Steroids

Steroids can be used as part of cancer treatment or to help with the side effects of treatment. Steroids (sometimes called corticosteroids) are substances that are made naturally in the body. They control different functions in our bodies, such as the immune system or the way the body uses food. They also help to reduce inflammation.

Steroids can also be man-made and used as part of your cancer treatment. Steroids can be taken as tablets or liquids by mouth or by injection. This depends on the type your doctor prescribes.

Steroids may cause side effects. Side effects can be different for each person and depend on the dose given. The most common side effects are:

  • tummy pain and indigestion
  • raised blood sugar levels
  • build-up of fluid
  • increased appetite
  • mood changes.

It’s important to take steroids exactly as prescribed. You will have regular appointments to monitor the effect of the steroids. If you are taking steroids for a long time your cancer specialist or GP will give you a card to carry that explains what you are taking.

What are steroids?

Steroids are substances that are naturally produced in the body. There are two adrenal glands, one on top of each kidney.

Steroids help control many different functions in our bodies, for example:

  • the way the body uses fats, proteins and carbohydrates
  • regulating our immune system and the balance of salt and water in our bodies
  • reducing inflammation.

Steroids can be manufactured synthetically as drugs. There are several types of steroids and they all have different effects on the body. Common types of steroids used in cancer treatment are:

  • hydrocortisone
  • dexamethasone
  • methylprednisolone
  • prednisolone.

Steroids can be used:

  • as part of your treatment to help destroy cancer cells and make chemotherapy more effective
  • to help reduce an allergic reaction to certain drugs
  • in low doses as anti-sickness drugs to improve your appetite.

In these situations, steroids are usually given only for short periods of time, and you won’t usually get the side effects described here.


How steroids are given

Steroids can be taken as tablets or given as an injection.

As tablets, steroids are swallowed with plenty of water or milk. They may need to be taken at set times each day. They are usually given in short courses. It’s important to make sure you know how long you need to take them for. If you have difficulty swallowing your doctor can prescribe prednisolone tablets that dissolve in water, or dexamethasone to take as a syrup.

Steroids can be given by injection in the following ways:

  • into a muscle (intramuscularly)
  • under the skin (subcutaneously)
  • into a vein a vein (intravenously) through a tube (cannula), either as a quick injection, or as a drip which takes up to 30 minutes
  • through a central line, a tube which is inserted under the skin into a large vein near your collarbone
  • through a PICC line, a tube inserted into a vein in the bend of your arm near the elbow.


Possible side effects of steroids

We explain the most common side effects of steroids here. But we don’t include all the rare ones that are unlikely to affect you.

You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have.

Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.

Serious and life-threatening side effects

Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.

More information about steroid drugs

We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).

Tummy pain and/or indigestion

Steroids can irritate the stomach lining. Let your nurse or doctor know if you have indigestion or pain in your tummy. They can prescribe drugs to help reduce stomach irritation.

Take your tablets with food to help protect your stomach. Some steroid tablets are coated to help reduce irritation.

Raised blood sugar levels

Steroids can raise your blood sugar levels. Your nurse will check your blood regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms.

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor can talk to you about this. They may adjust your insulin or tablet dose.

Build-up of fluid

You may put on weight or your ankles and legs may swell because of fluid building up. This is caused by steroids and is more common if you are taking them for a long time. Tell your doctor or nurse if fluid builds up. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling gets better after your treatment ends.

Increased appetite

Steroids can make you feel much hungrier than usual and you may gain weight. Your appetite will go back to normal when you stop taking them. If you’re worried about gaining weight, talk to your doctor or nurse.

Increased chance of infection and delayed healing

This is more likely to happen if you are having high-dose steroids or taking them for a long time. Tell your doctor if you notice signs of infection, such as redness, soreness or a temperature. You should also tell them if cuts take longer than usual to heal.

Washing your hands thoroughly after meals and using the toilet can help prevent infection. You should avoid anyone who may have signs of an infection, such as a cold.

Changes to your periods

Women may find that their periods become irregular or stop. These will usually return to normal once treatment with steroids has finished.

Mood and behaviour changes

Steroids can affect your mood. You may feel anxious or restless, have mood swings or problems sleeping. Taking your steroids in the morning may help if you’re having difficulty sleeping.

Tell your doctor or nurse if you have any of these side effects. They may make some changes to your treatment if the side effects become a problem.

Discomfort in your bottom

If the steroid dexamethasone is given quickly into a vein, it can cause a strange sensation in the area just in front of your back passage (the perineal area). This only lasts for a short time.


Less common side effects of steroids

We have listed some less common side effects that may develop with long-term use of steroids, which is when you take steroids for more than a few months.

Eye changes

Steroids can cause eye problems. There is also an increased risk of eye infections. If you notice any changes to your eyes, such as blurred vision, pain or redness, tell your doctor or specialist nurse.

Cushing’s syndrome

This can cause acne, puffiness of the face, facial hair in women and dark marks on the skin. Talk to your doctor if you have any of these side effects. Cushing’s syndrome can be reduced a little by lowering the dose of steroids.

Muscle wasting

Your legs may feel weaker. When the steroids are stopped, you may have muscle cramps for a short time.

Bone thinning (osteoporosis)

Let your doctor know if you have any pain in your bones, especially in the lower back. If you are at risk of osteoporosis, your doctor may prescribe drugs called bisphosphonates to protect your bones. They will also usually advise you to take calcium and vitamin D supplements.

Regular walking, eating a healthy diet, not smoking and sticking to sensible drinking guidelines will also help strengthen your bones.


Other information about steroids

You’ll be given a steroid card if you have to take steroids at home. The card should be carried with you at all times so that in an emergency a doctor will know you are having steroid treatment. A card is not necessary if you are only having a short course of steroids.

If you have been taking steroids for a long time and they are suddenly stopped, you may have withdrawal effects. These include:

  • fever
  • aching muscles or bones
  • feeling generally unwell.

For this reason, it's important to take the steroids exactly as prescribed by your doctor. When the steroid treatment is over, the dose is gradually reduced before being stopped. This will reduce the risk of withdrawal effects. Your doctor will advise you on this.

Medical and dental treatment

If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having steroids. Give them contact details for your cancer doctor. Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having steroids.


Things to remember about steroid tablets

  • Keep the tablets in a safe place, out of the reach of children.
  • If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
  • Tell your doctor if you are sick just after taking a tablet, as you may need to take another one.
  • If you forget to take your tablet, do not take a double dose. Ask your doctor or nurse for advice.
  • If you're having a short course of steroids as part of your treatment, do not get more from your GP.

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Treating symptoms

Depending on your symptoms your specialist may prescribe steroids to reduce swelling or drugs to prevent seizures (fits).