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 are often made worse by a belief that the discomfort of side effects cannot be relieved. However, it’s now possible to manage the common side effects of RCC treatment. Managing side effects is important because if you feel better, you’re 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 have 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, fatigue, pain and discomfort, which usually lessen after a few days. Depending on how severe your pain is, your doctor may prescribe a pain medication or recommend over-the-counter pain relievers. Your doctor will also suggest that you get plenty of rest and avoid doing too much. It’s important to know that your mobility may be limited for a brief time after surgery. In addition, you should drink plenty of fluids and eat healthy foods while you’re recovering from surgery.

Your doctor will look for any signs of bleeding, infection or other complications that can occur after surgery and will treat any issues that come up.

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

Side Effects of Cancer Medications

Although the side effects from chemotherapy, immunotherapy and targeted therapy have some differences, several of their most common side effects are the same.

It’s extremely important to talk openly with your doctor about any side effects you have. Keep a journal about your symptoms, and 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. Your doctor will tell you when you should call your treatment team about specific side effects.

If you are receiving immunotherapy, as with any cancer treatment, partnering with your doctor to monitor for complications is vital. Your doctor likely will perform baseline assessments to determine what is normal for you; the results of these assessments can be compared with those obtained throughout treatment. You will play a key role in detecting what is abnormal for you and communicating that to your doctor immediately, so it is important to know how to recognize serious side effects, known as immune-mediated adverse reactions, as some of these reactions may not produce obvious symptoms.

All medications 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 — ideally before treatment begins — about the best ways to manage them. Also, make sure your treatment team and all of your other health care professionals (primary care clinician, dentist, etc.) know all the drugs you’re taking. Tell your cancer treatment team about any medications you take for other health issues, as well as herbal supplements you may take, as some may interfere with your cancer treatment.

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.

Nausea and Vomiting

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 an area in your brain that sends signals to trigger nausea and vomiting. Nausea and vomiting are easier to prevent than to control once they’ve started.

Diarrhea

Diarrhea is the passing of loose or watery stools three or more times a day and may be accompanied by 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.

Mouth Sores

Mouth sores may 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 the development of 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.

Skin Reactions

Talk to your treatment team about possible skin reactions, as some may be more serious than others. Skin reactions to cancer treatments are common and include redness and irritation (similar to sunburn), rash, or dry, flaky skin. These reactions often cause itchiness and discomfort, and most are mild to moderate; however, some reactions can become severe if not treated early. If a rash develops 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) may be 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 some RCC therapies. Hyperlipidemia is a condition of excess lipids (fats) in the bloodstream and occurs when total cholesterol, low-density lipoprotein (LDL) and triglyceride levels are high. Hyperglycemia is a high level of sugar in the bloodstream; it occurs when the body does not have enough insulin and begins using fatty acids instead of glucose (sugar) as its energy source. Hyperglycemia can result in diabetes if it’s 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. Medications to lower your lipid or sugar levels in the blood are also available if your doctor thinks they’re necessary.

Recovering from Radiation Therapy

Although radiation therapy is not typically used to treat RCC, it may be used in some treatment plans and is often associated with certain side effects. Because radiation is delivered directly to the kidneys from outside the body, the skin and underlying tissues in the area being treated may become sensitive. This can lead to 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, nausea and vomiting.

No matter which treatment you have, frequent communication with your health care team is important for monitoring your symptoms. Seek treatment immediately, regardless of time of day, for any medical emergencies, including high fever, inflammation, swelling, severe abdominal pain or shortness of breath.

 

What You Can Do to Manage Side Effects

Managing Fatigue

  • Increase activity. Most people think more rest will help relieve fatigue, but the opposite may be true.
  • Perform regular exercise (such as walking or riding a bike).
  • Follow your doctor’s recommendations. For severe fatigue, your doctor may recommend taking a psychostimulant drug for a short period of time. This type of drug helps improve alertness during the day and raise your energy level while also decreasing fatigue.

Managing Nausea and Vomiting

  • Take antiemetics as recommended by your doctor. If you will be receiving treatment that is likely to cause nausea and vomiting, your doctor may recommend antiemetics, which are drugs that prevent and control nausea and vomiting. Most antiemetics can be given as either a pill or an intravenous injection.
  • Try some nondrug approaches to further protect yourself against nausea and vomiting. These approaches include progressive muscle relaxation, biofeedback, guided imagery, self-hypnosis and acupuncture.
  • Eat several small meals a day rather than a few big meals.
  • Drink plenty of fluids to stay hydrated.
  • Avoid unpleasant odors.

Managing Diarrhea

  • Follow a diet of only clear liquids so the lining of your intestines can heal. Once 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.
  • Avoid foods that can worsen diarrhea, including dairy products; spicy, greasy or fried foods; raw fruits or vegetables; or foods high in fiber.
  • Ask your doctor if you can take over-the-counter medicines and supplements and if you can follow the instructions on the drug label.
  • Follow your doctor’s recommendations. If diarrhea is severe, your doctor may prescribe other medications or choose to stop treatment temporarily until your diarrhea is controlled.

Managing 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.
  • Avoid hot, spicy, acidic, greasy, fried, coarse or rough-textured foods.
  • Avoid alcoholic beverages and tobacco products.

 

 

 

Possible Side Effects
by Treatment Type

Chemotherapy

  • Anemia
  • Cognitive dysfunction (“Chemo brain”)
  • Constipation
  • Diarrhea
  • Fatigue
  • Hair loss
  • Loss of appetite
  • Mouth sores
  • Nausea and vomiting
  • Nerve problems
  • Neutropenia (low white blood cell count)
  • Skin and nail changes

Targeted Therapy

  • Diarrhea
  • Fatigue
  • Hand-foot syndrome
  • High blood pressure
  • Increased risk of infection
  • Loss of appetite
  • Metabolic issues
  • Mouth sores
  • Nausea and vomiting
  • Skin reactions
  • Weakness

Immunotherapy

  • Bumpy or itchy red rash
  • Cough
  • Depression
  • Diarrhea
  • Dyspnea (difficulty breathing)
  • Fatigue
  • Flu-like symptoms (headache, muscle aches, fever)
  • Nausea
  • Swelling
  • Weakness

 

 

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