Managing Infections and Sepsis in People with Cancer
Sepsis is a very serious condition that can develop in anyone when their body overreacts to infection, but people with a weak immune system or neutropenia have a higher risk. Instead of just attacking the infection, sepsis causes inflammation throughout the body, attacking the tissues and organs.
Signs and symptoms of infection
Cancer and cancer treatments can increase a person’s risk for different types of infections. Infections that might not usually be a problem can make a person with cancer very sick. Signs and symptoms of an infection depend on its cause and where the infection is. Some of the most common signs of infection for people with cancer include:
- Fevers
- Chills and sweats
- Fast heartbeat
- Breathing problems or cough
- Dizziness or lightheadedness
- Rash, redness, swelling, or sores on the skin (especially near the genitals, rectum, or around a catheter, tube, or drain)
- Pain or swelling in the joints or bones
- Pain, swelling, or sores in the gums, mouth, or throat
- Pain in the abdomen (belly) or rectum
- Pain or burning when peeing
- Sore throat
- Sores or white patches in the mouth or on the tongue
It's very important to protect yourself from infection if you have neutropenia (a lower white blood cell count). A fever is often the only sign of an infection in people with neutropenia. Ask your cancer care team if and how often you need to check your temperature and when to call or get medical help.
Some cancer care teams can give you a thermometer if you don’t have one. You can also get an oral thermometer (one that goes in your mouth) at any drugstore or pharmacy.
Finding the cause of infection
If your doctor or cancer care team is worried you might have an infection, they’ll need to know what type of infection and where in the body it is. This helps them choose the best medicines and treatment.
Depending on what signs or symptoms you’re having, you'll get tests to look for the cause of the infection. This might include:
- Blood tests
- Imaging tests (such as an x-ray or CT scan)
- Samples of body fluids (such as sputum, urine, or stool)
- Samples of fluid from a wound or other area (such as around a catheter)
They might start you on a few medicines right away, while waiting for test results. This is to keep the infection from getting worse. Once they find out what types of germs are causing the infection, they will make sure you’re taking the correct medicines for that type of infection.
Treating infections in people with cancer
Infections are treated most effectively when the type of germ that is causing them is known. Anti-infectives is a general word for the different types of medicines used to treat infections. The most common types of anti-infectives used for people with cancer are:
- Antibiotics for infections caused by bacteria (such as urinary tract infections caused by E coli or Pseudomonas bacteria)
- Antivirals for infections caused by viruses (such as viral pneumonia caused by influenza or coronavirus)
- Antifungals for infections caused by fungi (such as thrush or yeast infections caused by candida yeast)
- Antiprotozoals for infections caused by protozoa (such as toxoplasmosis caused by a parasite called Toxoplasma gondii)
Signs and symptoms of sepsis
Once there are signs of organ damage from sepsis, it’s called septic shock. Common signs of septic shock include:
- A fast heart rate
- Low blood pressure
- Confusion
- Pale, cold, or clammy skin
- Nausea
- Breathing problems
Sepsis can turn into septic shock quickly. People with septic shock might need intensive care, medicines for blood pressure, and even breathing tubes. People with cancer who develop sepsis and septic shock have a higher risk of death than people who don’t have cancer. Sepsis also increases your risk for getting a blood clot.
When to get help
If you have a fever or other signs of infection, call your cancer care team, or get medical attention right away.
Signs of infection and sepsis to watch for:
- Fever or lower body temperature than normal
- Chills or sweats
- Cold, clammy, or pale skin
- Cough or trouble breathing
- New or worse confusion
- Feeling dizzy, lightheaded, or falling down
- Chest pain
- Not able to get out of bed for more than 24 hours
- Not having to pee or peeing only very little amounts that are dark orange or brown
If you go to the doctor, clinic, or emergency department, wear a face mask to protect yourself from other sick people.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Anderson DJ. Infection prevention: precautions for preventing transmission of infection. UpToDate. UpToDate Inc; 2023. Updated March 2023. Accessed November 29, 2023. https://www.uptodate.com/contents/infection-prevention-precautions-for-preventing-transmission-of-infection
National Comprehensive Cancer Network (NCCN). Anemia and neutropenia: Low red and white blood cell counts. NCCN Guidelines for Patients. Updated 2021. Accessed November 21, 2023. https://www.nccn.org/patients/guidelines/content/PDF/anemia-patient-guideline.pdf
National Comprehensive Cancer Network (NCCN). Prevention and treatment of cancer-related infections. Version 1.2023. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Updated June 2023. Accessed November 21, 2023. https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf
Neviere R. Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. UpToDate. UpToDate Inc; 2023. Updated September 2023. Accessed November 22, 2023. https://www.uptodate.com/contents/sepsis-syndromes-in-adults-epidemiology-definitions-clinical-presentation-diagnosis-and-prognosis
Taplitz RA, Kennedy EB, Bow EJ, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol. 2018 Oct 20;36(30):3043-3054. doi: 10.1200/JCO.18.00374.
Wingard JR. Diagnostic approach to the adult cancer patient with neutropenic fever. UpToDate. UpToDate Inc; 2023. Updated September 2022. Accessed November 29, 2023. https://www.uptodate.com/contents/diagnostic-approach-to-the-adult-cancer-patient-with-neutropenic-fever
Wingard JR. Overview of neutropenic fever syndromes. UpToDate. UpToDate Inc; 2023. Updated May 2022. Accessed November 21, 2023. https://www.uptodate.com/contents/overview-of-neutropenic-fever-syndromes
Wingard JR. Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults. UpToDate. UpToDate Inc; 2023. Updated July 2022. Accessed November 21, 2023. https://www.uptodate.com/contents/prophylaxis-of-infection-during-chemotherapy-induced-neutropenia-in-high-risk-adults
Last Revised: February 13, 2024
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
American Cancer Society Emails
Sign up to stay up-to-date with news, valuable information, and ways to get involved with the American Cancer Society.
