nLong ago, treatment options for people with metastatic kidney cancer were few and poor. Surgical removal of affected tissue has often been an effective and permanent solution for people with cancer that is confined to the kidneys. But for roughly 30% to 40% of people with kidney cancer that spreads to other parts of the body, the prognosis has been alarmingly grim.
Fortunately, things are a lot different today. Primo Lara, MD, professor, physician, and director of the Comprehensive Cancer Center at the University of California, Davis. Also known as angiogenesis inhibitors or targeted therapies, these drugs prevent the formation of the types of blood vessels that cause this Nourishing cancer cells With oxygen and nutrients. “These drugs are able to extend life, shrink tumors, and create meaningful states of remission,” Lara says.
at recent days, ImmunotherapyThey’re also emerging — drugs that help a person’s immune system recognize and eliminate cancer cells — as a very effective treatment for metastatic kidney cancer. Today, patients often take a combination of antiangiogenic and immunosuppressive drugs. Lara says this combination therapy has led to remarkable benefits for people with advanced kidney cancer.
While these new drugs save lives, they can also cause side effects ranging from diarrhea and rashes to fatigue and high blood pressure. Meanwhile, people with localized cancers have a host of difficulties with treatment. All kidney cancer patients face the psychological burden of battling a life-threatening disease.
While each person’s kidney cancer journey is unique, experts recommend an arsenal of strategies that can help people control symptoms and side effects. “In most cases, we can help patients manage it so they can carry on with minimal trouble,” Lara says.
Here you’ll find a guide on the most common symptoms of kidney cancer, the side effects of treatments, and some of the techniques doctors and other physicians may use to help people alleviate these challenges.
loss of kidney function
Almost all people with kidney cancer that hasn’t spread to other organs have a surgical procedure called nephrectomy. During the procedure, part or all of the affected kidney is removed. “A common complication of nephrectomy is the loss of some kidney function,” says Dr. Pavlos Maswell, MD, a cancer biologist at MD Anderson Cancer Center in Houston.
Simple job loss is not a big deal. (Masawil notes that people can live normally with only one kidney.) However, the job of your kidneys is to clean your blood. If its function deteriorates significantly, it can cause dangerous buildup of waste products or fluid imbalances in the blood. “At first, it’s not a side effect that you really feel — and it usually only shows up on blood tests,” Macauel explains. But over time, loss of kidney function can cause a range of symptoms including fatigue, nausea, weakness, and brain fog. In severe cases, it can be fatal.
A combination of lifestyle modifications and medication can help counter this loss of function. “A lot of these lifestyle changes are things we should all be doing regardless,” says Massauel. They include regular exercise and monitoring of sodium and sugar intake. In some cases, you may also need to adjust the amount of protein in your diet. Medications, including blood pressure medications or those that lower cholesterol, are also mainstays.
hand and foot syndrome
This is one of the most common side effects among people who take angiogenic inhibitors for metastatic kidney cancer. “These therapies are much more targeted than conventional chemotherapy – they focus more on cancer cells – but sometimes they affect other tissues,” says Maswell. In the case of hand-foot syndrome, also known as palmar-plantar erythroderma, these medications can affect the skin of the palms or soles of the feet. “This usually appears as blisters,” he explains. It can also cause redness and swelling. Sometimes, these skin problems can be so severe that people cannot drive a car or engage in other necessary activities.
To prevent hand and foot syndrome, doctors often ask people taking these medications to take special care of their hands and feet. Messwell says that over-the-counter moisturizers can help prevent dry skin and pimples. “We might recommend people to avoid exposing their hands and feet to really hot water, or to avoid wearing tight shoes,” he says. “We don’t want a lot of friction or things that can irritate the skin.” If those preventative measures fail and someone develops redness or blisters, he says, topical steroids — prescription skin creams that reduce inflammation — can be helpful. The same applies to pain-relieving creams, such as those containing lidocaine. “If it continues despite all of this, we may have the patient take a break for a few days or even weeks until the symptoms subside; then we can restart with a lower dose,” says Masswell. “A lot of times when we do that, if it comes back at all, it won’t be that bad.”
high blood pressure High blood pressure (hypertension) is a common side effect of many kidney cancer drugs, especially the vasopressors that have become the mainstay of treatment for patients with metastatic cancer. High blood pressure can also be caused by impaired kidney function. says Victoria Sinibaldi, MD, a practicing nurse and research associate in urology and oncology at Johns Hopkins University School of Medicine.
