What is neuropathy and what causes it?
Neuropathy means nerve damage. There are a few ways that cancer treatment can damage your nerves. Sometimes a cancer pressing on a nerve can cause neuropathy symptoms. But it’s more often caused by cancer treatment.
Cutting a nerve during surgery will cause numbness, tingling or sometimes pain. Nerves grow back very slowly, so this type of nerve damage can last a long time or even be permanent.
Radiotherapy can also damage nerves in the area that you have treated. But this is quite rare and can take a long time to develop. It may not show up for months or years after your treatment.
In cancer care, we most often mean nerve damage caused by drugs when we talk about neuropathy. You may hear your doctor talk about ‘peripheral neuropathy’. This means that the nerve damage is to sensory nerves in your hands and feet. This is the commonest type of nerve damage related to cancer treatment and affects the nerves controlling feeling. Sometimes other types of nerves can be damaged, such as the nerves controlling body functions. This is called autonomic neuropathy.
Which cancer drugs cause neuropathy?
Neuropathy can be caused by a variety of different chemotherapy drugs, including:
- Taxanes, such as Taxol (paclitaxel) and Taxotere (docetaxel)
- Vinca alkaloids, including vincristine, vinblastine and vindesine
- Platinum drugs, such as cisplatin, carboplatin and oxaliplatin
It can also be caused by biological treatments including thalidomide and Velcade (bortezomib)
What are the symptoms of neuropathy?
Peripheral neuropathy affects nerves that are responsible for how your hands and feet feel – sensations, in other words. So damage to them can cause:
- Pins and needles
If your hands and feet feel different, it can affect how you use them. You may find that your hands feel clumsy – as if you were wearing thick gloves – and that doing fiddly things like buttoning up clothes is more difficult. Numbness in the feet can make walking more difficult and you may be more likely to trip or fall.
If other, deeper, nerves in the body are affected, you may have different symptoms. If nerves that affect how the bowel works are affected, you may have constipation. With some cancer drugs, your doctor may suggest taking a laxative regularly from the start of treatment to try and prevent this.
In men, neuropathy can sometimes affect the nerves that control erections and can cause impotence.Please note: Do tell your specialist cancer doctor or nurse straight away if you start having neuropathy symptoms. They may need to alter your treatment dose or even stop it for a while to let your nerves recover.
How long do neuropathy symptoms last?
How long your symptoms last depends on a number of different things, including the cancer treatment that caused it and how much of it you had. It also varies from person to person. As we know, not everyone has the same side effects from a drug.
Neuropathy may start to get better when you’re treatment is over. This can be a slow process. Nerves grow and heal very slowly and it can take months or even years to go completely.
Unfortunately, in some people neuropathy can be permanent. Your doctor is unlikely to be able to tell you whether this is so in your case. It’s usually a case of waiting to see if it gets better, but your doctors and nurses will do all they can to help manage your symptoms. You may find that symptoms gradually lessen, even if they don’t go away altogether.
Are there treatments for neuropathy?
Unfortunately, there isn’t yet a treatment that can get rid of neuropathy but there are treatments that can help with symptoms. If your neuropathy is painful, your doctor may suggest painkillers. They also prescribe anti-depressants for neuropathy symptoms. This isn’t because they think you’re depressed. Nerve pain is known to respond to some anti-depressant drugs. Anti-epilepsy drugs may also help.
Some people try complementary or alternative therapies for their neuropathy. These include massage, reflexology and acupuncture. Do talk to your doctor if you are thinking of trying any of these treatments, just to make sure they are appropriate for your medical condition.
If you are finding that nerve damage is causing you difficulties using your hands or with walking, physiotherapy or occupational therapy may help. Your physio may be able to offer advice to improve your balance or mobility. An occupational therapist may be able to suggest equipment to help with tasks you are finding troublesome.
Is there anything I can do to help myself with neuropathy?
If nerves in your hands and feet are affected, you need to take extra care to protect them. Keep them warm as the cold may make your symptoms worse – wear gloves and warm socks in cold weather.
Lack of feeling may mean you are a little clumsier and more likely to injure yourself, so:
- Wear rubber gloves, oven gloves and gardening gloves to reduce risk of injury doing housework or in the garden
- Take care with hot water – you may not be able to tell if it’s too hot
- Make sure your shoes fit properly and don’t rub
- Don’t walk around in bare feet
- Check for trip hazards at home – rugs, clutter or damaged flooring
- Utensils with a wide grip may be easier to use – talk to your occupational therapist or check out disability aids made for people with arthritis
- Take care of your skin and nails: use moisturiser, take care cutting nails and check your hands and feet for cuts or sore places
If neuropathy is causing constipation, do tell your doctor or nurse as soon as you can. The sooner it’s treated, the easier it will be to get on top of it.
You may find it helpful to talk to other people with neuropathy. Join a support group or visit the Live Better With Cancer Community Forum – for information, advice, and tips and to share your own questions and suggestions.