Renal Cell Carcinoma

Side Effects

Fears about the side effects of treatment can increase the stress of a renal cell carcinoma (RCC) diagnosis. These fears grow from a belief that the discomfort of side effects cannot be relieved, but it is now possible to manage common side effects of RCC treatment. Managing side effects is important because if you feel better, you are more likely to complete your treatment as planned by your treatment team.

The side effects of cancer treatment differ in many ways. First, not all people treated for cancer will have the same side effects. A friend or relative may have had a certain side effect after treatment, but that does not mean you will experience the same side effect. Whether or not you experience a side effect depends on many factors, including your age, your overall health and your specific treatment plan. Second, side effects vary in severity. Some cause minor inconvenience or discomfort, and others may cause more discomfort, pain and/or emotional distress. Lastly, side effects differ according to the type of treatment you receive.

Recovering from surgery

Common side effects of surgery to treat RCC are weakness and fatigue as well as pain and discomfort, which usually subside after a few days. Depending on the severity of your pain, your doctor may prescribe a pain medication, and over-the-counter pain relievers can also help. You should get plenty of rest as well, and avoid overexerting yourself, as recommended by your doctor. Also know that your mobility may be limited for a brief period after surgery. In addition, it is important to stay hydrated and eat nutritiously while you are recovering from surgery.

Your doctor will be on the lookout for any signs of bleeding, infection or other complications that can arise from surgery and treat any issues that come up accordingly.

If one kidney is entirely removed, it is important to realize that it may take some time for your remaining kidney to adjust to its new workload. While one kidney is typically able to handle the work of two, that is not always the case. If your remaining kidney cannot properly clean your blood, you may either need dialysis or a kidney transplant.

Managing the side effects of cancer drugs

While the side effects from targeted therapy, biological therapy and chemotherapy drugs have some differences, several of their most common side effects are the same (Table 1). It is extremely important to keep an open dialogue with your doctor about any side effects you experience. Keeping a journal about any symptoms you experience can be helpful. List what the side effect is, when it started, how severe it is and any other relevant information. Take your journal with you and share it with your doctor at every office visit, and call your doctor immediately if you have a sudden onset of a potentially serious side effect.

All medicines have different side effect profiles, so be sure to read about the specific side effects associated with your treatment and always remember to talk to your doctor about the best ways to manage them. Also, inform your doctor about all medications and herbal supplements you are currently taking, as some may interfere with your treatment, and be sure to tell all of your health care professionals, including all doctors and dentists, about your treatment regimen.

Table 1. Common side effects of RCC drugs

Type of treatment Side effects
Targeted therapy
▪ Fatigue
▪ Diarrhea
▪ Nausea and vomiting
▪ Mouth sores
▪ High blood pressure
▪ Increased risk of infection
▪ Metabolic issues
▪ Skin reactions
▪ Hand-foot syndrome
Immunotherapy
▪ Dry, itchy skin and/or rash
▪ Swelling
▪ Fatigue
▪ Weakness
▪ Flu-like symptoms (headache,
  muscle aches, fever)
Chemotherapy
▪ Nausea and vomiting
▪ Increased risk of infection
▪ Anemia
▪ Fatigue
▪ Loss of appetite
▪ Hair loss
▪ Mouth sores
▪ Diarrhea
▪ Skin and nail changes
▪ Nerve problems
▪ Cognitive dysfunction

Fatigue

Treatment-related fatigue occurs primarily because the body needs extra energy to repair the healthy tissue damaged by cancer treatment. In addition, other side effects of treatment, such as pain, nausea and vomiting, can cause or worsen fatigue. Most people think more rest will help relieve fatigue, but the opposite is true. Increasing activity and performing regular exercise (such as walking or bike riding) are the best ways to help manage and reduce symptoms of fatigue. If your fatigue is severe, your doctor may recommend that you take a psychostimulant drug for a short period of time. These drugs help improve alertness during the day and raise your energy level while also decreasing fatigue.

Nausea and vomiting

Nausea and vomiting are different from each other, but they are often experienced together. Nausea is an unpleasant sensation of feeling the need to vomit and is often described as “sick to my stomach” or “queasy.” Vomiting occurs when the stomach muscles contract and push the stomach contents up through the mouth. Nausea and vomiting occur as the result of a series of reactions between your stomach and your brain, and these reactions start when cancer drugs damage the cells lining the inside of the stomach. The cells send signals to a vomiting center in your brain, which then sends signals to trigger nausea and vomiting.

Nausea and vomiting are easier to prevent than to control once they have started. Recent advances have led to the development of new drugs, called antiemetics, to prevent and control nausea and vomiting, and most can be given as either a pill or an intravenous injection. Your doctor will prescribe antiemetic drugs on the basis of the treatment you will receive. To further protect yourself from nausea and vomiting, you may want to try some nondrug approaches, including progressive muscle relaxation, biofeedback, guided imagery, self-hypnosis and acupuncture. Eating several small meals rather than a few big meals, staying hydrated and avoiding unpleasant odors can also help.

Diarrhea

Diarrhea is the passing of loose or watery stools three or more times a day, which may cause cramps in the abdomen and pain or discomfort in the rectum. When mild, diarrhea is an inconvenience, but left untreated it can lead to serious problems, such as dehydration, loss of important nutrients, weight loss and fatigue. Treatment-related diarrhea is a short-term side effect that typically occurs within the first few days after treatment starts and usually resolves within a few weeks after treatment stops.

