Kidney cancer

The treatment plan is not made by one person alone but in a round of surgery, oncology, radiology, pathology and radiotherapy. You may ask what was discussed there and which alternatives came up.

Before a big decision it is planned for in many clinics, and the records belong to you. It costs one to two weeks — acceptable in almost every course, and one asks about that if it is urgent.

It is today part of the treatment and not its opposite: it lessens the exhaustion, keeps muscle and bone and improves how the treatment is tolerated. Begin with guidance, less on bad days, but not nothing at all.

Unintended weight loss worsens how any treatment is tolerated. Restrictive diets do more harm than good here — with loss of appetite, dietary advice helps early, not only once kilos are already gone.

By the clock rather than as needed works better and needs less overall. Fear of dependence is the wrong adviser in this situation — untreated pain costs sleep, appetite and strength.

Psycho-oncological support, social advice for insurance and work, and the question of who takes on what at home. This is no emergency measure but belongs at the start — and the relatives belong in it.

Classic chemotherapy does little in kidney cancer — one of the reasons other routes are taken here. What works are drugs that throttle the tumour’s blood supply, and immunotherapies; in combination they hold the disease for years in many people. Small tumours under four centimetres are sometimes only watched, because they grow slowly. In surgery, as much kidney as possible is preserved today.

About six in ten are found by chance, usually on imaging done for another reason — the classic combination of blood in the urine, pain and a palpable tumour is today the exception. Small tumours under four centimetres grow on average two to three millimetres a year, which is why some are only watched. After surgery, follow-up runs five years; late return after ten years does occur.

The majority is found today on an ultrasound or a scan done for a completely different reason — long before any sign appears.

Blood in the urine, a dull flank pain and a lump that can be felt in the flank. Today they rarely occur together and mostly late — each of them alone is worth an appointment.

Recurring fever, night sweats, weight loss and a clearly raised sedimentation rate without a recognisable focus. The kidney is one of the places searched in this constellation.

Both occur: anaemia without blood loss, or the reverse, too high a haematocrit because the kidney releases too much of the messenger for blood formation. A newly raised blood pressure also belongs to the picture.

Anaemia without an obvious reason is among the commonest abnormalities. More rarely the opposite: too many red cells, because the tumour makes the hormone Epo.

Shows how much function the kidneys still have together. Before any procedure this value helps decide how much tissue has to be preserved.

A raised calcium without another explanation is a warning sign and causes tiredness, thirst and constipation.

A non-specific value for cell turnover. It says nothing about the site but is assessed as part of the follow-up.

The loss of muscle mass helps decide how well a treatment is tolerated. Enough protein spread across the day, together with movement, is the part one holds oneself.

A sufficient amount of urine across the day dilutes what would otherwise crystallise or irritate. Spread evenly it works better than in two large portions.

Low values are common with a longer illness, and correcting them counts for bone and muscle. For high-dose courses against the illness itself there are no studies; they can interfere with treatment.

With reduced kidney function it rises and becomes dangerous for the heart rhythm; under water tablets it falls. In both directions it belongs measured and not guessed.

Belong in the workup of an anaemia that is otherwise too quickly put down to the illness or the treatment. Both are easy to measure and easy to supplement.

After removal of one kidney the remaining one works for two. Potassium in capsules or as a salt substitute can then rise faster than before — and a potassium value that is too high shows itself at the heart before anywhere else. The laboratory value decides, not the feeling.

The kidney switches vitamin D into its active form. With reduced kidney performance the ordinary replacement can therefore achieve too little — that is a question of form, not of dose.

Creatine raises the creatinine value in the blood without the kidney working worse — in healthy kidneys a measurement artefact, but here an unnecessary confusion in exactly the value being watched. Anyone taking it says so before the blood draw.

Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.

Some kidney tumours make EPO themselves — the red blood pigment then rises instead of falling. A raised haemoglobin with no explanation is one of the quiet pointers that is rarely read that way.

High calcium with cancer usually comes from a tumour messenger that acts like parathyroid hormone — the hormone itself is low. Nausea, thirst and confusion are the signs; it is treatable and urgent.

More rarely the tumour makes renin and thereby drives blood pressure. A newly appeared, hard-to-control high pressure in younger people is one of the reasons to look at the kidneys.

With one kidney fewer the remaining one works harder. Very high protein amounts and a lot of salt burden it; targets are set with the kidney team, not by rule of thumb.

The claim usually rests on the PET scan: weakly radioactive glucose is injected, and the tumour lights up. That shows tumour cells take up sugar faster than the tissue next to them — not that eaten sugar feeds them. You come to a PET scan fasting, and the tumour lights up anyway; the body keeps blood sugar within narrow limits by itself. It cannot be starved out this way. There is an established link nonetheless, but it runs through body fat: in 2016 the International Agency for Research on Cancer (IARC) reviewed the available studies and found sufficient evidence, for thirteen cancers, that absence of excess weight lowers the risk. That concerns prevention — it is not an answer to where an existing illness came from.

With one kidney fewer the remaining one works harder. Very high protein amounts and a lot of salt burden it — the targets are set by the kidney team, not by a general rule.