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10 Steps to Understanding Therapy Options in Kidney Cancer

1 in 20 webKidney cancer is diagnosed in over 300,000 people worldwide every year. Kidney cancer is the 12th most common cancer in the world, the same numbers as pancreatic cancer. Fewer than 1 in 20 people with cancer have kidney cancer, meaning that it is quite a rare disease.
For more information about kidney cancer statistics by country, click here.

In this section you will learn more about the different types of kidney cancer, the known causes of kidney cancer and how kidney cancer can be treated from the early stages to more advanced disease. There is still a need for more research and new treatments for many types of kidney cancer.

This information provides context for various therapies, including some of the newer immuno-oncology therapies that are being researched.

For more information on immuno-oncology treatments, please read here: Understanding immuno-oncology

1. What is cancer?

Fotolia 61364218 S webCancer, tumour, mass, lump, bump, swelling, spot, shadow, lesion... You might have heard a number of these words to describe cancer. A more formal word is neoplasm, which means “new growth”. Medical experts might define cancer as a "neoplasm of abnormal tissue, the growth of which exceeds and is uncoordinated with normal tissue and persists once the stimulus for its growth is removed”.

Our bodies are made up of cells. Each tissue, each organ, every part of our body is made of these cells, which are all very different depending if they are in the liver, heart, blood or kidney. Our bodies are always making new cells: so we can grow, to replace worn-out cells, or to heal damaged cells after injury. Usually this process is very controlled.

For example, when you get a cut, skin cells receive a ‘go’ signal to start dividing. When the cut has healed, the skin cells get a ‘stop’ signal and stop dividing. This process is controlled by instructions and recipes within the cells, the so called “genes”. All cancers are caused by changes to these genes, called mutations.

Changes to genes that cause cancer usually happen during our lifetime, although a small number of people inherit these changes from a parent. There are many different types of cancer and cancer can affect almost any organ in the body. Where the cancer is, what type of tumour you have and what genetic mutations have caused the cancer could influence what treatment is best for that cancer.

2. What is kidney cancer?

kideny with tumourGraphic of kidney with tumourKidney cancer is a type of cancer that arises from the cells of the kidney. Another name for kidney cancer is “renal cell carcinoma”. The most common type of kidney cancer is “clear cell carcinoma”.

Kidney cancer describes all tumours that form in the kidney. But not all kidney cancers are the same. It’s important to know the type of kidney cancer you have (see Question 3). Cancers that come from the lining of the ureter, the tube that runs down from the kidney to the bladder, are typically more like bladder cancers, and so are usually not called kidney cancer.

Mutations that cause cancer usually accumulate during our lifetime, so like most cancers, kidney cancer tends to occur in older people. The average age of people found to have kidney cancer is 55 years. Kidney cancer is rare in children. Kidney cancers begin small and can grow larger over time. Kidney cancers usually grow as a single mass but more than one tumour may occur in one or both kidneys.

If kidney cancer is treated in its early stages it is most likely to be cured. If kidney cancer cells spread, they may spread into surrounding tissue or to other parts of the body. When kidney cells reach a new organ or bone they might continue to grow and form another tumour (a “metastasis”) at that site. Primary cancer is a cancer that has formed in an organ (in this case the kidney) but has not spread elsewhere. Other words like “localised” or “early” apply if the primary cancer has not spread. Advanced (or metastatic) kidney cancer is the same cancer that started in the kidney, but has now spread somewhere else.

These secondary cancers or "metastases" or “mets” are still made up of kidney cancer cells even if they appear in the lung or elsewhere in the body. It is rare for a cancer from another part of the body to spread to the kidney.

 

3. What are the types of kidney cancer?

kidney cancerNot all kidney cancers are the same.

Kidney cancers:

  1. can come from different cells of the kidney and thus have different “flavours” or "sub-types" of cancer (for further information read “histology”),
  2. can be more slow-growing or more aggressive (“grade”),
  3. and can be larger or smaller, or have spread outside the kidney (“stage”).

