Edema right after starting chemo?

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mpbser
Posts: 305
Joined: Wed Apr 19, 2017 11:52 am

Edema right after starting chemo?

Postby mpbser » Fri Oct 13, 2017 8:09 am

Husband's face swelled a bit after his first Oxi infusion on Wednesday. This morning, it is really swollen, and his neck is a bit as well. His ankles are OK, as far as we can tell. Did anyone experience this? What did you do about it, if anything?

He's at his cardiologist's office right now. Hopefully everything is OK with his cardiovascular system.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm width T1 N0
CEA: 1.4 Pre-op; 2.1 2 days Post-op
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal expression of MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53

Aqx99
Posts: 249
Joined: Fri Mar 31, 2017 7:28 am
Facebook Username: aqx99
Location: Pfafftown, NC

Re: Edema right after starting chemo?

Postby Aqx99 » Fri Oct 13, 2017 3:24 pm

Did they give him steroids in his premeds? I always get a bit swollen and flushed after my infusions because of the steroids they give to combat nausea. It usually lasts about a week for me. Definitely check it out with the doctor though, just in case it is a reaction to the chemo.
Anne, 40
Stage IIIB Rectal Cancer
T3N1bM0
Diagnosed at age 39
2/21/17 Diagnosis
2/21/17 CEA 0.9 ng/mL
3/23/17 - 5/2/17 Chemoradiation, 28 treatments
6/14/17 Robotic LAR with temp loop ileostomy, ovaries and fallopian tubes removed, 2/21 lymph nodes positive
7/24/17 Started CapeOx, 6 Cycles
7/24/17 Diagnosed with precursor ovarian cancer
9/6/17 CA 125 11.1 U/mL
1/18ish Reversal

cbsmith
Posts: 43
Joined: Sat Nov 28, 2015 11:45 am

Re: Edema right after starting chemo?

Postby cbsmith » Fri Oct 13, 2017 4:36 pm

I am always flush and a bit red after chemo from the steroids. It usually lasts for about 2-3 days and then goes away.
06/14-DX with FAP as 36yo Male
07/14-total colectomy, rectum removal, permanent ileostomy
08/14-DX Stage IIIC colon cancer KRAS mutant, MSS
09/14-12 rounds of FOLFOX
04/15-ended FOLFOX
07/15-CT showed one para-aortic lymph node, onc thought inflammation and said wait 3 mths
10/15-DX Stage IV, CT showed lymph node tripled in size and 1 small lung met
11/15-FOLFIRI + Avastin
06/16-lymph node is stable, now have a 2nd lung met
01/16-lymph node is stable, lung mets grown 2mm. Still on FOLFIRI + Avastin

MissMolly
Posts: 423
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Edema right after starting chemo?

Postby MissMolly » Fri Oct 13, 2017 8:24 pm

mpbser
You would be well advised to discuss with your hisband’s oncologist the dosage of dexamethasone (decadron) given to him as a pre-medication.

Dexamethasone is the most potent of the class of corticosteroids. 1 mg dexamethasone is equivalent to what the body produces naturally as cortisol in a given day. The typical pre-med dose administered is 4 mg of dexamethasone. It is a whopper of a dose.

Dexamethasone may affect your husband on more levels than other people. Corticosteroids have a direct affect on the pancreas, raising insulin levels and blood glucose levels. Management of your husband’s type 2 diabetes will be more challenging. Fluid retention and laying of added adipose tissue is a common effect of steroids. A rounded face (“Moon Face”), added adipose tissue around the waist and mid-section, and thickening of the upper back and scapula (“Buffalo Hump”) are specific areas where the visual effects of steroids are noteable. Steroids also cause transient suppression of the pituitary gland.
Adrenal gland failure (adrenal insufficiency) can occur with long-term steroid use or high dose steroid use over a shorter time interval.

I have adrenal insufficiency and often caution individuals receiving chemotherapy to query their oncologist regarding dexamethasone dosing. It is always advantageous to use the lowest steroid dose possible to arrive at the desired effect.

