by treatments or by psychological reactions and mood. Sexual problems can also be called "sexual dysfunction", and often fall into one of four categories:
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Libido (sex drive) or desire disorders, which is the decrease or loss of sexual fantasies and desire
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Arousal disorders, which include the inability to achieve or maintain sexual arousal, such as lubrication or swelling
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Orgasmic disorders, which is the delay or absence of orgasm following normal arousal
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Pain disorders, which is genital pain during sexual intercourse
Causes
In endometrial 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 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
For detailed ideas about what you can do, see
Intimacy and Sexuality After Treatment for Gynecologic Cancer [PDF].
More information
Sleep Problems
Many cancer patients have trouble sleeping, especially cancer patients who have had chemotherapy. These problems can continue even after cancer treatment has ended.
It is normal to wake up 1 to 2 times each night, but it is not normal to stay awake. If these symptoms occur three or more times a week, you may have a sleep problem.
Causes
Sleep problems can be caused by many factors in your life, including stress and the medicines used to treat cancer. Younger people are often more likely to have sleep problems than older people.
What you can do
There are a number of things you can try to help you manage your sleep problems. You can read more about managing your sleep problems in
Managing Sleep Problems after Cancer [PDF].
More information
Vaginal Stenosis
After radiation therapy and some types of chemotherapy, the vagina can become narrow. This is called vaginal stenosis. A vaginal dilator will help you to keep your vagina open (prevent vaginal walls from shrinking) and keep the walls more elastic and stretchable.
It is important to keep your vagina open to reduce discomfort during routine exams and exams to check for cancer recurrence, as well as during sex. Even if you are not currently having sex or do not want to have sex, vaginal dilators are very important to help maintain vaginal size so that you may have less discomfort with pelvic exams and for intercourse in the future.
Water based vaginal lubricants like KY Jelly® and vaginal moisturizers like Replens® may be needed for vaginal dryness. You can buy vaginal lubricants and moisturizers off the shelf at most pharmacies (no need for a prescription).
Causes
Various treatments for endometrial cancer can cause vaginal stenosis, including pelvic and vaginal radiation.
What you can do
Frequent vaginal sex is a good way to reduce vaginal narrowing and keep the tissue lining the vagina elastic (stretchable). If you have a supportive partner, try to have sex often to help keep your vagina open (prevent vaginal walls from closing). You can use vaginal lubricant during sex for your comfort.
You can also start to use a vaginal dilator a few days after your radiation therapy 3 times a week, for 6 months in total.
More information
Weight Gain
Some people gain weight during cancer treatment. Gaining a little weight during cancer treatment is normally not a problem. However, gaining a lot of weight may affect your health and wellbeing. Weight gain can also affect how quickly you recover after cancer.
Causes
- The cancer itself.
- Some types of cancer treatment.
- Medicine used to help manage side effects.
- Side effects like fatigue. Fatigue may cause cancer survivors to be less active.
What you can do
If you are worried about your weight gain, talk to your doctor or a registered dietitian. Do this before starting a diet or changing your eating habits. Your doctor can help find out the possible cause of the weight gain. Your doctor and dietitian can also help you find the best way to manage it. A dietitian can provide nutrition guidelines or a diet plan tailored to your needs.
You can attend classes on healthy eating or exercise, or view the healthy eating classes online. For more information about healthy eating classes or exercise classes, see the
Princess Margaret’s calendar of events.
More information
Weight Loss
Weight loss can be a problem for many survivors. This usually depends on the type of cancer and treatment. It is important to get to a healthy weight so you can:
- Have more energy
- Feel better
- Enjoy your life more
Causes
One possible cause of weight loss is the cancer itself. Cancer can change the way the body uses protein and calories, which sometimes leads to weight loss.
Cancer treatments can also cause weight loss, especially when they affect the digestive system. Side effects such as nausea, vomiting, mouth sores, swallowing difficulties or taste changes can affect your ability to eat, which can lead to weight loss.
Other side effects from cancer and its treatment may include pain, depression and fatigue. These can reduce your appetite, cause you to eat less and result in weight loss. These side effects may be short term and get better over time. Sometimes they can last long after treatment is finished.
What you can do
If you have finished your treatment and are still losing weight, talk to your doctor about what a healthy weight is for you at your follow-up appointment. Ask your doctor how to reach the weight that is best for you. You and your doctor can work together to control some side effects of cancer that make you lose weight.
If you would like to attend or view classes online around healthy eating, see the
Princess Margaret’s calendar of events.
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