Radiation Fibrosis

Radiation Fibrosis

Radiation therapy is used as an adjunct treatment for cancer to kill off any remaining cancer cells in the surrounding tissues which are often called “micrometastases.” Radiation therapy is not appropriate for all cancer patients, but for those who do have treatment plans which include radiation, the short and long-term effects can be difficult to tolerate. Today, I want to share more about one long-term effect of radiation therapy called radiation fibrosis.

What is Radiation Fibrosis?

Radiation fibrosis (RF) refers to tissue changes which occur locally after someone goes through radiation therapy. Tissues which are most often affected are the skin, subcutaneous tissues (fat, muscle, bone), organs such as the lungs or heart, or the gastrointestinal/genitourinary tracts depending on the part of the body that is irradiated. Ions from radiation beams cause DNA damage and localized inflammation around the tumor site as well as in the surrounding normal tissues. The degree of damage often depends on each individual’s sensitivity to the radiation itself as well as the dose given and area of tissue treated.

Who is at Risk for Radiation Fibrosis?

Anyone who undergoes radiation therapy as part of their cancer treatments is at risk for RF. Some factors that increase susceptibility of developing RF include:

  • Those who also have concurrent chemotherapy or surgery
  • Those with pre-existing connective tissue disorders (scleroderma, lupus, or Marfan’s syndrome)
  • Those with a genetic mutation in the ataxia-telangiectasia (ATM) gene which assists to repair damaged DNA

How does Radiation Fibrosis Present?

RF onset can be immediate, early delayed (0-3 months after treatment), or late delayed (>3 months after treatment), however most find that symptoms begin to show up 3-4 months after treatment ends. Symptoms usually come on gradually and they are, unfortunately, not reversible.

Some of the symptoms include:

  • Thickening of the skin
  • Muscle tightness or atrophy
  • Limited joint mobility
  • Lymphedema
  • Mucosal fibrosis (mouth, throat, GI tract, genitourinary tracts)
  • Pain

What Treatments are Available for Radiation Fibrosis?

Physical therapy is proven to increase range of motion lasting up to six months post-treatment (and probably longer if the person continues their exercises)! PT’s can use manual therapy or prescribe specific exercises to mobilize the skin and myofascial tissues, increase range of motion in affected joints, improve strength, and manage lymphedema (if they are a lymphedema specialist – if not, then they should refer you to someone who is a certified lymphedema specialist).

For reproductive/colorectal cancers in particular, seeing a pelvic floor physical therapist may be indicated to ensure independence with toileting (especially bowel movements) or to assist with sexual concerns like pelvic pain or tightness.

Other potentially-beneficial treatments may include hyperbaric oxygen therapy, pentoxyfilline (a drug that helps to improve blood flow to the tissues) with or without the addition of vitamine E (a powerful antioxidant), and botox injections – but the research is still pending on the true benefits of these treatments!

If you or someone you know is going through radiation therapy, let them know about RF & send them to a physical therapist to help with any mobility concerns they may have!

Aloha ❤

References:

  1. Radiation-induced fibrosis: mechanisms and implications for therapy (Straub, et al. 2015)
  2. Supervised physical therapy in women treated with radiotherapy for breast cancer (Braz da Silva Leal, et al. 2016)
  3. Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors (Stubblefield, et al. 2011)
Cancer & Pelvic Pain Conditions

Cancer & Pelvic Pain Conditions

On today’s blog, I wanted to bring attention to female pelvic pain and dyspareunia (pain with intercourse) secondary to cancer treatments.

Often, when a woman is put on adjuvant hormonal treatments, chemotherapy, or fertility-saving drugs during active treatment, the body goes into a state of menopause or “chemopause” as it’s commonly referred to in the cancer world.

Low estrogen levels during chemopause can cause symptoms like:

  • Amenorrhea (loss of menstrual cycle)
  • Low libido
  • Vaginal dryness or atrophy
  • Hot flashes
  • Mood changes
  • Joint aches and pains

In particular, vaginal dryness or atrophy can have a huge impact on sexual health, emotional health, and relationships post-cancer. If the pelvic floor muscles are compromised by treatment, it can result in pelvic pain (like pain from overactive or tight pelvic floor muscles, pain in the tailbone, lower abdominal pain, or pain around post-surgical scars), bladder/bowel changes, or painful sex.