All of these factors can affect:

  • how aggressive the tumour is and how likely it is to spread.
  • which treatment(s) (if any) you should have.
  • which clinical trials you could take part in.

 



Histology

Kidney cancer can be sub-divided into several different “flavours” or "sub-types" based on the appearance of the cancer cells under a microscope (the “histology” of the cancer). The type of kidney cancer is not usually important for surgery, but can be critical if more treatment is needed later.

The main histologies are:histo webClear cell carcinoma 75%, papillary cell carcinoma about 10% to 15%, chromophobe carcinoma accounts for about 5%, others less than 1%

  • Clear cell carcinoma: The most common form of kidney cancer, accounting for about 75% of people with renal cell carcinoma. When viewed under a microscope, the individual cells that make up clear cell renal cell carcinoma appear empty or clear.
  • Papillary cell carcinoma: About 10% to 15% of people have this form of kidney cancer. These cancers form little finger-like fronds (called papillae, hence “papillary”).
  • Chromophobe carcinoma: Accounts for about 5% of cases. The cells of these cancers are large and pale, and have certain other distinctive features.
  • Sarcomatoid carcinoma: Several of the other kinds of kidney cancer can turn into “sarcomatoid” kidney carcinoma. The appearance of the cancer cells down the microscope is more aggressive and disorganised.
  • Translocation carcinoma: A type of kidney cancer that occurs rarely, but mostly in children or young adults. In some cases these can occur in people that have previously received chemotherapy for malignancy, bone marrow transplant preparation or autoimmune disorders.
  • Urothelial carcinomas: Also called transitional cell carcinoma (TCC) are cancers that can form in the kidney from the lining of the drainage system of the kidney, rather than the cells of the kidney itself. These cancers are very similar to bladder cancers.
To find out what type of kidney cancer you have, please refer to your Pathology Report or ask your healthcare team.

Grade


Each patient’s tumour is different to other peoples cancers in how aggressive it looks; the “grade” of the tumour. The grade of a cancer describes if the cells in the cancer are almost uniform and well organised, almost like a normal organ or tissue might look under the microscope (low grade), or if the cancer looks very disorganised and the cells are different in size and shape (high grade).gradesCells from low grade on the left (cells look similar to normal cells) to high grade on the right (disorganised and different in shape)
 

Stage

The stage of a cancer describes the size of the cancer, and whether or not it has spread. This helps to guide treatment and can help plan long-term follow-up care. When staging is based on clinical assessment alone, it is referred to as the clinical stage. Microscopic examination of the affected tissue determines the “pathologic” stage. A staging system is a standardised way in which the cancer care team describes the extent of the cancer.

Your doctor will determine the "stage" of your kidney cancer based on:

  1. The size of the tumour (“T-stage”)
  2. Spread of the cancer to the nearby lymph nodes (“N-stage”). A lymph node is like a police station; it is a small round gland that makes up part of the immune system and houses white blood cells. Unfortunately cancer cells like to spread to lymph nodes.
  3. Spread of the cancer to other organs (e.g. metastasis to liver, lung or bone; “M-stage”)

The four main stages of kidney cancer below are based on this TNM staging system, which is one of the methods for ‘staging’ kidney cancer.

Stage 1                                    stage1 web
 
The cancer is only within the kidney and has not spread.
The cancer is less than 7cm in size.
If the cancer can be removed it is most likely to be cured with surgery.
9 out of 10 people will be alive and free of the cancer at five years after an operation. 
Stage 2  stage2 web
 
The cancer is larger than 7cm but is still confined to the kidney and has not spread outside of the kidney.
Surgery is a good treatment option.
The five year survival rate is still very high after surgery for stage 2 kidney cancer.
Stage 3  stage3 web
 
The kidney cancer has moved nearby outside the kidney, but has not spread to distant organs.
For example, the cancer might have spread into the fat around the kidney, into the blood vessel coming out of the kidney, or into lymph nodes near the kidney. Surgery is often the right treatment. The chance of being cured by surgery is lower, but not zero.
Stage 4 
 stage4 webmetastases
 
The kidney cancer has spread widely outside the kidney; to the abdominal cavity, to the adrenal glands, to distant lymph nodes or to other organs, such as the lungs, liver, bones, or brain. This stage of cancer is very unlikely to be cured at the present time, but various treatments can help.

