Cancer Support > Coping With Cancer Q&A's

Yes it is perfectly safe to continue with soya products in your diet. There is no evidence that they are in any way harmful to people who have cancer, nor do they affect any of the treatments used for cancer.

It will ask if your wife receives Mobility Allowance or the higher rate of the mobility component of Disability Living Allowance or if she is registered as blind. If the answer to any of these questions is yes then a badge will automatically be issued.

If the answer is no to all these then there will be a few short questions to fill in about your wife's illness and her walking ability. These will then be assessed by the Social Services Department and they may either issue a badge directly or might ask your wife to attend for a medical examination before making a decision.

Although I am Well, since completing chemotherapy for cancer I have been feeling rather depressed. I'm not keen on antidepressants but a friend has recommended St John's wort. What do you think?

The herbal medicine St John's wort is an extract from the flower St John's wort (Hypericum perforatum). In folk medicine remedies it has been used for many years to treat mild to moderate depression and insomniIt contains a mixture of chemicals and the way in which it works is not fully understood.

Studies have show that St John's wort does have a beneficial effect in easing mild depression for some people and is more effective than a placebo (an inactive tablet). Whether it works better than conventional (prescription) antidepressants is not certain but it does have the advantage of rarely causing any side effects, so it is usually quite safe.

The major problem with St John's wort is that it can interact with other medication you may be taking such as heart medication, some forms of contraceptive pill, some treatments for epilepsy and several other types of medication, and interfere with their action. So if you are taking any other medication you will need to check with your doctor before starting St John's wort.

Learning that you have a cancer and then going through a period of often difficult treatment causes a range of strong emotions, including sadness. These emotions usually get easier as time passes and you adjust to your situation. But if you are finding that episodes of feeling sad are changing to a situation where you are feeling low most of the time for weeks on end then it is likely that you have become depressed.

Depression is an illness and it can often be triggered by the emotional stresses of cancer and its treatment. Rest assured, depression isn't a sign of personal failure or inability to cope. It is important to realise if you might be depressed because a variety of treatments can be given for depression which could rapidly help you feel much better.

These symptoms are often accompanied by other problems such as difficulty sleeping, loss of concentration, tiredness and lack of energy, loss of motivation (being unable to star or finish things) and a loss of interest in sex.

If you feel that you are having a number of these problems then do talk to your doctors or nurses about things. Don't 'bottle things up' and keep them to yourself. Your doctors will understand but they can only help if you let them know how you are feeling.

There are a number of treatments that can be given which can dramatically improve the quality of life for you. If your mood does not improve your doctor may recommend antidepressants. Some people are worried at the thought of taking these medicines but modern antidepressants are often very effective, are usually well tolerated and are not addictive.

My mother was treated for breast cancer last year. Since then she has been taking tamoxifen. Over the last few months she has become very depressed. Do you think this is due to the tamoxifen?

We all have days when we feel 'down' or 'blue' but when you have these feelings for weeks on end and find that neither you nor your friends and family can lift you out of your low mood these are key symptoms which suggest you have developed the illness of 'depression'. Making this diagnosis is important because depression is a condition which can be very successfully treated.

Over the years there have been suggestions that taking tamoxifen might increase the chances of becoming depressed. Recently, however, a very large study in the USA, looking at more than 11,000 women has found that depression is no more common among those who were taking tamoxifen than those who were not. So tamoxifen itself does not seem to be a cause of depression.

Depression is quite a common problem for people who develop cancer, it may be triggered by learning the diagnosis or coping with the stresses of treatment and its side effects or by the changes in lifestyle that result from having the cancer. The important thing to stress is that whatever the cause, if depression is a problem it is something that can be greatly relieved or cured completely with simple treatment so do encourage your mother to seek help from her doctors and nurses.

1. Iodine treatment for thyroid cancer uses a radio-active chemical called radio-iodine. The radio-iodine is concentrated in thyroid tissue and is also taken up by some types of thyroid cancer cells. This treatment gives a high dose of radiation to those cancer cells, and normal thyroid cells, but a low dose to all other normal tissues.

The radio-iodine is taken as a capsule and treatment is usually given as an in-patient in hospital. This is because you will be quite radio-active for a few days afterwards as the radio-iodine stays in your body for a little while. This radio-activity will not make you feel ill in any way but it does mean that your visitors will be limited to spending only a few minutes each day with you. Also, young children and pregnant women will not be allowed to visit you.

