Steroids in Cancer Treatment

Steroids are chemicals that are produced by glands in our bodies. They regulate many of our natural functions, from our body temperature and blood pressure to our emotions.

Pharmaceutically produced, synthetic steroids are used for a number of reasons in medicine. Steroids are a key component in the treatment of leukemia, lymphoma and myeloma.

What Steroids are Used in Cancer Therapy?:

When we think of someone “taking steroids,” we often think of muscle-bound pro athletes or weight lifters in skimpy garments, flexing for the camera. These types of steroids are called anabolic-androgenic steroids, and are not typically used in cancer care.

Why Do I Need Steroids?:

In the treatment of blood and marrow cancers, steroids can serve a number of functions. Some examples include:

    To help prevent an allergic reaction to a blood product transfusion or medication
    Treatment of graft-versus-host disease (GVHD) following stem cell transplant
    As part of your chemotherapy regimen
    To reduce swelling in spinal cord compression of myeloma
    To decrease inflammation
    To help control nausea and vomiting
    To help increase your appetite
    To treat pain
    To treat skin reactions

Side Effects of Steroid Use:

The side effects of steroids tend to be worse when they are taken at higher doses and over long periods of time. Long-term side effects of steroids include:

    Immune suppression and infections
    Weight gain
    Weakness
    Psychosis or mood swings
    Stomach ulcers
    Elevated blood pressure
    Problems sleeping
    Elevated blood sugar (especially important if you are a diabetic)
    Osteoporosis (brittle bones)
    Swollen hands or feet

Taking your medication with food can help with some of the problems that steroids can cause to your digestive tract. You may also choose to take these types of medications early on in the day so that they are less likely to impact your sleep at night.

As with many medication side effects, your specialist, nurse, or pharmacist can often provide you with strategies to help control or minimize them. Keep them informed of any concerns you experience.

Impact of Steroids on Mood:

Many of us have heard the expression "'roid rage". It is often used to describe angry behaviors and outbursts of individuals who take anabolic steroids, but corticosteroids can also have serious effects on mood as well.

These reactions can range from irritability, restlessness, and anger all the way to paranoia, confusion, and mania. Conversely, it is not uncommon to have a low mood or even depression after you stop taking them.

Sometimes it can be difficult to determine the source of these feelings. Yes, you are on steroids, but you are also getting treated for cancer and trying to carry on a somewhat normal life -- no kidding you are more emotional than usual! Cut yourself a little slack.

But if your mood changes are impacting your quality of life or relationships, speak to your healthcare team about it. If these feelings are severe, you may need to seek immediate assistance.

Important Points About Taking Steroids:

As with most cancer treatment medications, it is very important to take steroids exactly as your doctor describes. Here are some good questions to ask your healthcare team about your steroids before you start:

    How long will I be expected to take this medication?
    Who can I contact if I have a serious reaction to this medication?
    What if I miss a dose?
    What if I vomit up my medication?

Taking steroid medications has an impact on how much natural steroid your body produces. For this reason, when your steroids are no longer needed as part of your therapy, your doctor will often taper the dose off instead of stopping them abruptly. It is extremely important that you do not stop taking this medication unless you are told to by your doctor. Stopping these drugs suddenly can have very serious consequences.

Steroids and Cancer Treatment

When you hear the word steroid you may think of "roid rage" and muscle-bound gym rats with shrunken testicles. But if your doctor prescribed steroids as part of your treatment for cancer or another serious illness, don't worry. It's not "that" kind of steroid.

Your doctor is actually talking about cortisol, a form of steroid that your body produces naturally. It's different from anabolic steroids, which are the illegal muscle-building kind.
How Steroids Help

Although the cortisol-type steroids prescribed for cancer treatment are different from anabolic steroids, you still need to take them under the close supervision of your doctor or medical specialist.

You'll probably get a manmade version of the natural steroid cortisol, such as:

    cortisone
    hydrocortisone
    prednisone
    methylprednisolone
    dexamethasone

These can help with your treatment in a variety of ways:

    reduce nausea associated with chemotherapy and radiation
    kill cancer cells and shrink tumors as part of chemotherapy
    decrease swelling
    reduce allergic reactions (before transfusions, for example)
    lessen headaches caused by brain tumors

Sometimes, your doctor will recommend steroid treatments just to help you sleep, eat, and feel better.

Doctors can prescribe steroids for cancer treatment several ways:

    by injection
    through an intravenous (IV) drip
    in liquid or pill form
    as a cream

Side Effects

Steroids used in medical treatments can have some side effects, although they're not as extreme as the side effects from anabolic steroids. Talk to your doctor and ask questions if you're worried.

You may not have any side effects. But if you do, don't worry — they'll only last as long as you're taking the steroids. When you stop your treatment, things will return to normal.