 

4. What causes kidney cancer?

Risk factorsLike most cancers, kidney cancer is caused by mutations that accumulate over time in your body. Like most other cancers kidney cancer most often arises in older people and it is mostly a disease seen in adults over 40. There are a number of other risk factors that are important in the development of kidney cancer:

Smoking: Smoking doubles the risk of developing kidney cancer. This reduces back to population risk levels if the person stops smoking. Quitting at any time, at any age is a great idea. It’s never too late.

Gender: Men are twice as likely to be diagnosed with kidney cancer as women.

Obesity: Being very overweight or obese appears to be associated with an increased risk of developing kidney cancer in both men and women.

High blood pressure (hypertension): High blood pressure has been found to be a risk factor for kidney cancer.

Kidney stones: Having kidney stones is associated with a higher risk of developing kidney cancer in men.

Occupational exposure to toxic compounds: People regularly exposed to certain chemicals may have an increased risk of kidney cancer. These include asbestos, lead, cadmium, dry-cleaning solvents, herbicides, benzene or organic solvents and petroleum products, as well as people who work in the iron and steel industries.

Long-term dialysis and acquired cystic disease: Being on dialysis treatment over a long period of time may cause kidney cysts. Kidney cancer may develop from the cells that line these cysts.

If you would like more information about these risks, please click here to visit the International Kidney Cancer Coalition website or contact your local kidney cancer patient organisation.
 

Is my family at risk of developing kidney cancer?

HereditaryPeople who have family members with kidney cancer, especially a sibling, are at increased risk. This can be due to genes that pass down from parent to child. Inherited gene mutations cause only 3-5% of kidney cancer.

Signs that your kidney cancer might be hereditary include:

  • you have more than one tumour in your kidney (multifocal tumours)
  • you have tumours in both kidneys (bilateral tumours)
  • you have a rarer form of kidney cancer (a non-clear cell renal cell carcinoma)
  • other members of your family have had kidney cancer
  • you had your first kidney tumour before you were 50 years old.

If you have any one of these risk factors and think you may have a hereditary kidney cancer , speak to your physician.

 

Types of Hereditary Kidney Cancer

There are several different types of hereditary kidney cancer. In the future we may have more information about new genes that cause kidney cancer. In the meantime, if you think your kidney cancer could be hereditary, speak with your doctor.

  • Von Hippel–Lindau syndrome (VHL). This is caused by a mutation in the VHL gene and usually causes clear-cell RCC.
  • Hereditary leiomyomatosis and renal cell cancer (HLRCC). This is caused by a mutation in the FH gene and usually causes papillary type 2 RCC.
  • Hereditary papillary renal cell carcinoma (HPRCC). This is caused by a mutation in the MET gene and usually causes papillary type 1 RCC.
  • Birt–Hogg–Dubé syndrome (BHD). This is caused by a mutation in the FLCN gene and usually causes chromophobe RCC or oncocytoma.
  • Renal cell carcinoma with hereditary paraganglioma and phaeochromocytoma. This is caused by mutations in the SDHB or SDHD gene.
  • Chromosome 3 translocation familial renal cell carcinoma. This is caused by a chromosome 3 translocation. A chromosome translocation is when part of a chromosome breaks off and attaches to a different chromosome.
  • Tuberous sclerosis complex (TSC). This is caused by a mutation in the TSC1 or TSC2 gene and usually causes a type of kidney cancer called angiomyolipoma. These tumours are benign, but they have a large number of blood vessels which can burst and lead to life-threatening internal bleeding if not treated.

