Steroids are naturally made by our bodies in small amounts. They help to control many functions including the immune system, reducing inflammation and blood pressure.
Man-made steroids can also be a treatment for many different conditions and diseases. The information on this page is about steroids used in cancer treatment.
The type of steroids you might have as part of your cancer treatment are usually a type called corticosteroids. These are man-made versions of the hormones produced by the adrenal glands just above the kidneys.
Steroids used in cancer treatment include:
What steroids do
Steroids help control many body functions including:
- how your body uses food to produce energy (metabolism)
- keeping the balance of salt and water in your body
- regulating blood pressure
- reducing allergies and inflammation
- controlling mood and behaviour
Why are steroids used in cancer treatment?
There are a number of reasons you might have steroids as part of your cancer treatment.
- treat the cancer itself
- reduce inflammation
- reduce your body’s immune response, for example after a bone marrow transplant
- help reduce sickness when having chemotherapy
- improve your appetite
You might have them:
- when you are first diagnosed
- before and after surgery
- before and after radiotherapy
- before, during and after chemotherapy treatment
- for an advanced cancer
How you have steroids
The most common ways of taking steroids during cancer treatment are as:
- tablets or liquid (take them after a meal or with milk as they can irritate your stomach)
- an injection into a vein (intravenous)
When you have steroids
The dose and length of steroid treatment is different depending on why you're having steroids.
You might need to take them:
- every other day
- once a day
- several times a day
You should have a steroid card to carry with you all the time if you take steroids for more than 3 weeks. Your doctor or pharmacist might also suggest you wear a medical alert bracelet. This is in case you need treatment in an emergency. It tells the healthcare team you are taking steroids.
Always let your dentist know you're taking steroids.
Stopping steroid treatment
Take your steroids exactly as your health professional has told you.
When you take steroid tablets, the higher amounts in your bloodstream stop your body from making its own supply. Stopping them suddenly can cause serious symptoms such as:
- pale, cold, clammy skin
- fast, shallow breathing
- feeling or being sick
Never just stop taking your tablets. Cut them down gradually with help and guidance from your doctor or pharmacist.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We haven't listed all the side effects. You may get some of them, but it is very unlikely that you will have all of them. You might have some of the side effects at the same time.
How often and how severe the side effects are can vary from person to person. We’re unable to give an idea of the frequency of these side effects because it depends on:
- what other treatment you are having - for example, your side effects could be worse if you are also having other drugs or radiotherapy
- the aim of the steroid treatment (for example to treat your cancer or to help with symptoms)
- if you’re taking steroids short or longer term
- the dose of steroids
When to contact your team
Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
You might have one or more of these side effects. They include:
Increased risk of infection
Steroids can hide or change the signs and symptoms of some infections. They might also make it harder for your body to deal with an infection. This means infections are more difficult to diagnose at an early stage.
Symptoms of an infection include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might feel more anxious and emotional than usual when you take steroids. You may also feel tired and sad for a while after you stop taking them.
Up to 6 out of 100 people (6%) experience serious mental health problems when they take steroids. This includes depression. Let your doctor know if you notice any changes in your emotional or psychological wellbeing. Let your doctor know if you or any family members have ever had depression or manic depression (bipolar disorder).
Rarely, steroids can cause a reaction called steroid induced psychosis. People can become excited, confused and imagine things that aren’t real. This can be frightening, but it goes away when you stop taking the steroids.
Changes in blood sugar levels
You might have regular blood and urine tests to check this. Some people develop diabetes. You might need to have blood sugar lowering treatment. But your sugar levels usually go back to normal shortly after you stop taking steroids.
If you have diabetes already, you might need to check your blood sugar levels more often than usual.
Increased appetite and weight gain
Steroids can increase your appetite. Feeling hungrier can make it difficult to keep your weight down. Your appetite will go back to normal when you stop steroids - but some people need to diet to lose the extra weight.
Talk to your nurse or your dietitian about how to safely control your weight.
Fluid build up
A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.
It can help to change a few things about when and where you sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
Try and take your steroids in the morning or around lunchtime.
Indigestion or heartburn
Take your tablets after a meal or with milk as they can irritate your stomach.
Steroids can cause ulcers in the stomach or top part of the small bowel (duodenum).
Tell your doctor or nurse if you have:
- a gnawing or burning pain in your tummy (abdomen)
Changes to your face and appearance (Cushing's syndrome)
You might develop:
- a swollen or puffy face
- stretch marks
- increased facial hair
You might put on weight around your tummy (abdomen).
This can be quite upsetting. Talk to your doctor or nurse about any of these side effects.
High blood pressure
Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.
You might have eye problems including:
- clouding of the lens of the eye (cataracts)
- glaucoma (damage to an eyesight nerve)
- eye infections
- problems with your vision, such as blurred vision due to increased pressure on the eyesight nerve
Let your doctor or nurse know if you have any problems with your eyes.
Skin changes might include:
- skin thinning
Wounds might take longer to heal than usual.
You might have weaker bones due to bone loss (osteoporosis).
Dizziness and loss of balance (vertigo)
You might feel dizzy and you may feel as though the room is spinning. This is vertigo. Let your doctor or nurse know if this happens.
Increased numbers of white blood cells
Steroids can increase the number of white blood cells in your blood. Your doctor might see this on a full blood count test.
You might have more body hair than usual. Your head hair may thin. This is usually not noticeable by other people but can be upsetting.
Steroids can cause severe heart problems if you have had a recent heart attack.
Your legs may feel weaker and walking or climbing stairs may be more difficult. You may have aching muscles for a short while after stopping treatment.
You might have an allergic reaction to steroids, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Tell your nurse or doctor immediately if at any time you feel odd or strange.
Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.
Growth problems in children
Steroids might cause growth problems in babies, children and teenagers. Your child’s doctor will look at the benefits and risks of prescribing high doses of steroids for your child
Low levels of potassium in your blood
A low level of potassium in the blood is called hypokalaemia. You might have blood tests during cancer treatment to check for this.
Burning or tingling around your bottom
You might have a burning or tingling sensation around your bottom during a steroid injection into a vein (intravenous). It usually goes once the injection finishes. Your nurse will give the injection slowly to try and prevent this.
Epilepsy becoming worse
If you have epilepsy this could become worse when taking steroids.
Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.
Symptoms of a blood clot include:
• pain, redness and swelling around the area where the clot is and may feel warm to touch
• pain in your chest or upper back – dial 999 if you have chest pain
• coughing up blood
Inflammation of the pancreas
This drug can cause inflammation of the pancreas (pancreatitis). Tell your doctor straight away if you have sudden and severe pain in your tummy (abdomen).
Changes to your periods
Women might have irregular periods, or they stop altogether (amenorrhoea).
You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Chicken pox and shingles
Keep away from people who have chicken pox or shingles whilst taking steroids if you have never had these illnesses. They could make you very ill.
If you do come into contact with someone who has them, tell your doctor or nurse straight away.
Other medicines, food and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
This treatment might harm a baby developing in the womb. Talk to your doctor or nurse about effective contraception before starting your cancer treatment.
There is evidence that steroid drugs may come through into your breast milk. Talk about breastfeeding with your doctor. You can make a decision together based on the benefits to you and the possible risks to your baby.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
You might be able to have other vaccinations if you have had:
- small doses of steroids for a short period of time (less than 2 weeks)
- local steroid treatment, such as eye drops or creams
Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.
This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.
You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
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