Persistent Fever in Cancer Patients: What You Need to Know

Persistent fever

Hello, my father was diagnosed with nasopharyngeal cancer last November.
Since then, he has undergone radiation therapy for the head and neck, liver, and pelvic region.
In May, two tumors were found in his liver, and he received 25 sessions of radiation therapy for this.
A CT scan at the end of August revealed 20 to 30 tumors in the liver.
His chemotherapy regimen was changed to a self-paid option combining gemcitabine and cisplatin.
He started experiencing fever three days after chemotherapy; aside from mild headaches and chills on the first day, he generally feels warm and fatigued.
He has been using acetaminophen to reduce the fever, but it returns about six hours after the medication wears off.
Although the intervals between fevers have gradually lengthened over the past five days, he has been experiencing continuous fever.
The doctor suspects this may be tumor fever.
I would like to know if tumor fever indicates that the tumors are growing rapidly? Will the fever persist? Is the change in the liver condition already severe? Thank you!

Judy, 30~39 year old female. Ask Date: 2011/09/05

Dr. Chen Junyi reply Oncology

An abdominal ultrasound can be performed to assess liver tumors and evaluate the condition.

Reply Date: 2011/09/05

More Info

Persistent fever in cancer patients can be a complex issue, often requiring careful evaluation and management. In your father's case, the development of a fever following chemotherapy, particularly after a significant treatment history including radiation therapy for nasopharyngeal cancer and liver tumors, raises several important considerations.

Firstly, it is essential to understand that fever in cancer patients can arise from various causes. These include infections, which are common due to immunosuppression from chemotherapy, as well as tumor-related fever, also known as "neoplastic fever." This type of fever can occur due to the release of pyrogens from the tumor itself or as a response from the immune system to the presence of cancer. In your father's situation, the oncologist's suggestion that the fever might be tumor-related is plausible, especially given the extensive treatment history and the presence of multiple liver tumors.

The fact that your father experiences fever that responds to antipyretics like acetaminophen (Tylenol) but returns after the medication wears off is indicative of a persistent underlying issue. While it is not uncommon for cancer patients to experience fluctuations in temperature, the duration and persistence of the fever over five days warrant further investigation. Continuous fever can lead to increased fatigue, dehydration, and a decline in overall health, which is particularly concerning in patients with advanced cancer.

Regarding your specific questions:
1. Does tumor fever indicate rapid tumor growth? While tumor fever can be associated with disease progression, it does not necessarily mean that the tumors are growing rapidly. It is essential to correlate the fever with imaging studies and clinical evaluations to determine the tumor's status. The presence of fever can sometimes be a sign of the body’s immune response to the tumor rather than direct evidence of tumor growth.

2. Will the fever persist? The persistence of fever can vary widely among individuals. In some cases, it may resolve as the body adjusts to the cancer or treatment, while in others, it may continue or recur. Close monitoring by healthcare professionals is crucial to manage symptoms and address any underlying causes.

3. Is the liver condition serious? The presence of multiple tumors in the liver, especially after previous treatments, suggests a significant disease burden. This situation requires careful management and possibly a reassessment of treatment strategies. It is vital to maintain open communication with your father's oncology team to discuss the implications of the imaging findings and the best course of action moving forward.

In summary, persistent fever in cancer patients like your father can be multifactorial, and while it may indicate tumor activity, it is essential to evaluate it in the context of his overall health and treatment plan. Regular follow-ups, imaging studies, and possibly blood tests to check for infections or other complications are necessary to ensure appropriate management. If the fever continues or worsens, it is crucial to seek immediate medical attention to rule out any serious complications.

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