Complications and side effects of treatment
Immediate side effects of surgery
The immediate effects include:
- bleeding,
- damage to blood vessels, the spleen or the intestines during surgery, and
- small bowel obstruction.
These complications are likely to lead to a substantial increase in the duration of the hospital stay following surgery but unlikely to lead to enduring care or mobility needs.
Short term side effects of chemotherapy
The effects of chemotherapy and the care needs that arise from ensuring the child has their chemotherapy treatment and copes with the side effects are the most likely reason for care needs to develop. Duration of care needs related to chemotherapy will relate to duration of treatment, which may extend from several weeks to almost 1 year. The immediate side effects of chemotherapy occur during treatment and can be expected to resolve within weeks of treatment finishing. These include:
- Nausea and vomiting.
- Diarrhoea.
- Hair loss.
- Increased risk of infection.
- Bruising and bleeding.
- Extreme tiredness.
- Mucositis.
- Reduced nutritional intake.
- Rarely peripheral neuropathy and difficulty walking.
Long term disabling effects of chemotherapy treatment
Long term complications of Wilms tumour treatment
Renal failure and dialysis
End stage renal failure occurs when the kidneys can no longer deal with waste products produced by the body and dialysis is necessary for ongoing survival. Only 1% of children with Wilms tumour develop end stage renal failure and of these 70% had bilateral tumours. Renal failure may occur at the time of treatment because of the removal of kidney tissue or later on due to damage to remaining kidney tissue by radiotherapy. In 99% of children treated for Wilms tumour the remaining kidney compensates for the kidney that was removed.
Heart Failure
Chemotherapy drugs, particularly doxorubicin, damage heart muscle cells. 25% of children receiving doxorubicin will have some evidence of heart muscle damage on testing. The overall incidence of heart failure after treatment for Wilms tumour is 1.7%. This rate rises to 5.4% in children who also received radiotherapy to the chest area.
Lung function
Lung function be affected by radiotherapy to the lungs and may cause breathlessness on exertion. Only a small number of children will have radiotherapy to the lungs so this is a rare problem following treatment for Wilms tumour.
Hepatic Veno-occlusive disease
Liver damage caused by radiotherapy and chemotherapy drugs, particularly Actinomycin D, may cause jaundice, ascites, enlarged liver and weight gain. Around 8% are affected and recovery is expected.
Hormonal insufficiency and infertility
Radiotherapy may affect the testes or more rarely the ovaries, puberty may not progress normally and sex hormone treatment may be required.
Second cancers
The risk of these is increased as with all childhood cancers and in Wilms tumour is 1.6% at 15 years follow up.