Sinibaldi says some lifestyle measures — again, a healthy diet and exercise — can be beneficial. But most people will need to take medication to ensure their blood pressure stays at safe levels. “It’s not uncommon for people to take two or three drugs to control blood pressure,” she says. In many cases, your primary care physician — not your oncology team — will lead the way when it comes to managing your blood pressure. “We refer a lot to primary care physicians because they are the people who already have clinical experience with blood pressure management,” she says.
Unfortunately, Diarrhea It is another common difficulty for people with kidney cancer who are taking targeted therapies, immunotherapy drugs, or both. “Some patients have to go every two hours, which is important,” Sinibaldi says. Diarrhea is not only annoying and uncomfortable, but frequent diarrhea can also cause unhealthy weight loss, nutritional deficiencies, or severe dehydration.
Sinibaldi often asks patients to keep a diary to record all their bowel movements as well as what they eat, which helps their care team identify problem foods or activities. “Over-the-counter medications like Imodium can help,” she says. Changes in diet can also make a difference. This may include cutting back on lactose, a type of sugar found in milk and other dairy products.
“We usually refer people to a dietitian who can help them adjust their diet,” says Msaouel of MD Anderson. While probiotics may be helpful in some cases, they can also cause problems, such as worsening diarrhea. “People get excited and think they can fix everything with probiotics, but they can be harmful,” he says. “This is something every patient needs to discuss with their oncologist.”
Oftentimes, talking about the complications of cancer can focus only on the body while ignoring the mind. Dr. Jennifer S. says: Medical School. Anxiety, fear, uncertainty, and spiritual distress can make life difficult throughout the cancer journey, she says. These can also contribute to a person’s experience of pain, fatigue, and other physical symptoms. Scherer and other palliative care professionals can help people overcome these psychological barriers.
“Patients also face uncertainty and complex medical decisions that they may need help understanding,” she says. Financial stress is another source of stress. “Palliative care looks at the patient from a holistic perspective and makes sure that their plan of care can address all of these different areas.” She and her team often connect people with a psychiatrist or psychiatrist. They also arrange visits with a spiritual advisor such as a chaplain. But in many cases, her work involves spending time talking to patients and helping them to overcome their feelings and difficulties. “We try to meet patients wherever they are, and give them an open, safe space to talk about their disease,” Scherer says.
Immunotherapy side effects
Unlike angiogenesis inhibitors or other kidney cancer treatments, Immunotherapy drugs Not toxic in nature. These drugs work by increasing the activity of the immune system in ways intended to help it recognize and eliminate cancer cells. “Most people who receive immunotherapy — 60% to 70% — will have only a few side effects,” Lara says. “But the other third will have more significant side effects, and these effects can be very unexpected because they are the result of the immune system bypassing and attacking healthy cells.”
He says that inflammation of the lungs, skin, thyroid or intestines are all relatively common among people who take these medications. This inflammation can lead to symptoms such as fatiguerash, breathing problems, weight loss, or diarrhea. “But any part of the body is fair game, so any side effect is possible,” he says.
If these types of complications arise, Lara says, steroids, anti-inflammatories, or other medications that suppress immune activity can help control them. It may also be necessary to reduce or even temporarily stop immunotherapy.
Every person is unique. Likewise, each person’s response to cancer treatment is unique. Experts say finding what works for someone involves periods of repair. Your care team may have to try different medications at different doses before they can determine the best regimen for you.
This is likely to be an ongoing process. You may eventually need to adjust a game plan that is effective for a few weeks or months. Understanding this from the start can help you prepare for bumps in the road. “It’s important to manage patient expectations and provide lots of information so they know what to expect,” Lara says.
Side effects are an unfortunate part of life for people with kidney cancer. But in most cases, it can be controlled. In the words of Lara, “I would say that over 95% of the time, we will find that sweet spot where the side effects are reasonably well tolerated and the quality of life is good.”
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