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Peripheral neuropathy (pronounced per-if-eral new-rop-athy) is a term used to describe changes in the way that particular nerves work. Many people who have cancer, or cancer treatments, may develop peripheral neuropathy. This information is about the condition.
The nervous system is made up of the brain, the spinal cord and a complicated network of nerves that thread throughout the body. It has two main divisions:
Nerves carry nerve impulses back and forth between the areas of the body and the brain. Nerves are made up of nerve cells called neurons.
Neurons are very thin. Some are very small, and others can be 3 feet (1 metre) long. Many are shaped a bit like stars that have been pulled at each end so that they have long fingers. The fingers of one nerve cell reach almost to the next neuron, but there is a gap between them.
Motor nerves carry messages out from the brain to all the muscles in the body. Once the muscle receives the message it will react with a movement. Messages can be sent from the brain to any part of the body.
Sensory nerves in the body carry messages to the brain from sensory receptors all around the body. They enable us to sense physical feelings such as pain, touch and vibration and also allow us to know where our body is in relation to the space and objects around us.
When a nerve cell is stimulated by a message such as heat, cold, touch, or sound vibrations, it begins to create a tiny electrical pulse in the cell. This electrical impulse causes a chemical change in the nerve that travels the full length of the neuron. When the electrical impulse reaches the end of the cell it usually triggers the release of chemicals that carry the electrical impulse to the next nerve cell. In this way messages can be sent from nerves anywhere in the body to the spinal cord and then up to the brain.
Peripheral neuropathy is not one specific disease, but can occur due to many different conditions that cause damage to the peripheral nerves. There are many causes of peripheral neuropathy, but this information looks specifically at peripheral neuropathy caused by cancer or treatments for cancer.
If only one nerve is affected by the neuropathy it is referred to as mononeuropathy, if several nerves are affected it is mononeuritis multiplex and if many nerves are affected on both sides of the body it is called polyneuropathy.
The symptoms of peripheral neuropathy tend to vary depending on which nerves are affected. In many people with cancer the neuropathy often affects the arms and hands, and/or legs and feet. It often starts with mild symptoms that may become more noticeable and more severe.
Common signs, depending on the type of neuropathy, may include:
Many neuropathies cause a loss of sensation in the hands, feet and lower legs. As the affected areas are similar to those covered by gloves and stockings this is known as glove and stocking sensory loss. It can cause problems with walking, or with carrying out daily tasks.
The symptoms of peripheral neuropathy will often vary from person to person and can affect people mildly or more severely. For some people it will mean that they have to change their lifestyle, however, and may also mean that this affects other members of their family.
Peripheral neuropathy can be caused by the cancer itself pressing on a nerve in a particular area of the body. This situation is known as radiculopathy and causes some of the changes mentioned above, but confined to a specific part of the body. Some types of cancer such as myeloma may cause generalised damage to nerves (polyneuropathy).
In some types of cancer, particular antibodies or other substances that damage the nerves may be produced by the body. This is known as paraneoplastic peripheral neuropathy and most commonly occurs in people with lung, breast or ovarian cancers, or Hodgkin lymphoma.
If nerves are damaged by surgery or radiotherapy they may cause neuropathy in the affected area: for example, numbness or tingling and pain in the arm after breast cancer surgery and/or radiotherapy.
Chemotherapy and other drug treatments for cancer are the most common cause of peripheral neuropathy in people with cancer as they can cause damage to peripheral nerves. The drugs that are most likely to cause peripheral neuropathy include:
The peripheral neuropathy may start soon after the first dose of treatment has been given and may gradually get worse. The type of peripheral neuropathy, and how much it affects the person, will depend on the drug given, the dose, how often it is given and whether it is given as tablets or capsules or into a vein. Other factors that can affect the peripheral neuropathy are whether other drugs or treatments that cause it (eg radiotherapy) are also being given and whether the person already has an existing condition that affects their nervous system.
Sometimes, lowering the dose of the drug that is causing the neuropathy can reduce this side effect. If the neuropathy continues to get worse it may be necessary to stop the drug. In this situation your doctors will usually discuss with you whether another type of chemotherapy drug can be given instead. There are a large number of chemotherapy drugs which do not cause peripheral neuropathy that can often be used. Alternatively some other kind of treatment, such as radiotherapy, may be suggested. It is extremely important not to stop treatment without first talking to your cancer specialist.
In most people the neuropathy will gradually decrease once the drug is stopped, but sometimes it can continue to get worse for a few weeks (known as coasting phenomenon). Occasionally the neuropathy may become permanent.
People who have diabetes or have a heavy alcohol intake may be at higher risk of developing peripheral neuropathy when they are given the above drugs. If you drink heavily it is important to let your doctor know, as taking vitamin B1 tablets can help to prevent neuropathy in this situation.
The best way of reducing the symptoms of peripheral neuropathy is to stop taking any drug that is causing it.
In cancer treatments, sometimes the benefits of taking the drug to cure or control a cancer may outweigh the discomfort and inconvenience of the neuropathy it is causing. However, if the neuropathy is severe you may feel that the disadvantages outweigh the benefits. It is important to discuss this with your doctor or nurse, who can let you know whether there are other treatment options that may suit you better and who can discuss the benefits and disadvantages of these alternatives.
If you need to have chemotherapy again, there are a large number of chemotherapy drugs that do not cause or aggravate peripheral neuropathy. Your doctor will discuss the possible options with you.
Research has not so far found any reliable way of treating or reducing peripheral neuropathy. Studies are looking at whether a drug called amifostine can reduce peripheral neuropathy, but it is not clear whether it will be helpful.
If the neuropathy is causing disability such as foot drop, or difficulty in carrying out daily tasks, there are many gadgets and aids that can help you, such as specially made supportive shoes or cutlery with larger handles. Organisations which provide equipment for people who need help with daily tasks are listed below.
Your specialist may ask you to have tests to see how much your nerves are affected by the neuropathy. These may include:
Other tests or scans may be done if it is thought that the neuropathy could be caused by a tumour pressing on a nerve.
Neuropathic pain symptoms are managed in four main ways:
Drugs Antidepressants, antiepileptic drugs and heart drugs may be used, as they affect the membrane that surrounds nerves and can alter the nerve impulses. Opioid drugs such as morphine can sometimes be helpful. Some people who are offered antidepressant drugs may worry that the health care staff think that their pain is just psychological. This is an understandable concern, but it is important to realise that antidepressant drugs are given as a treatment for the pain and can be very effective for some people.
Physical therapy Transcutaneous electrical nerve stimulation (TENS) and acupuncture can sometimes reduce pain. They are unlikely to cause side effects and may be tried early on.
Injections Injections of drugs, such as local anaesthetics, around the damaged nerve can block pain impulses for several days or weeks.
Psychological therapies Psychological support by counsellors and psychotherapists can help to reduce the anxiety, tension and fear caused by the pain and may make the pain more bearable. It may also reduce pain by resolving anxieties and fears.
The need for practical and emotional support will depend upon the individual. Some people with peripheral neuropathy may find that their life is not affected very much. For others the condition may be a source of great fear and distress.
If the peripheral neuropathy is severe and causing changes to your lifestyle it is natural to have feelings of isolation and frustration.
You may have many different emotions including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with side effects caused by their treatment.
This section has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography.
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