Once diarrhea occurs, following a diet of only clear liquids may help the lining of your intestines heal. As diarrhea begins to improve, you can slowly add solid foods to your diet, starting with low-fiber foods such as white rice or boiled potatoes. Some foods can worsen diarrhea, including dairy products; spicy, greasy or fried foods; raw fruits or vegetables; or foods that are high in fiber. Over-the-counter medicines and fiber supplements are also available, but be sure to talk to your doctor first, who may give you instructions that differ from those on the drug label. If diarrhea is severe, your doctor may prescribe other medications or choose to stop treatment temporarily until your diarrhea is controlled.

Mouth sores

Mouth sores are small cuts or ulcers that form in the lining of the inside of the mouth and can affect the gums, tongue, roof of the mouth or lips. Mouth sores sometimes begin as mild pain or burning, followed by white patches that may become large red lesions. Pain may range from mild to severe, making it difficult to talk, eat or swallow. Also, infection may develop if bacteria enter the open sores. Taking good care of your teeth and gums is essential to managing mouth sores, and you should brush and floss several times a day. Your doctor may suggest rinsing with special solutions or may prescribe a medication that coats the lining of your mouth or pain medications that can be topically applied.

To manage mouth sores, keep your mouth and lips moist by using lip balm, sipping on water, sucking on ice chips and drinking through a straw. Choose soft, moist foods that are easy to swallow, such as mashed potatoes and scrambled eggs, and always let your food cool down to room temperature before you eat. It is also a good idea to avoid alcoholic beverages and tobacco products, as well as hot, spicy, citric, greasy, fried, coarse or rough-textured foods, because they might irritate your mouth even further.

Skin reactions

Talk to your health care team about possible skin reactions, as some may be more serious than others. Skin reactions to cancer treatments are common among cancer patients and include redness and irritation (similar to sunburn), skin rash or dry, flaky skin. These reactions often cause itchiness and discomfort, and while most are mild to moderate, some can become severe if not treated early. If you develop a rash that causes itchiness or pain, your doctor may prescribe a mild corticosteroid cream or an antibiotic gel. Severe rashes are usually treated with an oral antibiotic and perhaps an oral corticosteroid. When a rash is severe, the dose of the cancer drug(s) is often reduced or temporarily stopped and then restarted if the rash gets better within two weeks.

Metabolic issues

Metabolic issues, such as hyperlipidemia and hyperglycemia, may arise from certain RCC therapies. Hyperlipidemia occurs when total cholesterol, low-density lipoprotein (LDL) and triglyceride levels elevate, which essentially means there are too many lipids (fats) in the bloodstream. Hyperlipidemia is commonly linked to high cholesterol. Hyperglycemia occurs when the body does not have enough insulin and begins using fatty acids instead of glucose as its energy source, resulting in high blood sugar. Hyperglycemia can result in diabetes if it is not treated in time. Your doctor will regularly monitor for both of these issues and may recommend weight loss, more exercise or avoidance of simple sugars and alcohol to manage them. Lipid-lowering and hypoglycemic medications are also available if your doctor deems them necessary.

Recovering from radiation

Although RCC typically does not respond to radiation, it may be used in some treatment plans and is often associated with certain side effects. Because radiation is delivered through the outside of the body, the skin and underlying tissues in the area being treated may become sensitive, including redness, dryness, peeling and itchiness. This sensitivity is short-term and usually resolves gradually within two months after treatment stops. Other side effects include fatigue, anemia, hair loss in the area treated and nausea and vomiting.

Living a healthy lifestyle

In addition to managing your side effects, living a healthy physical and emotional lifestyle is essential both during and after RCC treatment. It’s important to maintain good nutrition, be as active as you can, get enough rest and be emotionally healthy. Taking these actions can help you feel better both physically and psychologically, allowing you to better cope with the day-to-day challenges.

Maintain good nutrition

It is important to make healthy choices when it comes to nutrition before, during and after treatment. This can be a challenge if you have side effects such as loss of appetite or nausea and vomiting. But a healthy diet rich in protein can help you gain strength, which is especially needed during treatment cycles. In general, try to eat a wide variety of nutrient-rich foods and drink plenty of liquids. Because some cancer treatments can cause loss of bone mass, talk to your doctor about the need for calcium and vitamin D, either in your diet or as supplements.

Be active

Participating in physical activities or regular exercise can help you feel better overall. Studies have shown that people with cancer who exercise regularly feel less tired and have more energy. Weight-bearing activities, such as walking, can help strengthen bones, which is important if you have bone metastasis. Think about what physical activity you enjoy most and engage in it daily, as often as you can tolerate it.

Get enough rest

Sleep disturbances are common among people with cancer. One reason is that fatigue related to cancer and its treatment leads people to take frequent naps during the day, which then makes it difficult to sleep at night. You can still set aside time in your day to rest or take naps, but limit them to 20 to 30 minutes each, and avoid napping in the late afternoon or early evening. Your doctor may change the medications you are taking if he or she thinks that drug interactions or side effects are contributing to your sleep problems. Your doctor may also recommend a medication to help you sleep.

Stay emotionally healthy

A cancer diagnosis can cause significant emotional reactions. Allowing yourself to express those emotions freely is vital to remaining emotionally healthy. Discovering ways to reduce and manage stress will strengthen your coping abilities. Some possibilities are meditation, guided imagery, muscle relaxation and yoga. Ordinary “escapes,” such as reading, television and games, can also help you relax. Also, stay alert to depression and seek help if you’re experiencing a depressed mood and a loss of interest in normal activities. Lastly, maintaining relationships and participating in support groups can also go a long way toward good emotional health.

For more in-depth information on side effects please visit our Treatment Side Effects section.

 

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