The hospital team will measure your radioactivity and as soon as this has dropped to a safe level you will be allowed home. Even then you will usually be told not to go back to work and to avoid contact with small children and pregnant women for about two weeks, while the final traces of radioactivity disappear from your system.

As the radio-iodine is concentrated in the thyroid gland the dose of radiation to the reproductive organs is very small indeed, although there is a little radiation from traces of the radio-iodine passed out through the bladder. This can be further reduced by drinking plenty to insure the urine is kept dilute.

2. There are several types of thyroid cancer but the most common is known as 'differentiated' thyroid cancer. Differentiated thyroid cancers can be divided into two sorts, based on the appearance of the tumour cells under the microscope, these are papillary carcinomas and follicular carcinomas. The treatment of the two types of differentiated thyroid cancers is very similar.

Usually the first step in the treatment of differentiated thyroid cancers is surgery. Normally this will involve a total thyroidectomy, removing the tumour and the thyroid gland. Occasionally, for very small tumours, only part of the thyroid gland needs to be removed (a thyroid lobectomy).

Radioiodine therapy has no long-lasting effect on fertility. Many women have had completely successful pregnancies, with normal healthy children, following radioiodine treatment for thyroid cancer.

There may be very temporary changes in fertility immediately after receiving radioiodine as the treatment does effect hormone levels in the body, but this settles quite quickly. In any case, specialists advise that conception is delayed for at least four months after the treatment in order to allow any temporary effect on the reproductive system to settle completely This four month delay applies to both men and women after radioiodine treatment.

If someone is found to be already pregnant when radioidine treatment is being planned it will usually be quite safe to delay the treatment until after the end of the pregnancy (experts suggest radiodine treatment is still useful provided it is given within one year of the initial surgery to remove the thyroid cancer). If radioiodine therapy is given once a pregnancy is over one thing to be aware of is that breast feeding should be avoided as, for a while, traces of the radioiodine will be present in the mother's milk.

When someone becomes pregnant after radioiodine therapy they will be taking thyroid hormone replacement tablets, usually in the form of thyroxine. It is perfectly safe to continue this throughout pregnancy but the doctors will want to do regular blood tests of thyroid function (perhaps every two months) because the dose of thyroxine may need to be adjusted because of the pregnancy.

3. Chemotherapy can affect a man's fertility (the ability to father children). It is dependant upon the drugs being used and their dosage, as well as the age and the health of the man. Chemotherapy drugs can be grouped into different types, and some of these are more likely to affect fertility than others. Generally the greater the dose of a drug given, over a longer period of time, the smaller the chance of recovery of normal fertility. It is probably a good idea to discuss this with your boyfriend's oncologist (cancer specialist) who will know the drugs he is going to be having. However, the more modern chemotherapy regimens for Hodgkin's disease, such as ABVD, are less likely to cause infertility than previously used regimens such as MOPP.

The effect upon sperm production may be temporary or permanent. Any recovery of normal fertility may take several years following treatment. Some men with Hodgkin's disease have reduced fertility before starting any treatment for reasons that are unknown.

Couples are advised to avoid getting pregnant during chemotherapy and for one year afterwards, and to use a barrier method of contraception (condoms or caps) if having sex during their chemotherapy course, as there is a risk of the sperm irritating the cervix.

As it is not possible to predict whether a man's ability to father children will be affected, or if it will return after the treatment, many men choose to store sperm before they start. Sperm storage is reasonably easy and requires a man to collect samples that are then frozen and kept at a fertility clinic. Three or more samples are ideal, however with newer techniques to assist fertility, a single sperm can theoretically be used to fertilise an egg. Men are advised to abstain from sexual activity for a week before collection, in order to give the best possible sample. Throughout the collection period men are encouraged to stay relaxed, increase their fluid intake and take a well balanced diet. It is also advisable to avoid alcohol and coffee if possible as these can lower the sperm count. The costs of sperm storage are usually met by the cancer centre where the individual is receiving treatment, but it may be necessary for the man to pay himself.

If you are both concerned about your boyfriend's future fertility, now is a good time to discuss this with his doctors, before he starts his chemotherapy. They will be able to advise whether he needs to consider sperm storage, and can help him find a fertility clinic.

