Side Effects and After Treatment
Side Effects
A tumor and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of tumor treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.
Fear of treatment side effects is common after a diagnosis of a tumor, but it may be helpful to know that preventing and controlling side effects is a major focus of your child’s health-care team. Before treatment begins, talk with your child’s doctor about possible side effects of the specific treatments your child will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of tumor, its location, the individual treatment plan (including the length and dosage of treatment), and the child’s overall health.
Ask your child’s doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects your child may experience during and after treatment. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care.
Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your child’s doctor.
After Treatment
After treatment for Wilms tumor ends, talk with your child’s doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. All children treated for cancer, including Wilms tumor, should have life-long, follow-up care.
Follow-up care for Wilms tumor includes regular visits to the doctor for physical examinations, blood and urine tests, and imaging tests (CT scans, ultrasounds, and x-rays). At first, these visits and tests will be more frequent (such as every three months), but the time between checkups will increase until five years after treatment, then he or she will be scheduled for a follow-up visit once a year. The longer the time since treatment, the less likely the tumor will return. However, monitoring for late effects becomes an important part of the follow-up visits. Also, people who have been treated for cancer need to protect their skin from the sun by using sunblock, monitoring any suspicious skin lesions, and avoiding smoking.
Based on the type of treatment the child received, the doctor will determine what examinations and tests are needed to check for long-term side effects (see below) and the possibility of secondary cancers. Your doctor can recommend the necessary screening tests. Follow-up care should also address the child’s quality of life, including any developmental or emotional concerns. Learn more about childhood cancer survivorship.
The child’s family is encouraged to organize and keep a record of the child’s medical information, so that as the child enters adulthood, he or she has a clear, written history of the diagnosis and details of the treatment given. The doctor’s office can help you compile this, and it should include recommendations from the doctor about the schedule for follow-up care. This information will be valuable to doctors who care for your child during his or her lifetime.
Children who have had cancer can also enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating a balanced diet, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs.
Long-term effects
Although many children with Wilms tumor are treated successfully, they still need to be monitored closely for possible long-term effects of the treatment.
Kidney failure. Because children treated for Wilms tumor usually have only one kidney, they have a slightly higher risk of kidney failure and will need to be monitored for the rest of their lives. They also need to keep well hydrated to help promote good kidney health. There are some medications, such as codeine and ibuprofen, that should only be taken in small amounts to avoid kidney damage.
Heart problems. Children who have received doxorubicin have a higher risk of developing heart abnormalities that can occur even years after treatment has ended. Children treated with doxorubicin who also had radiation therapy to their lungs have an even higher risk of developing heart problems.
Skeletal abnormalities. If radiation therapy was given, depending on the site and dose, scoliosis (curvature of the spine) and underdevelopment of the soft tissue may occur.
Secondary cancer. Wilms tumor survivors have a small risk of developing another type of cancer within 15 years after Wilms tumor was first diagnosed. The most important risk factors are whether treatment included radiation therapy and doxorubicin.
Fertility. Chemotherapy alone does not increase the risk of miscarriage; however, women who received radiation therapy aimed at the side of the body between the rib and hip, (from the National Wilms Tumor Study records), depending on the dose, are more likely to have early labor, an unusual position of the baby’s head during birth, lower birthweight, and premature delivery (less than 36 weeks). Congenital (present at birth) abnormalities are also more common. Women who have had abdominal radiation therapy for Wilms tumor should be considered high risk during pregnancy and monitored closely by their doctor.