Steroids are hormonal substances, naturally produced in the body by the adrenal glands above the kidney and by reproductive organs. There are many different types of steroids and they all have different effects on the body. Some types of steroids have been found to help destroy some types of cancer cells, and can make more effective. This fact sheet describes steroids, how they are given and some of the side effects that may occur. Common types of steroids that are used in cancer treatment are: hydrocortisone, dexamethasone, methylprednisolone and prednisolone. Dexamethasone is also used in low doses as an anti-sickness drug.
In this case it is usually only given for short periods of time and the side effects described in this fact sheet will not necessarily apply. It is important to remember that each persons reaction to any drug is unique and some people have very few side effects. The effects will also vary according to the dose of the steroid that you are having and may be different if you are also receiving other drugs. We have outlined the commonest and less common side effects, so you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you.
If you do notice any effects which you think may be due to the drug, but which are not listed in the fact sheet, please discuss these with your doctor or nurse. You will have regular appointments with your doctor to monitor the effect of the steroids. This fact sheet should help you to discuss any queries about your treatment and its side effects with your doctor or chemotherapy nurse. They can help and advise you. What steroids look like A clear fluid after being dissolved from powder, or tablets. The color and dose of the tablets depends on the type of steroid used.
Soluble tablets are available for people who have difficulty in swallowing. How they are given The fluid is given by injection into a muscle (intra muscular) or vein (intravenous). If the steroids are given intravenously a small tube (cannula) will be inserted into the vein, and the steroids are given either as a quick injection through the tube or as a drip which takes about 30 minutes. They may be given through a central line which is inserted under the skin into a large vein near the collarbone. The tablets are swallowed with plenty of water. They may need to be taken at set times each day or may be given in short courses.
Possible side effects Irritation of the stomach lining. Steroids can increase the production of stomach acid and lower the production of protective stomach mucus. This can irritate the lining of the stomach and may cause or aggravate a stomach ulcer. To reduce this side effect the tablets should be taken with meals or milk. Tell your doctor if you have indigestion, stomach pains or abdominal discomfort. The levels of sugar in your blood may change temporarily. This may happen if you have high-dose or long-term treatment. While you are having your steroid therapy your blood sugar levels will be checked regularly by blood tests.
You may be asked to test your urine for sugar. You will be shown how to do this. Tell your doctor if you get very thirsty or if you are passing more urine than usual. Fluid retention due to changed salt and water balance. You may notice that your ankles and/or fingers swell. Some people have a bloated feeling in the abdomen. This is usually only a problem with long-term treatment. Increased appetite. You may notice that you feel than usual while taking steroids, and this can make you want to eat more than usual. If you are concerned about weight gain speak to your doctor or contact CancerBACUPs information service.
Increased chance of infection and delayed healing of injuries. This happens mainly with high-dose or long-term treatment. Tell your doctor if you notice signs of infection (inflammation, redness, soreness or a temperature) or if cuts take longer than usual to heal. It is important to maintain good personal hygiene to prevent infection. Menstrual changes. Women may find that their periods become irregular or stop. Behavioral changes. You may notice mood swings, difficulty in sleeping and perhaps anxiety or irritability. These happen mainly with high-dose or long-term treatment and will stop when the steroid therapy ends.
Tell your doctor about any behavioral changes which are worrying you. Difficulty in sleeping may be reduced by taking the steroids in the early part of the day, but discuss this with your doctor first. Less common side effects Eye changes. With long-term use of steroids, cataracts or glaucoma may develop. There is also an increased risk of eye infections. Tell your doctor if you notice any eye problems. This is usually caused only by long-term use of steroids. It can cause acne, puffiness of the face, dark marks on the skin and facial hair in women.
Cushings syndrome can be partially reduced by taking the steroids early in the morning, by taking them on alternate days instead of every day, or by reducing the dose, but discuss this with your doctor first. Muscle wasting. With very long-term use of steroids, wasting of leg muscles may occur. This can cause weakness. When the steroids are stopped some people experience muscle cramps for a short time. Osteoporosis. With very long-term use of steroids, calcium may be lost from the bones. This can result in pain (especially in the lower back), an increased susceptibility to fractures and loss of height.
Steroid Action in a Cell: Steroids are small and hydrophobic molecules. These hormones are lipid-soluble, so they could readily pass through the lipid plasma membrane. The steroid hormone binds to a cytoplasmic receptor once inside the cell. Only responsive cells have the receptor specific to the hormone. After the hormone binds to the receptor, the receptor changes shape, and the hormone-receptor complex enters the nucleus. It then binds to specific receptor sites on the chromatin, associates with the DNA, and activates mRNA transcription. The mRNA is then exported to the cytoplasm to be translated into proteins. “
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