Latest advances and outcomes from the treatment of acute leukemia today
Leukemia is a blood cancer that can be identified by the rapid growth of defective
blood cells. The marrow of our bone produces most of the blood in our body which is
the site of this abnormal growth. Typically, leukemia cells are immature white blood
cells. Leukemic cells alter the normal blood cell formation process, leading to various
signs and symptoms such as bleeding, infection, and tiredness.
There are two kinds of leukemia: acute leukemia and chronic leukemia. Further, the
acute type was classified into acute myeloid leukaemia (AML) and acute
lymphoblastic leukaemia (ALL). Myeloblasts, or defective white blood cells, are the
cause of acute myeloid leukaemia (AML). Acute myelogenous, granulocytic,
nonlymphocytic, or myeloblastic leukaemia are other terms for this kind of cancer.
However, the overproduction of lymphocytes is caused by acute lymphoblastic
leukaemia (ALL).
Stem cell transplantation, radiation therapy, and chemotherapy have been the
cornerstones of leukaemia treatment. Targeted therapy has also been included in the
standard of care for certain kinds of leukaemia within the past 20 years. These
medications target the proteins that regulate the growth, division, and metastasis of
cancer cells. Different treatment combinations are needed for different forms of
leukaemia.
For Acute lymphocytic leukemia (ALL), Immunotherapies are being used where
many elderly people are unable to handle the severe side effects of the intense
chemotherapy therapies required to treat ALL. Compared to chemotherapy, targeted
therapies might have fewer adverse effects.
Immunotherapies are treatments that enhance the body's ability to fight cancer
through the immune system. Currently, four immunotherapies are FDA approved for
the treatment of ALL: blinatumomab, inotuzumab ozogamicin, tisagenlecleucel and
midostaurin. In ALL, the following immunotherapy techniques are being tested or
employed are CAR T-cell therapy and bispecific T-cell engagers (BiTEs). A sort of
cancer treatment called CAR T-cell therapy involves genetically modifying the
patient & own immune cells. For the treatment of some children and young adults with
ALL, one kind of CAR T cell therapy is currently approved. Dosing is based on
weight reported at the time of leukapheresis.The use of this type in elderly B-cell
ALL patients is now being investigated. Adults with B-cell precursor ALL who have
not responded to previous treatment or have returned after treatment have been
approved for another course of CAR T-cell therapy.
Bispecific T-cell engagers (BiTEs) are another immunotherapy that is being studied
for ALL. These medications bind to both cancer and immune cells, drawing the two
groups of cells closer together so that the immune cells can locate and eliminate the
cancer cells with ease. Recently, it was demonstrated that one such BiTE,
blinatumomab, can increase survival for ALL patients in remission following
chemotherapy, even in situations where the disease is completely eradicated.
Acute myeloid leukaemia (AML) tends to be aggressive and was harder to treat than
ALL. However, AML cells sometimes have gene changes that cause the tumors to
grow but can be targeted with new drugs. The management of AML involves two
phases such as remission induction therapy (first phase of treatment to kill
the leukemia cells in the blood and bone marrow ) and remission continuation therapy
(second phase of treatment to kill any remaining leukemia cells).
The treatment of AML includes chemotherapy (drugs to stop the growth of cancer
cells), radiation therapy (uses high-energy x-rays or other types of radiation to kill
cancer cells), stem cell transplant (to replace the blood-forming cells from the blood
or bone marrow of the patient) and targeted therapy (drugs or other substances to
identify and attack specific cancer cells) or combination of both. Targeted treatments
such as Enasidenib, Olutasidenib, Ivosidenib, Venetoclax, Gemtuzumab ozogamicin,
Midostaurin, Gilteritinib, Glasdegib, and Quizartinib have recently been approved to
treat AML with specific gene alterations.
In order to achieve complete remission (CR) from acute leukaemia, standard
treatment paradigms have involved high-intensity induction chemotherapy. In certain
cases, this was followed by an allogeneic hematopoietic cell transplant (allo-HCT) to
eliminate residual disease through the "graft versus leukaemia effect, which is
mediated by the immune cells of the donor. Allo-HCT is not recommended for all
patients, though, and one of the biggest problems facing the industry at the moment is
the lack of viable chemotherapy-based choices for patients who relapse after allo-
HCT or who develop chemotherapy-refractory illness.