The role of dexamethasone is to quell nausea and inflammation of the intestinal tract due to chemotherapy and to uplift how a person feels systemically. Not all people need 4 mg dexamethasone per infusion to achieve those objectives. Some people are provided with additional oral dexamethasone to take at home for the first 2-3 days after an infusion. The point being: The amount of corticosteroid prescribed per round of chemotherapy can be substantial - with a delayed domino effect of unanticipated and medically troubling side effects.

Be an informed patient. Know the amount/dosing of corticosteroid that is being prescribed for you. Talk with your ordering oncologist. Work toward taking the lowest dosing of corticosteroid that keeps you comfortable during chemotherapy.
Karen
Devoted daughter to my father, diagnosed with stage 2 colon cancer Nov-2014.
Dear friend to Bella Piazza, former CC member.
I have a permanent ileostomy and offer advice on living with an ostomy.
I have been on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression and recurrent infection x 4 years. I transitioned to Hospice Sept-2016, but it was not yet my time. I am back on Palliative Care and live a simple life due to frail health.

mpbser
Posts: 305
Joined: Wed Apr 19, 2017 11:52 am

Re: Edema right after starting chemo?

Postby mpbser » Sat Oct 14, 2017 7:00 am

Thanks, everyone! Yes, he was given steroids. That can explain both the elevated BP and the facial swelling. He's looking much better and his BP is back to where it usually is, so it looks like the effect was thankfully only for a couple days.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm width T1 N0
CEA: 1.4 Pre-op; 2.1 2 days Post-op
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal expression of MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53

NHMike
Posts: 553
Joined: Fri Jul 21, 2017 3:43 am

Re: Edema right after starting chemo?

Postby NHMike » Sun Oct 15, 2017 6:32 pm

Good to hear that he's doing well. Is he getting Oxi with 5FU or without it? I take it that you're doing everything locally now.
06/23/17: ER rectal bleeding; Colonoscopy+Biopsy
07/13/17: Stage 3B rectal cancer. T3, N1b, M0. 5.2 x 4.5 x 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6 mm, 5 x 5 mm.
Xeloda 3,400 mg/day + radiation 07/31 - 09/08.
CEA 2.7; halfway through treatment: 1.9; after treatment: 1.8.
MSS, KRAS G12D
10/06/17: 2.7 x 2.2 x 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 mm (-75%), 5 x 3 mm (-40%). 5.1 CM from AV.
Surgery: 10/30/17 LAR, Temp Ileostomy

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CRguy
Posts: 9286
Joined: Sun Feb 10, 2008 6:00 pm

Re: Edema right after starting chemo?

Postby CRguy » Sun Oct 15, 2017 11:05 pm

mpbser wrote:Thanks, everyone! Yes, he was given steroids. That can explain both the elevated BP and the facial swelling. He's looking much better and his BP is back to where it usually is, so it looks like the effect was thankfully only for a couple days.

Glad he's feeling better as well !
Another consideration / issue may be the infused volume and rate ... if too much is infused too rapidly, you will get a "volume overload" effect
and that will increase blood pressure and may contribute to localized edematous changes.
Just a couple of things to be discussed and considered for future infusions. The total volume will likely stay the same BUTT if it is infused more slowly ... it could help decrease the BP / swelling issues !

No doubt the dexamethasone contributes to this as well, so ask the Oncs about a possible dose decrease for this.
I eventually had minimal dex only on infusion day with no follow up and did just fine ( NO allergic / nausea reactions )
His Oncs should be able to assist and guide you with this, based on the specifics of his situation.

Best wishes
CRguy
Caregiver x 3
Stage IV A rectal cancer/lung met
10 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

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LPL
Posts: 302
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Edema right after starting chemo?

Postby LPL » Wed Oct 18, 2017 2:13 pm

Mpbser,
Please see below in my signature what happens to my DH.
These steroids (as Miss Molly explained) can wreak havoc on some people. Hubby did his chemo NR 4-12 without steroids and he did not miss them!!! Steroids was like poison for him.
Good Luck with your DH’s following treatments.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets


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