Thankfully, a pelvic floor physical therapist with specialized training in examination and treatment of the pelvic floor muscles can treat these conditions and are an amazing asset to oncology patients on their road to recovery. Some PT treatments for pelvic pain and dyspareunia may involve:

  • Pelvic floor muscle strengthening or relaxation exercises with or without biofeedback training (computer or ultrasound-based pelvic floor training technology)
  • Stretches for tight muscles around the abdomen, pelvis or hips
  • Manual therapy including general massage, pelvic floor muscle release techniques, or scar tissue mobilization
  • Education and lifestyle strategies surrounding posture, nutrition, bowel and bladder habits, and lubrication options during intercourse
  • Education in the use of vaginal dilators to reduce pain that occurs with tampon insertion, gynecological exams, or sex
  • Encouragement around body image and sexual health (this could include referral to a sex therapist or psychologist when appropriate)

If you’re reading this, and you feel like you could benefit from pelvic floor physical therapy during or after cancer treatment, you can find a qualified pelvic floor PT in your area here or here. Ask your doctor for a referral today!

And a quick reminder for all of us…
The path to recovery from cancer involves a whole host of treatments including chemo, hormonal treatments, surgery, and radiation just to name a few. Each of these treatments can come with significant side effects or long-lasting comorbidities. Just because someone is “cured” from cancer doesn’t always mean they are living without long-term effects from treatment. Keep this in mind, and be kind!

*This blog is part 2 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Chemo & Constipation

Chemo & Constipation

Chemo and constipation. Oh, poop! As a pelvic floor physical therapist and breast cancer thriver who is currently in the home stretch of chemotherapy, I can personally testify that constipation is no joke!

Having regular bowel movements during chemo is important to help detox the body of chemotherapy medications. In doing so, other side effects of chemo can be reduced. Backed-up bowels can contribute to or worsen nausea and vomiting. Unmanaged constipation during chemo can cause painful hemorrhoids or anal fissures that can put a patient at risk of infection while immunocompromised.

So how do we treat or avoid constipation during chemo? Well, let’s start with the basics and go from there…

What is constipation?

Typically, a person should expect to have a bowel movement anywhere from three times per day to three times per week. Stools should be soft and easy to pass (like #3 or 4 on the Bristol Stool Chart below). You may have constipation if your bowel movements are irregular (several days pass between BM’s) or your stool is very firm and is painful or requires straining to pass. Sometimes, it may feel that you’re not able to empty your bowels completely as well.

Borrowed from abc.net.au1

What causes constipation?

Generally, constipation is related to not getting enough water or fiber in your diet. It can also be from not getting enough exercise or from changing your routine when you travel. Unfortunately for some people going through cancer treatment, certain chemotherapy medications can cause gastroparesis (slow or paused digestion of food), which can lead to constipation.

How can you relieve constipation?

*Drink warm liquids (water, tea, coffee) first thing in the morning to kick start digestion and bowel movements, and be sure to drink plenty of water throughout the day (aim to drink half your body weight in ounces of water).

*Exercise! Take a short 10-15 minute walk or try these gentle stretches to stimulate the bowels.

*Eat plenty of fiber. Try to eat 25-30 grams of fiber daily with foods like broccoli, Brussels sprouts, beans, lentils, oatmeal or whole grains.

*Practice good toileting habits:

  • Use proper pooping posture – place your feet on a stool or rest your elbows on your knees to make it easier to empty the rectum.
  • Relax your pelvic floor muscles & breathe!
  • Don’t strain – come back later if you’ve got to push!
Borrowed from MacMillan Cancer Support3

*Try supplements and medications if the above fail. Ask your doctor about magnesium supplements, fiber/psyllium supplements (like Benefiber or Metamucil), stool softeners, or laxatives that might be helpful.

Remember: When it comes to constipation – consistency is key! Don’t scale back on your bowel routine because things begin to lighten up. During chemotherapy, you’ve got to stay on top of things to stay comfortable. If you need help getting a routine that works well for you, ask your doctor about a referral to a pelvic floor physical therapist in your area!

*This blog is part 1 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Understanding your Lab Results During Chemo

Understanding your Lab Results During Chemo

During chemo, there are a few important labs that your provider will run frequently. These specific tests help them determine the best course of treatment for you and give you and your provider an idea of how your body responds to treatment, guide future treatments and help you understand your risk for infection, anemia, or liver/kidney damage as you go through treatment.