The potential of immunotherapy in the treatment of acute myeloid leukaemia (AML)
has been established by the effectiveness of allogeneic stem cell transplantation.
Alternative T-cell-based immunotherapies have demonstrated effectiveness, but there
is a chance that they could cause on-target off-leukemia hematotoxicity. Currently,
the use of adoptive autologous or allogeneic chimeric antigen receptor (CAR) T /
natural killer cell treatment as a bridge-to-transplant approach is almost only available
in clinical studies.
Acute leukaemia used to be nearly always fatal, but now it has a 63% 5-year survival
rate in the US. The therapeutic options for acute leukaemia have increased with the
introduction of immunotherapy, however, the advancement in AML has been slower.
Novel medicines such as ADCs, CAR T cell treatments, and BiTEs continue to show
remarkable response rates and favourable toxicity profiles in various disease states
every year. Even with these developments, a large number of patients are still not
eligible for immunotherapeutic treatments, and relapses following some of the more
recent modalities are still linked to extremely poor prognoses. In the future, new
medicines with potentially unique mechanisms of action will probably be approved
together with the expansion of the indications for currently available medications.
References:
1. Leukemia. National Cancer Institute. Available at:
https://www.cancer.gov/types/leukemia/hp/adult-aml-treatment-pdq
2. Boyiadzis MM, Aksentijevich I, Arber DA, et al. The Society for Immunotherapy
of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of
acute leukemia. Journal for ImmunoTherapy of Cancer. 2020
3. Kantarjian, H., Kadia, T., DiNardo, C. et al. Acute myeloid leukemia: current
progress and future directions. Blood Cancer J. 2021
4. Subklewe M, Bücklein V, Sallman D, Daver N. Novel immunotherapies in the
treatment of AML: is there hope? Hematology Am Soc Hematol Educ Program. 2023
Dec 8;2023
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What Are the Different Stages of Cancer?
What Are the Different Stages of Cancer? Hearing the word cancer can bring up several questions at once. What does the diagnosis mean? How serious is it? Has the cancer spread? What treatment options are available, and what happens next? One of the first things people often want to understand is the stage of the cancer, because it helps explain how far the disease has progressed and what the medical team may recommend. But cancer staging is not always as straightforward as it sounds. Some cancers are detected before they spread beyond the tissue where they began, while others may have reached nearby lymph nodes or distant organs by the time they are diagnosed. The stage also depends on the type of cancer, its location, and the results of the investigations performed. This is why understanding what are the different stages of cancer can help patients and their families make sense of a diagnosis without relying on assumptions or frightening information found online. In this blog, we will explain the different stages of cancer, how doctors determine them, what staging means for treatment, and how patients can approach the next steps with greater clarity. We will also discuss what to consider when exploring Cancer Treatment in Bangalore, so you can understand the process without unnecessary confusion or fear. What Does Cancer Staging Mean? Cancer staging is the process doctors use to describe the extent of cancer in the body. It helps establish where the cancer started, how large the tumour is, whether nearby lymph nodes are involved, and whether the disease has spread to distant parts of the body. Here are five important things to understand about cancer staging. It describes how far the cancer has spread: The stage gives doctors a structured way to describe the extent of the disease. For many solid tumours, this includes whether the cancer is limited to its original location, has grown into nearby tissues, or has spread to other parts of the body. Staging is different from grading: Cancer stage and cancer grade are not the same thing. Stage describes the extent of the cancer in the body, while grade describes how abnormal the cancer cells look under a microscope and, in many cancers, how aggressively they may behave. The stage depends on the type of cancer: Many solid tumours use a numbered staging system, but the details vary by cancer type. Breast cancer, lung cancer, colorectal cancer, and other solid tumours may use stages 0 through IV, although the criteria for each stage are different. Staging helps guide treatment decisions: Knowing the stage helps the medical team decide which treatments may be appropriate. Depending on the cancer, options may include surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, hormone therapy, or a combination of treatments. The stage does not tell the whole story: Cancer staging provides important information, but it cannot predict every detail of an individual’s experience. People with the same cancer stage can respond differently to treatment. What Are the Different Stages of Cancer? Many solid cancers are grouped into stages 0, I, II, III, and IV. Although the exact criteria differ by cancer type, the