Adjustment Disorder
Panic Disorder
Phobias
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Generalized Anxiety Disorder
Anxiety Disorder Caused by Other General Medical Conditions

Some persons may have already experienced intense anxiety in their life because of situations unrelated to their cancer. These anxiety conditions may recur or become aggravated by the stress of a cancer diagnosis. Patients may experience extreme fear, be unable to absorb information given to them by caregivers, or be unable to follow through with treatment. In order to plan treatment for a patient's anxiety, a doctor may ask the following questions about the patient's symptoms:

• Have you had any of the following symptoms since your cancer diagnosis or treatment? When do these symptoms occur (i.e., how many days prior to treatment, at night, or at no specific time) and how long do they last?
• Do you feel shaky, jittery, or nervous?
• Have you felt tense, fearful, or apprehensive?
• Have you had to avoid certain places or activities because of fear?
• Have you felt your heart pounding or racing?
• Have you had trouble catching your breath when nervous?
• Have you had any unjustified sweating or trembling?
• Have you felt a knot in your stomach?
• Have you felt like you have a lump in your throat?
• Do you find yourself pacing?
• Are you afraid to close your eyes at night for fear that you may die in your sleep?
• Do you worry about the next diagnostic test, or the results of it, weeks in advance?
• Have you suddenly had a fear of losing control or going crazy?
• Have you suddenly had a fear of dying?
• Do you often worry about when your pain will return and how bad it will get?
• Do you worry about whether you will be able to get your next dose of pain medication on time?
• Do you spend more time in bed than you should because you are afraid that the pain will intensify if you stand up or move about?
• Have you been confused or disoriented lately?

Anxiety disorder includes adjustment disorder, panic disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and anxiety disorder caused by other general medical conditions. Each of these is explained below.

Adjustment disorder includes behaviors or moods more extreme than expected in a reaction to a cancer diagnosis. Symptoms include severe nervousness, worry, jitteriness, and the inability to go to work, attend school, or be with other people. Adjustment disorder is more likely to occur in cancer patients during critical times of the disease. These include being tested for the disease, learning the diagnosis, and experiencing a relapse of the disease. Many cancer patients can achieve relief from adjustment disorder in several ways, including receiving reassurance from caregivers, exercising relaxation techniques, taking medication, and participating in support and education programs.

Patients with panic disorder experience intense anxiety. Patients may suffer shortness of breath, dizziness, rapid heart beat, trembling, profuse sweating, nausea, tingling sensations, or fears of "going crazy." Attacks may last for several minutes or several hours and are treated with medication. Symptoms of panic disorder may be very similar to other medical conditions.

Phobias are ongoing fears about or avoidance of a situation or object. People with phobias usually experience intense anxiety and avoid situations that may frighten them. Cancer patients may fear needles. They may also fear small spaces and avoid having tests in confined spaces, such as magnetic resonance imaging (MRI) scans.

A person with obsessive-compulsive disorder has persistent thoughts, ideas, or images (obsessions) that are accompanied by repetitive behaviors (compulsions). Patients with obsessive-compulsive disorder may be unable to follow through with cancer treatment because they are disabled by thoughts and behaviors that interfere with their ability to function normally. Obsessive-compulsive disorder is treated with medication and psychotherapy. Obsessive-compulsive disorder is rare in patients with cancer who did not have the disorder before being diagnosed with cancer.

The diagnosis of cancer may cause a person who has previously experienced a life-threatening event to relive the trauma associated with that event. Patients with cancer who have post-traumatic stress disorder may experience extreme anxiety before surgery, chemotherapy, painful medical procedures, or bandage changes. Post-traumatic stress disorder is treated with psychotherapy.

Patients with generalized anxiety disorder may experience extreme and constant anxiety or unrealistic worry. For example, patients with supportive family and friends may fear that no one will care for them. Patients may worry that they cannot pay for their treatment, although they have adequate financial resources and insurance. Generalized anxiety disorder may happen after a patient has been very depressed. A person who has generalized anxiety may feel irritable or restless, have tense muscles, shortness of breath, heart palpitations, sweating, dizziness, and be easily fatigued.