If there is a history of kidney cancer in your family, it is important that you tell your doctor so you can be tested. If the test shows that you do have a hereditary type of kidney cancer, other members of your family can be tested so that any sign of cancer could be treated early when it is most curable.

In rare cases, children can get kidney cancer, but they usually develop different types of kidney cancer to adults. The most common types of childhood kidney cancer are Wilms tumour and nephroblastoma. However, there have been rare cases of children with RCC or adults with Wilms tumour. In addition, there are other, mostly benign kidney tumours.

5. How do people find out they have kidney cancer?

Many kidney cancers do not cause symptoms; they are found incidentally during a scan, X-ray or ultrasound that was ordered for another problem. When kidney cancer does cause symptoms these can be non-specific, that is, many of the symptoms that kidney cancer might cause can be mistakenly attributed to other causes, like a urine infection or a muscle twinge.

Most kidney cancer does not cause pain until advanced stages when it has started to spread. Many people with kidney cancer are not aware they have a tumour until they have a test for another health problem. 

Always talk to your doctor if you are experiencing any of these signs or symptoms (please click here)

  • Blood in the urine or changes in urine colour to dark, rusty or brown in the urine (haematuria)
  • Lower back, abdominal or flank pain which is not linked to an injury
  • Abdominal pain (stomach area)
  • Weight loss
  • Newly developed high blood pressure
  • Constant tiredness
  • Fever or night sweats which are not linked with any other conditions

All of these symptoms can also be caused by other diseases. If you have any of these symptoms it is important to see your doctor so you can find out what’s causing them.

Kidney cancer is most often detected by chance, but if you have some of the symptoms listed above, speak with your doctor. As with all cancers, early detection can improve the chance of successful treatment and long-term outcomes. Your doctor may use different approaches, tests and investigations to diagnose kidney cancer, depending on the symptoms you display.

The most common tests for kidney cancer (please click here)

The most common tests that may be ordered include:

  • Ultrasound: A type of scan where a probe is slid over the skin and where the x-ray team looks for irregularities in the kidney and other organs.
  • Scans: Computer tomography (CT) scan or magnetic resonance imaging (MRI) scans can be used to get detailed pictures of organs in the body. This can help characterise a lump in the kidney if one is found.
  • Chest x-ray: An x-ray of organs and bones within the chest.
  • Urine test (urinalysis): The most common symptom and sign of a kidney tumour is blood in the urine. This test can also detect other irregularities in the urine such as protein.
  • Blood tests: Chemical tests of the blood can detect findings associated with kidney cancer.
  • Bone scan: A small amount of radioactive material is injected into a vein and travels through the bloodstream to the bones so the scanner can detect if cancer has spread to the bones.

The majority of kidney cancers are initially discovered by scans (ultrasound, CT scan, or MRI), showing something like a “lump” on the kidney. This does not prove it is kidney cancer however, and it must be examined under the microscope to be sure. Sometimes your doctor may be so suspicious they recommend immediate surgery; other times your doctor might order a biopsy. During a biopsy, a thin needle is used to remove some cells from the tumour. A doctor will then look at the cells to see if they are cancerous or not. Up to 20% of small kidney masses (or lumps) are non-cancerous.

6. My cancer is only in the kidney: what treatments could I take?

It may seem strange, but for some people with small (stage 1) kidney cancers, the first best treatment is often observation, or “active surveillance”. If you are older, or have significant medical problems, it may be safer to first carefully watch the cancer, with multiple scans and multiple visits to the cancer specialist. Because many kidney cancers are discovered by accident on scans that were recommended for other reasons, a number of small kidney lumps are now being detected. Kidney cancers that are smaller than 3cm are very unlikely to spread elsewhere, and sometimes the risk of dying during an operation outweighs the benefits of surgery. People who choose active surveillance with their doctors must continue to have regular follow-up care, in case the cancer starts to grow.

