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Of Kidneys, Cancer and Time

Posted Aug 10 2011 12:14am

 1: Parenchyma 2: Cortex  3: Medulla 4: Perirenal fat 5: Capsule 6: Ureter 7: Pelvis of kidney 8: Renal vessels 9: Hilus 10: Calyx

1: Parenchyma 2: Cortex 3: Medulla 4: Perirenal fat 5: Capsule 6: Ureter 7: Pelvis of kidney 8: Renal vessels 9: Hilus 10: Calyx

It’s been roughly 8 hours since I underwent the pleasures of a barium shake and a contrast CT Scan (Cigna willing) with the hope of identifying the 1.5cm lesion on my kidney. As I’ve written before , an ultrasound exam last week was unable to rule out cancer. At present, I wait for results on the CT scan with an ETA of somewhere around a grueling 24 to 48 hours. It’s hard to concentrate on much of anything else.

And the truth is, since hearing about this lesion of yet to be determined gravity, the prospect of a bout with cancer simply looms– it hangs like a cloak over every word I utter and every thing I do.  Work, on occasion, gives respite. At other times, I simply cannot free myself sufficiently to apply myself in the manner I must to do my job. I’ve managed to stay abreast of my workload, which is heavy, but am not entirely sure how. I work in bursts– and am truly fortunate to have a flexible and understanding employer.

So…left alone with a sense of my own mortality and some research skills, I have begun to learn about kidney cancer. I can honestly say that until last week I knew almost nothing about it–so it presents itself as a tabula rasa with the urgency that few things other than one’s own mortality can bring. KidneyCancer.org has been a tremendous help, as has a number of kidney cancer patient message boards . Something about hearing from someone who has been through the process–someone other than a doctor–is just wildly reassuring. In fact, in one of those coincidences that seems somehow divinely inspired, over the weekend I dragged myself to a barbecue/meeting where a close friend was speaking– and found myself sitting across a picnic table from someone who had survived a bout with kidney cancer two years ago. He was someone I knew in passing but had never gotten to know. Though sans 10% of one of his kidneys, at 62 he looked the picture of health. No amount of research could have benefited me the way his presence and reassurance did–not to mention the name and phone number of his surgeon. No small matter this, as it has been noted by some within the medical community that the removal of whole kidneys (radical nephrectomy) for early stage Kidney Cancer persists within the practice despite the equally efficacious  removal of only portions of a kidney (partial nephrectomy). Partial nephrectomy has the benefit of “renal functional preservation which can prevent or delay the onset of chronic kidney disease (CKD). CKD is an independent risk factor for hospitalization events, cardiovascular disease, and worse overall survival.”  I am told that a partial nephrectomy is much more difficult from a surgery skill perspective than simply removing the whole kidney. Who knew?

And what else has my research and new found friend taught me? For one, relatively speaking, Kidney Cancer is somewhat less common than many other cancers. According to Kidney Cancer.org

Last year, more than 1.3 million new cancers were diagnosed in the United States. According to the American Cancer Society, more than 50,000 of these individuals were diagnosed with kidney cancer. But there is hope: More than 200,000 kidney cancer survivors are living in the United States right now. Recent advances in diagnosis, surgical procedures, and treatment options will allow even more patients to live with the disease, continuing to maintain their normal schedules and lifestyles.

That means that only 3.84% of cancers diagnosed in the United States were of the kidney. The American Cancer Society estimates the incidence of Kidney Cancer in the U.S. for 2011 to be 56,046 cases-with 12,020 fatalities–or 21.5%. By way of comparison, the expected incidence of Breast Cancer (female) for 2011 is 230,480–with 39,520 fatalities, or 17.1%; Prostrate Cancer, 240,890–with 33,720 fatalities, or 13.99%; Lung Cancer, 221,130 with a whopping 156,940 fatalities, or 70.97%.

The problem with Kidney Cancer is that although fairly treatable, it is often not discovered until late in the process–after the tumor has grown–and, perhaps, spread. And the 5 year survival rate diminishes quickly with the rush from the least, Stage I, to the most, Stage IV . As of 5 years ago, there is a 73% difference between survival rates for Stage I and Stage IV. There is a phrase in Law which gives notice that within a contract, considerations of time are paramount, the breach of which is material: “Time is of the essence.” It is so with Kidney Cancer.

Unfortunately, the disease is readily capable of eluding detection–and often does. According to Kidney Cancer.org,

Many kidney cancers are found fairly early, while they are still only in the kidney. But others are found at a more advanced stage. There are a few reasons why kidney cancer may not be found until later:

  • The cancer can become quite large without causing any pain or other problems.
  • Because the kidneys are deep inside the body, small kidney tumors cannot be seen or felt during a physical exam.
  • There are no recommended tests that can be used to look for kidney cancer in people who are not at increased risk. Small amounts of blood in the urine could point to kidney cancer. But there are many other causes of blood in the urine, including infections and kidney stones. And some people with kidney cancer don’t have blood in their urine until the cancer is quite large.

    While tests like ultrasound, CT scans, and MRI can sometimes find small tumors, these tests cost a lot and can’t always show whether a tumor is cancer. They are recommended routinely only for those people who have a high risk of getting kidney cancer.

    It is important to tell your doctor if members of your family have had kidney cancer or other problems linked to kidney disease.

    Often kidney cancer is found “incidentally,” meaning that the cancer is found by accident during tests for some other illness. The survival rate for kidney cancer found this way is very high because the cancer is usually found at a very early stage.

    And here I sit– awaiting results– and thinking fondly of the kidney stones which were painful enough to reduce me to a shrieking mass and a trip to the hospital– which may well have “incidentally” uncovered a ticking time bomb in my kidney. And I don’t want to even consider what this would be like without health insurance– but I can tell you this, there’s no way I’d have gone to the hospital for those kidney stones without it.

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