Patients with cancer may experience anxiety that is caused by other medical conditions. Patients who are experiencing severe pain feel anxious, and anxiety can increase pain. The sudden appearance of extreme anxiety may be a symptom of infection, pneumonia, or an imbalance in the body's chemistry. It may also occur before a heart attack or blood clot in the lung and be accompanied by chest pain or trouble breathing. A decrease in the amount of oxygen that the blood is able to carry may also make the patient feel as though he or she is suffocating; this can cause anxiety.

Anxiety is a direct or indirect side effect of some medications. Some medications can cause anxiety, while others may cause restlessness, agitation, depression, thoughts of suicide, irritability, or trembling.

Certain tumors may cause anxiety or produce symptoms that resemble anxiety and panic by creating chemical imbalances or shortness of breath.

See the following PDQ summaries for more information:

• Normal Adjustment and Distress ¹
• Post-Traumatic Stress Disorder ²

Glossary Terms

A condition in which a person responds to a stressful event (such as an illness, job loss, or divorce) with extreme emotions and actions that cause problems at work and home.

A condition in which a person is unable to relax and be still. The person may be very tense and irritable, and become easily annoyed by small things. He or she may be eager to have an argument, and be unwilling to work with caregivers to make the situation better.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

The act of staying away from people, places, and thoughts that may cause anxiety, pain, or unpleasant feelings. Some types of cancer-related avoidance include refusing to accept a cancer diagnosis or get treatment, and using alcohol or other drugs to forget about having cancer.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

Too much or too little of any substance that helps the body work the way it should. A chemical imbalance may be caused by certain tumors and can cause changes in behavior or emotion.

Treatment with drugs that kill cancer cells.

An uncontrollable urge to say or do something without an obvious reason. A person may repeat a behavior, such as hand-washing, over and over.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease, such as cancer, from its signs and symptoms.

A specific test or series of steps done to help diagnose a disease or condition. Mammograms and colonscopies are examples of diagnostic procedures.

A mental state marked by confusion about time, place, or who one is.

The amount of medicine taken, or radiation given, at one time.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

A condition marked by excessive worry and feelings of fear, dread, and uneasiness that last six months or longer. Other symptoms of generalized anxiety disorder include being restless, being tired or irritable, muscle tension, not being able to concentrate or sleep well, shortness of breath, fast heartbeat, sweating, and dizziness. Also called GAD.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

A procedure in which radio waves and a powerful magnet linked to a computer is used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. Magnetic resonance imaging makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. Magnetic resonance imaging is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called MRI, NMRI, and nuclear magnetic resonance imaging.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

An anxiety disorder in which a person has intrusive ideas, thoughts, or images that occur repeatedly, and in which he or she feels driven to perform certain behaviors over and over again. For example, a person may worry all the time about germs and so will wash his or her hands over and over again. Having an obsessive-compulsive disorder may cause a person to have trouble carrying out daily activities.

A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.

A rapid or irregular heartbeat that a person can feel.

Sudden extreme anxiety or fear that may cause irrational thoughts or actions. Panic may include rapid heart rate, flushing (a hot, red face), sweating, and trouble breathing.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

An extreme, irrational, fear of something that may cause a person to panic. Examples of common phobias include fear of spiders, flying in an airplane, elevators, heights, enclosed rooms, crowded public places, and embarrassing oneself in front of other people.

A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.

An anxiety disorder that develops in reaction to physical injury or severe mental or emotional distress, such as military combat, violent assault, natural disaster, or other life-threatening events. Having cancer may also lead to post-traumatic stress disorder. Symptoms interfere with day-to-day living and include reliving the event in nightmares or flashbacks; avoiding people, places, and things connected to the event; feeling alone and losing interest in daily activities; and having trouble concentrating and sleeping. Also called PTSD.

Treatment of mental, emotional, personality, and behavioral disorders using methods such as discussion, listening, and counseling. Also called talk therapy.

To come back or to return.

The return of signs and symptoms of cancer after a period of improvement.

A method used to reduce tension and anxiety, and control pain.

A picture of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

The act of taking one's own life on purpose.

A group of people with similar disease who meet to discuss how better to cope with their disease and treatment.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The throat is about 5 inches long, depending on body size. Also called pharynx.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.