stages generally describe how much the cancer has grown or spread. The following table provides a general overview. It is not a substitute for the staging criteria used for a specific cancer. Cancer Stage What It Generally Means What Doctors May Consider Stage 0 Abnormal cells are present but have not invaded nearby tissue. This is often called carcinoma in situ. Whether the abnormal cells can be removed or treated locally and what follow-up is needed. Stage I Cancer is generally limited to a relatively small area or has not spread extensively. Surgery, radiation therapy, or other treatments depending on the cancer type. Stage II Cancer may be larger or may have grown further into nearby tissue. In some cancers, nearby lymph nodes may be involved. The extent of local growth, lymph node findings, tumour characteristics, and whether combined treatment is needed. Stage III Cancer has often spread more extensively into nearby tissues or regional lymph nodes. Whether surgery, radiation, systemic treatment, or a combination is appropriate. Stage IV Cancer has spread to distant organs or parts of the body. This is generally called metastatic cancer. Treatments to control the disease, manage symptoms, improve quality of life, and, in some cases, achieve prolonged remission. Stage 0: Abnormal cells that have not invaded nearby tissue Stage 0 is often used for certain cancers in which abnormal cells remain confined to the layer of tissue where they first developed. This is known as carcinoma in situ. These cells are not invasive cancer, but some forms may develop into invasive disease if left untreated. The risk and recommended management depend on the type of abnormality and its location. Treatment may involve removing the abnormal tissue or using another local treatment. In selected situations, careful monitoring may be considered. The decision depends on the diagnosis, the risk of progression, and the available clinical evidence. Stage I: Cancer that is generally localised Stage I often describes a cancer that is relatively small or limited to its original site. It has not spread extensively to nearby structures or distant organs. Some stage I cancers can be treated successfully with surgery or another local treatment. Other cancer types may require additional therapy depending on their biological features and risk of recurrence. The term early-stage cancer is often used for stage I disease, but it is important not to assume that every cancer labelled stage I behaves in the same way. The exact meaning depends on the specific cancer. Stage II: More extensive local growth Stage II often means the cancer has grown further into nearby tissue or is larger than a tumour classified as stage I. For certain cancers, limited regional lymph node involvement may also affect the stage. Treatment may involve surgery, radiation therapy, chemotherapy, or other medicines, depending on the cancer type. Doctors may recommend treatment before surgery
How Is Cancer Diagnosed If There Are No Symptoms?
How Is Cancer Diagnosed If There Are No Symptoms? Most people associate cancer with a noticeable change in the body. It could be a lump that was not there before, unexplained weight loss, unusual bleeding, a persistent cough, or a wound that does not heal. These changes often encourage people to visit a doctor and get themselves checked. But what happens when there are no warning signs at all? Can cancer still be present even when a person feels completely healthy? The answer is yes. Some cancers can develop and grow for a considerable period without causing obvious symptoms. In certain cases, they are discovered during routine health check-ups, screening tests, or investigations carried out for an unrelated medical concern. This is one reason why understanding how is cancer diagnosed if there are no symptoms matters, even if you feel well and have no immediate reason to worry about your health. Cancer does not always cause discomfort in its early stages. A small tumour may not press against nearby organs, affect their functioning, or produce noticeable changes. Some cancers also develop in parts of the body where early changes are difficult to detect without medical investigations. This means that the absence of symptoms cannot always rule out cancer. At the same time, it is important to remember that feeling healthy does not automatically mean you need extensive cancer testing. Screening recommendations depend on factors such as your age, personal and family medical history, lifestyle, and known risk factors. In this blog, we will explain how doctors detect cancer in people who have no symptoms, which screening tests may be recommended, how abnormal findings are investigated, and when specialist care may be necessary. We will also discuss how early detection fits into the broader journey of cancer care, including access to Cancer Treatment in Bangalore, so you can make informed decisions without unnecessary fear. Can Cancer Develop Without Causing Symptoms? Yes, cancer can develop without producing noticeable symptoms, particularly during its early stages. However, this does not happen in every case, and the likelihood of detecting cancer without symptoms varies depending on the type of cancer, its location, and the person’s individual risk factors. Here are five important things to understand. 