Knowledge is power.

Below, I’ll outline two common panels that your doctor may order to check on your general health. This is meant to be a rough reference guide so be sure to ask your doctor what it might mean for YOU specifically if something comes back outside of the reference range!

Complete Metabolic Profile1

A panel that relays important information about your body’s metabolism and chemical balance. Click on the number under additional info to read more!

TestNormal RangeAdditional Info
Glucose70-99 mg/dLYour blood sugar levels! Glucose is the body’s main source of energy so it’s important for this to be balanced. It can indicate diabetes if high.2
Blood Urea Nitrogen (BUN)
6-23 mg/dL

An indicator of your kidney’s ability to remove waste products from the blood.3
Creatinine0.7-1.4 mg/dLA waste product of muscle breakdown which happens with everyday activities. This test indicates kidney function as the kidneys typically clear creatinine from the blood/urine.4
Sodium5

Potassium6

Chloride7

Carbon Dioxide (CO2)8
133-145 mEq/L,
3.3-5.1 mEq/L,
95-108 mEq/L,
21-30 mEq/L
Substances, sometimes called electrolytes, which help balance your body’s fluid and acid/base regulation. These tests can indicate a variety of metabolic disturbances such as dehydration, irregular heart rhythms, or alkalosis.
Calcium8.3-10.5 mg/dLAn important mineral for regulation of nerve, muscle, and heart function! Not just good for your bones!9
Alkaline phosphatase (ALP)10,
Alanine transaminase (ALT)11,
Aspartate aminotransferase (AST)12
35-129 IU/L,
0-41 IU/L,
0-40 IU/L
A variety of liver enzymes which indicate liver function.
Bilirubin0-1.2 mg/dLA waste product from the liver that indicates liver function.13
Albumin3.5-5.2 g/dLA protein made in the liver that helps to carry out various bodily processes. Low levels may indicate liver or kidney dysfunction.14
Total protein6.4-8.3 g/dLA measure of the total protein in your blood.

Complete Blood Count15

An assessment of various cells which circulate in the blood which are good indicators of overall health and your risk for infection or disorders.

TestNormal Range Additional Info
Red Blood Cells (RBC)3.6-5.4 x 106/uLRBCs carry oxygen from lungs to your body. Low RBCs could indicate anemia.
Hemoglobin (Hb)11.2-15.7g/dLA protein that binds oxygen to RBCs. Low Hb can indicate anemia.
Hematocrit (Hct)34.1-44.9%The percentage of your blood made up of RBCs. Low Hct can also be used to screen for anemia as well as for dehydration.
Platelets151-424 x 103/uLPlatelets help with clotting. If platelets are low, you could bruise or bleed more easily, and if platelets are high, you could be at higher risk for blood clots (deep vein thrombosis or pulmonary embolism).
White Blood Cells (WBC)3.8-10.8 x 106/uLWBCs are immune cells which help to fight infection. Low WBC count could mean you are at higher risk for infections and you should take extra caution to stay healthy.16
Neutrophils34.0-72.0%,
(Absolute:
1.56-6.20 x 103/uL)
WBCs formed in bone marrow which specifically target bacteria and fungi. They are the first line of defence against infection!
Lymphocytes12.0-44.0%
(Absolute: 1.18-3.74 x 103/uL)
WBCs abundant in the lymphatic system that identify and destroy foreign invaders (like cancer cells!).
Monocytes0.0-12.0%WBCs that fight bacteria, viruses, and fungi, but which also play a role in tissue repair and healing.
Eosinophils0.0-7.0%WBCs that are involved in allergic inflammatory response and also target larger parasites (like worms).
Basophils0.0-2.0%WBC involved in allergic reactions.

Again, if your labs come back with any unusual values, be sure to discuss them with your physician so you fully understand the interpretation.

Here are some good questions to ask your doctor about your labs:

  • Why do you choose to run these specific lab tests?
  • What does it mean that my lab values came back high/low?
  • Are there any symptoms I should watch for that could indicate dehydration, anemia, blood clots, or infection?
  • What should I do if I think I am showing signs of infection (i.e. fever, chills, etc.)?
  • Is there a way I can see my lab values online? If not, can you print them for my records?
  • When should we run these tests again?

I hope this is a helpful reference guide for you as you begin to better understand your general health, but especially during chemotherapy. As always, feel free to leave any questions you may have in the comments!

xo