4. Chemotherapy can affect a man's ability to have children but the chemotherapy drugs and doses usually used for treating testicular teratoma only affect fertility in a minority of men. In some men who require more than the usual doses and extra drugs because the disease was not successfully treated the first time, or it has come back, it is more likely that the chemotherapy will affect their fertility.

The situation is further complicated by the fact that it is quite common for men with testicular cancer to have reduced fertility before beginning treatment for reasons that are not known. Also certain operations that men with testicular cancer sometime undergo, such as removal of the glands at the back of the abdomen may affect fertility.

You will be advised to use contraception for at least a year after chemotherapy as these drugs may theoretically cause problems to the unborn child, although there is no evidence that that occurs in practice. You should also use a barrier method of contraception (condoms or caps) if having sex during their chemotherapy course, as there is a risk of the sperm irritating the cervix.

Because of the theoretical effect the chemotherapy may have on your fertility it would be sensible for you to store sperm. Usually you collect 3 or 4 specimens over a week to 10 days and the sperm is then frozen until you need it.

You should discuss your concerns with your specialist. S/he will be able to help you find a fertility clinic that can store sperm for you. It may be helpful to try and speak with your specialist sooner rather than later, as this will give you more time to collect samples and prevent any unnecessary delay to your treatment.

There are many different drugs used in cancer treatment and some of these are more likely to lead to infertility than others. The dose of the drugs which is given and the number of courses of treatment can also have an effect: the higher the dose and the greater the number of courses then the more likely it is that fertility will be reduced.

Age is also very important. The closer you are to the menopause the greater the risk that fertility will be affected. So women over 40 will be much more at risk than those in their 20s or 30s.

In adjuvant chemotherapy for breast cancer one of a number of different types of chemotherapy may be given. Three of the most widely used treatments are known as CMF, FEC and AC. CMF is a combination of three drugs: cyclophosphamide, methotrexate and fluorouracil, FEC is also a three drug combination with epirubicin taking the place of methotrexate, AC is a two drug treatment with adriamycin and cyclophosphamide.

Cyclophosphamide, which forms part of all three of these treatments, is the drug which is most likely to reduce fertility. Careful analysis of the results of a number of trials have shown that chemotherapy treatments using either epirubicin or adriamycin seem to be more effective than the CMF treatment. Because of these findings there is an increasing feeling among specialists that the adjuvant chemotherapy given after surgery for breast cancer should be matched to the likely risk of further problems, with CMF being used in lower risk women and chemotherapy using either epirubicin or adriamycin being used in higher risk women.

Usually six courses, or cycles, of chemotherapy are given as adjuvant treatment after surgery for early breast cancer. However, clinical trials have suggested that for women who have a relatively low risk of further problems from their cancer, who would usually have received 6 cycles of CMF, just four courses of AC chemotherapy may well be sufficient. This means that women who have this particular treatment will receive lower doses of cyclophosphamide.

Figures from clinical trials have shown that for the CMF and FEC treatments the risk of an early menopause, and infertility, clearly relates to age. Only 1 in 10 to 1 in 20 women of 30 years of age are likely to see their periods stop. By the age of 35 the figure rises to about 1 in 6 to 7. By the age of 40, 4 out of 10 women are likely to be affected. By the age of 45 almost three quarters of women having CMF or FEC will enter the menopause.

For those women who have six courses of AC chemotherapy the chances of infertility are probably much the same as with CMF or FEC. But if your doctor feels that four courses of AC are adequate for you then then the risk of bringing on the menopause is significantly reduced.

So if fertility is an important issue for you then do discuss this with your specialist, so that if there is a choice of chemotherapy treatments that are suitable for your particular circumstances, then you can opt for the one which carries the smallest risk of becoming infertile as a result of that treatment.

6. Chemotherapy can have an effect on both male and female fertility. Depending on the age at which treatment is given, the drugs used and their doses, fertility may be reduced and sometimes there is permanent sterility.

If chemotherapy is given to a woman when she is pregnant then this can cause damage to the unborn child, particularly in the early stages of the pregnancy. Usually doctors will always check with women of child bearing age to make sure they are not pregnant before they start any chemotherapy treatment.