Some of the more common side effects of steroid treatments include:

    increased appetite
    weight gain, often in unfamiliar places, like your cheeks or the back of your neck
    mood swings
    stomach upset or ulcers
    osteoporosis (weaker bones)
    vision problems
    higher blood pressure
    increased blood sugar. Sometimes, people develop diabetes temporarily. If you already have diabetes, you'll need to monitor your blood sugar levels more closely.
    for girls, irregular menstruation (missed or late periods)

Less common side effects include bruising more easily, difficulty fighting infections, acne flare-ups, and increased facial hair.

If you develop several of these symptoms, you have a condition called Cushing syndrome. Sometimes it gets better if you make changes in the way you take the steroids. If you're having problems with these side effects, talk to your doctor.

Remember, you may not have any side effects. If you do, you'll probably find that they're overshadowed by the benefits of the treatment. But check with your doctor about ways to make them easier to live with.
Tips on Taking Steroids for Cancer Treatment

Your doc will give you all the details, of course, but there are some things to remember when taking steroids for cancer treatment. Here are a few:

Don't stop taking the medication without your doctor's guidance. If you notice anything strange while you're being treated with steroids, tell your parents and doctor right away. Don't stop taking the steroid, though. Your body makes less cortisol when you're having steroid treatments, so you need to ease off the medication and give your body a chance to get its own production back up to normal again. If you don't, your body could go through a potentially serious withdrawal. Weaning your body off the medication is easy to do, and your doctor will guide you through it.

Your card — don't leave home without it. A lot of steroid treatments happen in a doctor's office or clinic. But if you're on a long-term steroid treatment and have pills to take at home, your doctor may give you a steroid card or a medical alert bracelet. It's important to keep this card with you (or wear your medical alert bracelet) at all times. If there's an emergency, the card or bracelet will let doctors know you're being treated with steroids — or have been recently, which can change the treatment they need to give you.

Don't "double-up" if you miss a dose. Call your doctor or nurse and ask what to do if you forget to take a tablet.

No flush, no foul. If your treatment is done and you have tablets left over, give them to your doctor or a pharmacist. Don't flush them down the toilet or throw them away because they could get into the water supply and cause problems.

Steroid Use and Liver Cancer

Although well-documented reports linking steroids to liver cancer are rare, as more athletes use drugs to improve their performance or build their bodies, many types of dangerous side effects from the abuse of anabolic steroids are becoming known — and events are becoming more frequent.

Recently, there have been many instances in the news about famous athletes and performance-enhancing drugs, sometimes referred to as "doping." In most cases, the drugs that are being used are anabolic steroids. These drugs are manufactured steroids that behave like the male hormone testosterone.

Anabolic steroids are male-related hormones that can be used to increase muscle mass. When these drugs are abused they can have many side effects, including liver damage.

Liver Cancer: What Anabolic Steroids Can Treat

Anabolic steroids, under a doctor's prescription, will treat certain conditions in which increasing bone strength and muscle mass are required for health reasons. These medications can be helpful in the following types of cases:

    Delayed puberty
    Testosterone deficiency
    AIDS-related weakness

Liver Cancer: Anabolic Steroid-Related Liver Damage

Liver damage from anabolic steroids can cause a condition called cholestasis. With this condition, bile, a digestive fluid made in your liver, cannot get to where it needs to go and leaks out into your blood. Symptoms include:

    Itching
    Nausea
    Loss of appetite
    Dark urine
    Jaundice — the yellow discoloration of your eyes and skin

Damage to the liver is evident when enzymes called aminotransferases leak out of damaged liver cells into your bloodstream.

Another important point about anabolic steroids: They can be addictive. These steroids can cause steroid craving that leads to the need for more frequent and higher drug doses. Liver damage has been shown to be related to the cumulative effects of higher and more frequent use.

Liver Cancer: Can Anabolic Steroids Cause It?

Dr. Wu says that reports exist showing a slightly increased risk of developing liver cancer with long-term use of high-dose anabolic steroids. However, he says, “the scientific evidence supporting a cause-and-effect relationship is weak.”

But these steroids are known to cause tumors that form in your liver. Called hepatic adenomas, these tumors are not cancerous. However, they are dangerous because they can rupture and cause serious bleeding in the liver. There have been several reported deaths caused by bleeding from ruptured hepatic adenomas. The link between hepatic adenomas and anabolic steroid use in athletes is increasing. Recently, a case of a hepatic adenoma turning into liver cancer was reported.

Liver Cancer: Anabolic Side Effects

While there is not a strong link between liver cancer and anabolic steroids, there is strong evidence for serious liver damage. Other side effects of anabolic steroids include:

    High blood pressure
    Increased levels of bad cholesterol
    Mood swings
    Aggressive behavior
    Infertility in men
    Menstrual abnormalities in women

If you are an athlete or a body-builder and you are tempted to use anabolic steroids, consider that besides the legal and social risks involved, these drugs can and do cause life-theatening medical complications.