1. Early-stage cancers may be too small to cause noticeable changes 2. Some organs do not produce obvious warning signs in the early stages 3. Symptoms may be mild enough to go unnoticed 4. Cancer may be discovered during tests for another condition 5. Having no symptoms does not mean you should get every possible test Which Cancer Screening Tests Can Detect Disease Before Symptoms Appear? Screening tests are useful for certain cancers because they can identify early disease or changes that may develop into cancer. However, screening recommendations vary by cancer type, and not every cancer has an established screening test for people at average risk. Here are five screening approaches worth understanding. 1. Mammography for breast cancer 2. Cervical screening for cervical cancer 3. Colorectal cancer screening 4. Low-dose CT for selected people at high risk of lung cancer 5. Risk-based screening for people with inherited cancer susceptibility Screening Tests vs Diagnostic Tests: What Is the Difference? Screening and diagnostic testing may both be part of cancer detection, but they serve different purposes. Understanding this difference can help you know what to expect if a doctor recommends an investigation despite your having no symptoms. Screening Tests Diagnostic Tests Usually offered to eligible people who do not have symptoms. Used to investigate symptoms, abnormal screening results, or suspicious findings. Aim to identify signs of certain cancers or precancerous changes early. Aim to determine the cause of an abnormality and establish a diagnosis. Recommended according to age, individual risk, and screening guidelines. Selected according to the suspected condition and previous test results. Examples include mammography, cervical screening, and colorectal cancer screening. Examples include diagnostic imaging, endoscopy, and biopsy. A positive result does not automatically mean cancer is present. A diagnosis may require examination of tissue by a pathologist. May need to be repeated at recommended intervals. Timing depends on the findings, the person’s clinical situation, and the urgency of further assessment. What happens if a screening test is abnormal? An abnormal result is a reason to investigate further, not a reason to assume the worst. Doctors review the result, consider the person’s risk factors, and decide whether additional testing is necessary. For example, an abnormal mammogram may be followed by additional breast imaging and, in some cases, a biopsy. An abnormal cervical screening result may lead to repeat testing or a closer examination of the cervix. A positive colorectal screening test may require colonoscopy. Some findings turn out to be benign or temporary. Others may indicate precancerous changes or cancer that needs treatment. The follow-up plan depends on the specific result, so it is important to complete the recommended assessment rather than ignore the finding or assume it confirms a serious diagnosis. Why a biopsy may be needed A biopsy involves collecting a small sample of tissue or cells so that they can be examined in a laboratory. When cancer is suspected, this examination can help establish whether the abnormal cells are cancerous and, in many cases, identify the cancer type. Not every abnormal scan requires a biopsy. Sometimes, a doctor can assess a finding through imaging or recommend monitoring it over time. In other situations, a tissue sample is necessary to reach a reliable diagnosis. Your doctor will explain why a biopsy is being considered, how it is performed, and what the possible results could mean for your care. Who Should Consider Cancer Screening Even Without Symptoms? Not everyone needs the same screening plan. Some people are at average risk, while others may benefit from earlier or more frequent screening because of their personal or family history. Consider these five factors when discussing screening with a doctor. 1. Your age 2. Your family history 3. Smoking and other known risk factors 4. Previous precancerous changes or certain medical
What Tests Are Done to Detect Cancer?
What Tests Are Done to Detect Cancer? Hearing the words “you need to get tested for cancer” can make even a routine medical appointment feel suddenly serious. You may start wondering what the tests involve, whether they will be painful, how many tests you will need, and perhaps most importantly, whether an abnormal result automatically means cancer. It does not. Many symptoms and abnormal test results can have causes that are not cancer, which is why doctors usually use a combination of information and tests before reaching a diagnosis. So, what tests are done to detect cancer? There is no single test that can detect every type of cancer. Depending on your symptoms, medical history and the part of the body being investigated, your doctor may recommend a physical examination, blood or urine tests, imaging scans, an endoscopy, a biopsy or more specialised laboratory tests. A biopsy is often needed to confirm that abnormal cells are cancerous and to determine the type of cancer. For someone looking into Cancer Treatment in Bangalore, knowing how the diagnostic process works can make the first consultation less overwhelming. You will also understand why your doctor may recommend several tests instead of immediately jumping to a treatment plan. The most important thing to remember is that getting a test does not mean you have cancer. It simply means your doctor wants more information. The right test depends on the situation, and understanding why each test is being recommended can help you approach the process with greater clarity. What Happens Before Cancer Tests Are Recommended? Cancer diagnosis usually begins with a conversation, not a scan. Your doctor first needs to understand what is happening with your body and why further investigation may be necessary. 