If you have a larger cancer in the kidney, surgery is usually the first best treatment. Surgery to remove kidney cancers is performed by a specialist surgeon called a Urologist or Uro-oncologist (a Urologist who specialises in cancer). Surgery may either remove just a part of the kidney (called a “partial nephrectomy”) or the entire kidney, which is called a “radical nephrectomy”. Surgery might need to be done with a large incision (an “open” nephrectomy) or might be able to be done by keyhole surgery (a “laparoscopic” nephrectomy) which results in a shorter hospital stay and quicker recovery. If the cancer is small (stage 1, <7cm) a “partial” nephrectomy may be possible, where the remaining normal kidney can be spared. If the cancer is larger (stage 2), or has started to spread near the kidney (stage 3) then the whole kidney is removed.

Treating a localised kidney cancer without surgery?

In some people an operation is not possible due to their age or other medical problems. It may be still possible to treat a localised kidney cancer without surgery, using other treatments. These include:

  1. Radiofrequency ablation (RFA); where a needle containing a microwave antenna is inserted into the cancer under local anaesthetic, and the cancer is “cooked” from the inside.
  2. Cryoablation: where a series of probes are inserted into the cancer, and then cooled with liquid nitrogen to freeze the cancer cells. This has a similar effect as RFA but may require a general anaesthetic.
  3. Stereotactic body radiation therapy (SBRT): this newer, computer-controlled radiation has been tested in kidney cancer and many other cancers. SBRT gives lots of very small doses of radiation from a lot of different angles, such that a therapeutic dose of radiation lands on the cancer, but the normal organs and tissues around the cancer are only lightly affected.

If you have one of the inherited types of kidney cancer, it is possible you may get more kidney tumours in the future. Because of this, your surgeon might suggest a different approach for you. Patients with inherited types of kidney cancer need a long-term strategy and so should be seen by an expert in kidney cancer whenever possible.

Is there any treatment I can take to help ensure that the cancer won’t come back?

In many cancers, people can take additional “insurance policy” treatments to reduce the chance of the cancer coming back. You may have heard of chemotherapy, hormone therapy or radiotherapy as additional (“adjuvant”) treatments for cancer. Past studies indicated that these treatments did not seem to work for patients with kidney cancer. However one study published in 2017 showed benefit for select high-risk patients who took sunitinib for one year. Ongoing study of real-world data will help to determine which patients could benefit from taking sunitinib following surgery and how this approach affects their quality of life and overall survival. In the meantime, patients are encouraged to seek an expert opinion to make a fully informed decision.

Researchers are continuing to study immune therapy as an adjuvant treatment in kidney cancer. Current trials in the adjuvant setting are listed here: How can I find a clinical trial for kidney cancer?.

Follow-up after treatment?

All cancer survivors should have follow-up care. Once you have finished your cancer treatment, you will establish a follow-up cancer care plan with your treatment team, which may include seeing a range of health professionals.

In general, kidney cancer survivors usually return to their specialist every three to four months during the first few years after treatment, and once or twice a year after that. At these visits, your doctor will look for side effects from treatment and will check to ensure you cancer has not returned (recurred) or spread (metastasised) to another part of your body. The type of tests will depend upon your stage and grade of kidney cancer. Like most cancers, the chance of the cancer returning is highest soon after treatment. The longer away from the treatment, the more chance the cancer will not recur. However, your treatment team will want to follow you for some time. In some countries, kidney cancer patients are followed for 5 years following initial surgery. Your patient organisation can refer you to guidelines for follow-up that are specific to kidney cancer in your country or other countries.

7. My cancer has spread from the kidney to other parts of the body: what treatment could I take?

In people with advanced kidney cancer, where the cancer has spread to distant organs, the cancer is usually not curable. The goal of treatment is therefore to make life as long and as normal as possible. Combinations of different treatments may be recommended by different doctors, including urologists, medical oncologists who prescribe anti-cancer medications, and radiation oncologists who treat people with radiation. Throughout, this team of specialists will work with you and your family doctor to help you control your symptoms and live as normal a life as possible. Treatments for advanced kidney cancer include:

Active Surveillance (Observation)

In some people in whom the kidney cancer has spread, the cancer might be growing so slowly that the right first option is to watch carefully. This is especially the case when the cancer has been discovered by accident. If the cancer starts to grow quickly or cause symptoms then active treatments will be recommended. A small percentage of patients might live without symptoms from the cancer for a very long time, sometimes years, so your doctor might advise you to observe for a period of time, in case this applies to you.