If, however, a man or a woman remains fertile after having chemotherapy there is no evidence that their future offspring have any increased risk of birth defects. A number of studies have looked at the risk of abnormalities in the children of men and women who have had chemotherapy in the past and the risk is no greater than the general population. So the fact that you had chemotherapy in the past does not mean that there will be any ill effects on any children you may have in the future.

7. Some types of chemotherapy carry quite a high risk of damage to the male sperm and can lead to infertility. Sperm banking is a way of storing some of your sperm so that at a later date they can be used to artificially inseminate your partner so that you can still father your children.

Because of the risk of damage to the sperm from treatment, sperm banking is best before you start chemotherapy although it may be possible for it still to be done up to 4 to 6 weeks after treatment has started.

You must not have sex (or ejaculate) for at least 2 days before the sperm is collected. The sperm samples will be produced by you masturbating. (This can be embarrassing but this will be organised to make sure that things are private and comfortable for you.) Usually between 1 to 3 samples are collected over 1 to 3 days.

After collection the sperm are analysed, this means looking at the sample under the microscope and counting the number of sperm and how well they are swimming (their mobility). This gives an idea of how 'healthy' and fertile your sample is.

After this your sample is mixed with a cryopreservative (which protects the sperm during the freezing process) and then it is very carefully labelled, to clearly identify it is as your own sperm and frozen at temperatures as low as -190oC.

Legally sperm can only be stored for a maximum of 10 years, or until you are 55, whichever is the sooner, although in very special circumstances it may be possible to get these limits extended.

Once the sperm is needed in order to try for a pregnancy then it can be thawed. You will then need medical advice on how best to achieve the pregnancy. Usually this can be done by a simple insemination timed to the ovulation (release of the egg) of your partner. If your sperm count is low or the sperm have been damaged in any way by the freezing process, reducing their fertility then there are other special methods which have been developed which can increase the chance of a pregnancy, these include in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).

Sperm banking is usually done in special units which will only be at a few selected hospitals so you may have to travel some distance for your sperm banking. If you are unwell, and travelling is difficult, then it may be possible to arrange sperm collection at your local hospital, or even at home, but it will be necessary to get the sperm to the sperm banking centre within 90 minutes to give the best chances of successful preservation.

If producing a sperm sample is difficult then it might be possible to arrange for something called percutaneous epididymal sperm aspiration (PESA). This involves having a needle inserted into the testis to withdraw some sperm and it can be done with local anaesthetic, as an out-patient.

The sperm banking centres do charge for collecting, preserving and storing sperm samples. Very often this cost will be met by your own hospital as part of your overall treatment but sometimes you may find you are asked to contribute towards the costs. Also when you do try for a pregnancy there are differences around the country on the levels of fertility services available on the NHS and you may find again that you might have to pay for some parts of the process.

The whole idea of sperm banking and the doubts about future fertility can be very stressful and confusing, especially as you are coping with your cancer and chemotherapy as well. Most of the sperm banking centres do have trained counsellors who can help you with advice and support, so do ask about this.

In recent years the results of a number of careful scientific studies have shown that this is not true and that becoming pregnant after previous treatment for a breast cancer does not increase the chances of the cancer returning, or a new cancer developing. Indeed there is a suggestion from the figures that pregnancy might even help to reduce the risk of a recurrence (though this is not certain).

Despite these figures it is still common practice for specialists to suggest that pregnancy is delayed for at least two years after breast cancer treatment. The main reason for this is that if a breast cancer is going to come back this is most likely to happen during the first two years after treatment. This does not mean that there is no risk of recurrence after two years but the risk is considerably reduced.

Modern day breast cancer treatment often involves giving chemotherapy (after surgery and radiotherapy) and/or the use of hormonal treatments like the drug tamoxifen. Many types of chemotherapy can reduce fertility. Sometimes, particularly in younger women, fertility may be reduced for only a few months, but in older women, closer to the menopause, chemotherapy may often result in sterility. Taking tamoxifen can interfere with fertility although its effects are much less than chemotherapy.

Overall, therefore, there is no absolute reason to advise against further pregnancies after apparently successful treatment for a breast cancer but the situation is quite a complex one and every patient is a unique individual with their own special circumstances and so it would be best for your daughter to chat with her specialist to get their advice on what is best for her.