1. Your symptoms are discussed You may be asked about symptoms such as unexplained weight loss, persistent pain, unusual bleeding, a lump, changes in bowel or bladder habits, a persistent cough or changes in the skin. Having these symptoms does not automatically mean cancer, but persistent or unexplained symptoms may need evaluation. 2. Your medical history is reviewed Your doctor may ask about previous illnesses, medications, previous procedures and other health conditions. This information can help determine which tests are appropriate. 3. Your family history may be considered Certain cancers can run in families. Your doctor may ask whether close relatives have had cancer and, if so, what type and at what age. 4. A physical examination may be performed Depending on your symptoms, the doctor may examine areas such as your abdomen, lymph nodes, skin, breasts or other parts of your body. 5. Previous reports may be reviewed If you have already undergone blood tests, scans or other investigations, take those reports with you. Your doctor may be able to identify patterns or decide whether additional testing is needed. 6. Your risk factors may be discussed Age, smoking, alcohol use, occupational exposures, previous medical conditions and other factors may influence which cancers a doctor considers. This initial evaluation helps doctors decide what to investigate next. It also prevents unnecessary testing when a symptom may have a more common explanation. 8 Common Tests Used to Detect or Diagnose Cancer When people ask what tests are done to detect cancer, they often expect one particular test. In reality, doctors have several diagnostic tools available, and they may use them together. 1. Blood Tests Blood tests are often among the first investigations doctors order. They can provide information about your overall health and may reveal abnormalities that need further investigation. Some common blood tests include: 2. Imaging Tests Imaging tests allow doctors to look inside the body without making a surgical incision. They can help identify an abnormal area, understand its location and assess whether cancer may have spread. 3. Biopsy If there is one test patients should understand when asking what tests are done to detect cancer, it is the biopsy. A biopsy involves removing a sample of cells or tissue from an abnormal area so that a pathologist can examine it. In many cases, this is the test used to confirm whether cancer is present. A biopsy can be performed in different ways depending on where the suspected abnormality is located. Once the tissue reaches the pathology laboratory, it can be examined under a microscope and may undergo additional tests to determine the cancer type and other characteristics. 4. Endoscopy Tests Sometimes doctors need to look directly inside the body rather than relying only on external imaging. This is where endoscopy can be useful. An endoscope is a thin instrument with a light and camera that allows a doctor to examine the inside of certain organs or body passages. It can also allow tissue samples to be collected. Some commonly used endoscopic procedures include: Screening Tests vs Diagnostic Tests This is one distinction that is worth understanding before you start searching what tests are done to detect cancer online. Screening Tests Diagnostic Tests Usually performed in people who do not have symptoms Usually performed when there are symptoms, abnormal screening results, or another reason for concern Aim to find certain cancers early Aim to determine what is causing a symptom or abnormal finding Used for specific cancers where screening has an established role Selected according to the person’s symptoms and clinical situation Examples include mammography, cervical screening, and colorectal cancer screening Examples include biopsy, CT, MRI, ultrasound, blood tests, and endoscopy A positive screening result does not automatically mean cancer Diagnostic testing may be needed to confirm or rule out cancer Screening is not recommended as one universal test for every type of cancer. Established screening programmes exist for certain cancers, and recommendations can vary based on age, risk and other factors. Breast Cancer Screening: Mammography is an established screening test for breast cancer. If a screening mammogram shows an area that needs closer examination, additional imaging or a biopsy may be recommended. Cervical Cancer Screening: HPV testing and Pap testing are used for cervical cancer screening. These tests can
How Can I Manage Chemotherapy Side Effects?