Clinical trials

A clinical trial is sometimes erroneously perceived as a “last resort”, but with rapidly improving treatments it should be considered the “first port of call”. A clinical trial is a way of testing new treatments, or old treatments used in a new way. Clinical trials are not right for every person; not every person is right for a clinical trial. If a clinical trial is available it can be an interesting opportunity to consider. One always hopes that the new treatment will improve on standard treatments, but sometimes it works no better than before. Talk to your doctor to find out about clinical trials or use some of the tips in the section "Discovering IO clinical trials" to identify clinical trials that might be right for you.

Surgery to remove cancer that has spread

In a very small number of people, the cancer spreads to only one or two places; if this is the case it can be possible to try to cut out all the cancers (a “metastectomy”). Some patients can live a very long time in these circumstances, but it really only applies to patients where there is only one or two spots elsewhere and they can all be safely removed.

Surgery to remove cancer in the kidney

Surgery does not usually cure kidney cancer that has spread, but it may be recommended to prevent symptoms and problems from the cancer. However, if the kidney cancer that has spread is not causing a lot of problems, and your health is otherwise good, there is evidence that removing the original cancer in the kidney improves survival and helps other treatments work better. This “cytoreductive” nephrectomy would be performed by your urologist (or uro-oncologist).

Pills that block blood vessels (targeted therapy)

Chemotherapy is not used in kidney cancer. The current medical treatment for kidney cancer is based on pills that stop blood supply to the cancer, which slows or stops the growth of the tumour, and sometimes causes it to shrink. These pills target specific signals within the cancer, and are also called “targeted therapies”. Other names for this group of drugs are “anti-angiogenic therapies” and “tyrosine kinase inhibitors”. While these pills are not chemotherapy, they do have side effects. The tyrosine kinase inhibitors used to treat kidney cancer are: axitinib, pazopanib, sorafenib, sunitinib. Many other drugs in this family are in development and at various stages or research and approvals. Newer drugs include cabozantinib and lenvatinib:

  • Cabozantinib Phase III (METEOR) trial results were presented during the ECCO Conference in September 2015 and subsequently published in the New England Journal of Medicine: Trial results cabozantinib.
    In April 2016, cabozantinib was approved by the FDA (U.S.) for use in metastatic kidney cancer. For further information read here: FDA/cabozantinib
  • Lenvatinib Phase II trial results were presented at ASCO 2015 and published in The Lancet Oncology: Trial results lenvatinib
    In May 2016, lenvatinib given in combination with everolimus was approved by the FDA (U.S.) for use in metastatic kidney cancer. For further information: FDA/Lenvatinib+everolimus

Pills that block cancer’s growth

A second group of medicines for kidney cancer work by blocking a different signal (“mTOR inhibitors”). These are usually used only if the pills that block the blood supply have stopped working. The mTOR inhibitors used to treat kidney cancer are everolimus and temsirolimus.

Other medications

New clinical trials are underway to determine if other types of cell signalling can be turned off to prevent the growth of kidney cancer. One potential inhibitor is a MET inhibitor that works in other types of cancer and is particularly important in Papillary Renal Cell Carcinoma.

Other new types of inhibitors are in clinical trials for kidney cancer.

Immunotherapy

Before 2006, immunotherapy with interleukin-2 (IL-2) and alpha-interferon was commonly used to treat kidney cancer that had spread to other parts of the body (metastatic kidney cancer). These drugs worked for some people by activating killer T cells, which are the part of the body’s immune system that destroys cancer cells. New kinds of immune therapy are being tested in clinical trials in kidney cancer. For more information about the newer immune therapies, click here.

