A normal temperature is usually around 36.5-37.5C. If your body temperature is higher than normal, usually defined as over 38C, you have fever. You should always have a thermometer at home to check your body temperature.
Fever is a common symptom in patients with cancer. It can be uncomfortable and may cause a concern for you and your family. There are a few possible causes of fever. The most common one is infection. Other causes may include inflammation, medication reaction, or tumor itself. It is important to find out the cause of fever.
There are various causes of fever, including:
1. Infection
Infection is a common complication of cancer and cancer treatment. Bacteria, viruses and fungi can cause infection.
Chemotherapy can lower the while blood cell level in your body. The while blood cell is used to fight infection. If your white cell count is low, your immune system is not as strong as it should be and you may at a risk of getting infection.
Infection can sometimes be life threatening. Especially if you are on chemotherapy and your neutrophil is low, you may at risk of developing a serious condition called neutropenic fever. (Find out more about neutropenic fever: Cancer Information à Neutropenic fever)
Fever may only be a sign of infection. You may also have other symptoms.
Symptoms of infection include:
Remember to contact your healthcare professionals if you think you may have an infection. You may need immediate medical treatment.
2. Cancer itself
Some types of cancer can cause fever. This is often called “malignant fever”. Your doctor would probably have used some methods to find the source of fever but cannot find a particular reason to explain before calling it “malignant fever”. The cancers more likely to cause fever include:
For lymphoma, the fever may come and go with no obvious cause and may be associated with night sweats and weight loss.
3. Side effects of drug
Some medications may cause fever, e.g. zolendronic acid, allopurinol, G-CSF infection. If you have fever during infusion of a drug, please tell the nurse as it may be a drug reaction. Your nurse may slow down the drip and may give you medicine like paracetamol, antihistamine or steroid to combat the reaction.
4. Reactions to blood products
It is not uncommon to have a higher temperature during blood production transfusion. Since the blood product contains cells and antibodies from the donor, your body may react to these cells and antibodies. If there is fever, your nurse will assess your condition and may give your antihistamine or paracetamol to lower the temperature. You may worry if the blood product can give you an infection. However, this is very rare as all blood products are carefully screened for any bacteria and virus before use.
5. Bowel or bladder obstruction
If there is obstruction in your bowel or bladder, the waste cannot be passed out normally. The bacteria can start to grow and cause an infection.
Your doctor will examine you if you have fever. Usually your doctor will perform some tests to check for infection, e.g. sending urine, sputum, blood, wound sites, faeces, etc for bacterial culture. Your blood will also be checked for any high or low in white cell count. If these cannot give any clues on the cause of fever, your doctor may perform further investigations, e.g. Chest-X ray, CT scan or even PET-CT.
1. Fever due to infections:
If the fever is due to infection, you will start a course of broad spectrum antibiotics, which can fight a wide range of different infections. Once the culture result is back, your doctor may change to another specific type of antibiotics. Antibiotics can be given by mouth (oral tablets, capsules or liquids), intravenous injection or topically (cream or lotion).
If the infection is due to virus, e.g. herpes zoster or simplex, this will be treated with anti-virals. Examples of anti-virals include acyclovir, ganciclovir, foscarnet.
2. Fever due to cancer:
Malignant fever will usually subside after you receive anticancer treatment. However, you can also have paracetamol or non-steroid anti-inflammatory drugs (NSAID), e.g. Naprosyn, ibruprofen, diclofenac, to lower your temperature. However, please remember that NSAID may have side effects of gastric or duodenal ulcer or renal impairment. Please consult your doctor before use.
3. Fever due to blood products or drugs
Your nurse may stop the infusion of the blood product or drug if you have high temperature. You may receive paracetamol, antihistamine and steroid to treat the reaction.
Besides medications, you can try the following ways to make yourself feel more comfortable:
1. Granulocyte colony stimulating factor (G-CSF)
If you are having chemotherapy and the chemotherapy may cause a low white cell count, your doctor may prescribe granulocyte colony stimulating factor (G-CSF) to you. G-CSF is a type of growth factor that makes the bone marrow produce more white blood cells and makes the stem cells release from the bone marrow into the blood. This can reduce the risk of infection.
G-CSF is usually given by subcutaneous injection into your arm, tummy or thigh. There are two types: long acting and short acting ones. The long acting ones are given once only while the short acting ones are given several consecutive days in between two chemotherapies.
Common side effects of G-CSF include bone or muscle pain, headaches, tiredness or weakness, feeling sick, flu-like symptoms, sore throat and high temperature. These symptoms usually can be relieved with taking paracetamol and will be subsided a few days after G-CSF infection.
2. Prophylactic antibiotics
If your white cell count is very low, besides G-CSF, your doctor may prescribe antibiotics to you to prevent infection. Commonly used prophylactic antibiotics include ciprofloxacin, augmentin. Please follow your doctor’s instruction when using these antibiotics.
Special thanks to Dr Wendy Wing-Lok Chan, Department of Clinical Oncology, the University of Hong Kong, for authoring this article.