How Can I Manage Chemotherapy Side Effects? Starting chemotherapy can bring a strange mix of emotions. You may feel relieved that treatment has begun, worried about what comes next, and overwhelmed by everything you have been told to expect. One of the biggest concerns for many patients is not just the treatment itself, but the side effects that may come with it. Will I feel sick? Will I lose my hair? Will I always be tired? Can I continue working? What should I eat? And most importantly, how can I manage chemotherapy side effects without making everyday life even harder? The good news is that you do not necessarily have to simply tolerate every side effect until chemotherapy is over. Many common side effects can be prevented, reduced or treated. Your cancer care team can prescribe medicines for problems such as nausea and vomiting, monitor your blood counts, help manage pain and other symptoms, and make changes to your treatment plan when medically appropriate. Side effects also vary considerably from one person to another. The type and dose of chemotherapy, the cancer being treated, your general health and other medicines you take can all influence what you experience. This is why knowing what to expect can make chemotherapy feel a little less unpredictable. Fatigue, nausea, changes in appetite, constipation, diarrhoea, mouth sores, hair loss, skin changes and nerve-related symptoms are some of the effects that may occur, but not everyone experiences all of them. Why Does Chemotherapy Cause Side Effects? Before looking at ways to manage side effects, it helps to understand why they happen in the first place. Chemotherapy medicines are designed to attack cancer cells, particularly cells that grow and divide quickly. However, some healthy cells also grow quickly. These include cells in the hair follicles, mouth, digestive tract and bone marrow. When chemotherapy affects these healthy cells, side effects can occur. The important thing to remember is that side effects do not tell you whether chemotherapy is working. Having severe side effects does not necessarily mean the treatment is more effective, and having very few side effects does not mean the treatment is not working. 1. Different chemotherapy drugs cause different effects There are many types of chemotherapy medicines, and they do not all affect the body in the same way. Your doctor will consider the particular medicines being used when explaining what you might experience. 2. The dose matters The amount of chemotherapy you receive can influence the type and severity of side effects. Your oncology team will determine the dose based on factors such as your cancer, treatment plan and overall health. 3. Your health also plays a role Existing health conditions, nutritional status and other medicines can affect how your body handles chemotherapy. 4. Side effects can appear at different times Some effects may happen during or soon after treatment, while others may appear several days later. Certain side effects may continue for longer or develop after several treatment cycles. 5. Everyone responds differently Two people receiving similar chemotherapy can have very different experiences. One person may have significant nausea while another may have little or none. Some people experience considerable fatigue, while others remain relatively active. Understanding this difference is important because there is no single answer to how can I manage chemotherapy side effects. Your management plan needs to be based on the symptoms you actually experience and the treatment you are receiving. 8 Common Chemotherapy Side Effects and What You Can Do Chemotherapy side effects can affect different parts of your body and your everyday routine. Here are some of the most common ones and practical ways they may be managed. 1. Nausea and Vomiting Nausea is one of the side effects many patients worry about before chemotherapy even begins. Fortunately, several medicines are available to prevent or reduce chemotherapy-related nausea and vomiting. 2. Fatigue Fatigue can feel different from ordinary tiredness. You may sleep and still feel as though your energy has not returned. To manage it: Fatigue can also be related to anaemia, infection, poor nutrition or other treatment-related issues, so persistent or severe tiredness should be discussed with your care team. 3. Loss of Appetite and Taste Changes Food may suddenly taste different during chemotherapy. You may notice a metallic taste, reduced appetite or a dislike of foods you previously enjoyed. Try: If eating becomes difficult or you are losing weight, ask your cancer care team whether you should meet a dietitian. 4. Constipation Constipation can occur because of chemotherapy itself, reduced activity, changes in food intake or some medicines used during treatment. Depending on your doctor’s advice, you may benefit from: Do not start laxatives or supplements on your own without discussing them with your cancer care team. 5. Diarrhoea Diarrhoea can cause dehydration and weakness if it continues. You can help manage it by: Your doctor may recommend medicines depending on the cause and severity. 6. Mouth Sores Chemotherapy can affect the cells lining the mouth and may lead to soreness or ulcers. To protect your mouth: Tell your doctor if mouth sores make eating or drinking difficult. 7. Hair Loss 8. Nerve Problems Certain chemotherapy medicines can cause peripheral neuropathy. This may feel like tingling, numbness, burning, pain or unusual sensitivity, particularly in the hands and feet. Tell your doctor if you notice: Early reporting is important because your oncology team may be able to adjust treatment or recommend ways to manage the symptoms. Everyday Habits That Can Make Chemotherapy Easier Managing chemotherapy is not just about taking medicines when symptoms appear. Your everyday routine can also make a difference. Eat for nourishment, not perfection: During chemotherapy, your nutritional needs may change. The goal is usually to give your body enough energy, protein and fluids while working around changes in appetite, taste or digestion. If you are struggling to eat, ask your cancer care team about speaking with a dietitian. Keep moving when you can: You do not need to exercise intensely. If your