Radiation therapy

Uses high-energy radiation to kill cancer cells. Radiation can be very helpful if the cancer causes a lot of problems in one location, e.g. cancer in the bone causing pain, cancer in the kidney causing bleeding, cancer in the brain causing swelling. Radiation is predominantly used as a means of controlling symptoms (e.g. pain).

Palliative Care

Palliation doesn’t mean the “end of the road” or that the cancer is in its terminal stages. Palliative care is all the treatments that your team recommend to improve your symptoms and improve your quality of life. Your family doctor, your medical oncologist and your other doctors will help you with this. Sometimes palliative care physicians and nurses are consulted, and they can often provide specialised advice. Palliative treatment can improve quality of life by alleviating symptoms associated with advanced cancer.

8. Where does immuno-oncology fit into treatment for kidney cancer?

This is a question that kidney cancer researchers around the world are looking to answer. The truth is that we have a great deal of hope, but we currently have more questions than answers. The only way to find out the answers is to design and run clinical trials and to share the information widely.

For now, it’s best to remember that not everything that you read in the newspapers is factually correct. What makes for a good newspaper article is not necessarily true.

In future years we hope to better understand:

  • Whether there is a role for immuno-oncology in the standard treatment of kidney cancer?
  • Which patients are more likely to benefit? Which will not benefit?
  • What tests can be done ahead of time to choose the right treatment for each patient?
  • When is the best time in the treatment path to use immuno-oncology medications?
  • Is there a role for immuno-oncology before surgery? After surgery? After other medications? In combination with other medications?
  • Are there ways that we can maximise the benefits of immuno-oncology and yet minimise the side effects for patients?
  • What is the best treatment for the patient’s quality of life?
The truth is, we don’t have the answers to these questions yet for kidney cancer. Results from other cancers are certainly encouraging and we look forward to sharing more information from clinical trials worldwide. For further information please read: Understanding immuno-oncology

9. What about alternative and complementary therapies?

Alternative Therapies:
Everyone wants the best health care for themselves and their loved ones. If there are no suitable standard medical therapies available, “alternative” therapies might be proposed by well-intentioned friends, relatives or internet web-pages.

These are called “alternative” because they have not been scientifically proven to shrink cancers or help patients. Worse still, they might have been proven not to help or to even cause harm. Examples of unhelpful or harmful alternative “treatments” include mega-dose vitamins, herbal products or extreme diets. A good website to check if an alternative “therapy” has been debunked is www.quackwatch.org.

Some alternative therapies can interfere with medicines normally prescribed by a doctor, causing harm to the patient. So it’s important to inform your doctor or nurse if you are considering these therapies.

Complementary Therapies:
On the other hand, complementary therapies can “complement” established medical treatments, improving quality of life and symptoms. These include mindfulness meditation, relaxation techniques, remedial massage therapy, psychotherapy, prayer, yoga, acupressure and acupuncture. If there were any chance that the kidney cancer has spread to bones, chiropractic or osteopathy would not be a good idea.

10. What is my prognosis?

This can be a difficult question for you and your doctor to discuss. There are a number of questions that you can ask your doctor, and a number of things to keep in mind.

When one hears about the statistics of a cancer, or the benefit of a treatment, it is important to remember that these are statistics based upon the experience of often hundreds of patients. What will happen to you, a single person, can only be very vaguely inferred from these statistics. Some peoples’ cancers are very aggressive and treatment fails them. Other people have very slow-growing cancers, or have substantial benefits from taking a drug. One way that your doctor might give you some estimate of what your future might hold is to talk about worst-case and best-case scenarios.

It is also important to remember that no-one has a crystal ball, and that any prediction of the future can only be a best guess. As you develop a relationship with your doctor and health care team over time, this will also allow you to get a better understanding of how your particular cancer journey is unfolding. Many of the issues discussed above can influence prognosis, and understanding these can be important to help predict what your future might hold.